Accuracy of the Lacrimal Syringing Test in Relation to Dacryocystography and Dacryoendoscopy.

Purpose: This study aimed to evaluate the accuracy of the lacrimal syringing test (syringing) in relation to dacryocystography (DCG) and dacryoendoscopy (DE) in lacrimal pathway (LP) obstruction. Methods: We retrospectively reviewed 101 patients (188 LPs) who underwent syringing, cone-beam computed tomography (CBCT)-DCG, and DE to diagnose the degree and site of LP obstruction. The degree of obstruction was classified into patent, partial obstruction, and complete obstruction. The degree of LP obstruction was determined by combining the findings of DE and CBCT-DCG and was designated as DCG+DE. When differentiating complete or partial obstruction on DE was uncertain, complete or partial obstruction was assigned if the DCG showed evidence of contrast media obstruction or passage, respectively. The consistency between syringing and DCG+DE was evaluated by calculating the weighted kappa coefficient. Results: The sensitivity and specificity of syringing were 94% and 89%, respectively. The weighted Cohen's kappa value of agreement between syringing and DCG+DE was κ = 0.73 (SE = 0.04, 95% confidence interval [CI]: 0.66-0.80, p < 0.01). When divided into presaccal and postsaccal obstruction categories, the kappa values were κ = 0.40 (SE = 0.11, 95% CI: 0.19-0.62, p < 0.01) and 0.55 (SE = 0.09, 95% CI: 0.37-0.73, p < 0.01), respectively. Furthermore, when limited to common canaliculus obstruction (stenoses), which accounted for 78% (46 LPs) of the total presaccal obstructions, the kappa value was κ = 0.29 (SE = 0.12, 95% CI: 0.05-0.54, p = 0.021), which demonstrated the lowest consistency between syringing and DCG+DE. Conclusion: Syringing was "substantially" in agreement with DCG+DE in detecting the degree of LP obstruction. Moreover, syringing was a sufficiently sensitive and specific test when performed by an experienced clinician. However, distinguishing between complete and partial obstructions by syringing was sometimes difficult, particularly in the common canaliculus obstruction (stenosis).

Clinical characteristics of lacrimal drainage pathway disease-associated keratopathy.

PURPOSE: To report the clinical characteristics of 13 cases of noninfectious corneal ulceration related to lacrimal drainage pathway disease. METHODS: Medical records of 13 patients with lacrimal drainage pathway disease-associated keratopathy who were examined at Ehime University Hospital between April 2007 and December 2021 were analyzed. RESULTS: The predisposing lacrimal drainage pathway diseases for corneal ulceration were chronic dacryocystitis in seven patients and lacrimal canaliculitis in six patients. The corneal ulcers were located at the peripheral cornea in 10 patients and the paracentral cornea in three patients. All patients indicated few cellular infiltrations of the ulcerated area at the slit-lamp examination. Corneal perforation was found in seven patients. The primary identified organisms were Streptococcus spp. in chronic dacryocystitis and Actinomycetes spp. in lacrimal canaliculitis. All patients showed rapid healing of the epithelial defects after treatment of the lacrimal drainage pathway disease. The mean time elapsed between treatment of the lacrimal drainage pathway disease and re-epithelialization of corneal ulcer was 14.5 ± 4.8 days. CONCLUSION: Lacrimal drainage pathway disease-associated keratopathy may be characterized by peripheral corneal ulcer with few cellular infiltrations, occasionally leading to corneal perforation. Treatment of the lacrimal drainage pathway disease could be the most effective treatment for lacrimal drainage pathway disease-associated keratopathy.

Comparison of the efficacies of 1.0 and 1.5 mm silicone tubes for the treatment of nasolacrimal duct obstruction.

This retrospective observational study analyzed the postoperative outcomes of bicanalicular intubation using different diameters of tube stents for treating postsaccal nasolacrimal duct obstruction. A total of 130 patients diagnosed with postsaccal obstruction who underwent endoscopic-assisted silicone tube intubation were included in the study. Patients intubated with a 1.5-mm large-diameter tube were designated as the LD group, and those with a 1.0-mm normal-diameter tube were designated as the ND group. The patency rates of the two groups at 1 year after tube removal were compared using the Kaplan-Meier curve and restricted mean survival time (RMST) method with τ = 365 days. Results demonstrated that the recurrence rate after tube removal was significantly lower in the LD group as compared with the ND group (p = 0.001). The patency rates at 1 year after removal in the LD and ND group were 85.7% (95% confidence interval [CI]: 75.4, 91.9) and 73.9% (95% CI: 61.7, 82.8), respectively. When comparing the patency rates by the RMST method at τ = 365 days, the RMST difference, RMST ratio, and RMTL ratio were higher in the LD group at p = 0.045, 0.052, and 0.046, respectively.

