Kaercher, T; Brewitt, H
Blepharitis is characterized by a great variety of clinical manifestations, which often include alterations of the ocular surface. This as well as its tendency to be therapy-resistant and recurrent explains why blepharitis marks a challenge for all ophthalmologists. Occasionally dermatologic diseases represent one of the causes of the disease, thus calling for an interdisciplinary approach. The present article describes the state of the art with regard to pathogenesis and therapy of blepharitis.
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Full Text Available Dermatophytoses are the most common fungal infections of the skin. In the clinical practise, tinea pedis is most common clinical form of dermatophytosis. Other clinical forms are tinea cruris, tinea capitis, tinea corporis and tinea faciei. Tinea faciei is a rare form of dermatophytosis of glabrous skin, characterized by a well- circumscribed erythematous patch, and is more commonly misdiagnosed with some dermatologic diseases as seborrheic dermatitis, contact dermatitis, polymorphic light eruption and lymphocytic infiltrations. In addition, it is reported its clinical forms resembling folliculitis, perioral dermatitis, impetigo and sycosis. To date, a few cases of dermatophytosis involving eyelid were presented in the literature. Here, we present a patient who has an erythematous and fine scaly patch on her eyelid and who is diagnosed as dermatophytic blepharitis by helping typical tinea corporis on her wrist.
Lee, Chia-Yi; Ho, Yi-Ju; Sun, Chi-Chin; Lin, Hsin-Chiung; Hsiao, Ching-Hsi; Ma, David Hui-Kang; Lai, Chi-Chun; Chen, Hung-Chi
Aspergillus species produces a wide spectrum of fungal diseases like endophthalmitis and fungal keratitis ophthalmologically, but there has been no report about blepharitis caused by Aspergilus flavus to date. Herein, we report a 61-year-old ethnic Han Taiwanese male who had suffered from pain with burning and foreign body sensation after an insect bite on his left eye. Specimens from bilateral eyelids suggested infection of A. flavus, whereas corneal scraping showed the presence of Gram-negative bacteria. He was admitted for treatment of infectious keratitis with topical antibiotic and antifungal eye drops. Two weeks after discharge, recurrent blepharitis and keratitis of A. flavus was diagnosed microbiologically. Another treatment course of antifungal agent was resumed in the following 6 months, without further significant symptoms in the following 2 years. Collectively, it is possible for A. flavus to induce concurrent keratitis and blepharitis, and combined treatment of keratitis as well as blepharitis is advocated for as long as 6 months to ensure no recurrence. © The American Society of Tropical Medicine and Hygiene.
Full Text Available Case summary We report a clinical case of blepharitis due to Cryptococcus neoformans yeasts in a 2-year-old stray cat from northern Portugal (Vila Real without concurrent naso-ocular signs. Ophthalmological examination revealed mucopurulent discharge from an open wound in the right upper and lower lids. Slit-lamp biomicroscopy showed a normal anterior segment, and intraocular pressure was within the normal reference interval. No fundoscopic alterations were detected in either eye by direct and indirect ophthalmoscopic examination. Cytological examination of an appositional smear showed numerous polymorphic neutrophils and macrophages, together with spherical yeast cells compatible with Cryptococcus species. Molecular analysis by means of PCR and restriction fragment length polymorphism identified C neoformans genotype VNI. The cat was treated with itraconazole, and amoxicillin and clavulanic acid, combined with a commercial ear ointment and an imidacloprid/moxidectin spot-on application for bilateral parasitic otitis caused by Otodectes cynotis . One month after treatment, the clinical signs were completely resolved. Localised cutaneous lesions, as in the present case, probably result from contamination of cat-scratch injuries with viable encapsulated yeasts. Relevance and novel information This is, to the best of our knowledge, the first clinical report of feline blepharitis due to C neoformans without concurrent naso-ocular signs. The current findings, together with those from recent reports of the infection in domestic animals, should alert the veterinary community both in Portugal and in Europe to this underdiagnosed disease.
