Ocular manifestations of skin diseases with pathological keratinization abnormalities.

Keratinization means cytodifferentiation of keratinocytes turning into corneocytes in the stratum corneum. Disorders of keratinization (hyperkeratosis, parakeratosis and dyskeratosis) are causing many dermatological diseases, including various types of ichthyoses, pachyonychia congenita, pityriasis rubra pilaris, all subtypes of psoriasis, pityriasis lichenoides, dyskeratosis congenita, leukoplakia and keratosis follicularis, which apart from skin lesions may affect the eye's adnexae causing ectropion, entropion, blepharitis, madarosis, and trichiasis, the ocular surface causing keratitis, conjunctivitis, corneal ulceration and episcleritis, which in turn cause uveitis and various fundoscopic changes (proliferative retinopathy, retinal vasculopathy, macular oedema and birdshot chorioretinopathy). Knowledge of ocular symtoms associated with pathological keratinization is crucial, preventing sight-threatening complications such as corneal perforation, lagophthalmus, phthisis bulbi, retinal neovascularization, retinal vasculopathy and optic nerve atrophy. This review encourages dermatologists to monitor patients for ocular symptoms and encourage ophthalmologists to monitor patients for dermatological symptoms.

Fibromyalgia syndrome and the eye-A review.

Fibromyalgia is a chronic, widespread pain syndrome of unclear etiology characterized by fatigue, sleeping problems, cognitive disorders, somatic complaints, and severe pain in parts of the body at the time of physical activity, with no laboratory findings specific to the disease or diagnostic tests. Fibromyalgia can be associated with ocular symptoms (foreign body sensation, irritation) and visual disturbances (blurred vision), coexisting with dry eye syndrome and reduced corneal sensitivity. Cases of scleritis, including the necrotizing form, accompanying fibromyalgia have been reported. Changes in the eye may contribute to the pathogenesis of fibromyalgia. Research shows the choroid to be significantly thinner in patients with fibromyalgia, revealing changes in optic disc perfusion and a decreased retinal nerve fiber layer thickness. There are also thin corneal stromal nerves with diminished sub-basal plexus nerve density. Pathological changes and functional abnormalities of small nerve fibers are observed in patients with fibromyalgia. Corneal confocal bio-microscopy is a new noninvasive method to evaluate small nerve fiber morphology, serving as an alternative for skin biopsies, and reveals new possibilities in diagnostics and finding innovative therapies for this disease. Fibromyalgia remains a challenge for ophthalmologists, and further studies are required to evaluate ocular involvement. It may be that future diagnostic criteria for fibromyalgia will contain ophthalmic examination modalities. Observed ocular changes and their pathomechanisms may constitute new targets for therapy to improve the quality of life of patients with fibromyalgia.

Ocular manifestations of dermal paraneoplastic syndromes.

Dermal paraneoplastic syndromes are non-malignant disorders, caused indirectly by the increase in growth factors or as immunological reactions, which lead to a variety of inflammatory, hyperkeratotic or proliferative skin reactions. They can occur as facultative or obligate paraneoplastic dermatoses, which are associated with oncological processes (solid tumours or hematologic diseases). The recognition of paraneoplastic skin disorders can accelerate proper diagnosis and determine better prognosis for the patient and is also important to clinicians because it is often the first symptom of life-threatening malignancies. Many of them may also cause ocular changes that can lead to serious complications including perforation of the eye bulb, vascular changes in the retina resulting in vision loss and demand multidisciplinary co-operation with an ophthalmologist. This manuscript is a review of the literature about eye disorders in association with dermal paraneoplastic syndromes.

Interferon Alpha 2a and 2b in Ophthalmology: A Review.

Interferon alpha (IFN-α) is a glycoprotein with antitumor, antiviral, and immunomodulatory activity, used widely in the treatment of viral infections (hepatitis B and C, condylomata acuminata, herpes zoster, etc.), hematological disorders (leukemia, multiple myeloma, T cell lymphoma, and essential thrombocythemia), and solid tumors (clear cell carcinoma in the metastatic stage, melanoma, hepatocellular carcinoma, and cervical neoplasia). Studies have proven the effectiveness of IFN-α in the treatment of ophthalmic disorders involving the anterior segment of the eye (conjunctival papilloma, squamous neoplasia, conjunctival mucosa-associated lymphoid tissue, Mooren's ulcer, and vernal keratoconjunctivitis) and the posterior segment of the eye (serpiginous choroidopathy, posterior uveitis, pseudophakic and diabetic cystoid macular edema, and proliferative diabetic retinopathy). The therapy with IFN-α remains a promising alternative in cases of a failing response to conventional therapy, helping to maintain or improve visual acuity, prevent vision loss, and ameliorate the prognosis of the patient. However, clinicians who decide to use IFN-α in their patients must be aware of general and ophthalmological side effects and inform their patients to undergo a systemic evaluation such as a physical examination, blood and serological tests, and a chest X-ray before the beginning of treatment. This review presents the current knowledge of the use of IFN-α, its efficacy, and properties in ophthalmological diseases, and thus may encourage clinicians to administer this drug as a treatment modality in ophthalmological diseases in the future.

