Correlation among ocular surface disease, xerostomia, and nasal symptoms in patients with differentiated thyroid carcinoma subjected to radioiodine therapy: A prospective comparative study.

BACKGROUND: Some complications of radioiodine therapy have been reported, but the involvement of the eyes and adnexa is rarely discussed. The purpose of this study was to determine the correlation among ocular surface changes, xerostomia, and changes in the nasal mucosa associated with radioiodine therapy. METHODS: Patients subjected to radioiodine therapy (group 1) or not subjected (group 2) were prospectively evaluated by examinations of the ocular surface and tear film, saliva production, and nasal endoscopy. Ocular and nasal symptoms and xerostomia were evaluated using questionnaires. RESULTS: Evaluation of the ocular surface did not indicate significant differences between the groups. Nasal endoscopy revealed higher mucosal pallor in group 1 and worsening of the endoscopic appearance. Worsening of ocular symptoms and nasal symptoms, xerostomia, and a significant decrease in salivary production was also observed in group 1. CONCLUSION: Subjective worsening of xerostomia, xerophthalmia, nasal symptoms, and changes in the nasal mucosa in group 1 was observed.

Short- and long-term effects of zinc treatment on lacrimal gland histopathology and tear functions tests in radioiodine-administered rats.

PURPOSE:: To investigate the short-term (1 week) and long-term (8 weeks) protective effects of zinc administration on radioiodine (RAI)-induced lacrimal gland damage of rats. METHODS:: A total of 40 rats were divided into two groups: an RAI group (n=20), which was administrated a single dose of 3 mCi of 131I and 1 mL physiologic saline for 7 days by gastric gavage, and a zinc group (n=20), which received a single dose of 3 mCi of 131I and 1 mL of physiologic saline containing zinc sulfate at a concentration of 10 mg/kg concentration for 7 days by gastric gavage. All rats underwent tear function tests before and 1 week after RAI administration. About 1 week after irradiation, half of the animals in each group were sacrificed and the extraorbital lacrimal glands were removed for histopathological examination. The remaining animals of the groups underwent the same procedures at 8 weeks after irradiation. RESULTS:: In the RAI and zinc groups, the mean tear production was 3.75 ± 1.55 and 3.65 ± 1.53 mm at baseline, 2.10 ± 1.07 and 3.30 ± 1.34 mm at week 1 (p=0.004), and 3.22 ± 1.48 and 3.50 ± 1.78 mm at week 8, respectively; further, the mean corneal fluorescein staining scores were 4.65 ± 2.16 and 4.80 ± 2.21 points at baseline, 7.85 ± 1.90 and 5.45 ± 2.06 points at week 1 (p=0.001), and 5.44 ± 2.13 and 4.90 ± 2.08 at week 8, respectively. The histopathological changes in rat lacrimal glands at weeks 1 and 8 were consistent with the tear function test results. CONCLUSIONS:: Zinc treatment seems to be protective against RAI-induced lacrimal gland damage of rats, particularly in the acute period.

Short- and long-term effects of zinc treatment on lacrimal gland histopathology and tear functions tests in radioiodine-administered rats / Efeitos de curto e longo prazo do tratamento com zinco na histopatologia da glândula lacrimal e funções lacrimais em ratos que receberam iodo radioativo