Full Text Available PURPOSE: To assess the efficacy of topical 1.5% azithromycin in the treatment of moderate to severe chronic blepharitis and to compare the efficacy of two different treatment modalities. METHODS: A randomized clinical trial included 67 patients with chronic anterior and/or posterior blepharitis, followed-up for 3 months. Signs and symptoms were graded according to severity. Patients were randomized into two groups: 33 patients in group I and 34 patients in group II. Group I patients were treated with topical 1.5% azithromycin twice a day for three days, and Group II patients were treated with topical 1.5% azithromycin twice a day for three days then at bedtime for the rest of the month. All patients were instructed to apply warm compresses and an eye-friendly soap twice daily. RESULTS: Patients in both groups tolerated the treatment with minimal irritation. A significant improvement in signs and symptoms was noted at the one week follow-up visit. Group II showed a more pronounced and longer-lasting improvement that persisted after three months of follow-up. CONCLUSION: Topical 1.5% azithromycin ophthalmic solution is an effective treatment option for chronic blepharitis. In moderate to severe blepharitis, a one month treatment is safe and shows better improvement than the three-day protocol with no significant relapse until three months of follow-up.
Arrúa, M; Samudio, M; Fariña, N; Cibils, D; Laspina, F; Sanabria, R; Carpinelli, L; Mino de Kaspar, H
To compare the efficacy of 3 treatment options in patients with chronic blepharitis. An experimental, randomized, controlled study was conducted on 45 patients (female 67%; Mean age: 40.5 years) diagnosed with chronic blepharitis, in order to compare the effectiveness of three treatment options. Group 1: eyelid hygiene with neutral shampoo three times/day; group 2: neutral shampoo eyelid hygiene plus topical metronidazole gel 0.75% twice/day; group 3: neutral eyelid hygiene with shampoo plus neomycin 3.5% and polymyxin 10% antibiotic ointment with 0.5% dexamethasone 3 times/day. The symptoms and signs were assessed by assigning scores from 0: no symptoms and/or signs; 1: mild symptoms and/or signs, 2: moderate symptoms and/or signs; and 3: severe symptoms and/or signs. A significant improvement was observed in the signs and symptoms in all 3 treatment groups. While groups 1 and 2 had more improvement in all variables studied (P<.05), Group 3 showed no clinical improvement for itching (P=.16), dry eye (P=.29), eyelashes falling (P=.16), and erythema at the eyelid margin (P=.29). Shampoo eyelid hygiene neutral and neutral shampoo combined with the use of metronidazole gel reported better hygiene results than neutral shampoo lid with antibiotic ointment and neomycin and polymyxin dexamethasone. Copyright © 2013 Sociedad Española de Oftalmología. Published by Elsevier España, S.L.U. All rights reserved.
Karimian, Farid; Zarei-Ghanavati, Siamak; A, Baradaran-Rafii; Jadidi, Khosrow; Lotfi-Kian, Alireza
To evaluate the microbiological characteristics of eyelid margin flora in chronic blepharitis in mustard gas-exposed individuals and compare the results with those in age- and sex-matched unexposed people. In this comparative case series, 289 patients with ocular manifestations of mustard gas exposure (case) were evaluated for signs of chronic blepharitis. Additionally, microbiological evaluation of eyelid margins was conducted in these patients and compared with results of 100 unexposed patients with chronic blepharitis (control). One-hundred fifty (52.0%) of 289 mustard gas casualties had signs of chronic blepharitis. Microbiological evaluation revealed higher isolation rates of Staphylococcus epidermidis (78%) and Staphylococcus aureus (57%) in the case in comparison to control group (P mustard gas seems to alter the microbiological flora of the eyelid margin. Staphylococcus spp., including antibiotic-resistant strains, and fungi were more frequently isolated in these patients. The relationship between microbial culture results and the severity of ocular surface manifestations in mustard gas-injured cases warrant further investigation.
Altay, Yesim; Demirok, Gulizar; Balta, Ozgur; Bolu, Hulya
The online-ahead-of-print published article, "Azithromycin 1.5% Ophthalmic Solution for Blepharitis Treatment: Comparison of 14- Versus 30-Day Treatment," by Altay Yesim, Demirok Gulizar, Balta Ozgur, and Bolu Hulya (DOI: 10.1089/jop.2015.0099) is being officially retracted from Journal of Ocular Pharmacology and Therapeutics (JOPT) due to post-publication authorship disputes and the discovery of simultaneous submission to both JOPT and the International Journal of Ophthalmology, which is a violation of the proper protocols of peer review. Journal of Ocular Pharmacology and Therapeutics and its editorial leadership are committed to maintaining the highest levels of scientific reporting and publishing, and therefore officially retracts the article based on the infringements listed herein.
