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Abbott K, Hanson KS, Lally J. Prevalence of dry eye disease in the low vision population at the University of Colorado. J Optom 2024; 17:100501. [PMID: 37944476 PMCID: PMC10652114 DOI: 10.1016/j.optom.2023.100501] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/14/2023] [Revised: 09/22/2023] [Accepted: 10/11/2023] [Indexed: 11/12/2023]
Abstract
PURPOSE To evaluate the prevalence of diagnosed dry eye syndrome, meibomian gland dysfunction, and blepharitis amongst the low vision population. METHODS A retrospective analysis was conducted on patients seen in the University of Colorado Low Vision Rehabilitation Service between the dates of 12/1/2017 and 12/1/2022. 74 ICD-10 codes were used to identify patients as having dry eye syndrome or not having dry eye syndrome. Data was further analyzed to determine the prevalence of blepharitis and meibomian gland dysfunction using 29 blepharitis and 9 meibomian gland dysfunction ICD-10 codes. Data were also analyzed to determine the age and sex of the patients with diagnosed dry eye syndrome. RESULTS The percentage of patients with a diagnosis of dry eye syndrome by an eyecare provider was 38.02 %. The prevalence of dry eye syndrome by age group was 3.57 % for 0-19 years, 14.35 % for 20-39 years, 29.07 % for 40-59 years, 43.79 % for 60-79 years, and 46.21 % for 80 and above. The prevalence of meibomian gland dysfunction and blepharitis was 11.90 % and 9.1 % respectively. Dry eye syndrome prevalence amongst males was 31.59 % and 42.47 % for females. CONCLUSION This study demonstrates that dry eye syndrome in the low vision population is a significant co-morbidity occurring in over a third of patients in the University of Colorado Low Vision Rehabilitation Service. These findings are meaningful as ocular comfort should not be overlooked while managing complex visual needs.
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Affiliation(s)
- Kaleb Abbott
- University of Colorado School of Medicine Anschutz Medical Campus Department of Ophthalmology 1675 Aurora Court Aurora, CO 80045, USA.
| | - Kara S Hanson
- University of Colorado School of Medicine Anschutz Medical Campus Department of Ophthalmology 1675 Aurora Court Aurora, CO 80045, USA
| | - James Lally
- University of Colorado School of Medicine Anschutz Medical Campus Department of Ophthalmology 1675 Aurora Court Aurora, CO 80045, USA
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2
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Zhang Y, Zhao H. HIV-Associated Meibomian Gland Adenoma With Atypical Hyperplasia. Am J Ophthalmol 2024; 260:e1-e2. [PMID: 38266800 DOI: 10.1016/j.ajo.2024.01.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2023] [Revised: 01/07/2024] [Accepted: 01/15/2024] [Indexed: 01/26/2024]
Affiliation(s)
- Yuheng Zhang
- Beijing Tongren Eye Center, Beijing Tongren Hospital, Capital Medical University, Beijing Ophthalmology & Visual Sciences Key Laboratory, Beijing, China
| | - Hongshu Zhao
- Beijing Tongren Eye Center, Beijing Tongren Hospital, Capital Medical University, Beijing Ophthalmology & Visual Sciences Key Laboratory, Beijing, China.
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3
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Nassief M, Lotfy NM. Topical cyclosporin A 0.05% eye drops for management of symptomatic acquired punctal stenosis: a prospective, controlled clinical study. Orbit 2024; 43:190-195. [PMID: 37463348 DOI: 10.1080/01676830.2023.2232028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2023] [Accepted: 06/25/2023] [Indexed: 07/20/2023]
Abstract
PURPOSE To study the efficacy of cyclosporin 0.05% eye drops in the management of grade 1 and 2 acquired punctal stenosis and to compare the results with the clinical outcomes of mini-Monoka insertion. METHODS A prospective, controlled, interventional clinical study includes all patients (16 years and older) with symptomatic epiphora and diagnosed with grade 1 or grade 2 acquired punctal stenosis. All patients undergo punctal dilatation, canalicular probing, and nasolacrimal duct irrigation. Afterwards, patients are divided into two groups: Group A: patients receive only medical treatment in the form of topical 0.05% cyclosporin (Restasis®, Allergan Inc.) twice daily for 6 months. Group B: patients receive mini-Monoka stent insertion in the lower canaliculus for 6 weeks. Outcome measures are changes in Munk scoring, grading of the punctum, and functional and anatomical success. Functional success is defined as Munk score 0 to 1 and FDDT grade 0-2. Anatomical success is defined as grade 3 punctum. RESULTS Forty-two patients are included in the study, with 21 patients in each group. There were no significant differences in the Munk score between the two groups before treatment; however, group B had a significantly higher mean rank at 6 months after treatment. After treatment, the punctal size was significantly larger in group B at 4 weeks and 3 months. However, no significant difference in punctal size was detected at 6 months after treatment between the two groups. CONCLUSION Application of cyclosporin 0.05% eye drops is a simple and efficient non-interventional method in the management of grade 1 and 2 acquired punctal stenosis.
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Affiliation(s)
- Mona Nassief
- Department of Ophthalmology, Faculty of Medicine, Tanta University, Tanta, Egypt
| | - Nancy M Lotfy
- Department of Ophthalmology, Faculty of Medicine, Cairo University, Cairo, Egypt
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4
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Ben-Avi R, Kruger JM. Unilateral Benign Gaze-Evoked and Convergence-Evoked Eyelid Nystagmus. J Neuroophthalmol 2024; 44:e145-e146. [PMID: 34924520 DOI: 10.1097/wno.0000000000001396] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Affiliation(s)
- Ravid Ben-Avi
- Department of Ophthalmology, Hadassah Medical Center, Kiryat Hadassah, Jerusalem, Israel
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Ozcan AA, Ulas B, Aksoy M. An effective approach for the treatment of severe punctal stenosis: Bicanalicular silicone tube intubation with pigtail probe. J Fr Ophtalmol 2024; 47:104073. [PMID: 38320466 DOI: 10.1016/j.jfo.2024.104073] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2023] [Revised: 09/07/2023] [Accepted: 09/09/2023] [Indexed: 02/08/2024]
Abstract
PURPOSE To evaluate the results of using a pigtail probe to open the inferior punctum followed by bicanalicular silicone tube intubation in patients with severe acquired punctal stenosis. METHODS Forty-one eyes of 25 patients with severe inferior punctal stenosis admitted to our tertiary care center were included in the study. The degree of epiphora was determined using the Munk score and the fluorescein disappearance test. The inferior punctum was located and opened by entering the superior punctum with a pigtail probe. Then, bicanalicular silicone tube intubation was performed. The silicone tube was removed after six months. A Munk score of 0 or 1 and a fluorescein disappearance test score of 1 and 2 were considered a complete success. RESULTS Ten (40%) patients were male, and 15 (60%) were female. The mean age was 60.4±15.5years. One year after the surgery, epiphora was absent in 18 eyes (43.9%) (Munk score grade 0) and rarely seen in 9 eyes (22%) (Munk score grade 1). At the one-year follow-up, the fluorescein disappearance test score was stage 1 (<3min) in 21 eyes (51.2%) and stage 2 (3-5min) in 13 eyes (31.7%). There was a statistically significant difference between the preoperative and one-year postoperative test results (P<0.001). CONCLUSION In cases with severe punctal stenosis, a pigtail probe is an effective method for locating and opening the punctum, and punctal opening and prevention of restenosis were achieved by a bicanalicular stent.
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Affiliation(s)
- A A Ozcan
- Cukurova University Faculty of Medicine, Ophthalmology Department, 01330 Saricam/Adana, Turkey
| | - B Ulas
- Cukurova University Faculty of Medicine, Ophthalmology Department, 01330 Saricam/Adana, Turkey.
| | - M Aksoy
- Cukurova University Faculty of Medicine, Ophthalmology Department, 01330 Saricam/Adana, Turkey
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6
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Giacaman A, Corral-Magaña O, Saus Sarrias C, González-López G, Asensio Landa VJ, Martín-Santiago A. Multiple rhabdomyomatous mesenchymal hamartomas in a patient with mosaic Barber-Say syndrome. Pediatr Dermatol 2024; 41:307-310. [PMID: 37817291 DOI: 10.1111/pde.15436] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/24/2023] [Accepted: 09/09/2023] [Indexed: 10/12/2023]
Abstract
Barber-Say syndrome (BSS) is a rare congenital ectodermal dysplasia with few cases reported in the literature. We describe a 9-year-old boy with congenital generalized hypertrichosis and multiple rhabdomyomatous mesenchymal hamartomas (RMHs) on his nose and periocular region. Next-generation sequencing, performed in DNA from a blood sample, and RMH tissue, revealed a pathogenic variant in the TWIST2 gene, which was not detected in a salivary sample of the patient, nor in his parents. Therefore, we consider this variant as de novo mosaicism. To our knowledge, this is the first case of multiple RMHs associated with BSS.
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Affiliation(s)
- Aniza Giacaman
- Dermatology Department, Hospital Universitari Son Espases, Spain
| | | | | | | | - Víctor José Asensio Landa
- Molecular Diagnostics and Clinical Genetics Unit, Hospital Universitari Son Espases, Spain
- Institut d'Investigació Sanitária de les Illes Balears (IdISBa), Spain
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7
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Lin CW, Wang JJ, Lai CH, Wu PL. Sutureless amniotic membrane (ProKera®) in the management of symblepharon after Steven-Johnson syndrome: A case report. J Fr Ophtalmol 2024; 47:104005. [PMID: 38016870 DOI: 10.1016/j.jfo.2023.09.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2023] [Revised: 08/16/2023] [Accepted: 09/18/2023] [Indexed: 11/30/2023]
Affiliation(s)
- C-W Lin
- Department of Medical Education, Chang Gung Memorial Hospital, 61363 Chiayi, Taiwan; Department of Ophthalmology, Chang Gung Memorial Hospital, 61363 Chiayi, Taiwan
| | - J-J Wang
- Department of Ophthalmology, Chang Gung Memorial Hospital, 61363 Chiayi, Taiwan
| | - C-H Lai
- Department of Ophthalmology, Chang Gung Memorial Hospital, 61363 Chiayi, Taiwan; Department of Medicine, Chang Gung University, 33302 Taoyuan, Taiwan; Department of Nursing, Chang Gung University of Science and Technology, 61363 Chiayi, Taiwan; School of Traditional Chinese Medicine, College of Medicine, Chang Gung University, 33302 Taoyuan, Taiwan
| | - P-L Wu
- Department of Ophthalmology, Chang Gung Memorial Hospital, 61363 Chiayi, Taiwan; Department of Medicine, Chang Gung University, 33302 Taoyuan, Taiwan.
