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Scarabosio A, Surico PL, Patanè L, Tambasco D, Kahale F, Zeppieri M, Parodi PC, Coassin M, Di Zazzo A. The Overlooked Floppy Eyelid Syndrome: From Diagnosis to Medical and Surgical Management. Diagnostics (Basel) 2024; 14:1828. [PMID: 39202316 PMCID: PMC11353443 DOI: 10.3390/diagnostics14161828] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2024] [Revised: 08/13/2024] [Accepted: 08/20/2024] [Indexed: 09/03/2024] Open
Abstract
Floppy Eyelid Syndrome (FES) is an underdiagnosed ocular condition characterized by the abnormal laxity of the upper eyelids, often leading to chronic eye irritation and redness. This review provides an in-depth examination of FES, covering its pathophysiology, clinical presentation, and diagnostic and therapeutic approaches. We discuss the potential etiological factors, including genetic predispositions and associations with ocular and systemic conditions such as obesity, obstructive sleep apnea, keratoconus, and glaucoma. Diagnostic strategies are outlined, emphasizing the importance of thorough clinical examinations and specific tests for an efficacious grading and assessment of FES. Management of FES ranges from conservative medical treatments to surgical interventions for more severe cases and should be driven by a comprehensive and multidisciplinary approach. Herein, we illustrate the practical aspects of diagnosing and managing this condition. This comprehensive review aims to enhance the recognition and treatment of FES, ultimately improving the quality of life for affected patients.
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Affiliation(s)
- Anna Scarabosio
- Department of Plastic Surgery, Massachusetts General Hospital, Boston, MA 02114, USA;
- Department of Plastic Surgery, University Hospital of Udine, 33100 Udine, Italy;
| | - Pier Luigi Surico
- Department of Ophthalmology, Mass Eye and Ear, Harvard Medical School, Boston, MA 02114, USA;
- Department of Ophthalmology, Campus Bio-Medico University Hospital, 00128 Rome, Italy; (M.C.); (A.D.Z.)
| | - Luca Patanè
- Department of Plastic Surgery, Sapienza University of Rome, 00185 Rome, Italy;
| | - Damiano Tambasco
- Department of Plastic Surgery, Hospital San Carlo di Nancy, 00165 Rome, Italy;
| | - Francesca Kahale
- Department of Ophthalmology, Mass Eye and Ear, Harvard Medical School, Boston, MA 02114, USA;
| | - Marco Zeppieri
- Department of Ophthalmology, University Hospital of Udine, 33100 Udine, Italy
| | - Pier Camillo Parodi
- Department of Plastic Surgery, University Hospital of Udine, 33100 Udine, Italy;
| | - Marco Coassin
- Department of Ophthalmology, Campus Bio-Medico University Hospital, 00128 Rome, Italy; (M.C.); (A.D.Z.)
| | - Antonio Di Zazzo
- Department of Ophthalmology, Campus Bio-Medico University Hospital, 00128 Rome, Italy; (M.C.); (A.D.Z.)
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Fu YK, Sun CC, Chen KJ, Lin YJ, Chang CJ, Chang SC, Sun MH. Associations Between Obstructive Sleep Apnea Syndrome, Dry Eye Disease, and CPAP Usage Among Taiwanese Patients: A Retrospective Analysis. Nat Sci Sleep 2024; 16:1001-1009. [PMID: 39050364 PMCID: PMC11268847 DOI: 10.2147/nss.s458245] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/05/2024] [Accepted: 07/10/2024] [Indexed: 07/27/2024] Open
Abstract
Study Objectives To evaluate the association between obstructive sleep apnea (OSA) and dry eye disease (DED) and analyze the impact of Continuous Positive Airway Pressure (CPAP) on DED. Methods This is a retrospective population-based case-control study. Patients who underwent polysomnography in Taiwan from March 1, 2009, to March 1, 2020, were identified from the database of a sleep center. Patients who were diagnosed with keratoconjunctivitis sicca or tear film insufficiency were included. Patients without data from Schirmer's test, lacking tear break-up time values, or with a history of refractive surgery, Sjögren's syndrome, ocular injuries, or a disability in eyelid closure were excluded. All patients with DED enrolled had DED in both eyes. OSA severity between patients with and without DED was compared. Results In total, 86 patients with DED and 86 age-matched patients without DED were enrolled. Significant differences in apnea-hypopnea index values (patients with DED: 29.1 ± 23.4, patients without DED: 17.9 ± 20.2, P < 0.001), OSA severity (P < 0.001), and lowest oxygen saturation (P = 0.040) between patients with and without DED were observed. A multivariate logistic regression model indicated that the use of CPAP was independently associated with DED after adjustments for OSA severity. Patients undergoing CPAP were at greater risk of developing DED than those not undergoing CPAP (Odds ratio: 3.93, 95% confidence interval: 1.47-10.49, P = 0.006). Conclusion OSA severity is associated with DED and might be attributed to the use of CPAP.
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Affiliation(s)
- Yuan-Kai Fu
- Department of Ophthalmology, Linkou Chang Gung Memorial Hospital, Taoyuan, Taiwan
| | - Chi-chin Sun
- Department of Ophthalmology, Keelung Chang Gung Memorial Hospital, Keelung, Taiwan
- College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Kuan-Jen Chen
- Department of Ophthalmology, Linkou Chang Gung Memorial Hospital, Taoyuan, Taiwan
- College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Yu-Jr Lin
- Research Services Center for Health Information, Chang Gung University, Taoyuan, Taiwan
| | - Chee-Jen Chang
- Research Services Center for Health Information, Chang Gung University, Taoyuan, Taiwan
- Graduate Institute of Clinical Medical Sciences, Chang Gung University, Taoyuan, Taiwan
- Clinical Informatics and Medical Statistics Research Center, Chang Gung University, Taoyuan, Taiwan
| | - Shu-Chen Chang
- Research Services Center for Health Information, Chang Gung University, Taoyuan, Taiwan
| | - Ming-Hui Sun
- Department of Ophthalmology, Linkou Chang Gung Memorial Hospital, Taoyuan, Taiwan
- College of Medicine, Chang Gung University, Taoyuan, Taiwan
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Nirmalan A, Tran MT, Tailor P, Hodge D, Bradley EA, Wagner LH, Bartley GB, Tooley AA. Obstructive Sleep Apnea Associated With Increased Failure Rate of Ptosis Repair. Ophthalmic Plast Reconstr Surg 2024; 40:201-205. [PMID: 37995148 DOI: 10.1097/iop.0000000000002547] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2023]
Abstract
PURPOSE This study investigates how Obstructive sleep apnea (OSA) affects the outcomes of ptosis repair. We hypothesized that patients with OSA have an increased rate of reoperation after ptosis repair. METHODS This retrospective cohort study included patients age >18 from the Mayo Clinic who underwent ptosis repair by levator advancement or Müller muscle-conjunctiva resection between 2018 and 2021. Outcomes were measured at 1 to 3 months of follow-up with surgical failure defined as asymmetry or unsatisfactory eyelid height requiring revision surgery within 1 year. RESULTS A total of 577 patients met the inclusion criteria. There was a statistically significant difference in surgical failure between patients with OSA and those without (20.5% vs. 13.1%, p = 0.02). Patients with OSA showed a statistically significant difference in risk of revision by a factor of 1.70 (95% CI: 1.06-2.07). Revisions were attributed to unsatisfactory eyelid height in 72.6% of patients and eyelid asymmetry in 21.1%. All patients who had revision surgery had satisfactory outcomes. On logistic regression analysis, when adjusting for age and sex, OSA was significantly associated with ptosis revision ( p = 0.007). CONCLUSIONS OSA increases risk of surgical failure and need for revision surgery in patients undergoing blepharoptosis repair but is not a sole risk factor.
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Affiliation(s)
| | - Meagan T Tran
- Alix School of Medicine, Mayo Clinic, Scottsdale, Arizona
| | - Prashant Tailor
- Department of Ophthalmology, Mayo Clinic, Rochester, Minnesota
| | - David Hodge
- Department of Health Sciences Research, Mayo Clinic, Jacksonville, Florida, U.S.A
| | | | - Lilly H Wagner
- Department of Ophthalmology, Mayo Clinic, Rochester, Minnesota
| | | | - Andrea A Tooley
- Department of Ophthalmology, Mayo Clinic, Rochester, Minnesota
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Sabur H, Arslan N, Kabatas EU, Acar M. Effects of full-thickness wedge resection on ocular surface and in vivo confocal microscopy findings in floppy eyelid syndrome patients. Eur J Ophthalmol 2024:11206721241233623. [PMID: 38378008 DOI: 10.1177/11206721241233623] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/22/2024]
Abstract
OBJECTIVE To evaluate the effect of full-thickness wedge resection (FTWR) on ocular surface and in vivo confocal microscopy (IVCM) findings in patients with floppy eyelid syndrome (FES). METHODS The study included two groups: a surgical treatment (ST) group (26 eyes) consisting of patients who underwent FTWR surgery, and a conservative treatment (CT) group (30 eyes). Pre-treatment and post-treatment ocular surface disease index (OSDI), tear break-up time (TBUT), corneal fluorescein staining (CFS), IVCM findings along with the body mass index (BMI), FES grade, the presence and the treatment of obstructive sleep apnea syndrome (OSAS) were recorded and compared between the groups. RESULTS The groups were comparable in terms of BMI, FES grade, and OSAS data. After six months, TBUT in the ST group significantly increased to 12.92 ± 1.15, compared to 8.10 ± 1.60 in the CT group (p = 0.000). The CFS and OSDI scores were significantly lower in the ST group (0.15 ± 0.37, 18.0 ± 8.3, respectively) compared to the CT group (0.90 ± 0.61, 27.3 ± 9.3, respectively) (p = 0.000). IVCM analysis revealed a significant decrease in dendritic cell count (ST: 22.0 ± 12.4, CT: 39.5 ± 15.1, p = 0.000) and nerve tortuosity (ST: 1.38 ± 0.64, CT: 2.00 ± 0.59, p = 0.000), with a significant increase in total nerve density (ST: 4.27 ± 0.83, CT: 3.57 ± 0.90, p = 0.002) in the ST group compared to the CT group after six months. CONCLUSION In our retrospective cohort, FTWR surgery was shown to be an effective and reliable surgical treatment for FES, improving both ocular surface and IVCM findings. Patients with moderate to severe stages of FES not responding to conservative treatment may benefit from eyelid tightening.
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Affiliation(s)
- Huri Sabur
- Department of Ophthalmology, Dışkapı Yıldırım Beyazıt Training and Research Hospital, University of Health Sciences, Ankara, Turkey
| | - Nese Arslan
- Department of Ophthalmology, Dışkapı Yıldırım Beyazıt Training and Research Hospital, University of Health Sciences, Ankara, Turkey
| | - Emrah Utku Kabatas
- Department of Ophthalmology, Dışkapı Yıldırım Beyazıt Training and Research Hospital, University of Health Sciences, Ankara, Turkey
| | - Mutlu Acar
- Department of Ophthalmology, Yuksek Ihtisas University, Liv Hospital, Ankara, Turkey
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Bulloch G, Seth I, Zhu Z, Sukumar S, McNab A. Ocular manifestations of obstructive sleep apnea: a systematic review and meta-analysis. Graefes Arch Clin Exp Ophthalmol 2024; 262:19-32. [PMID: 37227479 PMCID: PMC10806133 DOI: 10.1007/s00417-023-06103-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2022] [Revised: 03/22/2023] [Accepted: 05/08/2023] [Indexed: 05/26/2023] Open
Abstract
BACKGROUND The association of obstructive sleep apnea (OSA) with development of eye diseases is unclear. This current systematic review and meta-analysis attempts to summarize and analyze associations between OSA and ocular disorders in the literature. METHODS PubMed, EMBASE, Google Scholar, Web Of Science, and Scopus databases were searched from 1901 to July 2022 in accordance with the Preferred Reporting in Systematic Review & Meta-Analysis (PRISMA). Our primary outcome assessed the association between OSA and the odds of developing floppy eyelid syndrome (FES), glaucoma, non-arteritic anterior ischemic optic neuropathy (NAION), retinal vein occlusion (RVO), keratoconus (KC), idiopathic intracranial hypertension (IIH), age-related macular degeneration (AMD), and central serous chorioretinopathy (CSR) through odds ratio calculated at the 95% confidence interval. RESULTS Forty-nine studies were included for systematic review and meta-analysis. The pooled OR estimate was highest for NAION [3.98 (95% CI 2.38, 6.66)], followed by FES [3.68 (95% CI 2.18, 6.20)], RVO [2.71(95% CI 1.83, 4.00)], CSR [2.28 (95% CI 0.65, 7.97)], KC [1.87 (95% CI 1.16, 2.99)], glaucoma [1.49 (95% CI 1.16, 1.91)], IIH [1.29 (95% CI 0.33, 5.01)], and AMD [0.92 [95% CI 0.24, 3.58] All observed associations were significant (p < 0.001) aside from IIH and AMD. CONCLUSION OSA is significantly associated with NAION, FES, RVO, CSR, KC, and glaucoma. Clinicians should be informed of these associations so early recognition, diagnosis, and treatment of eye disorders can be addressed in at-risk groups, and early referral to ophthalmic services is made to prevent vision disturbances. Similarly, ophthalmologists seeing patients with any of these conditions should consider screening and referring patients for assessment of possible OSA.