Newbold, Georgina M; Outerbridge, Catherine A; Kass, Philip H; Maggs, David J
To determine how frequently Malassezia spp were identified on the periocular skin of dogs and assess the respective associations between the presence of Malassezia spp on the periocular skin and blepharitis, ocular discharge, and the application of ophthalmic medications. Prospective clinical study. 167 eyelids of 84 dogs. Samples obtained from the surface of the eyelid skin by use of adhesive tape were evaluated cytologically for the presence of Malassezia spp. Dogs were grouped on the basis of the presence of blepharitis, nature of ocular discharge, and whether ophthalmic medications were applied, and the proportion of samples with Malassezia spp was compared among the groups. Malassezia spp were detected in 19 samples, of which 15 were obtained from eyes without blepharitis and 14 were obtained from eyes treated with topical ophthalmic medications. The proportion of samples with Malassezia spp was significantly higher for eyes with ocular discharge than for eyes without ocular discharge, especially if that discharge was mucoid or mucopurulent, and for eyes that were treated with aqueous-based medications only or a combination of oil- and aqueous-based medications than for eyes that were not treated. Malassezia organisms were detected on the periocular skin of 3 of 56 (5%) clinically normal dogs. Malassezia organisms were also frequently found on the periocular skin of dogs that had mucoid or mucopurulent ocular discharge or that were administered topical aqueous-based ophthalmic medications, and the periocular skin of these dogs should be cytologically evaluated for Malassezia organisms.
Assessment of the tolerability profile of an ophthalmic solution of 5% glycyrrhizin and copolymer PEG/PPG on healthy volunteers and evaluation of its efficacy in the treatment of moderate to severe blepharitis
Full Text Available Rita Mencucci, Eleonora Favuzza, Ugo MenchiniDepartment of Surgery and Translational Medicine – Eye Clinic, University of Florence, Florence, ItalyPurpose: To evaluate the tolerability on healthy volunteers and the efficacy on subjects affected by chronic moderate/severe blepharitis of a 5% glycyrrhizin and copolymer poly(ethylene glycol/poly(propylene glycol(PEG/PPG ophthalmic solution.Methods: The study was a randomized, controlled, open label, intra-patient monocentric study. It consisted of two different phases, the assessment of tolerability phase on 20 healthy volunteers, and the evaluation of the efficacy on 21 subjects affected by chronic moderate/severe blepharitis; the treatment period was 2 weeks, followed by 1-week of follow-up. In the efficacy phase, in both eyes, eyelid hygiene was also performed. At day 0, 3, 7, 14, and 21 a complete ophthalmological examination was performed. In the tolerability phase, signs of clinical toxicity were recorded and subject-reported symptoms were collected using a questionnaire. In the efficacy phase, global signs and symptoms of blepharitis scores were collected using standardized photographic scales and questionnaire. The statistical analysis was performed using the Wilcoxon signed-rank test. Results: No ocular signs of drug toxicity were reported. During the treatment period for tolerability phase, there were statistically significant higher scores of tearing and ocular discomfort in the tolerability study group versus the tolerability control group. In the efficacy phase, differences between global scores of the two groups were statistically significant at day 0 (score of the efficacy study group was higher than the efficacy control group; P = 0.005 and at day 21 (score of the efficacy study group was lower than the efficacy control group (P ≤ 0.001.The difference of global scores at day 3, 7, 14, and 21 versus day 0 was statistically significant in both groups. No serious adverse events
... WARM COMPRESSES Heating the eyelid margin will increase oil production and melt the “crusty” oil that has solidified in the glands. Use a ... remove oil, bacteria and debris which block the oil gland openings. Use a Q-tip, your ... Use a mild soap like cetaphil or CeraVe or dilute baby shampoo ( ...