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Chen X, Liu Y, Zheng T, Zhang Q, Ren Y, Shen Y, Ke M. Eyes on the Lid: The Impact of Fibroblast Growth Factor Receptor Targeting Drug on Human Meibomian Gland. Eye Contact Lens 2024; 50:102-105. [PMID: 37988104 DOI: 10.1097/icl.0000000000001058] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/26/2023] [Indexed: 11/22/2023]
Abstract
OBJECTIVE To determine whether fibroblast growth factor receptor (FGFR)-targeting drug could impact human meibomian gland. METHODS We followed up with three patients who were using pemigatinib for 4 to 10 weeks. The patients were evaluated for their ocular surface disease index, best-corrected visual acuity, Schirmer test, cornea staining, meibum expressibility score, tear meniscus height, noninvasive tear film breakup time, and meibomian gland area. The distribution of the FGFR family, FGF7, and FGF10 were evaluated by immunofluorescence staining and Western blot in fresh tarsal tissues from deidentified patients who underwent lid plastic surgeries. RESULTS All patients developed apparent meibomian gland atrophy, shortening and narrowing of ducts, and significantly increased meibum expressibility and decreased noninvasive tear film breakup time within 5 to 8 weeks. Laboratory evaluations confirmed that human meibomian gland expresses abundant fibroblast growth factor receptors. CONCLUSIONS These findings indicate that meibomian gland is a target tissue of FGFR inhibitors, and patients who use these drugs may develop meibomian gland dysfunction.
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Affiliation(s)
- Xiaomin Chen
- Ophthalmology Department, Zhongnan Hospital of Wuhan University, Wuhan, China
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Dougher MC, Hurley PE, Kalb RE, Helm TN. Chronic Lymphedema of the Eyelid and Face: Challenge. Am J Dermatopathol 2024; 46:e5-e6. [PMID: 38086093 DOI: 10.1097/dad.0000000000002564] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2023]
Affiliation(s)
- Meaghan C Dougher
- Department of Pathology and Laboratory Medicine, Hospital of the University of Pennsylvania, Philadelphia, PA
| | | | - Robert E Kalb
- Department of Dermatology, SUNY at Buffalo Jacobs School of Medicine and Biomedical Sciences, Buffalo, NY; and
| | - Thomas N Helm
- Department of Dermatology, Penn State College of Medicine, Hershey, PA
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10
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Dougher MC, Hurley PE, Kalb RE, Helm TN. Chronic Lymphedema of the Eyelid and Face: Answer. Am J Dermatopathol 2024; 46:64-65. [PMID: 38086089 DOI: 10.1097/dad.0000000000002565] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2023]
Affiliation(s)
- Meaghan C Dougher
- Department of Pathology and Laboratory Medicine, Hospital of the University of Pennsylvania, Philadelphia, PA
| | | | - Robert E Kalb
- Department of Dermatology, SUNY at Buffalo Jacobs School of Medicine and Biomedical Sciences, Buffalo, NY; and
| | - Thomas N Helm
- Department of Dermatology, Penn State College of Medicine, Hershey, PA
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11
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Onder H, Comoglu S. Alternating unilateral blepharospasm with apraxia of eyelid opening in a patient with progressive supranuclear palsy. Neurol Sci 2024; 45:331-333. [PMID: 37736851 DOI: 10.1007/s10072-023-07021-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2023] [Accepted: 08/13/2023] [Indexed: 09/23/2023]
Affiliation(s)
- Halil Onder
- Neurology Clinic, Etlik City Hospital, Varlık, Halil Sezai Erkut Street No: 5, 06170, Yenimahalle, Ankara, Turkey.
| | - Selcuk Comoglu
- Neurology Clinic, Etlik City Hospital, Varlık, Halil Sezai Erkut Street No: 5, 06170, Yenimahalle, Ankara, Turkey
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12
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Luo S, Djotyan GP, Joshi R, Juhasz T, Brown DJ, Jester JV. Modeling meibum secretion: Alternatives for obstructive Meibomian Gland Dysfunction (MGD). Ocul Surf 2024; 31:56-62. [PMID: 38042297 DOI: 10.1016/j.jtos.2023.11.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2023] [Revised: 11/07/2023] [Accepted: 11/19/2023] [Indexed: 12/04/2023]
Abstract
PURPOSE While changes in meibum quality are correlated with severity of meibomian gland dysfunction (MGD) and dry eye disease, little is known regarding the mechanics of meibum secretion. The purpose of this study was to develop a finite element model of meibum secretion and evaluate the effect of various factors that might impact meibum delivery to the ocular surface. METHODS A finite element analysis in COMSOL 6.0 was used to simulate the flow of meibum within the gland's terminal excretory duct. Historical normal human meibum rheology data taken over the meibum melting range from fluid (35-40 °C) to solid (25-30 °C) were then used to calculate the minimum yield stress and plastic viscosity of meibum. The effects of meibum melting state, eyelid pressure and terminal duct diameter on meibum flow rates were then systematically investigated. RESULTS The melting state of meibum from liquid to solid was associated with an increase in the minimum yield stress and plastic viscosity that caused an exponential decrease in meibum flow. Modeling also established that there was a linear correlation between meibum flow rate and eyelid pressure needed to express meibum and the 4th power of the terminal duct radius. CONCLUSIONS Our results suggest that changes in the melting state of meibum from fluid to solid, as well as changes in the radius of the terminal excretory duct and the force exerted by the eyelid can lead to dramatic decreases in the flow of meibum. Together these findings suggest alternative mechanisms for meibomian gland obstruction.
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Affiliation(s)
- Shangbang Luo
- Department of Ophthalmology, University of California, Irvine, CA, USA; Department of Biomedical Engineering, University of California, Irvine, CA, USA
| | - Gagik P Djotyan
- Institute for Particle & Nuclear Physics, Wigner Research Center, Budapest, Hungary
| | - Rohan Joshi
- Department of Ophthalmology, University of California, Irvine, CA, USA; Department of Biomedical Engineering, University of California, Irvine, CA, USA
| | - Tibor Juhasz
- Department of Ophthalmology, University of California, Irvine, CA, USA; Department of Biomedical Engineering, University of California, Irvine, CA, USA
| | - Donald J Brown
- Department of Ophthalmology, University of California, Irvine, CA, USA
| | - James V Jester
- Department of Ophthalmology, University of California, Irvine, CA, USA; Department of Biomedical Engineering, University of California, Irvine, CA, USA.
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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] [What about the content of this article? (0)] [Affiliation(s)] [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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Rasaruck U, Kasetsuwan N, Kittipibul T, Pongchaikul P, Chatsuwan T. Composition and diversity of meibum microbiota in meibomian gland dysfunction and the correlation with tear cytokine levels. PLoS One 2023; 18:e0296296. [PMID: 38134040 PMCID: PMC10745150 DOI: 10.1371/journal.pone.0296296] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2023] [Accepted: 12/10/2023] [Indexed: 12/24/2023] Open
Abstract
Meibomian gland dysfunction (MGD) leads to meibum stasis and pathogenic bacteria proliferation. We determined meibum microbiota via next-generation sequencing (NGS) and examined their association with tear cytokine levels in patients with MGD. This cross-sectional study included 44 moderate-severe patients with MGD and 44 healthy controls (HCs). All volunteers underwent assessment with the ocular surface disease index questionnaire, Schirmer without anesthesia, tear break-up time, Oxford grading of ocular surface staining, and lid and meibum features. Sample collection included tears for cytokine detection and meibum for 16S rRNA NGS. No significant differences were observed in the α-diversity of patients with MGD compared with that in HCs. However, Simpson's index showed significantly decreased α-diversity for severe MGD than for moderate MGD (p = 0.045). Principal coordinate analysis showed no significant differences in β-diversity in meibum samples from patients with MGD and HCs. Patients with MGD had significantly higher relative abundances of Bacteroides (8.54% vs. 6.00%, p = 0.015) and Novosphingobium (0.14% vs. 0.004%, p = 0.012) than the HCs. Significantly higher interleukin (IL)-17A was detected in the MGD group than in the HC group, particularly for severe MGD (p = 0.008). Although Bacteroides was more abundant in the MGD group than in the HC group, it was not positively correlated with IL-17A. The relationship between core meibum microbiota and tear cytokine levels remains unclear. However, increased Bacteroides and Novosphingobium abundance may be critical in MGD pathophysiology.
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Affiliation(s)
- Ubonwan Rasaruck
- Department of Ophthalmology, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
| | - Ngamjit Kasetsuwan
- Department of Ophthalmology, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
- Excellence Center of Cornea and Limbal Stem Cell Transplantation, Department of Ophthalmology, King Chulalongkorn Memorial Hospital and Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
| | - Thanachaporn Kittipibul
- Department of Ophthalmology, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
- Excellence Center of Cornea and Limbal Stem Cell Transplantation, Department of Ophthalmology, King Chulalongkorn Memorial Hospital and Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
| | - Pisut Pongchaikul
- Chakri Naruebodindra Medical Institute, Faculty of Medicine Ramathibodi Hospital Mahidol University, Samut Prakarn, Thailand
- Integrative Computational Bioscience (ICBS) Center, Mahidol University, Nakorn Pathom, Thailand
- Institute of Infection, Veterinary and Ecological Sciences, University of Liverpool, Liverpool, United Kingdom
| | - Tanittha Chatsuwan
- Department of Microbiology, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
- Center of Excellence in Antimicrobial Resistance and Stewardship, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
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Xue Y, Zhang Y, Dai X, Yao B. Phthiriasis palpebrarum with scalp and pubic hair infestation. Arq Bras Oftalmol 2023; 87:0213. [PMID: 38088669 DOI: 10.5935/0004-2749.2023-0213] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2023] [Accepted: 08/11/2023] [Indexed: 12/18/2023] Open
Affiliation(s)
- Yuanfeng Xue
- Department of General Practice, Nanjing Lishui District Baima Health Hospital, Nanjing, Jiangsu Province, China
- Department of Neurosurgery, Nanjing Lishui People's Hospital, Zhongda Hospital Lishui branch, Southeast University, Nanjing, Jiangsu Province, China
| | - Yuanyuan Zhang
- Department of Rehabilitation, Nanjing Lishui People's Hospital, Zhongda Hospital Lishui branch, Southeast University, Nanjing, Jiangsu Province, China
| | - Xiaoting Dai
- Department of Infectious Diseases, Nanjing Lishui People's Hospital, Zhongda Hospital Lishui branch, Southeast University, Nanjing, Jiangsu Province, China
| | - Bangtao Yao
- Department of Ophthalmology, Nanjing Lishui People's Hospital, Zhongda Hospital Lishui branch, Southeast University, Nanjing, Jiangsu Province, China
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Park HS, Choi JW. Association between xanthelasma palpebrarum and the risk of ischemic heart diseases: A nationwide register-based cohort study. J Dermatol 2023; 50:e406-e408. [PMID: 37534619 DOI: 10.1111/1346-8138.16913] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2023] [Accepted: 07/18/2023] [Indexed: 08/04/2023]
Affiliation(s)
- Hyoung Soo Park
- Department of Dermatology, Ajou University School of Medicine, Suwon, South Korea
| | - Jee Woong Choi
- Department of Dermatology, Ajou University School of Medicine, Suwon, South Korea
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Arazi M, Leshno A, Sussman N, Smadar L, Huna-Baron R, Sagiv O. Study in Patients With Unilateral Horner Syndrome Supports the Role of Müller's Muscle in the Eyelid-Dark Reflex. Invest Ophthalmol Vis Sci 2023; 64:35. [PMID: 38010698 PMCID: PMC10683770 DOI: 10.1167/iovs.64.14.35] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2023] [Accepted: 11/06/2023] [Indexed: 11/29/2023] Open
Abstract
Purpose A previous study demonstrated upper eyelid retraction synchronized with pupil dilation following a transition from photopic to scotopic conditions. The current study aimed to evaluate the role of Müller's muscle as the efferent arm of this suggested reflex arc. Methods A video scan of both eyes of patients with unilateral Horner syndrome was performed using optical coherence tomography infra-red mode to document the transition between photopic and scotopic conditions. The affected side with sympathetic denervation was the study group, whereas the contralateral unaffected side of the same patients served as the control group. The pupil diameter, upper eyelid margin-to-reflex distance 1, lower eyelid margin-to-reflex distance 2, and vertical palpebral fissure height were measured. The control group was compared to the healthy subjects of a previous study to verify any compensatory changes to the side contralateral to denervation. Results Ten patients with unilateral Horner Syndrome were included in the study. Transitioning from photopic to scotopic conditions, the mean change in margin-to-reflex distance 1 in the study and control groups was 315 ± 276 µm (P < 0.05) and 723 ± 432 µm (P = 0.005), respectively. Margin-to-reflex distance 1 and palpebral fissure height were significantly higher in the control group both in photopic (P = 0.005 and P = 0.017, respectively) and scotopic conditions (P = 0.005 and P = 0.007, respectively). The change in margin-to-reflex distance 1 and palpebral fissure height following the transition from light to dark was significantly greater in the control group (P = 0.022). Conclusions Reflexive eyelid retraction following a transition from photopic to scotopic conditions was significantly diminished in eyelids with sympathetic denervation compared with the unaffected contralateral side of the same patients. This study provides further evidence that the sympathetically innervated Müller's muscle serves as the efferent arm of this reflex.
