ABSTRACT
ABSTRACT The objective of this report is to describe a case of meibomian gland dysfunction associated with keratoconus and to examine the importance of treatment for evaporative dry eye in cases of corneal ectasia. A 45-year-old man diagnosed as having keratoconus complained of burning, tearing, itching, and red eye. He had a history of penetrating corneal transplantation and wearing rigid contact lenses. The meibography revealed a severe meibomian gland dropout and normal tear meniscus height in both eyes. Objective propaedeutic tests are important tools for dry eye diagnosis and proper evaluation of ocular surface and tear film. In older patients, the classic signs of atopic conjunctivitis are not always present, and the causes of chronic rubbing must be further investigated. Treatment of underlying chronic inflammation such as dry eye, meibomian gland dysfunction, and blepharitis might be important to prevent keratoconus progression and guarantee symptom relief.
RESUMO O objetivo é relatar um caso de associação entre disfunção de glândulas de meibomius (DGM) e ceratocone, assim como ressaltar a importância do tratamento do olho seco evaporativo em casos de ectasia corneana. Paciente do sexo masculino de 45 anos com ceratocone e queixas de ardência, lacrimejamento, prurido e olho vermelho. O mesmo tem histórico de transplante de córnea penetrante e uso de lentes de contato rígidas. A meibografia revelou severa perda de glândulas de meibomius e menisco lacrimal normal em ambos os olhos. Testes propedêuticos objetivos são importantes ferramentas para diagnóstico de olho seco e apropriada avaliação da superfície ocular e filme lacrimal. Em pacientes mais velhos, os sinais clássicos de atopia não estão sempre presentes e investigações adicionais das causas de prurido crônico são necessárias. O tratamento da inflamação crônica subjacente como olho seco, disfunção de glândulas de meibomius e blefarite podem ser importantes para prevenir a progressão do ceratocone e garantir alívio dos sintomas.
ABSTRACT
The objective of this report is to describe a case of meibomian gland dysfunction associated with keratoconus and to examine the importance of treatment for evaporative dry eye in cases of corneal ectasia. A 45-year-old man diagnosed as having keratoconus complained of burning, tearing, itching, and red eye. He had a history of penetrating corneal transplantation and wearing rigid contact lenses. The meibography revealed a severe meibomian gland dropout and normal tear meniscus height in both eyes. Objective propaedeutic tests are important tools for dry eye diagnosis and proper evaluation of ocular surface and tear film. In older patients, the classic signs of atopic conjunctivitis are not always present, and the causes of chronic rubbing must be further investigated. Treatment of underlying chronic inflammation such as dry eye, meibomian gland dysfunction, and blepharitis might be important to prevent keratoconus progression and guarantee symptom relief.
Subject(s)
Dry Eye Syndromes , Keratoconus , Meibomian Gland Dysfunction , Aged , Dry Eye Syndromes/diagnosis , Humans , Keratoconus/complications , Male , Meibomian Glands/diagnostic imaging , Middle Aged , TearsABSTRACT
To assess the quality of life of keratoconus patients using the Keratoconus Outcomes Research Questionnaire (KORQ), translated and validated in Portuguese language. The KORQ is the only validated keratoconus specific questionnaire and has a high rating for its psychometric properties. This cross-sectional study enrolled 100 keratoconus patients from a tertiary referral eye hospital between April 2018 and June 2019. Associations between age, sex, allergic conjunctivitis, keratoconus stage, best-corrected visual acuity (BCVA), maximum simulated keratometry (Kmax), steep keratometry (K2), pachymetry, treatments performed, hydrops, and KORQ scores were evaluated using univariate (Wilcoxon test and the Kruskal Wallis test) and multivariate linear regression with stepwise backward modeling. Lower KORQ scores are associated with better quality of life, whereas, higher scores are associated with greater impairment of functional activities and symptoms. Among the 100 patients, mild, moderate, and severe keratoconus were observed in 15%, 46% and 39% of participants, respectively. Univariate analysis showed lower function scores values, with male sex (p < 0.05) and both functional and symptom scores were significantly associated with BCVA < 0.3 (LogMAR) (p < 0.05). Multivariate analysis indicated significantly lower functional scores in individuals with BCVA < 0.3 (LogMAR) (p < 0.001) and those with a history of crosslinking treatment (p = 0.022), while symptom scores were only significantly associated with only BCVA < 0.3 (LogMAR) (p < 0.001). In patients with keratoconus, BCVA in the better eye and history of crosslinkig were factors associated with better quality of life scores using the KORQ.