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Affiliation(s)
- Gabriella Bulloch
- Department of Ophthalmology and Surgery, Centre for Eye Research Australia, Victoria, 3002, Australia
| | - Ishith Seth
- Department of Ophthalmology and Surgery, Centre for Eye Research Australia, Victoria, 3002, Australia.
- Central Clinical School, Monash University, Melbourne, 3004, Australia.
| | - Zhuoting Zhu
- Department of Ophthalmology and Surgery, Centre for Eye Research Australia, Victoria, 3002, Australia
| | - Sharanya Sukumar
- Department of Ophthalmology and Surgery, Centre for Eye Research Australia, Victoria, 3002, Australia
| | - Alan McNab
- Department of Ophthalmology and Surgery, Centre for Eye Research Australia, Victoria, 3002, Australia
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Hao L, Tian Q, Liu S, Xu Z, Yang L. Alterations of ocular surface parameters in patients with obstructive sleep apnea syndrome. Front Med (Lausanne) 2023; 10:1220104. [PMID: 37799593 PMCID: PMC10548263 DOI: 10.3389/fmed.2023.1220104] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2023] [Accepted: 09/04/2023] [Indexed: 10/07/2023] Open
Abstract
Purpose This study aimed to evaluate changes in ocular surface parameters among obstructive sleep apnea syndrome (OSAS) patients. Methods 44 healthy volunteers (88 eyes) and 27 OSAS patients (54 eyes) were recruited in our cross-sectional study. 14 patients were classified as mild&moderate OSAS, and 13 patients were classified as severe OSAS. For evaluating the ocular surface, the following tests were conducted: the height of tear meniscus (TMH), first non-invasive tear break-up time (FNITBUT), mean non-invasive tear break-up time (MNITBUT), the score of Meibomian gland dropout area (Meiboscore), the tear test of anesthesia-free Schirmer I (SIT), corneal fluorescein staining (CFS), partial blinks rate (PBR), the lipid layer thickness (LLT), ocular surface disease index (OSDI). The results obtained from the study were analyzed and compared among the groups. Results FNITBUT, MNITBUT, and TMH were lower. OSDI, CFS, Meiboscore and PBR were higher in the OSAS group than those in the control group. The mild&moderate as well as the severe OSAS subgroups had statistically significantly lower TMH, and higher OSDI and PBR than the control group. Meanwhile, we found there were no significant differences between two OSAS subgroups. CFS was higher in the severe OSAS group than the mild&moderate OSAS group. Significantly lower FNITBUT, MNITBUT and higher Meiboscore were observed in the severe OSAS subgroup than in the control group, and MNITBUT was higher in severe OSAS objects than in the mild&moderate OSAS objects. LLT and SIT did not exhibit significant differences among control and OSAS subgroups. FNITBUT and MNITBUT showed significantly negative correlations with BMI, while Meiboscore showed a significant positive correlation with AHI. Conclusion Patients with OSAS have a tendence of dry eyes, whereas control subjects do not. This indicates us that the OSAS patients should pay more attention to ocular surface care.
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Affiliation(s)
- Linlin Hao
- Department of Ophthalmology, The Second Hospital of Shandong University, Cheeloo College of Medicine, Shandong University, Jinan, China
| | - Qingfen Tian
- Department of Otolaryngology, Jinan Second People’s Hospital of Shandong University, Cheeloo College of Medicine, Shandong University, Jinan, China
| | - Shaohua Liu
- Department of Ophthalmology, The Second Hospital of Shandong University, Cheeloo College of Medicine, Shandong University, Jinan, China
| | - Zhe Xu
- Department of Ophthalmology, The Second Hospital of Shandong University, Cheeloo College of Medicine, Shandong University, Jinan, China
| | - Lixia Yang
- Department of Ophthalmology, The Second Hospital of Shandong University, Cheeloo College of Medicine, Shandong University, Jinan, China
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Sun J, He J, Liang Z. Comparison of ocular surface assessment outcomes between healthy controls and patients with obstructive sleep apnea-hypopnea syndrome: a meta-analysis of the literature. Front Physiol 2023; 14:1163947. [PMID: 37215172 PMCID: PMC10196462 DOI: 10.3389/fphys.2023.1163947] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2023] [Accepted: 04/21/2023] [Indexed: 05/24/2023] Open
Abstract
Objective: This meta-analysis aims to determine whether ocular surface alterations are associated with disease severity in patients with obstructive sleep apnea-hypopnea syndrome (OSAHS). Methods: The protocol for this systematic review and meta-analysis was registered in PROSPERO. We conducted the search in six electronic databases (China National Knowledge Infrastructure, EMBASE, Cochrane Library, Web of Science, Wanfang, and PubMed) from since the construction of the databases to 30 December 2022. The standard mean difference (SMD) and correlation coefficients are reported as measures of the effect size in the presence of retrieved data. In addition, the random effects model or fixed effects model was used in a combined analysis. Stata 11.0 and R 3.6.1 were used for statistical analyses of the data. Results: A total of 15 studies satisfied the inclusion criteria for this study. The prevalence of floppy eyelid syndrome (FES) and dry eye syndrome in patients with obstructive sleep apnea-hypopnea syndrome was 40 and 48%, respectively. In addition, the Schirmer 1 value and tear break-up time (TBUT) were remarkably reduced in patients with OSAHS when compared to that of the controls. The ocular surface disease index (OSDI) scores, Oxford corneal staining scores, and the rates of loss in the meibomian glands were elevated in patients with obstructive sleep apnea-hypopnea syndrome when compared to that of the controls, especially those with severe disease. Moreover, the Schirmer 1 value and tear break-up time exhibited a negative correlation with the apnea-hypopnea index (AHI), and the OSDI showed a positive association with the apnea-hypopnea index. Conclusion: Patients with OSAHS had a greater prevalence of FES than the healthy controls. They also showed lower Schirmer 1 value and tear break-up time but had a higher OSDI, Oxford corneal staining scores, and rates of loss in the meibomian glands than the healthy controls. Clinical Trial Registration: (https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=392527).
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Affiliation(s)
- Jian Sun
- Department of Respiratory and Critical Care Medicine, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Jie He
- Department of Pulmonary and Critical Care Medicine, The First Affiliated Hospital of Chengdu Medical College, Chengdu, Sichuan, China
| | - Zongan Liang
- Department of Respiratory and Critical Care Medicine, West China Hospital, Sichuan University, Chengdu, Sichuan, China
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Galor A, Britten-Jones AC, Feng Y, Ferrari G, Goldblum D, Gupta PK, Merayo-Lloves J, Na KS, Naroo SA, Nichols KK, Rocha EM, Tong L, Wang MTM, Craig JP. TFOS Lifestyle: Impact of lifestyle challenges on the ocular surface. Ocul Surf 2023; 28:262-303. [PMID: 37054911 DOI: 10.1016/j.jtos.2023.04.008] [Citation(s) in RCA: 17] [Impact Index Per Article: 17.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2023] [Accepted: 04/07/2023] [Indexed: 04/15/2023]
Abstract
Many factors in the domains of mental, physical, and social health have been associated with various ocular surface diseases, with most of the focus centered on aspects of dry eye disease (DED). Regarding mental health factors, several cross-sectional studies have noted associations between depression and anxiety, and medications used to treat these disorders, and DED symptoms. Sleep disorders (both involving quality and quantity of sleep) have also been associated with DED symptoms. Under the domain of physical health, several factors have been linked to meibomian gland abnormalities, including obesity and face mask wear. Cross-sectional studies have also linked chronic pain conditions, specifically migraine, chronic pain syndrome and fibromyalgia, to DED, principally focusing on DED symptoms. A systematic review and meta-analysis reviewed available data and concluded that various chronic pain conditions increased the risk of DED (variably defined), with odds ratios ranging from 1.60 to 2.16. However, heterogeneity was noted, highlighting the need for additional studies examining the impact of chronic pain on DED signs and subtype (evaporative versus aqueous deficient). With respect to societal factors, tobacco use has been most closely linked to tear instability, cocaine to decreased corneal sensitivity, and alcohol to tear film disturbances and DED symptoms.
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Affiliation(s)
- Anat Galor
- Bascom Palmer Eye Institute, University of Miami, Miami, FL, USA; Surgical Services, Miami Veterans Administration, Miami, FL, USA.
| | - Alexis Ceecee Britten-Jones
- Department of Optometry and Vision Sciences, Faculty of Medicine, Dentistry and Health Sciences, The University of Melbourne, Victoria, Australia
| | - Yun Feng
- Department of Ophthalmology, Peking University Eye Center, Peking University Third Hospital, Beijing, China
| | - Giulio Ferrari
- Cornea and Ocular Surface Unit, Eye Repair Lab, San Raffaele Scientific Institute, Milan, Italy
| | - David Goldblum
- Pallas-Kliniken, Olten, Bern, Zurich, Switzerland; University of Basel, Basel, Switzerland
| | - Preeya K Gupta
- Triangle Eye Consultants, Raleigh, NC, USA; Department of Ophthalmology, Tulane University, New Orleans, LA, USA
| | - Jesus Merayo-Lloves
- Instituto Universitario Fernandez-Vega, Universidad de Oviedo, Principality of Asturias, Spain
| | - Kyung-Sun Na
- Department of Ophthalmology, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Shehzad A Naroo
- College of Health and Life Sciences, Aston University, Birmingham, UK
| | - Kelly K Nichols
- School of Optometry, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Eduardo M Rocha
- Department of Ophthalmology, Othorynolaringology and Head & Neck Surgery, Ribeirao Preto Medical School, University of Sao Paulo, Ribeirao Preto, Sao Paulo, Brazil
| | - Louis Tong
- Cornea and External Eye Disease Service, Singapore National Eye Center, Ocular Surface Research Group, Singapore Eye Research Institute, Eye Academic Clinical Program, Duke-National University of Singapore, Singapore
| | - Michael T M Wang
- Department of Ophthalmology, New Zealand National Eye Centre, The University of Auckland, Auckland, New Zealand
| | - Jennifer P Craig
- Department of Ophthalmology, New Zealand National Eye Centre, The University of Auckland, Auckland, New Zealand
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Filatova IA, Kondratieva YP, Mohammad IM, Shemetov SA, Maybogin AM. Surgical treatment of the floppy eyelid syndrome. RUSSIAN OPHTHALMOLOGICAL JOURNAL 2023. [DOI: 10.21516/2072-0076-2023-16-1-96-100] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 03/22/2023]
Abstract
Purpose: to evaluate the effectiveness of surgical treatment of the floppy eyelid syndrome. Material and methods. The clinical group consisted of 23 patients (46 eyes) with the floppy eyelid syndrome (16 men and 4 women), ave. aged 46,0 ± 2.6 years. Of these 20 patients underwent surgery for floppy eyelid syndrome by vertical and horizontal shortening of the upper eyelid with or without correction of blepharoptosis. The observation period ranged from 1 month to 10 years. Fragments resected during the operation were subjected to histological examination. Results. A histological study revealed a reduced quantity or absence of elastin in the tarsal plate, destruction of collagen fiber beams, malformation of hair follicles accompanied by moderate chronic inflammation, In the postoperative period, the complaints caused by involuntary ectropion of the upper eyelid disappeared in all patients, the palpebral fissures became maximally symmetric. Conclusion. Surgeries performed by our technologies result in the best possible anatomical arrangement of the upper eyelid within a single-stage procedure.
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Affiliation(s)
- I. A. Filatova
- Helmholtz National Medical Research Center of Eye Diseases
| | | | - I. M. Mohammad
- Helmholtz National Medical Research Center of Eye Diseases
| | - S. A. Shemetov
- Helmholtz National Medical Research Center of Eye Diseases
| | - A. M. Maybogin
- Helmholtz National Medical Research Center of Eye Diseases
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Association between obstructive sleep apnea and floppy eyelid syndrome: A systematic review and metaanalysis. Surv Ophthalmol 2023; 68:257-264. [PMID: 36427560 DOI: 10.1016/j.survophthal.2022.11.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2022] [Revised: 11/16/2022] [Accepted: 11/18/2022] [Indexed: 11/25/2022]
Abstract
RATIONALE Obstructive sleep apnoea (OSA) has been linked to various ocular disorders, including floppy eyelid syndrome (FES). Previous studies have hypothesised the underlying association between the 2 , but results are currently still inconclusive. OBJECTIVE To investigate the association between OSA and FES. METHODS Four databases (Pubmed, Embase, Scopus, and Cochrane Library) were searched from inception until 28 February 2022 for observational studies and randomized controlled trials assessing the association between OSA and FES. Two reviewers selected studies, extracted data, graded the risk of bias using the Newcastle-Ottawa scale and the quality of assessment using the Grading of Recommendations Assessment, Development, and Evaluation system. Random-effects models were used to metaanalyze the associations. RESULTS Twelve studies were included in the systematic review, of which nine were suitable for metaanalysis, with a combined cohort of 1,109 patients. Risk of bias was low to moderate. The overall analysis showed a significant positive association between OSA and FES (OR = 1.89, 95% CI = 1.27-2.83, I 2 = 44%). Further analysis revealed that the more severe the OSA was, the higher the risk of developing FES. Patients with severe OSA had the nominally highest risk of developing FES (OR = 3.06, 95% CI = 1.62-5.78, I 2 = 0%), followed by moderate OSA (OR = 2.53, 95% CI = 1.29-4.97, I 2 = 0%), and patients with mild OSA had the lowest risk (OR = 1.76, 95% CI = 0.85-3.62, I 2 = 0%). CONCLUSION Our metaanalysis reports a positive association between OSA and FES, with increasing severity of OSA correlating with a significantly higher risk of FES. More longitudinal studies with sufficient duration of follow-up are needed to better characterise the relationship between OSA and FES.