Analysis of Lacrimal Duct Morphology from Cone-Beam Computed Tomography Dacryocystography in a Japanese Population.

Purpose: The dacryoendoscope is a practical instrument for the examination and the treatment of lacrimal duct obstruction. Nevertheless, as it is a rigid fiberscope, manipulation of the endoscope is somewhat affected by the patient's lacrimal duct alignment and the skeletal structure of the face. The morphology and inclination of the lacrimal duct vary among individuals and ethnic groups. We aimed to evaluate the alignment of the lacrimal duct from the perspective of endoscopic maneuverability in a Japanese population. Methods: This retrospective study analyzed the cone-beam computed tomography dacryocystography (CBCT-DCG) images of 102 patients diagnosed with unilateral primary acquired nasolacrimal duct obstruction (PANDO) at Ehime University Hospital from December 2015 to May 2021. The following parameters of the lacrimal duct on the contralateral side of unilateral PANDO were investigated: (1) angle formed by the superior orbital rim-internal common punctum-nasolacrimal duct opening, (2) angle formed by the lacrimal sac and the nasolacrimal duct, (3) length of the lacrimal sac, and (4) length of the nasolacrimal duct. Results: Measurements of the above parameters were (1) 10.2° ± 7.8° (range, -11° to +27°), (2) -6.3° ± 14.1° (range, -43° to +40°), (3) 8.9 ± 2.3 mm (range, 4.3-17.1), and (4) 13.2 ± 2.7 mm (range, 5.7-20.7), respectively. The Shapiro-Wilk test demonstrated that the values of all parameters, except (3), followed a normal distribution (p = 0.55, 0.30, 0.0002, and 0.39, respectively). No significant difference was found between the female and male groups (p > 0.05). Conclusion: This study reported anthropometric analysis data of the morphology of the lacrimal ducts using CBCT-DCG in a Japanese population. In our cohort, the line from the superior orbital rim through the internal common punctum to the nasolacrimal duct opening inclined anteriorly in 92% of the patients.

Anterior Segmental Optical Coherence Tomography Analyses of Severe Corneal Irregular Astigmatism following Blepharoptosis Surgery.

We report a case of severe irregular corneal astigmatism resulting from delayed diagnosis of suture exposure following blepharoptosis surgery. An 81-year-old man who had bilateral blepharoptosis surgery and two revisions on his right eye before he complained foreign body sensation (FBS) and blurred vision of his right eye. The visual acuity was 0.4 and the MRD1 was 1 mm for his right eye. A very severe corneal astigmatism of 7.7D, eccentricity of 0.53, corneal thinning, and higher order aberration (HOA) of 3.346 µm was found. Scratch-like lesions on the upper cornea suggested the presence of suture exposure; however, no sutures were found by the previous physicians and at our fist ⇒ first examination. With greater effort, a large conjunctival fold on the back of upper tarsus was turned over to reveal 2 interrupted sutures protruding the palpebral conjunctiva. The sutures were removed, and the FBS quickly disappeared. However, the patient's blurred vision persisted. His right eye's visual acuity was 0.6, and the astigmatism (6.8D), eccentricity (0.72), and HOA (2.993 µm) were comparable to that before suture removal. Early diagnosis of suture exposure is critical to avoid severe complications and vision impairment. Attention should be paid to large conjunctival folds especially in re-operated cases.

Outcomes of bicanalicular nasal stent inserted by sheath-guided dacryoendoscope in patients with lacrimal passage obstruction: a retrospective observational study.