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Affiliation(s)
- Mattan Arazi
- The Goldschleger Eye Institute, Sheba Medical Center and the Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Ari Leshno
- The Goldschleger Eye Institute, Sheba Medical Center and the Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Noa Sussman
- The Goldschleger Eye Institute, Sheba Medical Center and the Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Lital Smadar
- The Goldschleger Eye Institute, Sheba Medical Center and the Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Ruth Huna-Baron
- The Goldschleger Eye Institute, Sheba Medical Center and the Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Oded Sagiv
- The Goldschleger Eye Institute, Sheba Medical Center and the Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
- Section of Ophthalmology, Department of Head and Neck Surgery, The University of Texas M.D. Anderson Cancer Center, Houston, Texas, United States
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18
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Ansari F, Agrawal A, Bains A, Elhence P. Unilateral erythematous nodule over eyelid. Indian J Dermatol Venereol Leprol 2023; 89:928. [PMID: 37317719 DOI: 10.25259/ijdvl_1142_2022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2022] [Accepted: 03/11/2023] [Indexed: 06/16/2023]
Affiliation(s)
- Farzana Ansari
- Department of Dermatology, Seth Jagannath Pahadiya Medical College, Bharatpur, Rajasthan, India
| | - Akriti Agrawal
- Department of Dermatology, AIIMS Jodhpur, Rajasthan, India
| | - Anupama Bains
- Department of Dermatology, AIIMS Jodhpur, Rajasthan, India
| | - Poonam Elhence
- Department of Pathology and Lab Medicine, AIIMS Jodhpur, Rajasthan, India
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Hartong DT, van der Meeren SW, Coumou AD, Kloos RJHM, Saeed P. [Watery eyes: diagnostic and therapeutic considerations]. Ned Tijdschr Geneeskd 2023; 167:D7431. [PMID: 37930160] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 11/07/2023]
Abstract
Tear complaints can arise from either an increased tear production or from a disturbed tear drainage. Increased tear production from the lacrimal gland is a neuroregulated response to a dried out or irritated ocular surface. Dryness often results from a reduced quality of the tear film, but can also be caused by eyelid malposition with increased globe exposure. Impaired tear drainage usually occurs when the lacrimal drainage system is blocked at the level of the ductus nasolacrimalis, the canaliculi or the lacrimal punctae. Anatomical knowledge of the lacrimal system is necessary to distinguish between the different causes. Using cases and illustrations, we provide insight into the diagnostic considerations for a patient with a watery eye.
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Affiliation(s)
| | | | | | | | - Peerooz Saeed
- Amsterdam UMC, afd. Oogheelkunde, Amsterdam
- Contact: Peerooz Saeed
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20
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Kalayci M, Cetinkaya E, Yaprak L, Yigit K, Suren E, Dogan B, Erol MK. Ocular surface assessment and morphological alterations in meibomian glands with non-contact meibography in electronic cigarette smokers. Arq Bras Oftalmol 2023; 86:e20230069. [PMID: 35544939 DOI: 10.5935/0004-2749.20230069] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2021] [Accepted: 12/13/2021] [Indexed: 10/27/2023] Open
Abstract
PURPOSE The study aimed to evaluate the ocular surface and meibomian gland morphology in electronic cigarette (e-cigarette) smokers. METHODS The upper and lower eyelids of 25 male e-cigarette smokers and 25 healthy male non-smoker patients were evaluated using Sirius meibography. Meibomian glands loss was automatically calculated using Phoenix meibography imaging software module, with the result obtained as percentage loss. Ocular Surface Disease Index (OSDI) questionnaire, tear breakup time test, and Schirmer II test were administered and performed in all cases. RESULTS The mean e-cigarette smoking duration was 4.9 ± 0.9 (range, 3.4-7) years. While the mean Schirmer II test value was 9.16 ± 2.09 mm in e-cigarette group, it was 11.20 ± 2.14 mm in control group (p=0.003). Mean tear breakup time was 6.96 ± 2.31 seconds in e-cigarette group and 9.84 ± 2.13 seconds in control group (p=0.002). The mean OSDI value was 28.60 ± 6.54 and 15.16 ± 7.23 in e-cigarette and control groups, respectively (p<0.001). In Sirius meibography, the average loss for the upper eyelid was 23.08% ± 6.55% in e-cigarette group and 17.60% ± 4.94% in control group (p=0.002), and the average loss for the lower eyelid was 27.84% ± 5.98% and 18.44% ± 5.91%, respectively (p<0.001). Additionally, a significant positive correlation was identified between the loss rates for both upper and lower eyelid meibography with e-cigarette smoking duration (r=0.348, p<0.013 and r=0.550, p<0.001, respectively). CONCLUSION Long-term e-cigarette smoking causes damage to the meibomian glands; therefore, meibomian gland damage should be considered in ocular surface disorders due to e-ci-garette smoking.
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Affiliation(s)
- Mustafa Kalayci
- Department of Ophthalmology, Antalya Training and Research Hospital, University of Health Sciences, Antalya, Turkey
| | - Ersan Cetinkaya
- Department of Ophthalmology, Antalya Training and Research Hospital, University of Health Sciences, Antalya, Turkey
| | - Lütfiye Yaprak
- Department of Ophthalmology, Antalya Training and Research Hospital, University of Health Sciences, Antalya, Turkey
| | - Kenan Yigit
- Department of Ophthalmology, Antalya Training and Research Hospital, University of Health Sciences, Antalya, Turkey
| | - Elcin Suren
- Department of Ophthalmology, Antalya Training and Research Hospital, University of Health Sciences, Antalya, Turkey
| | - Berna Dogan
- Department of Ophthalmology, Antalya Training and Research Hospital, University of Health Sciences, Antalya, Turkey
| | - Muhammet Kazim Erol
- Department of Ophthalmology, Antalya Training and Research Hospital, University of Health Sciences, Antalya, Turkey
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21
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Ozkan J, Majzoub ME, Coroneo M, Thomas T, Willcox M. Ocular microbiome changes in dry eye disease and meibomian gland dysfunction. Exp Eye Res 2023; 235:109615. [PMID: 37586456 DOI: 10.1016/j.exer.2023.109615] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2023] [Revised: 07/17/2023] [Accepted: 08/11/2023] [Indexed: 08/18/2023]
Abstract
The most common and chronic ocular problem of aging is dry eye disease (DED) and the associated condition of meibomian gland dysfunction (MGD). The resident ocular surface bacteria may have a role in maintaining homeostasis and perturbation may contribute to disease development. The aim of this study was to compare the microbiomes of the conjunctiva and eyelid margin in humans with mild and moderate DED and controls using 16 S rRNA gene sequencing. The conjunctiva and lid margin of three cohorts (N = 60; MGD, MGD with lacrimal dysfunction [MGD + LD] and controls) were swabbed bilaterally three times over three months. Microbial communities were analysed by extracting DNA and sequencing the V3-V4 region of the 16 S ribosomal RNA gene using the Illumina MiSeq platform. Sequences were quality filtered, clustered into amplicon sequence variants (ASVs) using UNOISE algorithm and taxonomically classified using a Bayesian Last Common Ancestor (BCLA) algorithm against the GTDB 2207 database. The overall microbial communities of the MGD, MGD + LD and control groups were significantly different from each other (P = 0.001). The MGD and MGD + LD dry eye groups showed greater variability between individuals compared to the control (PERMDISP, P < 0.01). There was decreased richness and diversity in females compared to males for the conjunctiva (P < 0.04) and eyelid margin (P < 0.018). The conjunctiva in the MGD + LD group had more abundant Pseudomonas azotoformans, P. oleovorans and Caballeronia zhejiangensis compared to MGD and control (P < 0.05), while the MGD group had more abundant Corynebacterium macginleyi and C. kroppenstedtii compared to control (P < 0.05). The lid margin in MGD was more abundant in C. macginleyi, C. accolens, and C. simulans compared to the MGD + LD and control (P < 0.05). There were differences in the overall microbial community composition and certain taxa, including increased levels of lipophilic bacteria, on the conjunctiva and eyelid margin in mild to moderate DED/MGD compared to controls. DED/MGD was also associated with a reduced bacterial richness and diversity in females.
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Affiliation(s)
- Jerome Ozkan
- School of Optometry and Vision Science, University of New South Wales, Sydney, Australia; Centre for Marine Science and Innovation and School of Biological, Earth and Environmental Sciences, University of New South Wales, Sydney, Australia.
| | - Marwan E Majzoub
- Host-Microbiome Interactions Group, School of Biomedical Sciences, Faculty of Medicine and Health, University of New South Wales, Sydney, Australia
| | - Minas Coroneo
- Department of Ophthalmology, Faculty of Medicine, University of New South Wales, Sydney, Australia
| | - Torsten Thomas
- Centre for Marine Science and Innovation and School of Biological, Earth and Environmental Sciences, University of New South Wales, Sydney, Australia
| | - Mark Willcox
- School of Optometry and Vision Science, University of New South Wales, Sydney, Australia
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22
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Dohlman JC, Elliott AT. Severe Eyelid Malformation With Facial Clefting and Amniotic Bands. Ophthalmic Plast Reconstr Surg 2023; 39:e117-e119. [PMID: 36893073 DOI: 10.1097/iop.0000000000002374] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/10/2023]
Abstract
Amniotic bands can lead to eyelid colobomas contiguous with facial clefts, resulting in severe and highly variable eyelid malformations. There is no known underlying genetic cause of amniotic band sequence. Here, the authors review the case of an infant born with large, 4-eyelid colobomatous defects in the setting of facial clefts, amniotic bands and an underlying SMOC1 mutation, which has not previously been linked to amniotic band sequence or eyelid colobomas. Reconstructive technique and the postoperative course are described, and underlying etiologic theories of amniotic band sequence are reviewed and expanded upon. Although amblyopia prevention in this patient with poor visual potential was not a consideration, the goals of improving the patient's ocular surface and maintaining eye contact were achieved.