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Gunes I, Oltulu R, Oltulu P, Turk N, Yosunkaya S. Ocular Surface in Patients With Obstructive Sleep Apnea Syndrome: Evaluation of Clinical Parameters and Impression Cytology. Eye Contact Lens 2023; 49:14-18. [PMID: 36138005 DOI: 10.1097/icl.0000000000000945] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/14/2022] [Indexed: 12/24/2022]
Abstract
PURPOSE To evaluate the effect of obstructive sleep apnea syndrome (OSAS) on the ocular surface and conjunctival cytology and the relationship between the findings and disease severity. METHODS One hundred six eyes of 106 patients (77 patients with OSAS and 29 control subjects) were included in the study. Twenty-three patients with an apnea-hypopnea index (AHI) of 5 to 15 were classified as mild OSAS (group 1), 27 patients with an AHI of 15 to 30 were classified as moderate OSAS (group 2), and 27 patients with an AHI≥30 were classified as severe OSAS (group 3). The following tests were used to evaluate the ocular surface: tear break-up time (TBUT), Schirmer I test, ocular surface disease index (OSDI), and conjunctival impression cytology (CIC). The results obtained from the tests were analyzed and compared between the groups. RESULTS The mean value of the Schirmer I test was 15.03±10.16 (1-35) mm in the control group, whereas it was found as 13.39±8.80 (3-35) mm, 9.85±7.81 (1-30) mm, and 9.41±7.53 (2-35) mm in the mild, moderate, and severe OSAS groups, respectively, and the difference between the groups was significant ( P =0.002). Although the mean TBUT score was 9.83±5.03 (3-23) seconds in the control group, it was 11.04±6.22 (3-20), 6.26±3.48 (1-16), and 5.44±3.09 (1-10) in the mild, moderate, and severe OSAS groups, respectively, and the difference between the groups was significant ( P <0.001). Although the mean OSDI score was 12.76±14.84 (range, 0-41.65) in the control group, it was 11.52±12.95 (range, 0-44.40), 25.06±19.45 (range, 0-75), and 20.31±19.87 (range, 0-77.70) in the mild, moderate, and severe OSAS groups, respectively, and the difference between the groups was significant ( P =0.015). Although the mean CIC stage was 0.47±0.60 (0-2) in the control group, it was 0.89±0.74 (0-2), 1.52±0.75 (0-3), and 1.83±0.69 (1-3) in the mild, moderate, and severe OSAS groups, respectively, and the difference between groups was significant ( P <0.001). CONCLUSION In addition to decreased tear production and TBUT, cytological changes including squamous metaplasia were detected between patients with OSAS and the control group.
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Affiliation(s)
- Irem Gunes
- Ophthalmology Department (I.G.), Muş Government Hospital, Muş, Turkey; Ophthalmology Department (R.O.), Meram Faculty of Medicine, Necmettin Erbakan University, Konya, Turkey; Pathology Department (P.O.), Meram Faculty of Medicine, Necmettin Erbakan University, Konya, Turkey; Pathology Department (N.T.), 25 Aralık Government Hospital, Gaziantep, Turkey; and Chest Diseases Department (S.Y.), Meram Faculty of Medicine, Necmettin Erbakan University, Konya, Turkey
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12
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Obsructive sleep apnea syndrome: is it a risk factor for ocular surface disease and ocular comorbidities? Int Ophthalmol 2022:10.1007/s10792-022-02629-3. [PMID: 36580155 DOI: 10.1007/s10792-022-02629-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2022] [Accepted: 12/20/2022] [Indexed: 12/30/2022]
Abstract
PURPOSE To investigate the accompanying ocular findings in patients with obstructive sleep apnea syndrome (OSAS) and evaluate the susceptibility to ophthalmological diseases. MATERIALS AND METHODS In this cross-sectional study, qualifying study subjects were patients who had been diagnosed with severe OSAS (apnea/hypopnea index (AHI > 30/h), n = 31), and control subjects (n = 30) who had an AHI index of < 5 (as normal). General ophthalmological examination, eyelid laxity measurements, corneal topography, visual field, retinal nerve fiber layer parameters, dry eye tests were performed on the patients. RESULTS It was observed that the two groups had similar characteristics in terms of gender, age, presence of hypertension, diabetes, and body mass index. According to eyelid laxity measurements, the incidence of loose eyelids was higher in the OSAS patient group. Choroidal thickness was thinner in the study group than in the control group. Schirmer test and tear break-up time were significantly lower in the study group than in the control group. The percentage of meibomian gland loss in meibography and the ocular surface disease index score for symptoms was significantly higher in the study group than in the control group. CONCLUSION In this study, we found significant changes in ocular surface parameters, eyelid laxity, choroidal thickness, and visual field indices in OSAS patients. Dry eye syndrome might be related eyelid laxity and inflammation in OSAS patients. Early diagnosis and follow-up of ocular diseases in OSAS, which affect the quality of life and visual prognosis in advanced ages, are important.
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Aiello F, Gallo Afflitto G, Alessandri Bonetti M, Ceccarelli F, Cesareo M, Nucci C. Lax eyelid condition (LEC) and floppy eyelid syndrome (FES) prevalence in obstructive sleep apnea syndrome (OSA) patients: a systematic review and meta-analysis. Graefes Arch Clin Exp Ophthalmol 2022; 261:1505-1514. [DOI: 10.1007/s00417-022-05890-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2022] [Revised: 10/21/2022] [Accepted: 10/31/2022] [Indexed: 11/17/2022] Open
Abstract
Abstract
Purpose
Lax eyelid condition (LEC) and floppy eyelid syndrome (FES) represent two distinct conditions which have been associated with several ocular and systemic comorbidities. The main aim of this systematic review and meta-analysis is to explore the available literature to estimate the prevalence rate of LEC and FES in obstructive sleep apnea (OSA).
Methods
The protocol of this systematic review and meta-analysis has been registered in PROSPERO. Four electronic databases (PubMed/MEDLINE, Google Scholar, Cochrane Library, Web of Science) were searched from inception to December 24, 2021. A random intercept logistic regression model was carried out for the analysis of overall proportions. Odds ratio and mean difference were reported as measures of the effect size in the presence of binary and continuous outcomes, respectively. The estimated numbers of LEC/FES patients in OSA were calculated by multiplying the prevalence rate determined by our random-effects model and the corresponding Benjafield et al.’s population prospect.
Results
We included 11 studies comprising 1225 OSA patients of whom 431 and 153 affected by LEC and FES, respectively. Our model estimated a pooled prevalence rate for LEC and FES in OSA patients of 40.2% (95%CI: 28.6–53.1%) and of 22.4% (95%CI: 13.8–34.2%), respectively. The number of LEC/FES affected individuals among OSA patients is expected to peak up to 376 and to 210 million, respectively. OSA patients appeared to have a 3.4 (95%CI: 2.2–5.2) and a 3.0 (95%CI: 1.7–5.5) increased risk of developing LEC and FES than the healthy counterpart.
Conclusion
Prevalence of LEC and FES is higher in OSA-affected patients compared to controls. More studies are warranted to investigate the mechanisms leading to the development of LEC and/or FES in OSA patients, as well as the feasibility of the adoption of these clinical findings as screening tools for OSA.
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Liu S, Li S, Li M, Zeng S, Chen B, Zhang L. Evaluation of the Ocular Surface and Meibomian Gland in Obstructive Sleep Apnea Hypopnea Syndrome. Front Med (Lausanne) 2022; 9:832954. [PMID: 35223929 PMCID: PMC8863666 DOI: 10.3389/fmed.2022.832954] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2021] [Accepted: 01/14/2022] [Indexed: 12/03/2022] Open
Abstract
Purpose To assess the ocular surface and meibomian gland (MG) of patients with obstructive sleep apnea hypopnea syndrome (OSAHS) and to explore the effects of surgery for OSAHS on the ocular surface and MG. Methods Based on the apnea hypopnea index (AHI), 21 patients with mild OSAHS (Group A, 5/h ≤ AHI < 15/h), 20 patients with moderate OSAHS (Group B, 15/h ≤ AHI < 30/h), 62 patients with severe OSAHS (Group C, AHI ≥ 30/h) were examined. The ocular surface and MG were evaluated using Keratograph 5M. In addition, detailed Ophthalmic examination including visual acuity, refraction, slit-lamp examination of the anterior segment, corneal fluorescein staining (CFS), ocular surface disease index (OSDI) scoring, Schirmer I test (SIT) and serum lipid measurement was performed. For OSAHS patients with dry eye syndrome (DES) who underwent uvulopalatopharyngoplasty for improving AHI, the conditions of the ocular surface and MG were compared before surgery and 3 months after surgery. Only the data of the right eyes were analyzed. Results There were no significantly different in the OSDI score, tear meniscus height (TMH), or loss ratio of the lower eyelid (LRLE) among these groups. The first non-invasive tear film breakup time (fNIBUT), average non-invasive tear film breakup time (avNIBUT), bulbar redness index (BRI), lipid layer grading (LLG), CFS, plugged orifices and distortion in MG, the loss ratio of upper eyelid (LRUE), and the incidence of DES, floppy eyelid syndrome (FES) and meibomian gland dysfunction (MGD) showed significant differences between Groups A and C (p = 0.015, p = 0.018, p < 0.001, p = 0.022, p = 0.036, p = 0.007, p = 0.019, p = 0.017, p = 0.045, p = 0.013, and p = 0.029, respectively). The SIT in the Group A was significantly higher than in Group B (p = 0.025) and in Group C (p < 0.001). In the correlation analyses, the fNIBUT, avNIBUT, SIT and LLG had negative correlations with the AHI (p = 0.013, p = 0.010, p = 0.003, p < 0.001, and p = 0.006, respectively). The BRI, CFS and LRUE were positively correlated with the AHI (p = 0.006, p = 0.007, and p = 0.046, respectively). Three months after surgery, there were no significant differences in the ocular surface or MG. Conclusion Patients with severe OSAHS have poor stability of tear film and are prone to lipid-deficient dry eye as a result of the loss of meibomian gland. By improving the AHI, the ocular surface damage of OSAHS patients cannot be reversed in a short time.
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Affiliation(s)
- Shaohua Liu
- Department of Ophthalmology, The Second Xiangya Hospital of Central South University, Changsha, China.,Hunan Clinical Research Centre of Ophthalmic Disease, Changsha, China
| | - Shisheng Li
- Department of Otorhinolaryngology, The Second Xiangya Hospital of Central South University, Changsha, China
| | - Mengmeng Li
- Department of Otorhinolaryngology, The Second Xiangya Hospital of Central South University, Changsha, China
| | - Shiying Zeng
- Department of Otorhinolaryngology, The Second Xiangya Hospital of Central South University, Changsha, China
| | - Baihua Chen
- Department of Ophthalmology, The Second Xiangya Hospital of Central South University, Changsha, China.,Hunan Clinical Research Centre of Ophthalmic Disease, Changsha, China
| | - Liwei Zhang
- Department of Ophthalmology, The Second Xiangya Hospital of Central South University, Changsha, China.,Hunan Clinical Research Centre of Ophthalmic Disease, Changsha, China
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Shivaji S, Jayasudha R, Prashanthi GS, Arunasri K, Das T. Fungi of the human eye: Culture to mycobiome. Exp Eye Res 2022; 217:108968. [PMID: 35120870 DOI: 10.1016/j.exer.2022.108968] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2021] [Revised: 11/02/2021] [Accepted: 01/26/2022] [Indexed: 11/04/2022]
Abstract
The focus of the current review is multi-fold and compares the diversity and abundance of fungi on the ocular surface by the conventional culture-based method with the more sensitive, high throughput, culture-independent NGS method. The aim is to highlight the existence of a core ocular mycobiome and explore the transition of the ocular fungal microbiota from the normal eye to the diseased eye. PubMed, Google Scholar and Medline were used to search for publications and reviews related to cultivable fungi and the mycobiome of the normal and diseased eye. The conventional cultivable approach and the NGS approach confirm that the eye has its own mycobiome and several confounding factors (age, gender, ethnicity etc.) influence the mycobiome. Further, dysbiosis in the mycobiome appears to be associated with ocular diseases and thus impacts the health of the human eye. Considering that the mycobiome of the eye is influenced by several confounding factors and also varies with respect to the disease status of the eye there is a need to extensively explore the mycobiome under different physiological conditions, different ethnicities, geographical regions etc. Such studies would unravel the diversity and abundance of the mycobiomes and contribute to our understanding of ocular health. Research focused on ocular mycobiomes may eventually help to build a targeted and individualized treatment.