ABSTRACT Purpose: To investigate the short-term (1 week) and long-term (8 weeks) protective effects of zinc administration on radioiodine (RAI)-induced lacrimal gland damage of rats. Methods: A total of 40 rats were divided into two groups: an RAI group (n=20), which was administrated a single dose of 3 mCi of 131I and 1 mL physiologic saline for 7 days by gastric gavage, and a zinc group (n=20), which received a single dose of 3 mCi of 131I and 1 mL of physiologic saline containing zinc sulfate at a concentration of 10 mg/kg concentration for 7 days by gastric gavage. All rats underwent tear function tests before and 1 week after RAI administration. About 1 week after irradiation, half of the animals in each group were sacrificed and the extraorbital lacrimal glands were removed for histopathological examination. The remaining animals of the groups underwent the same procedures at 8 weeks after irradiation. Results: In the RAI and zinc groups, the mean tear production was 3.75 ± 1.55 and 3.65 ± 1.53 mm at baseline, 2.10 ± 1.07 and 3.30 ± 1.34 mm at week 1 (p=0.004), and 3.22 ± 1.48 and 3.50 ± 1.78 mm at week 8, respectively; further, the mean corneal fluorescein staining scores were 4.65 ± 2.16 and 4.80 ± 2.21 points at baseline, 7.85 ± 1.90 and 5.45 ± 2.06 points at week 1 (p=0.001), and 5.44 ± 2.13 and 4.90 ± 2.08 at week 8, respectively. The histopathological changes in rat lacrimal glands at weeks 1 and 8 were consistent with the tear function test results. Conclusions: Zinc treatment seems to be protective against RAI-induced lacrimal gland damage of rats, particularly in the acute period.

RESUMO Objetivo: Investigar se o tratamento com zinco tem efeito protetor, no curto prazo (1 semana) e longo prazo (8 semanas), sobre os danos induzidos na glândula lacrimal por iodo radiotativo (RAI) em ratos. Métodos: Quarenta ratos foram divididos em dois grupos. No grupo RAI (n=20) foi administrada uma única dose de 3 mCi 131I e 1 cc de solução salina fisiológica durante 7 dias, por gavagem gástrica. O grupo zinco (n=20) recebeu uma dose única de 3 mCi 131I e 1 cc de solução salina fisiológica contendo sulfato de zinco na concentração de 10 mg/kg durante 7 dias por gavagem gástrica. Os testes de função lacrimal foram realizadas para todos os animais antes e após uma semana da administração da RAI. Em seguida, após 1 semana da administração, metade dos animais de cada grupo foi sacrificada e as glândulas lacrimais extraorbitais foram removidas para exame histopatológico. Os animais remanescentes dos grupos foram submetidos aos mesmos procedimentos após 8 semanas a radiação. Resultados: As médias de produção lacrimal foram de 3,75 ± 1,55 e 3,65 ± 1,53 mm na linha de base, 2,10 ± 1,07 e 3,30 ± 1,34 mm na 1a semana (p=0,004), e 3,22 ± 1,48 e 3,50 ± 1,78 mm na 8a semana, para os grupos RAI e zinco, respectivamente. As pontuações médias de coloração fluoresceína foram 4,65 ± 2,16 e 4,80 ± 2,21 no início do estudo, 7,85 ± 1,90 e 5,45 ± 2,06 na primeira semana (p=0,001), 5,44 ± 2,13 e 4,90 ± 2,08 pontos na 8a semana, para os grupos RAI e zinco, respectivamente. As alterações histopatológicas das glândulas lacrimais em 1 e 8 semanas foram consistentes com os testes de função lacrimal resultados. Conclusões: O tratamento de zinco parece ser protetor sobre os danos glândula lacrimal induzidos por RAI em ratos, especialmente no período agudo.

X-ray irradiation alters the actin cytoskeleton in murine lacrimal glands.

OBJECTIVE: The aim of this study was to evaluate the effects of X radiation on the distribution of filamentous actin (F-actin) in the mouse exorbital lacrimal gland. MATERIALS AND METHODS: Mice were divided into groups that received no radiation (n = 6) or one single exposure of 36 mGy of X radiation (n = 12). The animals were sacrificed after 4, 8 or 24 h. The lacrimal glands were stained with Hematoxylin/Eosin or Rhodamine-phalloidin and the filamentous actin arrangement was analyzed by confocal microscopy. RESULTS: After 4 h of X-ray exposure there was an apparent increase in acini area and a decrease in the cortical F-actin content in secretory cells. This effect decreased gradually over time, returning to values close to the control after 24 h. CONCLUSION: This study shows that a 36 mGy diagnostic X-ray dose affected reversibly the mouse exorbital lacrimal gland, suggesting that radiation used in diagnosis may induce changes on cell morphology due to actin remodeling.