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Affiliation(s)
- Jenny C Dohlman
- Department of Ophthalmology, Krieger Eye Institute/Sinai Hospital of Baltimore, Baltimore, Maryland
- Department of Ophthalmology, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts, U.S.A
| | - Alexandra T Elliott
- Department of Ophthalmology, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts, U.S.A
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23
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Echalier EL, Larochelle RD, Patnaik JL, Echalier BR, Wagner A, Hink EM, Subramanian PS, Liao SD. Orbital Compartment Syndrome in Severe Burns: Predictive Factors, Timing, and Complications of Intervention. Ophthalmic Plast Reconstr Surg 2023; 39:341-346. [PMID: 36700833 DOI: 10.1097/iop.0000000000002313] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
PURPOSE Severe burn patients require high-volume fluid resuscitation, which increases risk for orbital compartment syndrome (OCS). We aimed to understand surgeons' practice patterns and to examine risk factors for OCS, timing of lateral canthotomy and cantholysis (LCC), and complications of intervention. METHODS A survey of American Society of Ophthalmic Plastic and Reconstructive Surgery and North American Society of Academic Orbital Surgeons' practice patterns in burn patients was undertaken. In addition, a retrospective analysis was conducted of 107 patients with burns greater than 20% total body surface area at 1 institution from January 1, 2009, to June 1, 2018. Patients with Stevens-Johnson Syndrome or Toxic Epidermal Necrolysis, frostbite, or no ophthalmologic consultation were excluded. Risk factors for OCS, timing of LCC, and complications of the intervention were examined. RESULTS In the survey, 37 of 54 respondents had treated burn patients, of which 29 followed no protocol. Threshold intraocular pressure for intervention varied widely, and nearly all reported having seen complications from LCC in burn patients. For the retrospective analysis, 107 patients met criteria, of which 22 (20.6%) required LCC. Renal failure, inhalation injury, eyelid burns, higher total body surface area, elevated lactate, increased number of escharotomies, and greater total fluid required were significantly associated with the clinical decision that the patient was at risk for OCS requiring LCC. Fluid resuscitation in excess of the Ivy Index (250 ml/kg) increased odds of LCC 8.6 times. Average time of LCC was 15.8 hours after burn. LCC patients experienced higher rates of complications including eyelid retraction, exposure keratopathy, and corneal ulceration. CONCLUSIONS Severe burn patients should be monitored closely by an ophthalmologist during the first 48 hours for signs of OCS. Further studies should aim to recommend protocols guiding evaluation and intervention.
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Affiliation(s)
- E Lacey Echalier
- Department of Ophthalmology, University of Colorado, Aurora, Colorado, U.S.A
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24
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Thomas LM, Yadalla D, Jayagayathri R. Comment on: Lagophthalmos: An etiological lookout to frame the decision for management. Indian J Ophthalmol 2023; 71:2606-2607. [PMID: 37322696 PMCID: PMC10417957 DOI: 10.4103/ijo.ijo_84_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/17/2023] Open
Affiliation(s)
- Linya M Thomas
- Department of Orbit and Oculoplasty, Aravind Eye Hospital and Post Graduate Institute of Ophthalmology, Pondicherry, India
| | - Dayakar Yadalla
- Department of Orbit and Oculoplasty, Aravind Eye Hospital and Post Graduate Institute of Ophthalmology, Pondicherry, India
| | - Rajagopalan Jayagayathri
- Department of Orbit and Oculoplasty, Aravind Eye Hospital and Post Graduate Institute of Ophthalmology, Pondicherry, India
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25
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Uner OE, Hubbard DC, Torres-Quinones C, Pegany R, Huang L, Ponsetto MK, Fletcher M, Sikka MK, Nanji A, Redd TK, Stutzman RD, Chamberlain W, Kim DH. Human MPox (Monkeypox) Virus Membranous Keratoconjunctivitis With Transient Corneal Hypoesthesia and Late Symblepharon Formation: A Novel Case and Clinical Implications. Cornea 2023; 42:751-754. [PMID: 36728311 PMCID: PMC10164038 DOI: 10.1097/ico.0000000000003231] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2022] [Accepted: 11/30/2022] [Indexed: 02/03/2023]
Abstract
PURPOSE The aim of this study was to describe a case of corneal involvement as an early manifestation of ocular disease in the 2022 human mpox (monkeypox) virus outbreak. METHODS This is a single case report with longitudinal care. RESULTS A 47-year-old immunocompetent man presented with viral conjunctivitis before development of skin lesions or systemic symptoms. Subsequently, he developed membranous keratoconjunctivitis and a corneal epithelial defect. Orthopoxvirus-positive polymerase chain reaction test from his ocular surface was positive. The epithelial defect did not heal with conservative treatment but was successfully treated with amniotic membrane transplantation over 8 days. Reduced corneal sensation was noted after epithelial healing, and polymerase chain reaction from the ocular surface remained positive at 17 days from symptom onset, with slowly recovering conjunctivitis at 21 days. Continued membrane formation required repeated removal but significantly improved with topical corticosteroid treatment after epithelial healing by 29 days of symptom onset. Corneal sensation normalized by 87 days from symptom onset at which time symblepharon were noted but PCR testing from the ocular surface was negative. CONCLUSIONS Early corneal involvement of human monkeypox virus is possible. Transient corneal hypoesthesia may be due to acute inflammation. Chronic inflammatory changes can result in symblepharon. These findings have potential implications in patient care and corneal donation.
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Affiliation(s)
- Ogul E Uner
- Department of Ophthalmology, Casey Eye Institute, Oregon Health and Science University, Portland, OR
| | - Donald C Hubbard
- Department of Ophthalmology, Casey Eye Institute, Oregon Health and Science University, Portland, OR
| | - Carlos Torres-Quinones
- Department of Ophthalmology, Casey Eye Institute, Oregon Health and Science University, Portland, OR
| | - Roma Pegany
- Department of Ophthalmology, Casey Eye Institute, Oregon Health and Science University, Portland, OR
| | - Lingling Huang
- Department of Ophthalmology, Casey Eye Institute, Oregon Health and Science University, Portland, OR
| | - Momoko K Ponsetto
- Department of Ophthalmology, Casey Eye Institute, Oregon Health and Science University, Portland, OR
| | - Miles Fletcher
- School of Medicine, Oregon Health and Science University, Portland, OR; and
| | - Monica K Sikka
- Department of Medicine, Division of Infectious Diseases, Oregon Health and Science University, Portland, OR
| | - Afshan Nanji
- Department of Ophthalmology, Casey Eye Institute, Oregon Health and Science University, Portland, OR
| | - Travis K Redd
- Department of Ophthalmology, Casey Eye Institute, Oregon Health and Science University, Portland, OR
| | - Richard D Stutzman
- Department of Ophthalmology, Casey Eye Institute, Oregon Health and Science University, Portland, OR
| | - Winston Chamberlain
- Department of Ophthalmology, Casey Eye Institute, Oregon Health and Science University, Portland, OR
| | - Donna H Kim
- Department of Ophthalmology, Casey Eye Institute, Oregon Health and Science University, Portland, OR
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26
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Pascali M, Marchese G, Diaspro A. Letter in reply to Letter to the Editor: Fat injection as a valuable tool for lower eyelid retraction management: a retrospective, observational, single blind, case-control study. Aesthetic Plast Surg 2023; 47:219-220. [PMID: 36820860 DOI: 10.1007/s00266-023-03276-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2023] [Accepted: 01/24/2023] [Indexed: 02/24/2023]
Abstract
DEAR EDITOR We have read Dr Riccardo Fondrini and Colleagues commentary on our paper, and we are grateful for their remarks. We herewith would clarify the critical points mentioned about fat reabsorption and survival, along with the risk of periorbital chronic oedema as per the recorded outcomes in the presented case series. Lastly, we have unfortunately to disagree with the commentary's point related to recommended injection depth as it is mandatory to point out that in our experience the superficial injection of nano-fat is a crucial step for lower eyelid retraction management, otherwise a retraction may persist due to the untreated scar in the anterior lamella, thus missing the therapeutic goal that we aim to achieve. LEVEL OF EVIDENCE V This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .
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Affiliation(s)
- Michele Pascali
- Plastic and Reconstructive Surgeon, Plastic Surgery Academy, Rome, Italy
| | | | - Alberto Diaspro
- Rigeneralab Centre for Regenerative Medicine, Corso Unione Sovietica 159/a, 10134, Turin, Italy.
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27
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Zhang LW, Chen T, Xu RH. Phthiriasis palpebrarum. CMAJ 2023; 195:E454. [PMID: 36972915 PMCID: PMC10042457 DOI: 10.1503/cmaj.221649] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/28/2023] Open
Affiliation(s)
- Li-Wen Zhang
- Department of Dermatovenereology (Zhang, Chen) and Institute of Dermatology (Xu), Chengdu Second People's Hospital, Chengdu, Sichuan, China
| | - Tao Chen
- Department of Dermatovenereology (Zhang, Chen) and Institute of Dermatology (Xu), Chengdu Second People's Hospital, Chengdu, Sichuan, China
| | - Rong-Hua Xu
- Department of Dermatovenereology (Zhang, Chen) and Institute of Dermatology (Xu), Chengdu Second People's Hospital, Chengdu, Sichuan, China
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28
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Uddin O, Choi JH, Causey E, Levin MR, Alexander JL. Congenital ankyloblepharon in a newborn with an IRF6 mutation. J AAPOS 2023; 27:55-57. [PMID: 36638957 PMCID: PMC9975086 DOI: 10.1016/j.jaapos.2022.11.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/18/2022] [Revised: 10/27/2022] [Accepted: 11/09/2022] [Indexed: 01/12/2023]
Abstract
We present the case of a boy born at 41 weeks' gestational age who was found to have multiple anatomic anomalies, including abnormalities of the oral cavity, eyelids, and digits. He had ankyloblepharon that was localized to the lateral portion of the palpebral fissure bilaterally. Genetic testing confirmed a mutation in the interferon regulatory factor 6 (IRF6) gene, a known etiology for a spectrum of rare disorders that includes eyelid abnormalities. We present a novel surgical technique for bedside ankyloblepharon repair and describe the relevant clinical features of this case.
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Affiliation(s)
- Olivia Uddin
- Department of Ophthalmology and Visual Sciences, University of Maryland School of Medicine, Baltimore, Maryland
| | - Jamie H Choi
- Department of Ophthalmology and Visual Sciences, University of Maryland School of Medicine, Baltimore, Maryland
| | - Erin Causey
- Department of Ophthalmology and Visual Sciences, University of Maryland School of Medicine, Baltimore, Maryland
| | - Moran R Levin
- Department of Ophthalmology and Visual Sciences, University of Maryland School of Medicine, Baltimore, Maryland
| | - Janet L Alexander
- Department of Ophthalmology and Visual Sciences, University of Maryland School of Medicine, Baltimore, Maryland.