BACKGROUND: The dacryoendoscope is the only instrument that can observe the luminal side of the lacrimal passage with minimal invasiveness. It was developed to treat lacrimal passage obstructions by inserting a bicanalicular nasal stent with sheath-guided bicanalicular intubation (SG-BCI). The purpose of this study was to determine the outcomes of SG-BCI to treat lacrimal passage obstructions. In addition, to determine the effects of SG-BCI treatment on the quality of life. METHODS: This was a retrospective observational study of 128 patients (mean age 70.9 ± 11.0 years, range 28-93 years) diagnosed with a unilateral lacrimal passage obstruction. There were 73 patients with a nasolacrimal duct obstruction, 37 with a lacrimal canaliculus obstruction, 7 with a lacrimal punctum obstruction, and 11 with common lacrimal canaliculus and nasolacrimal duct obstructions. They were all treated with SG-BCI. The postoperative subjective outcomes were assessed by the answers to the Glasgow Benefit Inventory (GBI) questionnaire and to an ocular specific questionnaire on 6 symptoms including tearing, ocular discharges, swelling, pain, irritation, and blurred vision. The objective assessments were the surgical success rates and the patency at 6 months after the bicanalicular nasal stent was removed. The patients were divided into those with a pre-saccal obstruction, Group 1, and with a post-saccal obstruction, Group 2. The subjective and objective outcomes were compared between the two groups. RESULTS: One hundred twenty-four sides (96.9%) had a successful probing and intubation of the lacrimal passage obstruction by SG-BCI. Of the 124 sides, 110 sides (88.7%) retained the patency after the stent was removed for at least 6 months. The GBI total, general subscale, social support, and physical health scores were + 37.1 ± 29.0, + 41.5 ± 30.0, + 28.0 ± 39.4, and + 24.1 ± 37.7, respectively, postoperatively. All of the 6 ocular specific symptom scores improved significantly postoperatively. The postoperative score of tearing improved in Group 1 (P < 0.0001), while the postoperative scores of all symptoms improved significantly in Group 2. CONCLUSIONS: The relatively high surgical success rates and positive GBI scores, and improved ocular symptom scores indicate that SG-BCI is a good minimally invasive method to treat lacrimal passage obstructions.

Improvement of visual function and ocular and systemic symptoms following blepharoptosis surgery.

Purpose: To study the changes of the visual function and ocular and systemic symptoms following blepharoptosis surgery.Methods: Seventy-eight involutional blepharoptosis patients (72.1 ± 6.4 years) underwent levator advancement procedure. Before and at 2 months after the surgery, OPD-Scan III (Nidek) was used to measure corneal astigmatism, total higher order aberrations (HOAs), and area ratio (AR), an index of the objective contrast sensitivity. FVA-100 (Nidek) was used to determine the functional visual acuity (FVA) and visual maintenance ratio (VMR). The ocular and systemic symptoms were also determined by a questionnaire using visual analogue scale (VAS) scores.Results: Before surgery, the corneal astigmatism, HOAs, AR, FVA, and VMR were 1.56 ± 0.52 diopters (D), 0.23 ± 0.24 µm, 14.8 ± 4.2%, 0.68 ± 0.32 logMAR units and 0.76 ± 0.06, respectively. After surgery, these values were 1.29 ± 0.41 D, 0.19 ± 0.21 µm, 18.6 ± 3.4%, 0.31 ± 0.18 logMAR units and 0.88 ± 0.03, respectively. Corneal astigmatism and HOAs were significantly reduced after surgery (P=0.007 and P=0.023, paired t test, respectively), and AR, FVA and VMR were significantly improved after surgery (P=0.033, P=0.012 and P=0.016, respectively). The VAS scores significantly improved after surgery, and this improvement was positively and significantly correlated with the increase of the AR (r=0.421, P=0.003) and the VMR (r=0.497, P =0.005).Conclusions: Blepharoptosis surgery is visual functionally beneficial and can help to reduce the ocular and systemic symptoms.

Digital Image Analyses of Preoperative Simulation and Postoperative Outcome following Blepharoptosis Surgery.