Ocular manifestations of pulmonary hypertension.

Pulmonary hypertension, if left untreated, may result in increasing cardiac back pressures and lead to right heart failure and death. An increase in venous pressure in cases of pulmonary hypertension influences other organs. Ocular complications occur as a result of elevated venous pressure in the superior vena cava and in the ophthalmic veins, which cause dilation of the ocular veins, resulting in congestion of the choroid and leading to complications such as ciliary detachment, central retinal vein occlusion, acute serous retinal detachment, macular edema, retinal neovascularization, choroidal effusions, chemosis, angle-closure glaucoma, transient myopia, and proptosis. Other ophthalmic disorders are the results of side effects of treatment. Patients may present primarily to an ophthalmologist, who may diagnose these diseases. Patients with pulmonary hypertension should be taught careful self-observation of visual function, and if it deteriorates, they should immediately report this to an ophthalmologist. Before initiation of any target-oriented therapy, the patient must be informed about possible sight-threatening complications. We review ophthalmological disorders that may develop in the course of pulmonary hypertension and emphasize multidisciplinary cooperation.

Low serum 25-hydroxyvitamin d concentrations are associated with increased risk for melanoma and unfavourable prognosis.

BACKGROUND: Low vitamin D status (serum 25(OH)D concentration) is associated with increased incidence and unfavourable outcome of various types of cancer. However, there are limited data on influence of serum 25(OH)D on risk and prognosis of malignant melanoma. METHODS: Basal serum 25(OH)D concentrations were retrospectively analyzed in a cohort of melanoma patients (n = 324) and healthy controls (n = 141). We tested the hypothesis that serum 25(OH)D concentrations are predictive of melanoma risk, thickness of primary melanomas, and overall survival (OS). RESULTS: Median serum 25(OH)D concentrations were significantly lower (p = 0.004) in melanoma patients (median = 13.6 ng/ml) as compared to controls (median = 15.6 ng/ml). Primary tumors of patients with low serum 25(OH)D concentrations (<10 ng/ml) had significantly (p = 0.006) greater Breslow thickness (median: 1.9 mm) as compared to patients with higher levels (>20 ng/ml; median: 1.00 mm). Patients with 25(OH)D serum concentrations in the lowest quartile had inferior overall survival (median: 80 months) comparing with the highest quartile (median: 195 months; p = 0.049). CONCLUSIONS: Our data support the concept that serum 25(OH)D concentrations are associated with risk and prognosis of melanoma. Whether normalizing serum 25(OH)D concentrations in these patients improves outcomes will require testing in future clinical trials.

Hormone replacement therapy regimens in chemotherapy-induced premature ovarian failure and the subsequent correction of hormone levels.

OBJECTIVES: Premature ovarian failure (POF) is a consequence of gonadotoxic chemoradiotherapy given in antyneoplasia treatment. In young women it will correlate with menopausal symptoms which tend to appear due to depleted ovarian follicle reserve. DESIGN: It was a case series study that included women 18-50 years old who were treated for malignancy with gonadotoxic chemioradiotherapy. We have measured blood hormonal levels of follicle stimulating hormone (FSH), luteinizing hormone (LH), estradiol (E2) and progesterone within one month of various hormone replacement therapy (HRT). RESULTS: We have observed different kind of hormonal reaction according to FSH, LH, estradiol and progesterone levels due to various hormonal replacement therapy. The administration of various HRT regimens presented with a decrease in the blood concentration of estradiol E2 and progesterone and a concomitant increase of FSH and LH. These findings demonstrate a shift to physiological ranges and a simultaneous improvement of symptoms associated with CI-POF. CONCLUSIONS: The most appropriate therapy needs to be selected according to the patient's alleviation of symptoms and correction of blood hormone levels.