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Affiliation(s)
- Sisinthy Shivaji
- Prof. Brien Holden Eye Research Centre, L. V. Prasad Eye Institute, Kallam Anji Reddy Campus, Hyderabad, Telangana, 500034, India.
| | - Rajagopalaboopathi Jayasudha
- Prof. Brien Holden Eye Research Centre, L. V. Prasad Eye Institute, Kallam Anji Reddy Campus, Hyderabad, Telangana, 500034, India.
| | - Gumpili Sai Prashanthi
- Prof. Brien Holden Eye Research Centre, L. V. Prasad Eye Institute, Kallam Anji Reddy Campus, Hyderabad, Telangana, 500034, India.
| | - Kotakonda Arunasri
- Prof. Brien Holden Eye Research Centre, L. V. Prasad Eye Institute, Kallam Anji Reddy Campus, Hyderabad, Telangana, 500034, India.
| | - Taraprasad Das
- Srimati Kanuri Santhamma Centre for Vitreo Retinal Diseases, L. V. Prasad Eye Institute, Kallam Anji Reddy Campus, Hyderabad, Telangana, 500034, India.
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Lin PW, Lin HC, Chang CT, Friedman M, Salapatas AM, Lin MC, Lin CY. Alterations of Ocular Surface and Tear Film in Patients with Obstructive Sleep Apnea/Hypopnea Syndrome. Nat Sci Sleep 2022; 14:277-290. [PMID: 35450223 PMCID: PMC9017596 DOI: 10.2147/nss.s340105] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/19/2021] [Accepted: 01/24/2022] [Indexed: 11/23/2022] Open
Abstract
PURPOSE Obstructive sleep apnea/hypopnea syndrome (OSA) results in repeated oxygen desaturation, repeated arousals, and episodic nocturnal activation of sympathetic nervous system during sleep. Untreated OSA is strongly associated with an increase of cardio- and cerebrovascular disorders, as well as the damages of ophthalmological microstructures. However, previous literature only simply studied the association between the ophthalmic disorders and OSA. In the present study, we first investigated the alterations of ocular surface and tear film non-invasively with the innovated corneal topographer in untreated OSA patients and normal control subjects. Furthermore, we analyzed in depth whether the correlations between OSA severity and ocular surface exams exist. PARTICIPANTS AND METHODS Participants underwent a full-night polysomnography to determine OSA occurrence and severity. All participants subsequently received Ocular Surface Disease Index questionnaire and comprehensive ocular exams, including floppy eyelid syndrome (FES) assessment, oculus scan for tear meniscus height, non-invasive keratograph tear film breakup time (NIKBUT), and ocular surface redness, endothelial cell density, and corneal fluorescein staining. RESULTS One hundred eighty-one participants were prospectively enrolled in the study. FES was found in 11.5% of the normal control group and 60.0% of the severe OSA group (p=0.0005). There were significant differences in the first-NIKBUT (F-NIKBUT) (p < 0.0001), average-NIKBUT (A-NIKBUT) (p = 0.0007), and redness scores over the nasal bulbar (p = 0.032), temporal bulbar (p < 0.0001), nasal limbal (p = 0.014), and temporal limbal (p < 0.0001) areas among the four groups. F-NIKBUT and A-NIKBUT were significantly shorter in the moderate/severe OSA group (apnea/hypopnea index (AHI) ≥15) than in the normal/mild OSA group (AHI <15) (both p < 0.0001). The redness scores over the temporal bulbar (p < 0.0001) and temporal limbal (p < 0.0001) areas were also significantly different in these two OSA groups. Moreover, F-NIKBUT and A-NIKBUT negatively correlated with AHI. Nasal bulbar redness, temporal bulbar redness, nasal limbal redness, and temporal limbal redness positively correlated with AHI. CONCLUSION OSA patients had higher occurrence of FES. The NIKBUT was significantly shorter, and the temporal conjunctival redness scores over bulbar and limbal areas were higher in the moderate/severe OSA group than in the normal/mild OSA group. NIKBUT and conjunctival hyperemia significantly correlated with the severity of untreated OSA.
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Affiliation(s)
- Pei-Wen Lin
- Division of Glaucoma, Department of Ophthalmology, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung City; Chang Gung University College of Medicine, Taoyuan City, Taiwan.,Sleep Center, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung City, Taiwan
| | - Hsin-Ching Lin
- Sleep Center, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung City, Taiwan.,Department of Otolaryngology, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung City; Chang Gung University College of Medicine, Taoyuan City, Taiwan.,Robotic Surgery Center and Center for Quality Management, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung City, Taiwan.,Department of Business Management, Institute of Healthcare Management, National Sun Yat-sen University, Kaohsiung City, Taiwan
| | - Chun-Tuan Chang
- Department of Business Management, Institute of Healthcare Management, National Sun Yat-sen University, Kaohsiung City, Taiwan
| | - Michael Friedman
- Department of Otolaryngology, Division of Sleep Surgery, Rush University Medical Center, Chicago City, IL, USA.,Department of Otolaryngology, Advanced Center for Specialty Care, Advocate Illinois Masonic Medical Center, Chicago City, IL, USA
| | - Anna M Salapatas
- Department of Otolaryngology, Advanced Center for Specialty Care, Advocate Illinois Masonic Medical Center, Chicago City, IL, USA
| | - Meng-Chih Lin
- Sleep Center, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung City, Taiwan.,Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung City; Chang Gung University College of Medicine, Taoyuan City, Taiwan
| | - Chih-Yun Lin
- Biostatistics Center, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung City, Taiwan
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Ulutas HG, Balıkcı Tufekci A, Gunes A. Evaluation of corneal, ocular surface, and meibomian gland changes in obstructive sleep apnea syndrome. J Fr Ophtalmol 2021; 45:191-200. [PMID: 34961649 DOI: 10.1016/j.jfo.2021.09.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2021] [Revised: 09/01/2021] [Accepted: 09/03/2021] [Indexed: 01/05/2023]
Abstract
PURPOSE To evaluate the ocular surface, eyelid changes, meibomian gland morphology, corneal endothelial morphology, and corneal topographic measurements in patients with obstructive sleep apnea syndrome (OSAS). METHODS There were 47 patients diagnosed with OSAS and 47 healthy volunteers included in the study. Non-invasive tear break-up time (NITBUT), corneal topography, meibography, and specular microscopy were performed. RESULTS The mean ages of the study and control groups were 45.77±9.65 years and 44.26±8.54 years, respectively (P=0.229). The presence of floppy eye lid (17% vs. 0%; P=0.006) and lid margin abnormality score (1.09±0.8 vs. 0.21±0.51; P<0.001) were significantly different between the study and the control groups. There were insignificant differences between the groups in NITBUT and corneal topographic measurements, except for the ACT (556.96±42.4μm vs. 569±103μm, P=0.037). The mean endothelial cell density (CD) in the OSAS and control groups were 2609±259.96 and 2756±179 cells/mm2, respectively (P=0.002). Meibomian gland loss in the lower and upper eyelids was significantly higher in the OSAS group (P<0.001 for both). CONCLUSION OSAS patients develop eyelid margin abnormalities, loss of meibomian glands, and morphological changes in the meibomian glands. A significant reduction in corneal endothelial CD indicates that systemic hypoxia in OSAS has an effect on the cornea.
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Affiliation(s)
- H G Ulutas
- Department of Ophthalmology, University of Health Sciences, Yuksek Ihtisas Training and Research Hospital, 16310 Bursa, Turkey.
| | - A Balıkcı Tufekci
- Department of Ophthalmology, University of Health Sciences, Yuksek Ihtisas Training and Research Hospital, 16310 Bursa, Turkey
| | - A Gunes
- Department of Neurology, University of Health Sciences, Yuksek Ihtisas Training and Research Hospital, Bursa, Turkey
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Liu PK, Chiu TY, Wang NK, Levi SR, Tsai MJ. Ocular Complications of Obstructive Sleep Apnea. J Clin Med 2021; 10:jcm10153422. [PMID: 34362205 PMCID: PMC8348497 DOI: 10.3390/jcm10153422] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2021] [Revised: 07/20/2021] [Accepted: 07/28/2021] [Indexed: 12/13/2022] Open
Abstract
Obstructive sleep apnea (OSA), the most common form of sleep-disordered breathing, is characterized by repetitive episodes of paused breathing during sleep, which in turn induces transient nocturnal hypoxia and hypercapnia. The high prevalence of OSA and its associated health consequences place a heavy burden on the healthcare system. In particular, the consequent episodic oxygenic desaturation/reoxygenation series and arousals from sleep in patients with OSA have the potential to trigger oxidative stress, elevated systemic inflammatory responses, and autonomic dysfunction with sympathetic activation. Given these adverse side-effects, OSA is highly correlated to many eye diseases that are common in everyday ophthalmic practices. Some of these ocular consequences are reversible, but they may permanently threaten a patient’s vision if not treated appropriately. Here, this article seeks to review the ocular consequences and potential pathophysiologic associations in patients with OSA. Understanding these OSA-related eye diseases may help clinicians provide comprehensive care to their patients.
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Affiliation(s)
- Pei-Kang Liu
- Department of Ophthalmology, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung 807, Taiwan; (P.-K.L.); (T.-Y.C.)
- School of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung 807, Taiwan
- Institute of Biomedical Sciences, National Sun Yat-sen University, Kaohsiung 804, Taiwan
- Department of Ophthalmology, Edward S. Harkness Eye Institute, Columbia University, New York, NY 10032, USA; (N.-K.W.); (S.R.L.)
| | - Tzu-Yu Chiu
- Department of Ophthalmology, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung 807, Taiwan; (P.-K.L.); (T.-Y.C.)
- School of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung 807, Taiwan
| | - Nan-Kai Wang
- Department of Ophthalmology, Edward S. Harkness Eye Institute, Columbia University, New York, NY 10032, USA; (N.-K.W.); (S.R.L.)
| | - Sarah R. Levi
- Department of Ophthalmology, Edward S. Harkness Eye Institute, Columbia University, New York, NY 10032, USA; (N.-K.W.); (S.R.L.)
| | - Ming-Ju Tsai
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung 807, Taiwan
- Sleep Disorders Center, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung 807, Taiwan
- Department of Respiratory Care, College of Medicine, Kaohsiung Medical University, Kaohsiung 807, Taiwan
- Graduate Institute of Clinical Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung 807, Taiwan
- Correspondence: ; Tel.: +886-7-3121101 (ext. 5601)
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The Associations of Obstructive Sleep Apnea and Eye Disorders: Potential Insights into Pathogenesis and Treatment. CURRENT SLEEP MEDICINE REPORTS 2021. [DOI: 10.1007/s40675-021-00215-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
Abstract
Abstract
Purpose of Review
Obstructive sleep apnea (OSA) patients are at significantly increased risks for cardiovascular and cerebrovascular morbidities. Recently, there has been heightened interest in the association of OSA with numerous ocular diseases and possible improvement of these conditions with the initiation of OSA treatment. We reviewed the current evidence with an emphasis on the overlapping pathogeneses of both diseases.
Recent Findings
Currently available literature points to a substantial association of OSA with ocular diseases, ranging from those involving the eyelid to optic neuropathies and retinal vascular diseases. Since the retina is one of the highest oxygen-consuming tissues in the body, the intermittent hypoxia and hypercapnia ensuing in OSA can have deleterious effects on ocular function and health. Tissue hypoxia, autonomic dysfunction, microvascular dysfunction, and inflammation all play important roles in the pathogenesis of both OSA and ocular diseases. Whether OSA treatment is capable of reversing the course of associated ocular diseases remains to be determined. It is anticipated that future therapeutic approaches will target the common underlying pathophysiologic mechanisms and promote favorable effects on the treatment of known associated ocular diseases.
Summary
Emerging evidence supports the association of ocular diseases with untreated OSA. Future studies focusing on whether therapeutic approaches targeting the common pathophysiologic mechanisms will be beneficial for the course of both diseases are warranted.