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29
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Kandasamy S, Agrawal S, Pushker N, Meel R, Bajaj MS, Thirumurthy V, Jyotsna VP. Correlation of Levator-Muller's Complex Thickness on Ultrasound Biomicroscopy to Botulinum Toxin A Injection in Thyroid-Related Upper Eyelid Retraction. J Ultrasound Med 2023; 42:399-408. [PMID: 35546328 DOI: 10.1002/jum.16004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/15/2022] [Revised: 04/21/2022] [Accepted: 05/01/2022] [Indexed: 06/15/2023]
Abstract
OBJECTIVES To study the thickness of levator palpebra superioris-Muller's muscle complex (LMC) on ultrasound biomicroscopy (UBM) and to correlate with the clinical response to botulinum toxin A (BTA) injection in patients with inactive-stage of thyroid-related upper eyelid retraction (UER). We also studied the correlation of clinical parameters, preinjection with postinjection values. METHODS This was a prospective, interventional study. Patients with thyroid-related UER who underwent subconjunctival injection of BTA were recruited. Demographic data and clinical details were evaluated. UBM (50 MHz) was done to measure the thickness of LMC. Patient's satisfaction was graded at each follow-up. Follow-up was done at 1 week, 1 month, and 3 months' time intervals. RESULTS A total of 13 patients were recruited and 26 eyes were divided into two groups; group 1 included eyes with UER (n = 17), and group 2 included eyes without UER (n = 9). There was a statistically significant reduction in margin reflex distance 1 (MRD1) after BTA injection at 1-week, 1-month, and 3-months follow-up with maximum reduction at 1 month. The mean LMC thickness of 26 eyes was 0.96 mm which was found to be significantly more than normal controls. On comparison of mean LMC thickness with the amount of UER and reduction in MRD1, we did not find a significant difference. CONCLUSIONS Patients with TED have significantly thicker LMC on UBM than controls. Further studies are needed with a larger sample size on the correlation of UBM features of levator aponeurosis with response to BTA injection.
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Affiliation(s)
- Sindhuja Kandasamy
- Oculoplastics & Oncology Services, All India Institute of Medical Sciences, New Delhi, India
| | - Sahil Agrawal
- Oculoplastics & Oncology Services, All India Institute of Medical Sciences, New Delhi, India
| | - Neelam Pushker
- Oculoplastics & Oncology Services, All India Institute of Medical Sciences, New Delhi, India
| | - Rachna Meel
- Oculoplastics & Oncology Services, All India Institute of Medical Sciences, New Delhi, India
| | - Mandeep S Bajaj
- Oculoplastics & Oncology Services, All India Institute of Medical Sciences, New Delhi, India
| | - Velpandian Thirumurthy
- Department of Ocular Pharmacology, Dr R. P. Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, India
| | - Viveka P Jyotsna
- Department of Endocrinology, All India Institute of Medical Sciences, New Delhi, India
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Yanchenko SV, Malishev AV, Teshaev SZ, Sapharov ZO, Petrosyan LM, Odilova GR, Ramazonova SS. [Acaricidal therapy in chronic demodex blepharitis and meibomian gland dysfunctions]. Vestn Oftalmol 2023; 139:36-42. [PMID: 37942595 DOI: 10.17116/oftalma202313905136] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2023]
Abstract
PURPOSE The study comparatively evaluates the effectiveness of various approaches to acaricidal treatment in patients with chronic demodex blepharitis and meibomian gland dysfunctions. MATERIAL AND METHODS The study included 40 patients with chronic blepharitis (CB) of demodicosis etiology in conditions of meibomian gland dysfunction (MGD) and dry eye (DE). The 1st group of patients (20 people) received acaricidal treatment as part of therapeutic eyelid hygiene (TEH; 2 times a day) involving the use of «Blefarogel ochishchenie», «Blefarolosion», «Blefarogel forte» (contains sulfur and metronidazole). Acaricidal treatment in the patients of the 2nd group involved applications of a product containing metronidazole (2 times a day) without TEH. Control points: 1) at inclusion in the study; 2) after a course of therapy (45 days). Evaluation included: patient acarograms, symptoms and signs of CB (points); OSDI; tear film break-up time (TBUT, sec), severity of meibomian gland dysfunction (S-MGD, points). Statistical analysis: calculation of M±SD, Mann-Whitney, and Wilcoxon tests. RESULTS Acaricidal treatment was effective in both groups (reduction in demodex population, which was more pronounced in the 1st group). Symptoms and signs of CB were significantly less pronounced in the patients of the 1st group after therapy. The patients of the 1st group showed a significant decrease in S-MGD, OSDI and an increase in TBUT, the 2nd group - a significant decrease in OSDI and an increase in TBUT at the second control point. The positive OSDI and TBUT trends were significantly more pronounced in the 1st group. CONCLUSION Acaricidal treatment as part of TEH showed a significantly more pronounced reduction in demodex population, relief of CB symptoms and sign, OSDI decrease and TBUT increase, compared to the 2nd group. Apparently, this was associated with combined acaricidal effect and significant S-MGD decrease in the patients of the 1st group.
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Affiliation(s)
- S V Yanchenko
- Kuban State Medical University, Krasnodar, Russia
- Scientific Research Institution - Ochapovsky Regional Clinical Hospital No. 1, Krasnodar, Russia
- Bukhara State Medical Institute named after Abu Ali ibn Sino, Bukhara, Republic of Uzbekistan
| | - A V Malishev
- Kuban State Medical University, Krasnodar, Russia
- Scientific Research Institution - Ochapovsky Regional Clinical Hospital No. 1, Krasnodar, Russia
| | - Sh Zh Teshaev
- Bukhara State Medical Institute named after Abu Ali ibn Sino, Bukhara, Republic of Uzbekistan
| | - Zh O Sapharov
- Bukhara branch of the Republican Specialized Scientific and Practical Center for Eye Microsurgery, Bukhara, Republic of Uzbekistan
| | - L M Petrosyan
- Scientific Research Institution - Ochapovsky Regional Clinical Hospital No. 1, Krasnodar, Russia
| | - G R Odilova
- Bukhara State Medical Institute named after Abu Ali ibn Sino, Bukhara, Republic of Uzbekistan
| | - Sh Sh Ramazonova
- Bukhara State Medical Institute named after Abu Ali ibn Sino, Bukhara, Republic of Uzbekistan
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Vongsachang H, Bleicher ID, Reshef ER, Stagner AM, Wolkow N. Wells Syndrome Presenting as Atypical Periorbital Cellulitis. Ophthalmic Plast Reconstr Surg 2022; 38:e167-e170. [PMID: 35699219 DOI: 10.1097/iop.0000000000002220] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
A 62-year-old man presented with diffuse, painless, left-sided preseptal edema, erythema, and woody induration extending to the left temple. The induration generated an orbital compartment syndrome with markedly elevated intraocular pressure necessitating lateral canthotomy and cantholysis. Although atypical for an infectious etiology, empiric broad-spectrum intravenous antibiotics were initiated with no improvement. A tissue biopsy demonstrated extensive perivascular and interstitial eosinophils with focal flame figures, and the patient was diagnosed with a severe hypersensitivity reaction or eosinophilic cellulitis (Wells syndrome). The disease process remitted rapidly upon initiation of oral prednisone. Wells syndrome is a rare inflammatory eosinophilic dermatosis, most often presenting in the limbs and trunk, with few reports of facial and periorbital involvement. This case highlights the importance of considering Wells syndrome in the differential diagnosis of atypical periorbital cellulitis that is nonresponsive to antibiotics and reviews the clinicopathologic nature of this disease.
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Affiliation(s)
| | - Isaac D Bleicher
- Department of Ophthalmology, Ophthalmic Plastic Surgery, Massachusetts Eye and Ear, Harvard Medical School, Boston, Massachusetts
| | - Edith R Reshef
- Department of Ophthalmology, Ophthalmic Plastic Surgery, Massachusetts Eye and Ear, Harvard Medical School, Boston, Massachusetts
| | - Anna M Stagner
- David G. Cogan Laboratory of Ophthalmic Pathology, Massachusetts Eye and Ear, Harvard Medical School, Boston, Massachusetts, U.S.A
| | - Natalie Wolkow
- Department of Ophthalmology, Ophthalmic Plastic Surgery, Massachusetts Eye and Ear, Harvard Medical School, Boston, Massachusetts
- David G. Cogan Laboratory of Ophthalmic Pathology, Massachusetts Eye and Ear, Harvard Medical School, Boston, Massachusetts, U.S.A
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Toyos R, Desai NR, Toyos M, Dell SJ. Intense pulsed light improves signs and symptoms of dry eye disease due to meibomian gland dysfunction: A randomized controlled study. PLoS One 2022; 17:e0270268. [PMID: 35737696 PMCID: PMC9223330 DOI: 10.1371/journal.pone.0270268] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2021] [Accepted: 05/26/2022] [Indexed: 11/18/2022] Open
Abstract
Purpose To compare the safety and efficacy of intense pulsed light (IPL) followed by meibomian gland expression (MGX), against monotherapy of MGX. Methods Patients with moderate to severe meibomian gland dysfunction (MGD) were 1:1 randomized to 4 sessions of intense pulse light + MGX at 2-week intervals, or 4 sessions of Sham + MGX at 2-week intervals. Both patients and examiners were blinded to the allocation. Outcome measures, evaluated at the baseline (BL) and at a follow-up (FU) conducted 4 weeks after the last IPL session, included fluorescein tear breakup time (TBUT) as the primary outcome measure, OSDI (Ocular Surface Disease Index) questionnaire, Eye Dryness Score (EDS, a visual analog scale (VAS)-based questionnaire), Meibomian gland score (MGS, a score of meibum expressibility and quality in 15 glands on the lower eyelid), daily use of artificial tears, and daily use of warm compresses. In addition, during each treatment session, the number of expressible glands was counted in both eyelids, the predominant quality of meibum was estimated in both eyelids, and the level of pain/discomfort due to MGX and IPL was recorded. Results TBUT increased from 3.8±0.2 (μ±standard error of mean (SEM)) to 4.5±0.3 seconds in the control arm, and from 4.0±0.2 to 6.0±0.3 in the study arm. The difference between arms was statistically significant (P < .01). Other signs/symptoms which improved in both arms but were greater in the study arm included MGS (P < .001), EDS (P < .01), the number of expressible glands in the lower eyelids (P < .0001) and upper eyelid (P < .0001), the predominant meibum quality in the lower eyelid (P < .0001) and upper eyelid (P < .0001), and the level of pain due to MGX (P < .0001). Outcome measures which improved in both arms with no significant differences between the two were OSDI (P = .9984), and the daily use of artificial tears (P = .8216). Meibography, daily use of warm compresses, and severity of skin rosacea did not show statistically significant changes in either arm. No serious adverse events were observed. There was a slight tendency for more adverse events in the control group (P = 0.06). Conclusions The results of this study suggest that, in patients with moderate to severe symptoms, combination therapy of intense pulse light (IPL) and meibomian gland expression (MGX) could be a safe and useful approach for improving signs of dry eye disease (DED) due to meibomian gland dysfunction (MGD). Future studies are needed to elucidate if and how such improvements can be generalized to different severity levels of MGD.