Henningsen, Emil; Bygum, Anette
We report a case of periorificial dermatitis caused by suboptimal inhalation of budesonide for asthma. The initial skin lesions presented in the eye surroundings, leading to diagnostic difficulties and treatment of presumed chalazion and staphylococcal folliculitis. After several months, the patient developed perioral papules and pustules and was diagnosed with periorificial dermatitis. He was efficiently treated with topical metronidazole and oral erythromycin. © 2011 Wiley Periodicals, Inc.
Henningsen, Emil; Bygum, Anette
We report a case of periorificial dermatitis caused by suboptimal inhalation of budesonide for asthma. The initial skin lesions presented in the eye surroundings, leading to diagnostic difficulties and treatment of presumed chalazion and staphylococcal folliculitis. After several months, the pati......We report a case of periorificial dermatitis caused by suboptimal inhalation of budesonide for asthma. The initial skin lesions presented in the eye surroundings, leading to diagnostic difficulties and treatment of presumed chalazion and staphylococcal folliculitis. After several months...
Anca Chiriac; Anca E Chiriac; Alina Murgu; Liliana Foia
We present a typical case of seborrheic dermatitis, with no cutaneous manifestations, rarely reported in children, frequently misdiagnosed (especially by ophthalmologists), simply confirmed by microscopic examination of scales and with wonderful therapeutic results with antifungal agents (topical and/or systemic treatments).
Full Text Available We present a typical case of seborrheic dermatitis, with no cutaneous manifestations, rarely reported in children, frequently misdiagnosed (especially by ophthalmologists, simply confirmed by microscopic examination of scales and with wonderful therapeutic results with antifungal agents (topical and/or systemic treatments.
Thuraya Noaman Maher
RESULTS: All patients receiving TTO improved in symptoms, signs, and tear film stability, and the improvement was statistically significant at P < 0.001. Only five patients in massage group showed improvement. The changes in massage group were not statistically significant at P < 0.001. TTO is very effective in relieving symptoms and improving tear film stability and lid signs.
... of the Eyelids and Tears Blepharitis Blepharospasm Canaliculitis Chalazion and Stye (Hordeolum) Dacryocystitis Dacryostenosis Entropion and Ectropion ... of the Eyelids and Tears Blepharitis Blepharospasm Canaliculitis Chalazion and Stye (Hordeolum) Dacryocystitis Dacryostenosis Entropion and Ectropion ...
... of the Eyelids and Tears Blepharitis Blepharospasm Canaliculitis Chalazion and Stye (Hordeolum) Dacryocystitis Dacryostenosis Entropion and Ectropion ... of the Eyelids and Tears Blepharitis Blepharospasm Canaliculitis Chalazion and Stye (Hordeolum) Dacryocystitis Dacryostenosis Entropion and Ectropion ...
... of the Eyelids and Tears Blepharitis Blepharospasm Canaliculitis Chalazion and Stye (Hordeolum) Dacryocystitis Dacryostenosis Entropion and Ectropion ... mimic other eye disorders (such as blepharitis and chalazion ), so a doctor usually biopsies any growths that ...
... of the Eyelids and Tears Blepharitis Blepharospasm Canaliculitis Chalazion and Stye (Hordeolum) Dacryocystitis Dacryostenosis Entropion and Ectropion ... of the Eyelids and Tears Blepharitis Blepharospasm Canaliculitis Chalazion and Stye (Hordeolum) Dacryocystitis Dacryostenosis Entropion and Ectropion ...
Full Text Available diagnosis of blepharitis is almost always based on the history and clinical examination. Long-term management... ... Duncan K, Jeng BH ... TITLE ... Medical management of blepharitis. ... JOURNAL ... Curr Opin Ophthalmol 26:289-94 (2015) DOI:10.1097/ICU.0000000000000164 ...