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Vieira MJ, Silva MJ, Lopes N, Moreira C, Carvalheira F, Sousa JP. Comment on the Reply: "Prospective Evaluation of Floppy Eyelid Syndrome at Baseline and after CPAP Therapy". Curr Eye Res 2021; 46:763-764. [PMID: 33233957 DOI: 10.1080/02713683.2020.1855659] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Affiliation(s)
- Maria J Vieira
- Ophthalmology Department, Centro Hospitalar de Leiria, Leiria, Portugal
| | - Maria J Silva
- Pulmonology Department, Centro Hospitalar de Leiria, Leiria, Portugal
| | - Nádia Lopes
- Ophthalmology Department, Centro Hospitalar de Leiria, Leiria, Portugal
| | - Cláudia Moreira
- Pulmonology Department, Centro Hospitalar de Leiria, Leiria, Portugal
| | | | - João Paulo Sousa
- Ophthalmology Department, Centro Hospitalar de Leiria, Leiria, Portugal
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Abstract
PURPOSE To evaluate the effect of obstructive sleep apnea-hypopnea syndrome (OSAHS) on the meibomian glands, ocular surface, and tear parameters. METHODS The study included 59 individuals (32 subjects with OSAHS, 27 control subjects) who underwent polysomnography in the Chest Diseases Clinic. The right eyes of all individuals were evaluated in the Ophthalmology Clinic. The first noninvasive tear break-up time (f-NTBUT) and the average noninvasive tear break-up time were measured, and Schirmer test was applied. Meibography was taken (Sirius; CSO, Florence, Italy), and meiboscore was used for indexing meibography. Finally, a sample was taken for conjunctival impression cytology. RESULTS In the study and control groups, the median of f-NTBUT was 2.1 seconds [interquartile range (IQR); 1.5-5.0] and 5.7 seconds (IQR; 2.9-8.8) and the median of average noninvasive tear break-up time was 5.6 seconds (IQR; 3.6-9.5) and 7.2 seconds (IQR; 4.2-10.7), respectively (P = 0.007 and P = 0.487, respectively). The mean Schirmer value was 16.3 ± 5.9 mm (range; 5-25) and 17.3 ± 6.6 mm (range; 5-30) in the study and control groups (P = 0.604). In upper eyelid meibography, the median of loss in the meibomian glands was 20.10% (IQR; 11.60%-40.80%) in the study group and 14.70% (IQR; 10.40%-21.30%) in the control group (P = 0.043). In lower eyelid meibography, the median of loss in the meibomian glands was 19.00% (IQR; 13.60%-35.30%) in the study group and 12.40% (IQR; 9.10%-16.40%) in the control group (P = 0.002). The median of the Nelson grade in conjunctival impression cytology was 1 (IQR; 0-1) in the study group and 1 (IQR; 0-1) in the control group (P = 0.445). CONCLUSIONS The loss in the meibomian glands together with the shortened f-NTBUT shows that there could be a predisposition in OSAHS for evaporative dry eye originating from meibomian gland damage.
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Matossian C, Song X, Chopra I, Sainski-Nguyen A, Ogundele A. The Prevalence and Incidence of Dry Eye Disease Among Patients Using Continuous Positive Airway Pressure or Other Nasal Mask Therapy Devices to Treat Sleep Apnea. Clin Ophthalmol 2020; 14:3371-3379. [PMID: 33116388 PMCID: PMC7573305 DOI: 10.2147/opth.s274949] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2020] [Accepted: 09/17/2020] [Indexed: 11/29/2022] Open
Abstract
Introduction Dry eye disease (DED) prevalence is estimated at 9.3% of the US adult population, although diagnosed rate is much lower. This study examined real-world incidence rates (IR) and prevalence rates (PR) of DED in adults using continuous positive airway pressure (CPAP) or nasal mask therapy (NMT) devices to treat sleep apnea. Methods Using IBM MarketScan Commercial and Medicare Supplemental claims databases, this study identified adults with ≥1 claim of CPAP or other NMT device between January 1, 2014 and June 30, 2018, ≥1 diagnosis of sleep apnea during a 12-month pre-index period, and continuous benefit enrollment ≥12 pre- and post-index date. The date of the first CPAP or NMT device claim was considered the index date. Descriptive analyses included PR, IR, and IR per 100-person years (100PY) for the overall population and subgroups including age, sex, and baseline comorbidities. Results The 1-, 2-, and 3-year PR of DED was 6.2%, 10.0%, and 13.0%, while the IR of DED was 4.0%, 7.3%, and 10.3%, respectively. Females had a higher IR of DED compared to males: 5.8%, 10.8%, and 15.1% vs 3.0%, 5.4%, and 7.9%, respectively. DED increased with age with a 1-, 2-, and 3-year PR for patients aged 18–24 years of 2.2%, 3.4%, and 5.0% vs 17.6%, 25.8%, and 32.1% in patients aged ≥75, respectively. Overall, IR per 100PY of DED was 3.68, higher for females than males (5.51 vs 2.73). PR and IR of DED were high among patients with comorbid inflammatory or metabolic conditions. Conclusion The PR and IR of DED in CPAP or NMT users were higher than the reported prevalence of DED in the general population. CPAP/NMT users who were female, older, or had comorbid inflammatory or metabolic conditions may experience a higher incidence and prevalence of DED.
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Affiliation(s)
| | - Xue Song
- Outcomes Research, IBM Watson Health, Cambridge, MA, USA
| | - Ishveen Chopra
- Outcomes Research, IBM Watson Health, Cambridge, MA, USA
| | | | - Abayomi Ogundele
- Medical Affairs, Sun Pharmaceutical Industries, Inc., Princeton, NJ, USA
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Acar M, Firat H. Reply to Prospective Evaluation of Floppy Eyelid Syndrome at Baseline and after CPAP Therapy. Curr Eye Res 2020; 46:762. [PMID: 32905715 DOI: 10.1080/02713683.2020.1822416] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Affiliation(s)
- Mutlu Acar
- Department of Ophthalmology, University of Health Sciences, Ankara Diskapi Yildirim Beyazit Training and Research Hospital, Ankara, Turkey.,Department of Chest Diseases and Sleep Center, University of Health Sciences, Ankara Diskapi Yildirim Beyazit Training and Research Hospital, Ankara, Turkey
| | - Hikmet Firat
- Department of Ophthalmology, University of Health Sciences, Ankara Diskapi Yildirim Beyazit Training and Research Hospital, Ankara, Turkey.,Department of Chest Diseases and Sleep Center, University of Health Sciences, Ankara Diskapi Yildirim Beyazit Training and Research Hospital, Ankara, Turkey
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24
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Assessing the ocular surface microbiome in severe ocular surface diseases. Ocul Surf 2020; 18:706-712. [PMID: 32717380 DOI: 10.1016/j.jtos.2020.07.007] [Citation(s) in RCA: 48] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2019] [Revised: 07/05/2020] [Accepted: 07/09/2020] [Indexed: 12/16/2022]
Abstract
PURPOSE There is growing evidence for a critical role of the microbiome in ocular health and disease. We performed a prospective, observational study to characterize the ocular surface microbiome (OSM) in four chronic ocular surface diseases (OSDs) and healthy controls. METHODS Sterile swabs were used to collect samples from each eye of 39 patients (78 eyes). Sterile technique and multiple controls were used to assess contamination during DNA extraction, amplification and sequencing. Concurrent use of topical antibiotics, steroids, and bandage contact lenses (BCLs) was documented. RESULTS Despite the low biomass of the ocular surface, 47/78 (60%) eyes sampled had positive sequencing reads. We observed that half of patients (8/17, 47%) had distinct microbiomes in each eye. Healthy controls had a Lactobacillus/Streptococcus mixture or significant Corynebacterium. Staphylococcus predominated in 4/7 (57%) patients with Stevens-Johnson Syndrome (SJS) in at least one eye, compared to 0/10 healthy controls. Interestingly, 8/11 (73%) eyes with SJS were using BCLs, including 4/5 (80%) eyes dominated by Staphylococcus. Lax eyelid syndrome (LES) and Dry Eye Disease (DED) patients had similar OSMs, with Corynebacterium being the most prevalent bacteria. Alpha diversity was higher in controls and ocular graft-vs-host (oGVHD) patients compared to the other OSDs. CONCLUSIONS Only 50% of the 39 patients had similar microbiomes in each eye. A majority of healthy eyes had a Lactobacillus/Streptococcus mix or Corynebacterium microbiome. Staphylococcus predominated in SJS, Lactobacillus in oGVHD, and Corynebacterium in DED and LES. There may be an association between different OSDs and the microbiome.
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Vieira MJ, Silva MJ, Lopes N, Moreira C, Carvalheira F, Sousa JP. Prospective Evaluation of Floppy Eyelid Syndrome at Baseline and after CPAP Therapy. Curr Eye Res 2020; 46:31-34. [PMID: 32482105 DOI: 10.1080/02713683.2020.1776332] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
PURPOSE/AIM Floppy eyelid syndrome (FES) is an ocular manifestation of obstructive sleep apnea (OSA), but no studies have analyzed whether it can be improved by nocturnal continuous positive airway pressure (CPAP) therapy. The aim of this study was to analyze the effect of CPAP on FES by comparing objective measurements before and after 6 months of CPAP therapy. MATERIALS AND METHODS We conducted a prospective study of 47 patients (74.5% males) with newly diagnosed OSA at a secondary care Portuguese hospital who underwent objective diagnostic testing for FES (upper eyelid eversion for >6 seconds and tarsal conjunctival exposure and upper eyelid laxity ≥1.5 mm). Patients with hyperelastic eyelid or FES were re-evaluated by the same ophthalmologist (blinded to the patients' condition) after 6 months of CPAP therapy. RESULTS Mean apnea hypopnea index (AHI), analyzed as number of events per hour, was 28.7 ± 18.6 overall and 42.8 ± 20.0 in the supine position. Thirty-four percent of patients had FES. Mean AHI in the supine position was significantly higher in patients with FES (p = .041) and was an independent predictor of FES (p = .034; OR = 0.48). Severe OSA was significantly associated with FES (p = .023). FES resolved in 53.8% of patients after CPAP therapy. Patients with non-reversible FES had more severe OSA and worse airway access according to the Mallampati classification (from class I: visualization of soft palate and entire uvula, to class IV: soft palate not visible). CONCLUSIONS A higher AHI in the supine position may be predictive of FES. CPAP therapy might reverse FES and patients with non-reversible FES appear to have more severe OSA and a worse airway access.
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Affiliation(s)
- Maria J Vieira
- Ophathmology Department, Centro Hospitalar De Leiria , Leiria, Portugal
| | - Maria J Silva
- Pulmonology Department, Centro Hospitalar De Leiria , Leiria, Portugal
| | - Nádia Lopes
- Ophathmology Department, Centro Hospitalar De Leiria , Leiria, Portugal
| | - Cláudia Moreira
- Pulmonology Department, Centro Hospitalar De Leiria , Leiria, Portugal
| | | | - João Paulo Sousa
- Ophathmology Department, Centro Hospitalar De Leiria , Leiria, Portugal.,Health Sciences Research Centre in Biomedicine, Faculty of Health Sciences, University of Beira Interior
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Löw U, Schießl G, Spira-Eppig C, Seitz B. [Floppy eyelid syndrome : A frequently underdiagnosed entity of interdisciplinary importance]. Ophthalmologe 2019; 116:1091-1102. [PMID: 31641846 DOI: 10.1007/s00347-019-00985-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
Clinically, the floppy eyelid syndrome is a frequent but underdiagnosed condition. This clinical phenotype is characterized by an extreme laxity of the eyelid, which is enlarged and has a rubber-like structure in combination with a pronounced hyperelastic tarsus. When looking down, minimal vertical tension can trigger spontaneous eversion of the upper eyelid leading to chronic papillary conjunctivitis. This syndrome usually affects older, adipose men who also suffer from sleep apnea and metabolic syndrome. Due to the resistance of chronic papillary conjunctivitis to conservative treatment, surgical treatment is often necessary; however, due to the frequent association between floppy eyelid syndrome, sleep apnea and metabolic syndrome a collaborative interdisciplinary approach is necessary.
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Affiliation(s)
- U Löw
- Klinik für Augenheilkunde und Poliklinik, Universitätsklinikum des Saarlandes, 66421, Homburg/Saar, Deutschland.
| | - G Schießl
- Klinik für Augenheilkunde und Poliklinik, Universitätsklinikum des Saarlandes, 66421, Homburg/Saar, Deutschland
| | - C Spira-Eppig
- Klinik für Augenheilkunde und Poliklinik, Universitätsklinikum des Saarlandes, 66421, Homburg/Saar, Deutschland
| | - B Seitz
- Klinik für Augenheilkunde und Poliklinik, Universitätsklinikum des Saarlandes, 66421, Homburg/Saar, Deutschland
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Salinas R, Puig M, Fry CL, Johnson DA, Kheirkhah A. Floppy eyelid syndrome: A comprehensive review. Ocul Surf 2019; 18:31-39. [PMID: 31593763 DOI: 10.1016/j.jtos.2019.10.002] [Citation(s) in RCA: 34] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2019] [Revised: 09/21/2019] [Accepted: 10/03/2019] [Indexed: 01/11/2023]
Abstract
Floppy eyelid syndrome (FES) is defined as eyelid hyperlaxity with reactive palpebral conjunctivitis. It is a common condition that can be associated with significant ocular irritation. FES presents with easily everted eyelids and chronic papillary conjunctivitis in the upper eyelids. It is frequently associated with ocular and systemic diseases, notably keratoconus and obstructive sleep apnea, respectively. This comprehensive review describes the epidemiology, pathological changes, proposed pathogenesis, clinical manifestations, and a variety of treatment options for this condition. Conservative treatment of FES includes aggressive lubrication, nighttime eye shield, and avoiding sleeping on the affected eye. Patients with FES and obstructive sleep apnea may have an improvement in their ocular signs and symptoms after long-term therapy with continuous positive airway pressure. In refractory cases, a corrective surgery that addresses the eyelid laxity can result in significant improvement. All patients with ocular irritation should be evaluated for the presence of FES.
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Affiliation(s)
- Ricardo Salinas
- Department of Ophthalmology, Long School of Medicine, University of Texas Health at San Antonio, San Antonio, TX, USA
| | - Madeleine Puig
- Department of Ophthalmology, Long School of Medicine, University of Texas Health at San Antonio, San Antonio, TX, USA
| | - Constance L Fry
- Department of Ophthalmology, Long School of Medicine, University of Texas Health at San Antonio, San Antonio, TX, USA
| | - Daniel A Johnson
- Department of Ophthalmology, Long School of Medicine, University of Texas Health at San Antonio, San Antonio, TX, USA
| | - Ahmad Kheirkhah
- Department of Ophthalmology, Long School of Medicine, University of Texas Health at San Antonio, San Antonio, TX, USA.