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Affiliation(s)
- Rolando Toyos
- Department of Ophthalmology, Toyos Clinic, Germantown, Tennessee, United States of America
- * E-mail:
| | - Neel R. Desai
- Eye Institute of West Florida, Largo, Florida, United States of America
| | - Melissa Toyos
- Department of Ophthalmology, Toyos Clinic, Germantown, Tennessee, United States of America
| | - Steven J. Dell
- Dell Laser Consultants, Austin, Texas, United States of America
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Govindasamy G, Lim C, Riau AK, Tong L. Limiting plastic waste in dry eye practice for environmental sustainability. Ocul Surf 2022; 25:87-88. [PMID: 35613675 PMCID: PMC9124366 DOI: 10.1016/j.jtos.2022.05.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2022] [Accepted: 05/19/2022] [Indexed: 11/29/2022]
Affiliation(s)
- Gayathri Govindasamy
- Cornea and External Eye Disease Service, Singapore National Eye Center, Singapore.
| | - Chris Lim
- Singapore Eye Research Institute, Singapore; Department of Ophthalmology, National University Health System, Singapore; School of Optometry and Vision Science, University of New South Wales, Sydney, NSW, Australia; Department of Ophthalmology, Yong Loo Lin School of Medicine, NUS, Singapore.
| | - Andri Kartasasmita Riau
- Singapore Eye Research Institute, Singapore; Eye Academic Clinical Program, Duke-National University of Singapore (NUS) Medical School, Singapore.
| | - Louis Tong
- Cornea and External Eye Disease Service, Singapore National Eye Center, Singapore; Singapore Eye Research Institute, Singapore; Department of Ophthalmology, Yong Loo Lin School of Medicine, NUS, Singapore; Eye Academic Clinical Program, Duke-National University of Singapore (NUS) Medical School, Singapore.
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Yang MK, Sa HS, Kim N, Jeon HS, Hyon JY, Choung H, Khwarg SI. Quantitative analysis of morphological and functional alterations of the meibomian glands in eyes with marginal entropion. PLoS One 2022; 17:e0267118. [PMID: 35421204 PMCID: PMC9009701 DOI: 10.1371/journal.pone.0267118] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2021] [Accepted: 04/01/2022] [Indexed: 11/18/2022] Open
Abstract
Purpose
To quantitatively analyze morphological and functional alterations of the meibomian glands in eyes with marginal entropion and their changes after surgery.
Methods
Sixty eyes of 52 patients with marginal entropion and underwent meibography and interferometer were included. One-hundred and seventeen age- and sex-matched eyes with minimal to mild meibomian gland dysfunction (MGD) were recruited as control eyes. Meibomian gland loss (MGL) and lipid layer thickness (LLT) were compared between eyes with marginal entropion and control eyes. Subgroup analysis was performed according to the extent of entropion. MGL and average LLT at 1 and 5 months after surgery were compared with those of 20 eyes with marginal entropion followed without surgery.
Results
In eyes with marginal entropion, MGL was higher (27.7% vs. 12.8%, P = 0.014), and average LLT was thinner (64 nm vs. 86 nm, P = 0.005) than those in control eyes. MGL was higher in eyes with more extensive entropion (> 2/3 eyelid width) than in eyes with less extensive entropion (≤ 1/3 eyelid width) (40.5% vs. 13.2%, P = 0.001). Average LLT increased after surgery (97 nm at 1 month, P = 0.003; 75 nm at 5 months, P = 0.319), and thicker than that of eyes followed without surgery (97 nm vs. 66 nm, P = 0.046). MGLs after surgery remained unchanged from the preoperative MGL (all P > 0.7).
Conclusion
Marginal entropion is associated with morphological and functional alterations of the meibomian glands. Functional improvement after entropion repair suggests that marginal entropion could cause or exacerbate MGD. Further studies are required to establish the role of entropion repair in managing MGD.
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Affiliation(s)
- Min Kyu Yang
- Department of Ophthalmology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Ho-Seok Sa
- Department of Ophthalmology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Namju Kim
- Department of Ophthalmology, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Seongnam, Korea
- * E-mail:
| | - Hyun Sun Jeon
- Department of Ophthalmology, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Joon Young Hyon
- Department of Ophthalmology, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Hokyung Choung
- Department of Ophthalmology, Seoul Metropolitan Government-Seoul National University Boramae Medical Center, Seoul, Korea
| | - Sang In Khwarg
- Department of Ophthalmology, Seoul National University College of Medicine, Seoul National University Hospital, Seoul, Korea
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Tong JY, Powys M, Phan T, Krivanek M, Kellie SJ, Tumuluri K. Pediatric Subcutaneous Panniculitis-like T-cell Lymphoma of the Orbit. Ophthalmic Plast Reconstr Surg 2022; 38:e38-e41. [PMID: 34652312 DOI: 10.1097/iop.0000000000002075] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
Subcutaneous panniculitis-like T-cell lymphoma (SPTCL) is a rare and distinct subtype of peripheral T-cell lymphoma, representing <1% of all non-Hodgkin lymphomas. SPTCL usually arises in the fourth decade of life with multifocal involvement of the limbs and trunk. Orbital disease is uncommon. We present the youngest known case of orbital SPTCL in a 3-year-old child, where the diagnosis was initially confounded by a lower eyelid mass masquerading as preseptal cellulitis. MRI revealed a poorly defined anterior orbital mass. Immunophenotyping and histological analysis of an orbital biopsy specimen confirmed SPTCL, which was managed by the pediatric oncology team with multiagent chemotherapy. This case is unique due to the young age of presentation and primary orbital involvement. Nonresolving or atypical periorbital cellulitis needs to be investigated, as malignancy can mimic such conditions.
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Affiliation(s)
- Jessica Y Tong
- Department of Ophthalmology, The Children's Hospital at Westmead, Westmead, New South Wales, Australia
- Save Sight Institute, Sydney Medical School, Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
- Faculty of Medicine and Health Sciences, Macquarie University, Sydney, New South Wales, Australia
| | - Madeleine Powys
- Cancer Centre for Children, The Children's Hospital at Westmead, Westmead, New South Wales, Australia
| | - Tracey Phan
- Department of Ophthalmology, The Children's Hospital at Westmead, Westmead, New South Wales, Australia
| | - Michael Krivanek
- Department of Histopathology, The Children's Hospital at Westmead, Westmead, New South Wales, Australia
| | - Stewart J Kellie
- Cancer Centre for Children, The Children's Hospital at Westmead, Westmead, New South Wales, Australia
- Discipline of Child and Adolescent Health, Sydney Medical School, University of Sydney, Sydney, New South Wales, Australia
| | - Krishna Tumuluri
- Department of Ophthalmology, The Children's Hospital at Westmead, Westmead, New South Wales, Australia
- Save Sight Institute, Sydney Medical School, Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
- Faculty of Medicine and Health Sciences, Macquarie University, Sydney, New South Wales, Australia
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Nichols KK, Malloy KA, Karpecki PM, Bacharach J, Douglas RS, Foster S, Gromacki SJ, Whitley WO. Topical Review: An Update of Diagnostic and Management Algorithms for Acquired Blepharoptosis. Optom Vis Sci 2022; 99:230-240. [PMID: 35058403 DOI: 10.1097/opx.0000000000001868] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
SIGNIFICANCE Acquired ptosis is a condition of the upper eyelid that has negative cosmetic and functional effects but is likely underdiagnosed and undertreated. Given the evolving understanding of the condition and expanding therapeutic options, this review reappraised published evidence and clinical experience regarding diagnosis and treatment of acquired ptosis.The authors met over two structured virtual working sessions to review current evidence and develop timely recommendations for acquired ptosis identification, differential diagnosis, characterization, and treatment selection. Diagnostic algorithms, plus management and referral guidelines, are presented. Eyelid evaluation and, when needed, ptosis diagnostic workup are essential in the comprehensive eye examination. Acquired ptosis can be efficiently identified via patient questionnaire, history, and photograph review combined with assessment of eyelid position and symmetry using established methods. When ptosis is present, it is essential to evaluate onset, symptoms, pupil diameter, and extraocular muscle function to identify or rule out serious underlying conditions. If signs of serious underlying etiology are present, immediate referral/follow-up testing is required. After ruling out serious underlying causes, masquerade conditions, and pseudoptosis, pharmacologic or surgical treatment should be selected based on the clinical evidence. Effectively managing acquired ptosis requires practice-wide commitment to thorough eyelid evaluation, accurate diagnosis, and adoption of new treatment modalities. Aided by evolving pharmacologic therapeutic options, shifting from a "detect and refer" to a "diagnose and manage" approach can support identification and treatment of more patients with acquired ptosis, particularly mild-to-moderate cases.
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Affiliation(s)
| | - Kelly A Malloy
- The Eye Institute of the Pennsylvania College of Optometry, Salus University, Philadelphia, Pennsylvania
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Seeds A, Coleman SL, Strul S. Gradenigo Syndrome: Mimicker of Slipped Muscle and Shunt Failure. J Neuroophthalmol 2022; 42:e410-e411. [PMID: 34310461 DOI: 10.1097/wno.0000000000001311] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Affiliation(s)
- Anais Seeds
- Department of Ophthalmology and Visual Sciences, University of Minnesota, Minneapolis, Minnesota
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Affiliation(s)
| | - Daniel J Ozzello
- Division of Oculofacial Plastic and Reconstructive Surgery, UC San Diego Viterbi Family Department of Ophthalmology, Shiley Eye Institute, La Jolla, California, U.S.A
| | - Don O Kikkawa
- Division of Oculofacial Plastic and Reconstructive Surgery, UC San Diego Viterbi Family Department of Ophthalmology, Shiley Eye Institute, La Jolla, California, U.S.A
| | - Catherine Y Liu
- Division of Oculofacial Plastic and Reconstructive Surgery, UC San Diego Viterbi Family Department of Ophthalmology, Shiley Eye Institute, La Jolla, California, U.S.A
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Abstract
There are currently no effective methods to prevent or durably treat ocular symblephara, the adhesions between the palpebral and bulbar conjunctiva. How symblephara form at the molecular level is largely unknown. We present here an overview of current clinical symblephara treatments and describe potential molecular mechanisms behind conjunctival adhesion formation that may inform future symblephara treatment and prevention options. Understanding how symblephara form at the molecular level will facilitate treatment development. Preventative therapies may be possible by targeting symblephara progenitor cells immediately after injuries, while novel therapeutics should be aimed at modulating TGF-β pathways and effector cells in conjunctival scarring to treat symblephara formation more effectively.
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Affiliation(s)
- Aditi Swarup
- Department of Ophthalmology, Stanford University School of Medicine
| | - Christopher N Ta
- Department of Ophthalmology, Stanford University School of Medicine
| | - Albert Y Wu
- Department of Ophthalmology, Stanford University School of Medicine.