BACKGROUND: Before blepharoptosis surgery, simulation of eyelid features, including lid height and crease position, is often performed. However, discrepancies of the simulation and outcome can occur. The purpose of this study was to analyze the pre- and postoperative images and to evaluate factors contributing to the discrepancies. METHODS: Forty-one involutional blepharoptosis patients (68.2 ± 7.1 years) underwent levator aponeurosis advancement. A semicircular bent wire was used to push the preoperative ptotic eyelid up to simulate the postoperative appearance of the eyelid. Digital images of the simulation were compared with the appearance at 3 months after the surgery. The ImageJ software was used to analyze the pre- and postoperative margin reflex distance-1 (MRD-1), pretarsal show (PTS), fissure height (FH), and ocular surface area (OSA). Factors with a potential of affecting the predictability of simulation were determined. RESULTS: During simulation, the MRD-1 was 3.6 ± 0.4 mm, the PTS was 3.48 ± 1.2 mm, the FH was 8.5 ± 0.9 mm, and the OSA was 120.7 ± 22.3 mm2. After the surgery, the corresponding values were 3.3 ± 1.2 mm, 3.3 ± 1.5 mm, 8.6 ± 1.4 mm, and 119.1 ± 25.1 mm2, respectively. The postoperative MRD-1 was significantly smaller than that of the simulation (P = 0.005, paired t test). The MRD-1 simulation error was positively correlated with the length and width of the skin resection (all P < 0.05), and the PTS error was positively correlated with the length of the skin resection (r = 0.332, P = 0.031) and negatively correlated with the preoperative OSA (r = -0.588, P = 0.007). CONCLUSIONS: The postoperative appearance of the eyelid can be simulated fairly accurately by pushing up the upper eyelid with a curved wire. However, the MRD-1 tended to be overestimated, especially for cases requiring a large skin resection.

Changes of Visual Symptoms and Functions in Patients with and without Dry Eye after Lacrimal Passage Obstruction Treatment.

Purpose: To determine the quality of life (QOL) and quality of vision (QOV) of patients who developed and did not develop dry eye disease (DED) after nasolacrimal duct obstruction (NLDO) treatment. Methods: This was a retrospective nonrandomized observational study of 91 patients diagnosed with unilateral NLDO. The subjects underwent lacrimal stent insertion, and the stent was removed after 10-12 weeks. The QOL and QOV of the patients were examined preoperatively and at 6 months after the stent was removed. The postoperative outcomes were assessed subjectively with the Glasgow Benefit Inventory (GBI) questionnaire and an ocular specific questionnaire of 6 symptoms. The best-corrected visual acuity, functional visual acuity, and dry eye scores were also determined. Results: Of the 91 eyes, 19 eyes (20.9%) were diagnosed with DED (D group) and 72 were not (N group). Five of the 6 symptoms improved in the N group, while only 3 symptoms improved in the D group without blurred vision. For the GBI questionnaire, the social support and physical health scores were significantly higher in the N group than in the D group. The functional visual acuity improved significantly in the N group but not significantly in the D group. Conclusions: Patients who develop DED after treatments for NLDO may not have an improvement of their QOL or QOV. Therefore, careful dry eye assessments are important before treatments for NLDO.

Effect of Mandarin Orange Yogurt on Allergic Conjunctivitis Induced by Conjunctival Allergen Challenge.

Purpose: To evaluate the effects of mandarin orange yogurt containing nobiletin and ß-lactoglobulin on the allergic conjunctivitis induced by a conjunctival allergen challenge (CAC). Methods: Experiment 1 was performed on 26 asymptomatic patients (age, 25.3 ± 5.3 years) with proven seasonal allergic conjunctivitis due to cedar pollen. We compared the degree of conjunctivitis induced by CAC before and after ingesting mandarin orange yogurt for 2 weeks. Experiment 2 was a double-blind, placebo-controlled trial performed on 31 patients (age, 32.5 ± 12.2 years). A diet containing mandarin orange yogurt was compared to a diet containing yogurt lacking the mandarin orange on the conjunctivitis induced by CAC. The temperature of the inferior bulbar conjunctiva was measured before and 20 minutes after the CAC with an ocular surface thermographer (OST). The degree of conjunctival injection and chemosis was graded by slit-lamp biomicroscopy. The changes in the symptoms were evaluated by a questionnaire. Results: In experiment 1, the scores of redness (3.07 ± 3.03 vs. 1.05 ± 1.70), chemosis (2.84 ± 2.27 vs. 0.81 ± 1.11), itching (4.34 ± 3.05 vs. 1.39 ± 2.12), and temperature (0.73 ± 0.42°C vs. 0.45 ± 0.43°C) were significantly lower (P < 0.001) after a diet of mandarin orange yogurt for 2 weeks. In experiment 2, the scores of redness (1.03 ± 0.18 vs. 1.28 ± 0.52; P = 0.0156), itching (1.93 ± 1.92 vs. 2.82 ± 2.21; P = 0.0133), and surface temperature (0.54 ± 0.21°C vs. 0.31 ± 0.25°C; P < 0.001) were significantly lower in the mandarin orange yogurt group than in the control yogurt group. Conclusions: Mandarin orange yogurt can be an effective nutritional intervention for allergic conjunctivitis.