V. N. Trubilin
Full Text Available When acute inflammation in anterior eye segment of a forward piece of an eye was stopped, ophthalmologists face a problem of absence of acute inflammation signs and at the same time complaints to the remain discomfort feelings. It causes dissatisfaction from the treatment. The complaints are typically caused by disturbance of tears productions. No accidental that the new group of diseases was allocated — the diseases of the ocular surface. Ocular surface is a difficult biologic system, including epithelium of the conjunctiva, cornea and limb, as well as the area costal margin eyelid and meibomian gland ducts. Pathological processes in conjunctiva, cornea and eyelids are linked with tears production. Ophthalmologists prescribes tears substitutions, providing short-term relief to patients. However, in respect that the lipid component of the tear film plays the key role in the preservation of its stability, eyelids hygiene is the basis for the treatment of dry eye associated with ocular surface diseases. Eyelids hygiene provides normal functioning of glands, restores the metabolic processes in skin and ensures the formation of a complete tear film. Protection of eyelids, especially the marginal edge from aggressive environmental agents, infections and parasites and is the basis for the prevention and treatment of blepharitis and dry eye syndrome. The most common clinical situations and algorithms of their treatment and prevention of dysfunction of the meibomian glands; demodectic blepharitis; seborrheic blepharitis; staphylococcal blepharitis; allergic blepharitis; barley and chalazion are discussed in the article. The prevention keratoconjunctival xerosis (before and postoperative period, caused by contact lenses, computer vision syndrome, remission after acute conjunctiva and cornea inflammation is also presented. The first part of the article presents the treatment and prevention algorithms for dysfunction of the meibomian glands, as well as
Chalazion cases attending the Eye Clinic of the Gadjah Mada University had been collected during 1978. It was found that the incidence of chalazion was 1,78%. Chalazion at the upper palpebra are more frequent than at the lower.Key Words: chalazion - blepharitis - palpebra - Meibomian glands - excochleation
The differential diagnosis of these eyelid affections should be performed with basal cell carcinomas, blepharitis and styes. Complications of eyelid involvement are: entropion, ectropion, trichiasis, eye irritations, corneal ulcers and abscesses or conjunctival haemorrhages. Their management is surgical because eyelid ...
Moraxella catarrhalis, and Staphylococcus epidermidis (1). The coagulase negative staphylococci, a subject of debate in the 1980s, regarding its role in pathogenicity, are remarkable for its opportunism. It has thus been incriminated in chronic blepharitis (2), corneal ulcers, and endophthalmitis after traumatic eye surgery (3) ...
Seborrhoeic dermatitis, acne rosacea and chronic blepharitis are factors that predispose to chalazion development. Chalazion has also been associated with meibomian gland dysfunction, hyperlipidaemia,. 7 immunodeficiency and hyperimmunoglobulin E syndrome. (hyper lgE syndrome/Job syndrome). Some viruses and.
Wilson, L A; Julian, A J; Ahearn, D G
Over 150 mascaras representing eight popular brands were examined for their susceptibility to microbial contamination during their use by study group members. Additional mascaras from patients with symptoms and clinical findings of long-term blepharitis also were investigated. Early in the study, two brands without preservatives supported reproducing populations of microorganisms, including potential eye pathogens. These products, as currently manufactured, were recalcitrant to microbial attack. Microbes associated with the facial skin and fingers of the study group users were typically isolated from mascaras after use. Initial microorganisms isolated from mascaras were usually transients. Establishment of reproducing populations within the cosmetics appeared related to the number of uses, personal habits of the user, and the formulation of the product. Four patients with staphylococcal blepharitis and cosmetics heavily laden with Staphylococcus epidermidis showed marked clinical improvement when they stopped using the contaminated cosmetics. The application of used eye area makeup prior to and following ocular surgery should be avoided.
Avgitidou, G; Cursiefen, C; Heindl, L M
A 2-year-old boy suffering from Cornelia de Lange syndrome, presented with mucopurulent ocular discharge and epiphora since birth. Irrigation and probing of the nasolacrimal system revealed and successfully treated bilateral nasolacrimal duct obstructions. Cornelia de Lange syndrome is characterized not only by typical facial features, visceral and urogenital anomalies but also by ophthalmological manifestations in 99% of cases. The most common ophthalmological disorders are synophrys, blepharitis, epiphora, hypertrichosis of the eyebrows and eyelashes, myopia, ptosis and nasolacrimal duct obstruction.