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Yu X, Guo H, Liu X, Wang G, Min Y, Chen SHS, Han SS, Chang RT, Zhao X, Hsing A, Zhu S, Yao K. Dry eye and sleep quality: a large community-based study in Hangzhou. Sleep 2019; 42:5532656. [PMID: 31310315 DOI: 10.1093/sleep/zsz160] [Citation(s) in RCA: 33] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2018] [Revised: 05/16/2019] [Indexed: 12/20/2022] Open
Abstract
Abstract
Study Objectives
To investigate the relationship between dry eye and sleep quality in a large community-based Chinese population.
Methods
A total of 3,070 participants aged 18–80 were recruited from a community-based study in Hangzhou, China during 2016–2017. Sleep quality was evaluated using the Chinese version of the Pittsburgh Sleep Quality Index (CPSQI), and dry eye was evaluated using the Ocular Surface Disease Index (OSDI) questionnaire. Multivariable linear regression and logistic regression models were used to investigate the associations, adjusting for age, smoking, drinking, season, and other potential confounders.
Results
Overall, CPSQI score and sleep dysfunction were significantly associated with mild, moderate, and severe dry eye (ORs for CPSQI score: 1.07, 1.13, 1.14, all p < 0.001; for sleep dysfunction: 1.31, 1.73, 1.66, all p < 0.05). Furthermore, worse OSDI score was presented in participants with worse CPSQI score or sleep dysfunction (CPSQI score > 7) (β: 0.13, 0.54; all p < 0.001). In addition, six of the seven components of CPSQI showed significant associations with dry eye (all p < 0.001), except for the component of sleep medication use. Moreover, we observed significant associations of dry eye in all three subscales of OSDI with CPSQI score and sleep dysfunction.
Conclusion
Our large, community-based study showed a strong association between poor sleep quality and an increased severity of dry eye, suggesting that preventing either one of the discomforts might alleviate the other.
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Affiliation(s)
- Xiaoning Yu
- Eye Center, The Second Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, China
- Chronic Disease Research Institute, School of Public Health, School of Medicine, Zhejiang University, Hangzhou, China
- Women’s Hospital, School of Medicine, Zhejiang University, Hangzhou, China
| | - Huilan Guo
- Chronic Disease Research Institute, School of Public Health, School of Medicine, Zhejiang University, Hangzhou, China
- Women’s Hospital, School of Medicine, Zhejiang University, Hangzhou, China
- Department of Nutrition and Food Hygiene, School of Public Health, School of Medicine, Zhejiang University, Hangzhou, China
| | - Xin Liu
- Eye Center, The Second Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, China
- Chronic Disease Research Institute, School of Public Health, School of Medicine, Zhejiang University, Hangzhou, China
- Women’s Hospital, School of Medicine, Zhejiang University, Hangzhou, China
| | - Guowei Wang
- Chronic Disease Research Institute, School of Public Health, School of Medicine, Zhejiang University, Hangzhou, China
- Women’s Hospital, School of Medicine, Zhejiang University, Hangzhou, China
- Department of Nutrition and Food Hygiene, School of Public Health, School of Medicine, Zhejiang University, Hangzhou, China
| | - Yan Min
- Stanford Prevention Research Center, Department of Medicine, Stanford School of Medicine, Stanford University, Stanford, CA
| | - Shih-Hua Sarah Chen
- Stanford Prevention Research Center, Department of Medicine, Stanford School of Medicine, Stanford University, Stanford, CA
| | - Summer S Han
- Department of Neurosurgery, Stanford School of Medicine, Stanford University, Stanford, CA
| | - Robert T Chang
- Department of Ophthalmology, Stanford School of Medicine, Stanford University, Stanford, CA
| | - Xueyin Zhao
- Chronic Disease Research Institute, School of Public Health, School of Medicine, Zhejiang University, Hangzhou, China
- Women’s Hospital, School of Medicine, Zhejiang University, Hangzhou, China
- Department of Nutrition and Food Hygiene, School of Public Health, School of Medicine, Zhejiang University, Hangzhou, China
| | - Ann Hsing
- Stanford Prevention Research Center, Department of Medicine, Stanford School of Medicine, Stanford University, Stanford, CA
| | - Shankuan Zhu
- Chronic Disease Research Institute, School of Public Health, School of Medicine, Zhejiang University, Hangzhou, China
- Women’s Hospital, School of Medicine, Zhejiang University, Hangzhou, China
- Department of Nutrition and Food Hygiene, School of Public Health, School of Medicine, Zhejiang University, Hangzhou, China
| | - Ke Yao
- Eye Center, The Second Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, China
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Karaca I, Yagci A, Palamar M, Tasbakan MS, Basoglu OK. Ocular surface assessment and morphological alterations in meibomian glands with meibography in obstructive sleep apnea Syndrome. Ocul Surf 2019; 17:771-776. [PMID: 31226420 DOI: 10.1016/j.jtos.2019.06.003] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2019] [Revised: 05/30/2019] [Accepted: 06/17/2019] [Indexed: 01/10/2023]
Abstract
PURPOSE To evaluate ocular surface and Meibomian glands morphology of patients with obstructive sleep apnea syndrome (OSAS). MATERIALS AND METHODS Based on polysomnography, 36 eyes of 36 patients with severe OSAS (Group 1, apnea-hypopnea index (AHI) ≥30/h) and 24 eyes of 24 patients with primary snoring or mild OSAS (Group 2, AHI<15/h) were enrolled. Detailed eye examination along with ocular surface staining (fluorescein, 2%) according to Oxford scale, tear film break-up time (t-BUT), Schirmer 1 test, ocular surface disease index (OSDI) scoring, and evaluation of upper and lower eyelid Meibomian glands using infrared filter of slit-lamp biomicroscope were performed. In addition to grading Meibomian gland drop-out, the presence morphologic alterations such as Meibomian gland duct distortion, thinning and dilatation were also assessed. RESULTS The mean ages were 50.8 ± 8.3 (range, 35-68) and 47.9 ± 10.5 (range, 27-69) in Group 1 and Group 2, respectively (p = 0.616). Best-corrected visual acuity, Schirmer 1 test, Oxford scale and OSDI scores, and lower meiboscores did not differ significantly between groups. In Group 1, average t-BUT was lower (p = 0.003), upper and total (upper + lower) meiboscores were higher as compared to Group 2 (p < 0.05). The frequency of Meibomian gland duct distortion, thinning and dilatation were also significantly greater in Group 1 (p < 0.05). CONCLUSION Morphological changes, in addition to Meibomian glands dropout were significant in severe OSAS patients as demonstrated objectively with meibography. Schirmer 1 and t-BUT tests were in favor of evaporative type dry eye syndrome, which also support Meibomian gland alterations in severe OSAS patients.
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Affiliation(s)
- Irmak Karaca
- Department of Ophthalmology, Ege University School of Medicine, Izmir, Turkey.
| | - Ayse Yagci
- Department of Ophthalmology, Ege University School of Medicine, Izmir, Turkey
| | - Melis Palamar
- Department of Ophthalmology, Ege University School of Medicine, Izmir, Turkey
| | | | - Ozen K Basoglu
- Department of Chest Diseases, Ege University School of Medicine, Izmir, Turkey
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The Presence of Conjunctivochalasis in Obstructive Sleep Apnea Patients. Eye Contact Lens 2018; 44 Suppl 1:S163-S166. [DOI: 10.1097/icl.0000000000000361] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Sward M, Kirk C, Kumar S, Nasir N, Adams W, Bouchard C. Lax eyelid syndrome (LES), obstructive sleep apnea (OSA), and ocular surface inflammation. Ocul Surf 2018; 16:331-336. [PMID: 29729418 DOI: 10.1016/j.jtos.2018.04.003] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2018] [Revised: 03/28/2018] [Accepted: 04/11/2018] [Indexed: 12/20/2022]
Abstract
PURPOSE Lax eyelid syndrome (LES) is defined as the association of distensible "floppy" eyelids and chronic papillary conjunctivitis. LES is also found in patients with obstructive sleep apnea (OSA) who have systemic elevation of inflammatory markers, including matrix metalloproteinases (MMP). Locally elevated MMP levels have also been demonstrated co-localized with elastin loss in eyelids of patients with LES, accounting for their "floppiness." The purpose of this study was to investigate tear film MMP levels and determine their association with eyelid laxity and OSA. We also evaluated 3 previous grading systems to determine the severity of lid laxity and introduced a new "laxometer" device. METHODS Thirty-seven subjects underwent bilateral eyelid laxity assessments prior to polysomnography testing. OSA severity was graded using the apnea hypopnea index (AHI). The degree of eyelid laxity was determined using three published methods and a newly proposed "laxometer" method. Commercially available InflammaDry® kits were used to determine the presence of MMP-9 in the tear film. RESULTS There was a significant elevation in tear MMP-9 levels in patients with LES compared to controls (p < .05). Of the 37 total patients enrolled in this study, 2 patients (5.4%) did not have sleep study results. Thirty-two of the remaining 35 patients (91.4%) were determined to have OSA (AHI > 5). In this sample, there was no meaningful association between OSA and MMP-9 (p = .12). Although there were positive associations between OSA severity, laxometer measurements, and previously established grading methods, none achieved statistical significance (all p > .05). CONCLUSIONS There was an elevation of MMP-9 in tears of patients with LES. Elevated tear MMP-9 was also not associated with OSA. Although there is some evidence to support the association of eyelid laxity and OSA, the most accurate and reliable method for grading eyelid laxity remains unclear.
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Affiliation(s)
- Mackenzie Sward
- Department of Ophthalmology, Loyola University Medical Center, Maywood, IL, USA
| | - Clayton Kirk
- Loyola University Chicago, Stritch School of Medicine, Maywood, IL, USA
| | - Sunita Kumar
- Department of Pulmonology, Loyola University Medical Center, Maywood, IL, USA
| | - Nabila Nasir
- Department of Pulmonology, Loyola University Medical Center, Maywood, IL, USA
| | - William Adams
- Clinical Research Office Biostatistics Core, Loyola University Chicago Health Sciences Division, USA
| | - Charles Bouchard
- Department of Ophthalmology, Loyola University Medical Center, Maywood, IL, USA.
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Fox TP, Schwartz JA, Chang AC, Parvin-Nejad FP, Yim CK, Feinsilver SH, Wu AY. Association Between Eyelid Laxity and Obstructive Sleep Apnea. JAMA Ophthalmol 2017; 135:1055-1061. [PMID: 28880982 DOI: 10.1001/jamaophthalmol.2017.3263] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
Importance While much has been reported on the relationship between floppy eyelid syndrome and obstructive sleep apnea (OSA), the diagnostic criteria of floppy eyelid syndrome are often subjective and vague. Objective To evaluate the association between OSA and quantitative markers of eyelid laxity or secondary ocular surface disease in a sleep clinic population. Design, Setting, and Participants This investigation was a cross-sectional observational study at the Center for Sleep Medicine at Icahn School of Medicine at Mount Sinai. Participants were individuals referred for overnight polysomnography from March 1 to August 30, 2015. Main Outcomes and Measures Eyelid laxity and ocular surface disease were assessed on bedside ophthalmologic examination. The presence and severity of OSA were determined from polysomnography results. Initial correlation between OSA and ocular surface and eyelid markers was calculated through bivariate linear regression analysis, and the association between ocular symptoms was obtained through bivariate ordered logistic regression. Analysis was repeated adjusting for known associations between OSA and sex, age, body mass index, and medical comorbidities through multivariable analysis. Results In total, 201 individuals (402 eyes) were enrolled in the study. Their mean (SD) age was 53.2 (13.5) years, 43.3% (n = 87) were female, 56.7% (n = 114) were of white race/ethnicity, 26.9% (n = 54) were black/African American, 4.0% (n = 8) were Asian, 8.0% (n = 16) were multiracial or other, and 4.5% (n = 9) were of unknown race/ethnicity, with 21.9% (n = 44) of all individuals self-identifying as Hispanic and 75.1% (n = 151) self-identifying as non-Hispanic. After adjustment, no association was observed between OSA severity and an eyelid laxity score (regression coefficient, 0.85; 95% CI, -0.33 to 0.62; P = .40) or an ocular surface score (regression coefficient, 1.09; 95% CI, -0.32 to 0.29; P = .93). Through subset analysis, male sex was associated with a higher ocular surface score, while older age and diabetes were associated with a higher eyelid laxity score. Only one patient (0.5%) exhibited findings of floppy eyelid syndrome. Conclusions and Relevance Among individuals referred for overnight polysomnography, quantitative markers of eyelid laxity were not associated with the presence or severity of OSA. Subset analysis suggests that prior studies may have been limited by confounding variables or the technique of identifying eyelid laxity.