Noninvasive Dry Eye Assessment Using High-Technology Ophthalmic Examination Devices.

Recently, the number of dry eye cases has dramatically increased. Thus, it is important that easy screening, exact diagnoses, and suitable treatments be available. We developed 3 original and noninvasive assessments for this disorder. First, a DR-1 dry eye monitor was used to determine the tear meniscus height quantitatively by capturing a tear meniscus digital image that was analyzed by Meniscus Processor software. The DR-1 meniscus height value significantly correlated with the fluorescein meniscus height (r = 0.06, Bland-Altman analysis). At a cutoff value of 0.22 mm, sensitivity of the dry eye diagnosis was 84.1% with 90.9% specificity. Second, the Tear Stability Analysis System was used to quantitatively measure tear film stability using a topographic modeling system corneal shape analysis device. Tear film stability was objectively and quantitatively evaluated every second during sustained eye openings. The Tear Stability Analysis System is currently installed in an RT-7000 autorefractometer and topographer to automate the diagnosis of dry eye. Third, the Ocular Surface Thermographer uses ophthalmic thermography for diagnosis. The decrease in ocular surface temperature in dry eyes was significantly greater than that in normal eyes (P < 0.001) at 10 seconds after eye opening. Decreased corneal temperature correlated significantly with the tear film breakup time (r = 0.572; P < 0.001). When changes in the ocular surface temperature of the cornea were used as indicators for dry eye, sensitivity was 0.83 and specificity was 0.80 after 10 seconds. This article describes the details and potential of these 3 noninvasive dry eye assessment systems.

Visualization of Tear Clearance Using Anterior Segment Optical Coherence Tomography and Polymethylmethacrylate Particles.

We previously reported 2 new methods, anterior segment optical coherence tomography (AS-OCT) and polymethylmethacrylate particles suspended in fluorescein solution (PPF), for the evaluation of tear clearance and rapid tear flow after blinking (tear Krehbiel flow). Here, we investigated age-related OCT tear clearance and tear film thickness (TFT) and the potential correlation of OCT tear clearance and PPF velocity indicative of tear Krehbiel flow. Normal subjects separated into young and older groups received 5 µL of saline solution into the lower conjunctival sac, and an image of the central lower eyelid tear meniscus was captured by AS-OCT immediately and 30 seconds after natural blinking. Tear meniscus height (TMH) and tear meniscus area (TMA) were measured, and their percentage decrease was defined as OCT clearance rate. A Spectralis OCT Anterior Segment Module captured the central corneal tear film layer for TFT measurements. OCT clearance rates were significantly higher in young versus older subjects (P = 0.0002). When all subjects were analyzed, age was significantly and negatively correlated with TMH clearance rate (r = -0.4928, P = 0.0003) and TMA clearance rate (r = -0.4596, P = 0.0008). TFT values were significantly and negatively correlated with age (r = -0.6662, P < 0.0001). A second experiment examined tear Krehbiel flow by measuring PPF velocity in frontal and medial gaze positions. The medial gaze position showed significantly increased PPF velocity compared with the frontal gaze position (P = 0.006). Significant and positive correlations were found between OCT clearance rates and PPF velocity (TMH rate: r = 0.2926, P = 0.0392; TMA rate: r = 0.3274, P = 0.0205). AS-OCT and PPF might be novel techniques for quantitative evaluation of tear clearance and Krehbiel flow.

New method for viewing Krehbiel flow by polymethylmethacrylate particles suspended in fluorescein solution.