Full Text Available Hyperimmunoglobulinemia E (Job′s syndrome is characterized by markedly increased levels of immunoglobulin E, recurrent cutaneous and systemic pyogenic infections, atopic dermatitis, and peripheral eosinophilia. Although ocular involvement in Job′s syndrome is rare, there are reports of keratoconus, staphylococcal chalazia with blepharitis, and endophthalmitis by various authors. We present the first case report of retinal detachment with complicated cataract in Job′s syndrome.
Full Text Available In this study, 3,490 children were examined to know the pattern of ocular problems in children in this part of the country. It showed that heritable diseases were quite prevalent, i.e., 41.49%. In this group refractive error, nasolacrimal duct block, and primary squint were most common, while in the non-heritable group various types of conjunctivitis, trauma, foreign bodies, blepharitis and nutritional diseases were most prevalent.
Maria Fernanda de Souza Ferraz
Full Text Available The Keratoconjunctivitis Sicca is a common ophthalmopathy among dogs and can be accompanied by periocular alopecia resulting from the extension of inflammation and concomitant eyelid. In the study, medical records of dogs with keratoconjunctivitis sicca and blepharitis treated at the Veterinary Teaching Hospital of the Londrina State University between the years 2008 and 2012 were analyzed, seeking patients with periocular alopecia and checking the frequency of these diseases in the population in relation to gender, age, breed, affected eye, other concomitant ophthalmic disorders, possible etiologies and the presence of systemic diseases. From the analysis of data it was intended to discuss the relationship between the occurrence of periocular alopecia and decreased tear production and possible causes, ocular present, systemic illnesses, affected breeds, gender and age. The Schirmer Tear Test was the method used to measure the tear production. 187 dogs were studied, 147 of which had keratoconjunctivitis sicca and 71 had blepharitis. 31 dogs showed associated diseases. There were 41 cases of alopecia periocular with no difference in the frequency of involvement in relation to gender. In regard to the affected eye, 95% of cases were bilateral. The breeds with higher prevalence were Poodle, Lhasa Apso, English Cocker Spaniel and mixed breed dogs. The ages with higher occurrence were two years, with 19% of the animals, four and twelve years with 12%. Among the 32 animals with periocular alopecia who had systemic diseases, 22 had dermatopathies. It was concluded that keratoconjunctivitis sicca and blepharitis are not frequently associated and the occurrence of periocular alopecia occurs in most cases of blepharitis, although it may less frequently present itself in the CCS. Despite the decreased tear production displayed in some patients with periocular alopecia, one cannot say that it is always present in these cases.
Cheikhrouhou, F; Makni, F; Neji, S; Sellami, H; Masmoudi, A; Turki, H; Ben Zina, Z; Fki, J; Ayadi, A
Demodicidosis is an ectoparasitosis, common to humans and many mammals. It is caused by the proliferation of a mite Demodex sp in the pilosebaceous follicles. Its pathogenic role remains controversial. The aim of our study was to report epidemiological and clinical particularities of cases of demodicidosis diagnosed in our region. Over a period of nine years (January 2000 to December 2008), 427 cases of demodicidosis were diagnosed. 73.2% of cases were blepharitis and 26.8% of cases were facial dermatosis. The mean age was 44 years. Women were slightly more affected (56%) than men. Among 787 chronic blepharitis, 243 cases were due to Demodex sp (30.9%). They were treated with yellow oxide of mercury (Ophtergine® 1%). In the face, this mite has been isolated from erythematous and pruritic papulopustular lesions, and their distribution was as follows: cheeks (22.1%), forehead (13.4%), and nose (11.5%). The diagnosis was confirmed by parasitological examination of scales showing more than 5 Demodex sp/cm(2) and response to treatment with metronidazole (Flagyl®) for three months. Currently, there were a large number of arguments for the incrimination of Demodex sp in pathogenesis of dermatosis and blepharitis. Dermatologists and ophthalmologists must therefore think to this mite. The density of Demodex sp found by parasitological exam is a determining factor in establishing an anti-Demodex treatment whose effectiveness is a further argument for the diagnosis.
Kulovesi, P.; Telenius, J.; Koivuniemi, A.