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Affiliation(s)
- Timothy P Fox
- Department of Ophthalmology, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Jeffrey A Schwartz
- Department of Ophthalmology, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Aimee C Chang
- Department of Ophthalmology, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Fatemeh P Parvin-Nejad
- Department of Ophthalmology, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Cindi K Yim
- Department of Ophthalmology, Icahn School of Medicine at Mount Sinai, New York, New York
| | | | - Albert Y Wu
- Department of Ophthalmology, Icahn School of Medicine at Mount Sinai, New York, New York.,Department of Medical Education, Icahn School of Medicine at Mount Sinai, New York, New York
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Pedrotti E, Demasi CL, Bruni E, Bosello F, Di Sarro PP, Passilongo M, Fasolo A, Gennaro N, De Gregorio A, Ferrari M, Marchini G. Prevalence and risk factors of eye diseases in adult patients with obstructive sleep apnoea: results from the SLE.E.P.Y cohort study. BMJ Open 2017; 7:e016142. [PMID: 29061607 PMCID: PMC5665218 DOI: 10.1136/bmjopen-2017-016142] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/12/2023] Open
Abstract
OBJECTIVES To assess the occurrence of glaucoma, eyelid, corneal and macular disorders in a cohort of patients with obstructive sleep apnoea (OSA) diagnosed by overnight polysomnography and to investigate into the risk factors for the above eye diseases (EDs). DESIGN Cross-sectional cohort study between 2014 and 2015. SETTING Unit of Respiratory Medicine and Eye Clinic of the University of Verona. PARTICIPANTS 431 consecutive patients were considered eligible. Of these, 87 declined to participate, 35 were untraceable and 13 were deceased. INTERVENTIONS A complete ophthalmic evaluation of both eyes for each patient. PRIMARY AND SECONDARY OUTCOME MEASURES Best-corrected distance visual acuity, intraocular pressure, corneal, macular and optic nerve optical coherence tomography, ocular aberrometry, optic nerve laser polarimetry, visual field test, and eyelid examination. RESULTS 296 patients aged 64.5±12.8 years, 23% female and 77% male, underwent ophthalmic examination. There was 56% (n=166) prevalence of eyelid disorders, 27% (n=80) of corneal disorders, 13% (n=39) of macular disorders and 11% (n=33) of glaucoma. Advancing age was not associated with the severity of OSA, while significant differences were found for gender, body mass index, Oxygen Desaturation Index, smoking habit, hypertension and diabetes. Severe OSA was significantly associated with glaucoma (OR, 95% CI 1.05 to 5.93, p=0.037). CONCLUSIONS EDs were more prevalent in our patinets with OSA than in the general population. Severe Apnoea/Hypopnoea Index level seemed to play a role as risk factor only for glaucoma.
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Affiliation(s)
- Emilio Pedrotti
- Department of Neurosciences, Biomedicine and Movement Sciences, Eye Clinic, University of Verona, Verona, Italy
| | - Christian Luigi Demasi
- Department of Neurosciences, Biomedicine and Movement Sciences, Eye Clinic, University of Verona, Verona, Italy
| | - Enrico Bruni
- Department of Neurosciences, Biomedicine and Movement Sciences, Eye Clinic, University of Verona, Verona, Italy
| | - Francesca Bosello
- Department of Neurosciences, Biomedicine and Movement Sciences, Eye Clinic, University of Verona, Verona, Italy
| | - Paolo Plinio Di Sarro
- Department of Neurosciences, Biomedicine and Movement Sciences, Eye Clinic, University of Verona, Verona, Italy
| | - Mattia Passilongo
- Department of Neurosciences, Biomedicine and Movement Sciences, Eye Clinic, University of Verona, Verona, Italy
| | - Adriano Fasolo
- Department of Neurosciences, Biomedicine and Movement Sciences, Eye Clinic, University of Verona, Verona, Italy
- The Veneto Eye Bank Foundation, Venezia Zelarino, Italy
| | | | | | - Marcello Ferrari
- Unit of Respiratory Medicine, Department of Medicine, University of Verona, Verona, Italy
| | - Giorgio Marchini
- Department of Neurosciences, Biomedicine and Movement Sciences, Eye Clinic, University of Verona, Verona, Italy
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Shiba T, Takahashi M, Muramatsu R, Matsumoto T, Hori Y. Evaluation of ocular surface tear dynamics patients with obstructive sleep apnea syndrome. Sleep Biol Rhythms 2017. [DOI: 10.1007/s41105-017-0119-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Kan S, Acar U, Kizilgul M, Beyazyildiz E, Cankaya A, Ozcelik O, Ozbek M. The effects of blood glucose regulation on tear function tests in diabetic patients. J Fr Ophtalmol 2017; 40:499-504. [DOI: 10.1016/j.jfo.2016.10.019] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2016] [Revised: 10/05/2016] [Accepted: 10/14/2016] [Indexed: 10/19/2022]
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Kan S, Acar U, Kizilgul M, Beyazyildiz E, Cankaya AB, Apaydin M, Beysel S, Ozbek M. Tear Film and Ocular Surface Evaluation in Gestational Diabetes Mellitus. Semin Ophthalmol 2016; 33:402-406. [PMID: 28005448 DOI: 10.1080/08820538.2016.1250919] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
BACKGROUND Dry eye syndrome is one of the complaints of diabetic patients. The aim of the present study was to evaluate the tear functions in pregnant women with gestational diabetes mellitus (GDM) using tests: Schirmer, tear break-up time (TBUT), and tear film osmolarity (TFO) tests and the Ocular Surface Disease Index score (OSDI). METHODS Pregnant women with GDM (Group 1, n=46) and healthy pregnant women (Group 2, n=36) were enrolled. Initially, all participants were asked to answer the OSDI and then they underwent a detailed ophthalmic examination including Schirmer, TBUT, and TFO tests. The individuals with ocular or systemic disorders that might affect the tear function tests and who were using topical medications were excluded. RESULTS The results of Schirmer, TBUT, TFO tests and OSDI scores were 11.20±4.93 mm, 5.59±2.16 sec, 309.65±14.80 mOsm/L, and 9.59 ± 9.69 in Group 1, respectively, and 12.33±5.33 mm, 5.67±2.68 sec, 308.36±16.00 mOsm/L, and 10.62±8.66 in Group 2, respectively. There was no significant difference in any of the tear function tests and OSDI scores between the study groups (p>0.05). CONCLUSION GDM seems to have no negative effects on tear function tests. This may be due to a lack of duration of hyperglycemia long enough to affect the tear function tests of pregnant women.
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Affiliation(s)
- S Kan
- a Department of Endocrinology and Metabolism , Diskapi Training and Research Hospital , Ankara , Turkey
| | - U Acar
- b Department of Ophthalmology, Faculty of Medicine , Hacettepe University , Ankara , Turkey
| | - M Kizilgul
- a Department of Endocrinology and Metabolism , Diskapi Training and Research Hospital , Ankara , Turkey.,c Schulze Diabetes Institute, University of Minnesota , Minneapolis , MN , USA
| | - E Beyazyildiz
- d Department of Ophthalmology , Samsun Teaching and Research Hospital , Samsun , Turkey
| | - A B Cankaya
- b Department of Ophthalmology, Faculty of Medicine , Hacettepe University , Ankara , Turkey
| | - M Apaydin
- a Department of Endocrinology and Metabolism , Diskapi Training and Research Hospital , Ankara , Turkey
| | - S Beysel
- a Department of Endocrinology and Metabolism , Diskapi Training and Research Hospital , Ankara , Turkey
| | - M Ozbek
- a Department of Endocrinology and Metabolism , Diskapi Training and Research Hospital , Ankara , Turkey
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Karaca EE, Akçam HT, Uzun F, Özdek Ş, Ulukavak Çiftçi T. Evaluation of Ocular Surface Health in Patients with Obstructive Sleep Apnea Syndrome. Turk J Ophthalmol 2016; 46:104-108. [PMID: 27800271 PMCID: PMC5076291 DOI: 10.4274/tjo.57778] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2015] [Accepted: 08/13/2015] [Indexed: 12/01/2022] Open
Abstract
Objectives: To evaluate ocular surface health in obstructive sleep apnea syndrome (OSAS) and to investigate the tendency of these patients toward dry eyes. Materials and Methods: Fifty patients who underwent polysomnography and were diagnosed with OSAS and 50 normal control subjects were compared with respect to ocular surface disease index (OSDI), Schirmer I test and tear film break-up time (TBUT) values. Results: Patients were grouped as mild (n=15, 30%), moderate (n=15, 30%) and severe (n=20, 40%) according to apnea-hypopnea index values. The right eyes of patients were included in both groups. OSDI values were as follows: control group, 18.7±8.5; mild OSAS group, 40.2±2.8; moderate OSAS group, 48.5±2.2 and severe OSAS group, 62.7±2.3 (p<0.001). TBUT values were as follows: control group, 12.3±4.9; mild OSAS group, 8.2±4.7; moderate OSAS group, 5.8±2.1 and severe OSAS group, 4.2±3.7 (p<0.001). Schirmer values were as follows: control group, 18±6.1 mm; mild OSAS group, 12.9±6.7 mm; moderate OSAS group, 8.5±5.2 mm and severe OSAS group, 7.9±4.7 mm (p<0.001). Conclusion: Patients with OSAS seem to have a tendency toward dry eyes. Clinicians should be aware of dry eye development in these patients.
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Affiliation(s)
| | | | - Feyzahan Uzun
- Recep Tayyip Erdoğan University Faculty of Medicine, Department of Ophthalmology, Rize, Turkey
| | - Şengül Özdek
- Gazi University Faculty of Medicine, Department of Ophthalmology, Ankara, Turkey
| | - Tansu Ulukavak Çiftçi
- Gazi University Faculty of Medicine, Department of Pulmonary Diseases, Ankara, Turkey
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Is Floppy Eyelid Syndrome More Prevalent in Obstructive Sleep Apnea Syndrome Patients? J Ophthalmol 2016; 2016:6980281. [PMID: 27366328 PMCID: PMC4913017 DOI: 10.1155/2016/6980281] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2016] [Revised: 03/06/2016] [Accepted: 05/09/2016] [Indexed: 11/18/2022] Open
Abstract
Controversial findings are reported about the relationship between floppy eyelid syndrome (FES) and obstructive sleep apnea syndrome (OSAS). The main goal of this study was to evaluate whether FES is more prevalent in OSAS patients by performing a meta-analysis. A comprehensive literature search of Pubmed, Embase, and Cochrane databases was performed. Only studies related to the prevalence of FES in OSAS were included in the meta-analysis. We estimated a pooled odds ratio (OR) for the prevalence of FES in OSAS. In total, 6 studies with 767 participants met the inclusion criteria. Using a fixed-effects model, the pooled OR was 4.12. The test for the overall effect revealed that FES was statistically prevalent in OSAS patients when compared with that in non-OSAS subjects (Z = 4.98, p < 0.00001). In the subgroup analysis by OSAS severity, the incidence of FES in OSAS increased with severity of OSAS as indicated with increased OR values (OR = 2.56, 4.62, and 7.64 for mild, moderate, and severe OSAS). In conclusion, the results indicate that FES is more prevalent in OSAS patients. However, this result was based only on unadjusted estimates. Prospective cohort studies are needed to determine whether OSAS is an independent risk factor for FES.
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The association between ophthalmologic diseases and obstructive sleep apnea: a systematic review and meta-analysis. Sleep Breath 2016; 20:1145-1154. [PMID: 27230013 DOI: 10.1007/s11325-016-1358-4] [Citation(s) in RCA: 53] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2016] [Revised: 05/04/2016] [Accepted: 05/10/2016] [Indexed: 10/21/2022]
Abstract
PURPOSE The purpose of this study was to evaluate the association between obstructive sleep apnea (OSA) and ophthalmologic diseases, specifically glaucoma, nonarteritic anterior ischemic optic neuropathy (NAION), retinal vein occlusion (RVO), central serous chorioretinopathy (CSR), and floppy eyelid syndrome (FES), by performing a systematic review and meta-analysis of published studies. METHODS PubMed, Embase, and Scopus databases were searched for observational studies on OSA and its association with select ophthalmologic diseases. Data was pooled for random-effects modeling. The association between OSA and ophthalmologic diseases was summarized using an estimated pooled odds ratio with a 95 % confidence interval. RESULTS Relative to non-OSA subjects, OSA subjects have increased odds of diagnosis with glaucoma (pooled odds ratio (OR) = 1.242; P < 0.001) and floppy eyelids syndrome (pooled OR = 4.157; P < 0.001). In reverse, the overall pooled OR for OSA was 1.746 (P = 0.002) in the glaucoma group, 3.126 (P = 0.000) in the NAION group, and 2.019 (P = 0.028) in the CSR group. For RVO, one study with 5965 OSA patients and 29,669 controls demonstrated a 1.94-fold odds increase in OSA patients. CONCLUSIONS Our results suggest significant associations between OSA and glaucoma, NAION, CSR, and FES. Screening for OSA should be considered in patients with glaucoma, NAION, CSR, or FES.