Salivary and lacrimal gland dysfunction after remnant ablation with radioactive iodine in patients with differentiated thyroid carcinoma prepared with recombinant human thyrotropin.

BACKGROUND: One of the adverse effects of radioactive iodine (¹³¹I) treatment in patients with thyroid cancer is damage to the salivary and lacrimal glands. In almost all studies evaluating salivary and lacrimal gland dysfunction, the patients received ¹³¹I after levothyroxine (L-T4) withdrawal. Since the biokinetics of ¹³¹I after recombinant human thyrotropin (rhTSH) is not the same as in hypothyroidism, studies need to evaluate ¹³¹I-induced salivary and lacrimal toxicity after preparation with rhTSH. This prospective study investigated the occurrence of salivary and lacrimal damage after ablation with ¹³¹I using this preparation. METHODS: One hundred forty-eight patients who had a total thyroidectomy were included in the study. The subjects were evaluated after thyroidectomy during L-T4 use to exclude those who already showed symptoms or had a history of ocular or oral disease. Symptoms were investigated 12 and 18 months after ablation. In patients who had persistent symptoms, specific tests were performed to confirm glandular dysfunction and to rule out other causes. RESULTS: Twelve months after ablation, symptoms of salivary or lacrimal dysfunction were observed in 10 (6.7%) patients, including oral symptoms in 8 (5.4%) and ocular symptoms in 6 (4%). Eighteen months after ¹³¹I, symptoms persisted in eight (5.4%) patients, including oral symptoms in seven (4.7%) and ocular symptoms in five (3.4%). In all of the patients, glandular dysfunction was confirmed by specific tests and other causes were ruled out. No symptoms were seen in the patients who received a low ¹³¹I dose (30 mCi). In the patients who received high ¹³¹I doses (100 or 150 mCi), symptoms were noted 12 months after ¹³¹I in 10 patients (9.2%), and 18 months after ¹³¹I in 8 patients (7.4%). CONCLUSIONS: Apparently, the rates of salivary and lacrimal damage were lower than those reported in prospective studies that used similar ¹³¹I activities, but these studies were performed in patients who were hypothyroid at the time of ¹³¹I ablation. Further studies are needed to compare radiotoxicity between patients prepared for ¹³¹I ablation with rhTSH and those prepared for ¹³¹I ablation with L-T4 withdrawal.

Análise das alterações do piscar, do filme lacrimal e da superfície ocular induzidas pelo uso de monitor de computador / Analysis of alterations in blinking, lacrimal tear film and ocular surface induced by the use of video terminal display

A relação trabalho e visão é tão remota que determinou a adaptação da espécie humana ao meio em que está inserida. Demonstrou-se que trabalhar em um ambiente confortável, sem doenças ocular, favorece o desempenho visual e aumenta a produtividade. Conhecer os efeitos do monitor de computador (VDT) sobre o sistema visual significa planejar melhor o ambiente de trabalho e a atividade laboral para se obter máximo conforto e produtividade. Este estudo teve como objetivo geral analisar as alterações do piscar, do filme lacrimal e da superfície ocular induzidas pelo uso de monitor de computador (VDT). Para sua realização efetivou-se um estudo transversal, descritivo, observacional, analítico, realizado na Volkswagen do Brasil, São José dos Pinhais (PR), tendo como amostra, a população de funcionários do setor administrativo que utiliza VDT, com idade acima de 18 anos, sem doenças da superfície ocular, sistema palpebral e lacrimal. O ambiente de trabalho foi caracterizado pela temperatura, grau de umidade, velocidade do ar e iluminamento. Preencheram os critérios de inclusão 108 funcionários (idade média 34,1±7,88 anos e tempo mínimo de utilização do VDT 6 horas/dia). Foram avaliados as sintomatologias, filmagem da face para mensuração do tempo entre piscadas na situação de conversação, exame do olho externo e biomicroscopia das pálpebras, conjuntiva e córnea, filmagem videoceratoscópica para determinar tempo de ruptura do filme lacrimal, avaliação da quantidade de lágrima do lago lacrimal pelo Zone-Quick Phenol Red Thread tear test, avaliação do epitélio corneano pelo teste da lissamina verde, filmagem da face dos sujeitos para mensuração do tempo entre piscadas em leitura de VDT. Ao final da jornada de trabalho, foram feitas a reavaliação do tempo de ruptura do filme lacrimal da quantidade de lágrima e a avaliação do epitélio corneano. Compararam-se o tempo entre as piscadas em conversação e em uso de VDT e o tempo de ruptura do filme...