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Kyei S, Asiedu K, Ephraim RKD, Animful S, Adanusa M, Ali-Baya SK, Akorsah B, Sekyere MA. Meibomian Gland Dysfunction and Lipid Profile: A Study Among Pregnant Women. Eye Contact Lens 2021; 47:598-603. [PMID: 34224447 DOI: 10.1097/icl.0000000000000815] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/25/2021] [Indexed: 11/27/2022]
Abstract
PURPOSE This study aimed to estimate the frequency of meibomian gland dysfunction (MGD) and its associated factors among pregnant women. METHODS This was a hospital-based cross-sectional study of consecutive pregnant women visiting the University of Cape Coast hospital's antenatal clinic. Meibomian gland assessment and tear function test were performed along with the administration of a symptom questionnaire. Correlation, analysis of variance, and logistic regression analyses were used to examine predictors of MGD. RESULTS All 201 pregnant women who met the inclusion criteria and gave informed consent were included in the study. The mean age of the entire sample was 29.96 (±4.74) years. The frequency of MGD among the cohort of pregnant women was 22.9% (95% confidence interval, 17.4%-28.9%). Univariate logistic regression revealed that the following factors were significantly associated with MGD: high-density lipoprotein (HDL) (odds ratio [OR] 1.017; 95% confidence interval [CI], 1.001-1.034; P=0.042), total cholesterol (TC) (OR 1.009; 95% CI, 1.003-1.016; P=0.006), and low-density lipoprotein (LDL) (OR 1.008; 95% CI, 1.00-1.016; P=0.049). In multivariate analysis, the model confirmed that MGD was not significantly associated with TC, LDL, and HDL. CONCLUSIONS In summary, this study showed a high frequency of MGD in pregnant women but comparable with that reported in the normal population. Clinicians examining pregnant women for dry eye disease may need to pay attention to other causative instigators aside MGD to enable the clinicians to make an appropriate etiology-based diagnosis.
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Affiliation(s)
- Samuel Kyei
- Department of Optometry and Vision Science (S.K., S.A.), College of Health and Allied Sciences, University of Cape Coast, Cape Coast, Ghana; School of Optometry & Vision Science (K.A.), Faculty of Medicine and Health, University of New South Wales, Australia ; Eye Clinic (K.A.), Cosmopolitan Medical Center, North-Dzorwulu, Accra Ghana; Department of Medical Laboratory Science (R.K.D.E., S.K.A.-B., B.A., M.A.S.), School of Allied Health Sciences, University of Cape Coast, Cape Coast, Ghana ; and Division of Family Medicine (M.A.), Directorate of University Health Services, University of Cape Coast, Cape Coast, Ghana
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Abstract
SIGNIFICANCE Quantifying meibomian gland morphology from meibography images is used for the diagnosis, treatment, and management of meibomian gland dysfunction in clinics. A novel and automated method is described for quantifying meibomian gland morphology from meibography images. PURPOSE Meibomian gland morphological abnormality is a common clinical sign of meibomian gland dysfunction, yet there exist no automated methods that provide standard quantifications of morphological features for individual glands. This study introduces an automated artificial intelligence approach to segmenting individual meibomian gland regions in infrared meibography images and analyzing their morphological features. METHODS A total of 1443 meibography images were collected and annotated. The dataset was then divided into development and evaluation sets. The development set was used to train and tune deep learning models for segmenting glands and identifying ghost glands from images, whereas the evaluation set was used to evaluate the performance of the model. The gland segmentations were further used to analyze individual gland features, including gland local contrast, length, width, and tortuosity. RESULTS A total of 1039 meibography images (including 486 upper and 553 lower eyelids) were used for training and tuning the deep learning model, whereas the remaining 404 images (including 203 upper and 201 lower eyelids) were used for evaluations. The algorithm on average achieved 63% mean intersection over union in segmenting glands, and 84.4% sensitivity and 71.7% specificity in identifying ghost glands. Morphological features of each gland were also fed to a support vector machine for analyzing their associations with ghost glands. Analysis of model coefficients indicated that low gland local contrast was the primary indicator for ghost glands. CONCLUSIONS The proposed approach can automatically segment individual meibomian glands in infrared meibography images, identify ghost glands, and quantitatively analyze gland morphological features.
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Affiliation(s)
| | | | | | | | - Andrew D Graham
- Clinical Research Center, School of Optometry, University of California, Berkeley, Berkeley, California
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Chiou C, Wolkow N, Freitag SK. Eyelid Keratoacanthoma in an 86-Year-Old Man: Clinical and Histopathologic Features. Ophthalmic Plast Reconstr Surg 2021; 37:S166. [PMID: 32732539 DOI: 10.1097/iop.0000000000001721] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Affiliation(s)
- Carolina Chiou
- Ophthalmic Plastic Surgery Service, Department of Ophthalmology and
| | - Natalie Wolkow
- Ophthalmic Plastic Surgery Service, Department of Ophthalmology and
- David G. Cogan Laboratory of Ophthalmic Pathology, Massachusetts Eye and Ear Infirmary, Harvard Medical School, Boston, Massachusetts, U.S.A
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Musayeva A, Gericke A, Jäger F, Paulsen F, Braun M, Fabry B, Braun R, Pauly D, Holtmann C, Geerling G. [Results of the Dry Eye Research Grant Award 2016]. Ophthalmologe 2021; 118:337-344. [PMID: 32638094 PMCID: PMC8043874 DOI: 10.1007/s00347-020-01163-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2022]
Abstract
The Sicca-Förderpreis (Dry Eye Award) supports the development of scientific research on the pathogenesis, diagnostics, and treatment of dry eye and ocular surface diseases. It is awarded after a limited call for proposals in German-speaking countries, written application and selection of the award winner after evaluation by a jury of ophthalmologists working in basic and clinical science. In this article examples of the results of funded projects of the Sicca-Förderpreis 2016 are cursorily described, which were presented at the Ophthalmological Academy of Germany 2019 (Augenärztliche Akademie Deutschland 2019) and therefore provide an insight into current scientific developments. The role of muscarinic receptors and those of urea in the pathogenesis of dry eye as well as the (missing) correlation of tear film stability, viscosity and surface tension are highlighted. A project on the early detection of ocular involvement in graft versus host disease and the idea of treating meibomian gland dysfunction with eyelid surgery techniques are also groundbreaking. The outlined projects represent the potential for further substantial developments in the understanding, diagnostics and treatment of dry eye; however, their long-term clinical relevance still needs to be established.
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Affiliation(s)
- A Musayeva
- Augenklinik und Poliklinik, Klinikum der Johannes-Gutenberg-Universität Mainz, Mainz, Deutschland
| | - A Gericke
- Augenklinik und Poliklinik, Klinikum der Johannes-Gutenberg-Universität Mainz, Mainz, Deutschland
| | - F Jäger
- Institut für Funktionelle und Klinische Anatomie, FAU Erlangen-Nürnberg, Erlangen, Deutschland
| | - F Paulsen
- Institut für Funktionelle und Klinische Anatomie, FAU Erlangen-Nürnberg, Erlangen, Deutschland
| | - M Braun
- Institut für Physik der kondensierten Materie, FAU Erlangen-Nürnberg, Erlangen, Deutschland
| | - B Fabry
- Institut für Physik der kondensierten Materie, FAU Erlangen-Nürnberg, Erlangen, Deutschland
| | - R Braun
- Klinik und Poliklinik für Augenheilkunde, Universitätsklinikum Regensburg, Regensburg, Deutschland
| | - D Pauly
- Klinik und Poliklinik für Augenheilkunde, Universitätsklinikum Regensburg, Regensburg, Deutschland
| | - C Holtmann
- Klinik für Augenheilkunde, Universitätsklinikum Düsseldorf, Moorenstr. 5, 40225, Düsseldorf, Deutschland
| | - G Geerling
- Klinik für Augenheilkunde, Universitätsklinikum Düsseldorf, Moorenstr. 5, 40225, Düsseldorf, Deutschland.
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Singh PP, Yu C, Mathew R, Perez VL, Saban DR. Meibomian gland dysfunction is suppressed via selective inhibition of immune responses by topical LFA-1/ICAM antagonism with lifitegrast in the allergic eye disease (AED) model. Ocul Surf 2021; 21:271-278. [PMID: 33812087 DOI: 10.1016/j.jtos.2021.03.009] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2020] [Revised: 03/17/2021] [Accepted: 03/18/2021] [Indexed: 11/18/2022]
Abstract
PURPOSE The etiology of meibomian gland dysfunction (MGD) is incompletely understood, despite being a common ophthalmic condition and an area of unmet medical need. It is characterized by an insufficiency in glandular provision of specialized lipids (meibum) to the tear film and is a major cause of dry eye. Work in the allergic eye disease (AED) mouse model has revealed an immunopathogenic role in MGD causation, now raising interest in the applicability of immunomodulatory therapies. As such, we herein ask whether inhibition of lymphocyte function associated antigen (LFA)-1/intracellular adhesion molecules (ICAM)-1 signaling via topical lifitegrast administration has a therapeutic effect on MGD in AED mice. METHODS Mice were induced with AED by i.p. injection of ovalbumin (OVA) mixed with alum and pertussis toxin, followed 2 weeks later by once daily topical OVA challenges for 7 days. Mice were treated topically with 5% lifitegrast ophthalmic solution or vehicle (PBS) 30 min prior to challenge. We developed a clinical ranking method to assess MGD severity, and also scored clinical allergy. Conjunctivae and draining lymph nodes were collected for flow cytometry. RESULTS Topical lifitegrast significantly inhibited clinical MGD severity, which was associated with diminished pathogenic TH17 cell and neutrophil numbers in the conjunctiva. No significant change in conjunctival TH2 cells or eosinophils, and only marginal differences in ocular allergy were observed. CONCLUSIONS In AED mice, lifitegrast inhibited MGD severity marked by a reduction in select immune populations in the conjunctiva. Our findings warrant future examination of lifitegrast in the treatment of patients with forms of MGD.
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Affiliation(s)
- Pali P Singh
- Duke University School of Medicine, Durham, NC, USA
| | - Chen Yu
- Department of Ophthalmology, Duke Eye Center, Duke University School of Medicine, Durham, NC 27710, USA
| | - Rose Mathew
- Department of Ophthalmology, Duke Eye Center, Duke University School of Medicine, Durham, NC 27710, USA
| | - Victor L Perez
- Foster Center for Ocular Immunology, Department of Ophthalmology, Duke Eye Center, Duke University School of Medicine, Durham, NC, 27710, USA
| | - Daniel R Saban
- Department of Ophthalmology, Duke Eye Center, Duke University School of Medicine, Durham, NC 27710, USA; Foster Center for Ocular Immunology, Department of Ophthalmology, Duke Eye Center, Duke University School of Medicine, Durham, NC, 27710, USA; Department of Immunology, Duke University School of Medicine, Durham, NC, 27710, USA.