PURPOSE: To investigate the changes in the tear flow velocities caused by ageing. METHODS: Ninety-nine subjects (41 men, mean age 48.3 ± 20.7 years) were recruited from the Department of Ophthalmology of the Ehime University Hospital. None of the subjects had serious abnormalities of the external surface of the eye. The Krehbiel flow of tears was determined by 40-µm polymethylmethacrylate (PMMA) beads suspended in a fluorescein sodium solution (PPF). The movement of the beads was video recorded through a slit-lamp during normal blinking. The flow of the beads was determined with a Motion ANALYZER(®) software (KEYENCE Co., Osaka, Japan). The velocity of the beads in young age, 20-40 years, middle age, 41-60 years and old age, ≥61 years, groups was determined. RESULTS: The equation describing the velocity (mm/second) of the PMMA particles as a function of age in the lower tear meniscus measured in the direction of the lacrimal punctum was Y = 2.49-0.04X, where Y = velocity and X = age (r(2) = 0.214; p < 0.0001). For the upper meniscus, the equation was Y = 4.83-0.05X (r(2) = 0.195, p < 0.0001). The average velocity was 0.70 ± 1.66 mm/second in the lower and 2.16 ± 1.93 mm/second in the upper tear meniscus (p < 0.0001). The particle velocity decreased significantly with increasing age, but no significant difference between the male and female groups except for the lower tear meniscus when all subjects were analysed. CONCLUSION: The PPF technique is a simple method of examining Krehbiel flow of tears and may be used for evaluating functional nasolacrimal duct obstruction quantitatively.

New method for evaluation of early phase tear clearance by anterior segment optical coherence tomography.

PURPOSE: To describe a new method of measuring early phase tear clearance by anterior segment optical coherence tomography (AS-OCT). METHODS: Sixty normal subjects were divided into a young group (30 subjects; 29.6 ± 7.2 years) and an elder group (30 subjects; 71.4 ± 10.8 years). AS-OCT (CASIA SS-1000, Tomey, Japan) with customized software was used to record the tear meniscus at the centre of the lower eyelid. Five microlitres of lukewarm saline solution was dropped into the lower conjunctival sac, and an image of the tear meniscus was obtained immediately and again 30 seconds after natural blinking. The tear meniscus height (TMH) and tear meniscus area (TMA) were measured in the AS-OCT images, and the percentage decrease in the TMH and TMA was used as a measure of the tear clearance. Correlations between tear clearance and clinical features including degree of conjunctivochalasis, degree of protrusion of inferior lacrimal punctum, distance of lacrimal punctum from the Marx line and fluorescein clearance rates were also determined in another healthy population consisting of 30 subjects. RESULTS: The OCT tear clearance rate was 35.2 ± 11% for TMH and 28.1 ± 12.4% for TMA in the young group, and 12.4 ± 7.3% and 6.2 ± 9.1%, respectively in the elder group. The differences were significant for both the TMH (p = 0.017) and the TMA (p = 0.024). The OCT-determined tear clearance was positively correlated with the fluorescein clearance rate, and negatively correlated with the distance between the lacrimal punctum and Marx line, degree of conjunctivochalasis and degree of lacrimal punctum protrusion. CONCLUSION: AS-OCT can be used as a rapid, non-invasive and quantitative method of determining the early phase tear clearance rate in a normal healthy population.

Screening for dry eye with newly developed ocular surface thermographer.

PURPOSE: To evaluate the newly developed Ocular Surface Thermographer (TOMEY Corporation) for dry eye screening. DESIGN: Prospective, controlled study. METHODS: We studied 30 eyes of 30 patients diagnosed with dry eye (mean age ± standard deviation, 52.9 ± 17.1 years) and 30 eyes of 30 normal subjects (42.7 ± 17.0 years). The ocular surface temperature was measured immediately after eye opening and every second during 10 seconds of eye opening. The reliability of the measurements was determined by calculating intraclass correlation coefficients. Then, the correlations between the change in the ocular surface temperature and tear film break-up time, Schirmer I test values, and fluorescein staining scores were determined. RESULTS: The measurements of the ocular surface temperature had a high degree of reliability. Immediately after eye opening, the temperature in the dry eye did not differ significantly from that in normal eyes in any of the 3 regions tested. The decrease in the ocular surface temperature in dry eyes was significantly greater than that in normal eyes (P < .001) at 10 seconds after eye opening. The decrease in the temperature of the cornea was correlated significantly with the tear film break-up time (r = -0.572; P < .001). When the changes in ocular surface temperature of the cornea were used as an index for dry eye, the sensitivity was 0.83 and the specificity was 0.80 after 10 seconds. CONCLUSIONS: Measurements of the ocular surface temperature obtained with our newly developed Ocular Surface Thermographer after 10 seconds of eye opening may provide a simple, noninvasive screening test for dry eyes.