The relationship between work and vision is so remote that has determined the adaptation of human beings to the environment in which they are inserted. It has been demonstrated that working in a pleasant environment, without any ocular disease, has favored visual performance and increased productivity. Knowing the effects of video terminal display (VDT) on the visual system helps plan labor environments and labor activities more effectively so that optimal comfort and productivity are obtained. This transversal study, performed at Volkswagen do Brasil, São José dos Pinhais, PR, has the objective to investigate the influence of VDT labor activities on blinking, tear film and ocular surface, ocular exposure and amount of tear in the lacrimal lake. The population sample comprised VDT administrative department employees older than 18, without diseases on the ocular surface, tear film and blinking system. The evaluation of the working environment included measurements of temperature, humidity, air speed and lighting. One hundred and eight employees met the study criteria (mean age 34.1±7.88 and minimal VDT use time of 6 hours/day). Several evaluations were performed: the ocular surface symptomatology; the measurement of the blink time in conversation situations; the examination of the ocular surface and lacrimal film; a videokeratoscopy to establish the tear film break-up time; evaluation of the amount of tears of the lacrimal lake by means of the Zone-Quick Phenol Red Thread tear test; evaluation of the corneal epithelium by means of thelissamine green test; and determination of the blink time in VDT reading situations. At the end of the working period, the amount of tears and the corneal epithelium structure were re-evaluated. Comparisons between the blink time in conversation and VDT reading situations were performed before and at the end of the working day. The comparison data obtained classifies the subjects into two categories: exposed...

Retinoblastoma--comparative analysis of external radiotherapy techniques, including an IMRT technique.

PURPOSE: To compare the numerous external radiotherapy (RT) techniques for the treatment of retinoblastoma, as well as an intensity-modulated RT (IMRT) technique. The latter was elaborated to evaluate the potential dose reduction in the surrounding tissue, as well as the potential avoidance of subdosage in the ora serrata retinae. METHODS AND MATERIALS: A 2-year-old patient with unilateral retinoblastoma underwent CT. With the aid of an ophthalmologist, the ocular structures were delimited, and 13 techniques described in published reports were reproduced on three-dimensional planning software and identified according to their authors. A technique with four noncoplanar fields using IMRT was also elaborated. These techniques were compared according to the dose to the ora serrata retinae, lens, orbit (volume that received a dose of >or=20 Gy), vitreous, optic nerve, lacrimal gland (volume that received a dose of >or=34 Gy), and cornea and according to their ease of reproducibility. RESULTS: The techniques that attained the therapeutic dose to the ora serrata retinae were the IMRT technique and the techniques of Haye, Cassady, Cormack, and al-Beteri. The Cormack technique had the lowest volume that received a dose of >or=20 Gy in the orbit, followed by the IMRT technique. The IMRT technique also achieved the lowest volume that received a dose of >or=34 Gy (14%) in the lacrimal gland. The Abramson/McCormick/Blach, Cassady, Reese, and Schipper techniques were the easiest to reproduce and the Chin the most complex. CONCLUSION: Retinoblastoma treatment with IMRT has an advantage over the other techniques, because it allows for the greatest reduction of dose to the orbit and lacrimal gland, while maintaining the therapeutic dose to the ora serrata retinae and vitreous.