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45
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García-Marqués JV, García-Lázaro S, Martínez-Albert N, Cerviño A. Meibomian glands visibility assessment through a new quantitative method. Graefes Arch Clin Exp Ophthalmol 2021; 259:1323-1331. [PMID: 33409681 DOI: 10.1007/s00417-020-05034-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2020] [Revised: 11/25/2020] [Accepted: 11/28/2020] [Indexed: 10/22/2022] Open
Abstract
PURPOSE The aim of this study is to develop a new objective semiautomatic method for analysing Meibomian glands visibility quantitatively. METHODS One hundred twelve healthy volunteers aged between 18 and 90 years (48.29 ± 27.46 years) participated in this study. Infrared meibography was obtained from the right upper eyelid through Oculus Keratograph 5 M. Meibographies were classified into 3 groups: Group 1 = patients with good subjective glands visibility and a gland dropout percentage < 1/3 of the total Meibomian gland area; Group 2 = patients with low subjective glands visibility and a gland dropout < 1/3; and Group 3 = patients with low subjective glands visibility and a gland dropout > 1/3. New metrics based on the visibility of the Meibomian glands were calculated and later compared between groups. Rho Spearman test was used to assess the correlation between each metric, and Meibomian gland dropout percentage with the entire sample and after excluding Group 2. A p value less than 0.05 was defined as statistically significant. RESULTS Fifty-six subjects were classified in Group 1 (24.48 ± 9.62 years), 19 in Group 2 (69.16 ± 21.30 years) and 37 in Group 3 (73.59 ± 13.70 years). No statistically significant differences were found between Groups 1 and 2 in dropout percentage. All metrics, with the exception of entropy, showed a higher Meibomian gland visibility in Group 1 than in the other two groups. Moderate correlations were statistically significant for all metrics with the exception of entropy. Correlations were higher after excluding Group 2. CONCLUSION The proposed method is able to assess Meibomian gland visibility in an objective and repeatable way, which might help clinicians enhance Meibomian gland dysfunction diagnosis and follow-up treatment.
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Affiliation(s)
- José Vicente García-Marqués
- Department of Optics and Optometry and Vision Sciences, University of Valencia, C/Dr Moliner, 50 - 46100, Burjassot, Spain
| | - Santiago García-Lázaro
- Department of Optics and Optometry and Vision Sciences, University of Valencia, C/Dr Moliner, 50 - 46100, Burjassot, Spain.
| | - Noelia Martínez-Albert
- Department of Optics and Optometry and Vision Sciences, University of Valencia, C/Dr Moliner, 50 - 46100, Burjassot, Spain
| | - Alejandro Cerviño
- Department of Optics and Optometry and Vision Sciences, University of Valencia, C/Dr Moliner, 50 - 46100, Burjassot, Spain
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Hwang HS, Mikula E, Xie Y, Brown DJ, Jester JV. A novel transillumination meibography device for in vivo imaging of mouse meibomian glands. Ocul Surf 2020; 19:201-209. [PMID: 33075493 PMCID: PMC10388835 DOI: 10.1016/j.jtos.2020.08.012] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2020] [Revised: 07/17/2020] [Accepted: 08/31/2020] [Indexed: 01/09/2023]
Abstract
PURPOSE While mouse models of dry eye disease (DED) have been developed, studies evaluating the role of the meibomian glands limited by the inability to temporally document changes. In this report we describe the development of a novel mouse transillumination meibography device and assess the ability of this device to detect age-related changes in the meibomian glands of young and old mice. METHODS The mouse meibography device was comprised of a 3 mm wide right angle prism attached to broad spectrum light source by an optical fiber. Eyelids were then pulled over the prism using double tooth forceps and imaged using a stereomicroscope and low light level camera. Meibomian glands from four young and four old male, BALB/c mice were then imaged and analyzed using ImageJ. RESULTS In young mice, meibography documented the presence of 7-8 meibomian glands appearing as black and distinct eyelid structures with the length shorter in the lower eyelid compared to the upper eyelids. Eyelids of old mice showed apparent dropout of meibomian glands along with smaller and more irregularly shaped acini. The mean acini area of one meibomian gland was 0.088 ± 0.025 mm2 in young mice and 0.080 ± 0.020 mm2 in old mice (p = 0.564), but the Meibomian gland density was significantly lower in older mice (41.7 ± 6.4%, 27.3 ± 4.2%) (p = 0.021). CONCLUSION We have developed an in vivo meibography device that may prove useful in sequentially documenting changes during development of meibomian gland dysfunction and following treatment.
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Affiliation(s)
- Ho Sik Hwang
- Department of Ophthalmology, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea; Department of Ophthalmology, University of California, Irvine, Irvine, CA, United States
| | - Eric Mikula
- Department of Ophthalmology, University of California, Irvine, Irvine, CA, United States
| | - Yilu Xie
- Department of Ophthalmology, University of California, Irvine, Irvine, CA, United States
| | - Donald J Brown
- Department of Ophthalmology, University of California, Irvine, Irvine, CA, United States
| | - James V Jester
- Department of Ophthalmology, University of California, Irvine, Irvine, CA, United States.
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Kasparova EA, Kasparov AA, Sobkova OI, Kasparova EA, Rozinova VN. [A method of treating purulent corneal ulcer in the eyes with neuroparalytical keratitis and lagophthalmos]. Vestn Oftalmol 2019; 135:220-225. [PMID: 31691664 DOI: 10.17116/oftalma2019135052220] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
PURPOSE To develop a method for treatment of advanced purulent corneal ulcers in eyes with neurotrophic keratitis that developed as a complication of intracranial pathological processes or brain surgeries. MATERIAL AND METHODS The study involved 13 patients (14 eyes) that underwent combined surgery - keratoplasty, autoconjunctival flap covering, partial tarsorrhaphy performed simultaneously. Before and after the surgery, patients received frequent instillations of antimicrobial agents and autologous serum. RESULTS The organ of vision was preserved in all patients, visual function - in 50% of cases, it improved in 35.7% of cases from 0.07±0.05 to 0.26±0.11. Lagophthalmos has decreased from 6.11±0.99 to 2.78±0.62 mm. CONCLUSION Patients with intracranial lesions and complicated by neurotrophic keratitis and lagophthalmos often develop advanced severe and progressive corneal purulent ulcers, which seldom respond to the most active conservative therapy. Simultaneous surgery that includes keratoplasty, auto conjunctival flap covering and partial superficial tarsorrhaphy is an effective treatment option that helps preserve visual function in such eyes.
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Affiliation(s)
- Evg A Kasparova
- Research Institute of Eye Diseases, 11A Rossolimo St., Moscow, Russian Federation, 119021
| | - A A Kasparov
- Research Institute of Eye Diseases, 11A Rossolimo St., Moscow, Russian Federation, 119021
| | - O I Sobkova
- Research Institute of Eye Diseases, 11A Rossolimo St., Moscow, Russian Federation, 119021
| | - El A Kasparova
- Research Institute of Eye Diseases, 11A Rossolimo St., Moscow, Russian Federation, 119021
| | - V N Rozinova
- Research Institute of Eye Diseases, 11A Rossolimo St., Moscow, Russian Federation, 119021
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Affiliation(s)
- Allen M Putterman
- From the Department of Ophthalmology, University of Illinois College of Medicine, Chicago, IL
| | - Catherine Y Liu
- From the Department of Ophthalmology, University of Illinois College of Medicine, Chicago, IL
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49
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Ning XL, Ma Q. [Clinical Features Analysis of Demodectic Blephartis Observed in 40 Patients]. Zhongguo Ji Sheng Chong Xue Yu Ji Sheng Chong Bing Za Zhi 2016; 34:182-183. [PMID: 30124258] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
Conjunctival scrapings for cytological examination and demodicid mite microscopic examination were performed in 55 cases of blephartis patients. Demodicid mites were detected in 40 cases, with a detection rate of 72.7%. The following signs/symptoms displayed among the 40 cases: conjunctival congestion(37), eyelid hyperemia and hypertrophy(40), eyelash epilation and abnormal growth(39), eyelash root with sleeve-like scales(33), conjunctival lesions(37), corner lesions(21), meibomian gland orifice occlusion(18), accompanied with skin lesions as acne or acne rosacea(19), hordeolum and chalazion(15). Conjunctival scrapings for cytological examination in the 27 cases revealed medium- and small-sized lymphocyte-predominant inflammatory cells, indicating that the conjunctiva lesion was a result of chronic inflammation.
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50
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Ding J, Zhang Y, Li B, Xu X, Hou Z, Li D. [Repair of full-thickness lower eyelid defect following surgical excision of malignant tumor using Hughes technique]. Zhonghua Yan Ke Za Zhi 2014; 50:579-583. [PMID: 25385376] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
OBJECTIVE To evaluate surgical outcome of reconstruction of full-thickness lower eyelid defect resulting from tumor excision. METHODS A retrospective case series review of patients with lower eyelid malignant tumor who underwent surgical repair of full-thickness eyelid defect from June 2008 to May 2013 was made. The defect ranged from 50% to 80% of the lower eyelid after excision of tumor with frozen section control of the surgical margins. Hughes technique was used to reconstruct the posterior lamellar and local flap and free graft were fashioned to repair the anterior defect. The pedicle was divided at 1-3 months postoperatively. RESULTS Of the 157 lower eyelid malignant tumors, the 3 most common types were basal cell carcinoma (107/157, 68.2%), sebaceous gland carcinoma (32/157, 20.4%), and malignant melanoma (10/157, 6.4%). Twenty-one eyelids of 21 patients (aged from 43 to 77 years old) were identified. No tumor recurred during follow-up period (8-60 months). There was only one case with squamous carcinoma metastasized to the parotid gland and then excised. The contour of all lower eyelids was satisfactory. No eyelid margin deformity or upper lid retraction was observed. Revision surgery was performed to treat lower lid entropion (3 patients), while mild lower lid retraction (2 patients) and temporary ectropion (one patient) required no management. CONCLUSION Hughes flap, which is a posterior lamellar replacement for lower eyelid defect after removal of malignant tumor, achieves favorable functional and cosmetic results.
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Affiliation(s)
- Jingwen Ding
- Beijing Tongren Eye Center, Beijing Institute of Ophthalmology, Beijing Tongren Hospital; Beijing Ophthalmology & Visual Science Key Lab, Capital Medical University, Beijing 100730, China
| | - Yue Zhang
- Beijing Tongren Eye Center, Beijing Institute of Ophthalmology, Beijing Tongren Hospital; Beijing Ophthalmology & Visual Science Key Lab, Capital Medical University, Beijing 100730, China
| | - Bin Li
- Beijing Tongren Eye Center, Beijing Institute of Ophthalmology, Beijing Tongren Hospital; Beijing Ophthalmology & Visual Science Key Lab, Capital Medical University, Beijing 100730, China
| | - Xiaolin Xu
- Beijing Tongren Eye Center, Beijing Institute of Ophthalmology, Beijing Tongren Hospital; Beijing Ophthalmology & Visual Science Key Lab, Capital Medical University, Beijing 100730, China
| | - Zhijia Hou
- Beijing Tongren Eye Center, Beijing Institute of Ophthalmology, Beijing Tongren Hospital; Beijing Ophthalmology & Visual Science Key Lab, Capital Medical University, Beijing 100730, China
| | - Dongmei Li
- Beijing Tongren Eye Center, Beijing Institute of Ophthalmology, Beijing Tongren Hospital; Beijing Ophthalmology & Visual Science Key Lab, Capital Medical University, Beijing 100730, China.
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