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Ferrandez B, Ferreras A, Calvo P, Abadia B, Pajarin AB, Marin JM, Iester M. Macular Retinal Ganglion Cell Layer Thickness Is Not Reduced in Patients with Obstructive Sleep Apnea. Ophthalmic Res 2016; 56:85-91. [PMID: 27192975 DOI: 10.1159/000445353] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2015] [Accepted: 03/10/2016] [Indexed: 11/19/2022]
Abstract
PURPOSE To evaluate macular ganglion cell layer (GCL) and ganglion cell-inner plexiform layer (GCIPL) thicknesses in patients with obstructive sleep apnea (OSA) syndrome. METHODS 73 OSA patients and 67 age-matched controls were consecutively and prospectively enrolled. All participants underwent at least one reliable standard automated perimetry (SAP) and were imaged with spectral-domain optical coherence tomography (OCT) using two different devices. The OCT parameters were compared between groups, and Pearson correlations between main indices of SAP and OCT parameters were calculated. RESULTS The pattern standard deviation of SAP was higher in the OSA group (p = 0.001). Mean GCIPL thickness was 82.99 ± 10.30 and 80.78 ± 12.15 µm in the control and OSA groups, respectively (p = 0.25), and GCL thickness was 44.93 ± 11.42 µm in the control group and 48.81 ± 10.85 µm in OSA individuals (p = 0.47). Pearson correlations between the GCIPL-GCL measurements and the main indices of SAP were not significant. CONCLUSIONS Neither GCIPL nor GCL thickness were reduced in OSA subjects compared with healthy individuals. Retinal sensitivity evaluated with SAP was however decreased in OSA patients.
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Affiliation(s)
- Blanca Ferrandez
- Department of Ophthalmology, IIS-Aragx00F3;n, Miguel Servet University Hospital, Zaragoza, Spain
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Bayır Ö, Acar M, Yüksel E, Yüceege M, Saylam G, Tatar EÇ, Özdek A, Firat H, Gürdal C, Korkmaz MH. The effects of anterior palatoplasty on floppy eyelid syndrome patients with obstructive sleep apnea. Laryngoscope 2016; 126:2171-5. [DOI: 10.1002/lary.25905] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2015] [Revised: 12/18/2015] [Accepted: 01/11/2016] [Indexed: 12/19/2022]
Affiliation(s)
- Ömer Bayır
- Department of Otolaryngology; Head & Neck Surgery, Ministry of Health Diskapi Yildirim Beyazit Training and Research Hospital; Ankara Turkey
| | - Mutlu Acar
- Department of Ophthalmology; Ministry of Health Diskapi Yildirim Beyazit Training and Research Hospital; Ankara Turkey
| | - Elvan Yüksel
- Department of Otolaryngology; Head & Neck Surgery, Ministry of Health Diskapi Yildirim Beyazit Training and Research Hospital; Ankara Turkey
| | - Melike Yüceege
- Department of Respiratory Medicine; Ministry of Health Diskapi Yildirim Beyazit Training and Research Hospital; Ankara Turkey
| | - Güleser Saylam
- Department of Otolaryngology; Head & Neck Surgery, Ministry of Health Diskapi Yildirim Beyazit Training and Research Hospital; Ankara Turkey
| | - Emel Çadalli Tatar
- Department of Otolaryngology; Head & Neck Surgery, Ministry of Health Diskapi Yildirim Beyazit Training and Research Hospital; Ankara Turkey
| | - Ali Özdek
- Department of Otolaryngology; Head & Neck Surgery, Ministry of Health Diskapi Yildirim Beyazit Training and Research Hospital; Ankara Turkey
| | - Hikmet Firat
- Department of Respiratory Medicine; Ministry of Health Diskapi Yildirim Beyazit Training and Research Hospital; Ankara Turkey
| | - Canan Gürdal
- Department of Ophthalmology; Ministry of Health Diskapi Yildirim Beyazit Training and Research Hospital; Ankara Turkey
| | - Mehmet Hakan Korkmaz
- Department of Otolaryngology; Head & Neck Surgery, Faculty of Medicine, Yildirim Beyazit University; Ankara Turkey
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Affiliation(s)
- Permesh Singh Dhillon
- Royle Eye Department, Pilgrim Hospital, Boston, United Lincolnshire Hospitals Trust, Boston, UK
| | - Gareth Lewis
- Royle Eye Department, Pilgrim Hospital, Boston, United Lincolnshire Hospitals Trust, Boston, UK
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Abstract
PURPOSE The aim of this study was to study prevalence, risk factors, and morbidity of eyelid laxity in a veteran population. METHODS This prospective cross-sectional study with a retrospective chart review included 150 subjects evaluated from either an outpatient eye clinic or a geriatric clinic at the Miami Veterans Affairs Hospital from June through August 2013. Clinical data were gathered from a questionnaire and a computerized medical record system including demographics, medical history, and ocular irritation history. Upper and lower eyelid laxity was clinically graded. Main outcome measures were prevalence of eyelid laxity, risk factors for its presence, and its correlation to ocular surface symptoms. RESULTS Fifty-four percent of participants (n = 81) had laxity (grade 1 or higher) in either upper and/or lower eyelids. Risk factors for eyelid laxity in our population included older age, higher body mass index, and a diagnosis of sleep apnea. Patients with any eyelid laxity (grade 1 or more in any eyelid) had a 2.23-fold risk of severe ocular surface symptoms (score of 12 or higher on the dry eye questionnaire 5) compared with those without laxity (95% confidence interval, 1.15-4.31; P = 0.017), and this was primarily driven by the presence of upper eyelid laxity. CONCLUSIONS We found high prevalence of eyelid laxity in our population, and its presence was associated with significant ocular surface morbidity. This study reinforces the need to incorporate dynamic eyelid testing into ophthalmic examination in patients with ocular surface discomfort.
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Acar M, Fırat H, Gürdal C. Re: Ulander et al.: Side effects to continuous positive airway pressure treatment for obstructive sleep apnoea: changes over time and association to adherence. (Sleep Breath. 2014 Dec;18(4):799-807). Sleep Breath 2015; 19:1343-4. [PMID: 25893320 DOI: 10.1007/s11325-015-1146-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2015] [Revised: 01/24/2015] [Accepted: 02/10/2015] [Indexed: 11/25/2022]
Affiliation(s)
- Mutlu Acar
- Department of Ophthalmology, Ministry of Health, Ankara Diskapi Yildirim Beyazit Training and Research Hospital, 06110, Ankara, Turkey.
| | - Hikmet Fırat
- Department of Chest Diseases and Sleep Center, Ministry of Health, Ankara Diskapi Yildirim Beyazit Training and Research Hospital, Ankara, Turkey
| | - Canan Gürdal
- Department of Ophthalmology, Ministry of Health, Ankara Diskapi Yildirim Beyazit Training and Research Hospital, 06110, Ankara, Turkey
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Acar M, Firat H, Yuceege M, Ardic S. Long-term effects of PAP on ocular surface in obstructive sleep apnea syndrome. Can J Ophthalmol 2014; 49:217-21. [PMID: 24767232 DOI: 10.1016/j.jcjo.2013.11.010] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2013] [Revised: 11/16/2013] [Accepted: 11/20/2013] [Indexed: 10/25/2022]
Abstract
OBJECTIVE To assess the long-term effects of positive airway pressure (PAP) therapy on the ocular surface and eyelid in patients with obstructive sleep apnea hypopnea syndrome (OSAHS). DESIGN Single-centred, prospective, and double-blinded study. PARTICIPANTS Fifty-one patients with OSAHS. METHODS Fifty-one patients with OSAHS were treated with PAP for a period of 18 months. The pre- and post-PAP values for eye examination scores (presence of floppy eyelid syndrome [FES], results of the Ocular Surface Disease Index [OSDI] questionnaire, Schirmer I test, tear film break-up time [TBUT] values, and corneal staining stages) were compared. RESULTS Based on the apnea-hypopnea index, 17 patients were followed with moderate and 34 patients were followed with severe OSAHS. The presence of FES before and after PAP was 56.9% and 74.5% (p < 0.01). FES stage was determined as 1.41 ± 0.98 before PAP and 0.78 ± 0.78 after PAP (p < 0.01). Pre-PAP and post-PAP OSDI results were 47.79 ± 21.04 and 42.17 ± 19.97, respectively (p < 0.01). Schirmer values before and after PAP were 7.23 ± 1.95 and 8.49 ± 1.79 mm, respectively (p < 0.01). TBUT values before and after PAP were 7.11 ± 1.82 and 8.68 ± 1.76 seconds, respectively (p < 0.01). Scores of the corneal staining stages before and after PAP were 1.05 ± 0.75 and 0.68 ± 0.54, respectively (p < 0.01). CONCLUSIONS OSAHS is associated with low Schirmer and TBUT values, and high scores in OSDI questionnaire, and high corneal staining stage. An appropriate PAP therapy helps to relieve both the systemic findings and the ocular surface problems most likely by providing a return to normal sleep patterns. We believe that long-term (at least 1 year) use of PAP improves the clinical picture of FES and can overcome the problem of ocular irritation that is encountered in the early stage of PAP.
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Affiliation(s)
- Mutlu Acar
- Ministry of Health, Department of Ophthalmology, Ankara Diskapi Yildirim Beyazit Training and Research Hospital, Ankara, Turkey.
| | - Hikmet Firat
- Department of Chest Diseases and Sleep Center, Ankara, Turkey
| | - Melike Yuceege
- Department of Chest Diseases and Sleep Center, Ankara, Turkey
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Chervin RD, Ruzicka DL, Vahabzadeh A, Burns MC, Burns JW, Buchman SR. The face of sleepiness: improvement in appearance after treatment of sleep apnea. J Clin Sleep Med 2014; 9:845-52. [PMID: 23997695 DOI: 10.5664/jcsm.2976] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
STUDY OBJECTIVES Anecdote but no formal evidence suggests that facial appearance improves after hypersomnolent patients with obstructive sleep apnea are treated. We investigated whether masked volunteer raters can identify post- rather than pre-treatment images as looking more alert, and whether impressions are predicted by any objective changes on highly precise 3-dimensional digital photogrammetry. METHODS Participants included 20 adults with obstructive sleep apnea on polysomnography and excessive sleepiness on Epworth Sleepiness Scales. Photogrammetry was performed before and after ≥ 2 months of adherent use of positive airway pressure. Twenty-two raters then assessed pre- and post-treatment facial images, paired side-by-side in random order. RESULTS Subjects included 14 men and 6 women, with mean age 45 ± 11 (SD) years and mean baseline apnea/hypopnea index of 26 ± 21. The 22 raters twice as often identified post-treatment rather than pre-treatment images to look more alert (p = 0.0053), more youthful (p = 0.026), more attractive (p = 0.0068), and more likely to reflect the treated state (p = 0.015). Photogrammetry documented post-treatment decreases in forehead surface volume and decreased infraorbital and cheek redness, but no narrowing of the interpalpebral fissure. Decreased deep NREM sleep at baseline, and pre- to post-treatment decrements in facial redness showed promise as predictors of improved subjective ratings for alertness. CONCLUSIONS Patients with obstructive sleep apnea are perceived to appear more alert, more youthful, and more attractive after adherent use of positive airway pressure. Objective changes in facial surface volume and color were identified. Post-treatment decrements in redness may inform subjective impressions of improved alertness.
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Affiliation(s)
- Ronald D Chervin
- Sleep Disorders Center and Department of Neurology, University of Michigan, Ann Arbor, MI 48109-5845, USA.
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Huseyinoglu N, Ekinci M, Ozben S, Buyukuysal C, Kale MY, Sanivar HS. Optic disc and retinal nerve fiber layer parameters as indicators of neurodegenerative brain changes in patients with obstructive sleep apnea syndrome. Sleep Breath 2013; 18:95-102. [PMID: 23636560 DOI: 10.1007/s11325-013-0854-z] [Citation(s) in RCA: 46] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2013] [Revised: 04/05/2013] [Accepted: 04/18/2013] [Indexed: 12/24/2022]
Abstract
PURPOSE Retina is a unique part of the central nervous system (CNS) for visualizing the processes of axonal and neuronal degeneration. Optical coherence tomography (OCT) allows direct visualization and measurement of retinal nerve fiber layer (RNFL) thickness, macular volume, and optic disc (OD) parameters. One of the disorders associated with atrophy in different brain regions is obstructive sleep apnea syndrome (OSAS). In the present study, we aimed to determine OD and RNFL changes measured by OCT for investigating the progress of neurodegeneration development in OSAS, excluding all the other conditions that can directly affect RNFL thickness and optic nerve parameters. METHODS Both eyes of 101 patients with OSAS and 20 controls were investigated by OCT. Full-night polysomnography (PSG) and ophthalmologic examination including automated visual field (VF) examination and OCT were performed in all of the patients. RESULTS According to the OSAS grading, patients were grouped as mild (n=15), moderate (n=27), and severe (n=59). We found significant decrease in RNFL thickness only in the patients with severe OSAS compared with the other groups and decreased macular ganglion cell thickness in the severe OSAS group compared with the control group. VF parameters were significantly worsened in all the OSAS subgroups compared to the control group. We found different data such as normal or increased optic nerve parameters as result of subtle OD edema, which may mask possible peripapillar axonal loss. CONCLUSIONS We think that evaluation of neurodegeneration in OSAS is not always possible by examining OD and RNFL because there are difficulties due to the confounding issues of cerebral atrophy and OD edema.
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Affiliation(s)
- Nergiz Huseyinoglu
- Department of Neurology, Medical Faculty, Kafkas University, Kars, Turkey,
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