[Temporal changes in intraocular pressure during adrenocorticotropic hormone therapy of two cases of West syndrome].

BACKGROUND: Two cases of West syndrome demonstrated changes in intraocular pressure (IOP) associated with adrenocorticotropic hormone (ACTH) therapy. CASES: A nine-month-old (Case 1) and a six-month-old (Case 2) female infant were treated for West syndrome. In Case 1, the IOP was 14 mmHg in the right eye and 16 mmHg in the left eye before ACTH therapy was started. Although the IOP did not change at the beginning of the treatment, it rose to 36 mmHg in the right eye and 25 mmHg in the left eye after an increase in ACTH dosage. In Case 2, the IOP was 10 mmHg in the right eye and 9 mmHg in the left eye before ACTH therapy, it increased to 18 mmHg in both eyes after treatment was started. The IOP returned to baseline levels in both cases after ACTH therapy concluded. CONCLUSION: These findings suggest that it is necessary to monitor IOP when ACTH therapy is given to patients with West syndrome.

Genetic dissociation of dacryoadenitis and sialadenitis in a Sjogren's syndrome mouse model with common and different susceptibility gene loci.

PURPOSE: Sjögren's syndrome (SS) is a systemic autoimmune disease in which the main lesions are dacryoadenitis and sialadenitis. It is unclear whether these lesions develop in a common genetic background. A quantitative trait locus (QTL) analysis was performed in the SS mouse model, MRL/MpJ-lpr/lpr (MRL/lpr), to identify the susceptibility loci to dacryoadenitis and sialadenitis and the association with both loci. METHODS: MRL/lpr, C3H/HeJ-lpr/lpr (C3H/lpr), (MRL/lpr x C3H/lpr) F1, and (MRL/lpr x C3H/lpr) F2 intercross mice were prepared, and the severity of dacryoadenitis and sialadenitis in individuals was quantified by histopathologic grading. In genomic DNA samples from the F2 mice, the polymorphic microsatellite markers highly associated with each lesion were determined as susceptibility loci. RESULTS: QTLs with significant linkage for dacryoadenitis were mapped on chromosome 1 (the position of maximum logarithm of odds [LOD] score; 64.1 cM), designated Adacm1; chromosome 2 (88.4 cM), Adacm2; and chromosome 5 (63.9 cM), Adacm3. Those for sialadenitis were mapped on chromosome 1 (69.0 cM), Asm3, and chromosome 2 (65.3 cM and 82.1 cM), Asm4 and Asm5. Adacm1/Asm3 and Adacm2/Asm5 seemed to be a common chromosomal region, respectively. MRL-homozygous at Adacm1 and Adacm2 and at Asm3 and Asm5 manifested an additive effect on the development of dacryoadenitis and sialadenitis, respectively, whereas Adacm3 did not. CONCLUSIONS: Dacryoadenitis and sialadenitis in MRL/lpr mice are under the control of common and different susceptibility loci, with an allelic combination that leads to regular variations in pathologic phenotypes.

[Case of metastatic intraocular malignant lymphoma with neovascular glaucoma].

BACKGROUND: It is relatively rare to encounter a case of neovascular glaucoma induced by malignant lymphoma metastasized into the eyeball. CASE: A 79-year-old woman initially visited our ophthalmology clinic with the chief complaint of blurring of vision in the left eye which was affected by neovascular glaucoma. She had a history of systemic malignant lymphoma, first diagnosed from skin biopsy and treated to complete remission 3 years previously. A metastatic brain lesion, detected 2 months before her initial visit to our clinic, was cured by radiotherapy. FINDINGS: By ultrasound biomicroscopy (UBM) we detected abnormal thickening of the temporal half of the ciliary body of her left eye. Cytological examination of the aqueous humor revealed invasion by malignant cells of presumed lymphocyte origin. Radiation therapy to the left eye normalized the intraocular pressure in a week, followed by a reduction in the neovascularization of the iris and the thickening of the ciliary body. CONCLUSION: This case showed that metastatic malignant lymphoma in the eye could result in neovascular glaucoma and that UBM is useful to detect and to observe lesions in the iris and ciliary body.