The tear fluid protects the corneal epithelium from drying and pathogens and it also provides nutrients to these cells. Tear fluid is composed of an aqueous layer as well as a lipid layer that resides at the air-tear interface. The function of the lipid layer is to lower the surface tension...... and dynamics of the lipid layer, since physiologically this condition resembles the tear fluid of chronic blepharitis patients. Our results indicate that neutral lipids residing on top of phospholipids and facing the air phase are needed to produce a stable lipid film at the air-water interface for a wide...
Hung, Jia-Horung; Chu, Chang-Yao; Lee, Chaw-Ning; Hsu, Chao-Kai; Lee, Julia Yu-Yun; Wang, Jen-Ren; Chang, Kung-Chao; Huang, Fu-Chin
Herpes simplex virus (HSV) ocular infection causes significant visual burden worldwide. Despite the fact that dendritic or geographic corneal ulcers are typical findings in HSV epithelial keratitis, conjunctival ulcer as a sign of HSV infection has rarely been reported. Although easily overlooked, this important sign could be enhanced by fluorescein staining. We report two cases of conjunctival geographic ulcers proven to be HSV infection by viral isolation and polymerase chain reaction (PCR). One patient had bilateral disease and blepharitis, and the other had unilateral involvement without skin lesions. With timely diagnosis and proper management, excellent visual outcome can be expected. Copyright © 2015 Elsevier B.V. All rights reserved.
Blum, A; Brummer, C; Lischka, G
Cosmetics and ophthalmological topical preparations are the main causes of allergic contact eczema about the eye. In most cases, clinical signs are conjunctival injection, blepharitis, periorbital dermatitis and edema of lids, often combined with itching. Pure edematous swelling of the eyelids should not immediately be blamed on a contact allergy, but sufficiently evaluated to exclude a benign or malignant process of the eyelids, orbita, lacrimal duct and paranasal sinus. We present a patient with pure edematous swelling of the eyelids due to a contact allergy by the sympathicomimetic phenylephrine hydrochloride, an uncommon allergen.
V. N. Trubilin
Full Text Available Currently, ultrasound biomicroscopy (UBM is the only diagnostic method that uses a 50‑100 MHz transducer with a depth of penetration of 4 mm. This provides greater sensitivity and resolution.Aim. To visualize meibomian glands and to evaluate their morphological and functional status using UBM.Methods. UBM was performed in 14 patients aged 29‑81 with obvious meibomian gland dysfunction (MGD and healthy meibomian glands. 6 patients had no biomicroscopic signs of blepharitis while 8 patients had biomicroscopic signs of blepharitis, blepharoconjunctivitis, and MGD.Results. UBM provides detailed information on meibomian glands and eyelid margins and their pathological conditions, i.e., eyelid margin thickening due to inflammation, meibomian gland orifice obstruction, increase in distance between meibomian glands due to their atrophy, and cartilaginous tissue destruction. UBM findings may depend on patient age as well as on disease stage and severity. When re-positioning UBM transducer, bullous conjunctiva and subconjunctival cysts can be visualized. This provides differential diagnosis between opaque cysts and tumors.Conclusion. UBM combined with standard exams increases information value, reliability, and accuracy of the diagnostics of anterior segment disorders and facilitates the development of targeted therapeutic approaches. Further studies on diagnostic value of conjunctiva and eyelids UBM are required.
Full Text Available AIM: To investigate correlation between ocular Demodex infestation and serum immunoreactivity.METHODS:Demodex counting of 68 inpatients was performed based on eight lashes sampling. Serum immunoreactivity to two 62-kDa and 83-kDa proteins derived from B oleronius was determined by Western blot analysis.RESULTS: These 68 patients without facialrosacea or blepharitis were age matched(P=0.888and gender matched(P=0.595regarding serum immunoreactivity or ocular Demodex infestation. According to the eyelash, creep mite infection was divided into positive and negative groups, age-matched(P=0.590and sex-matched(P=0.329. There was no significant correlation between serum immunoreactivity and Demodex infestation(P=0.925. There were 27 patients with positive serum immunoreactivity in 38 patients with Demodex infestation(71%, and there were 21 patients in 30 patients without Demodex infestation(70%. There was no significant correlation between serum immunoreactivity and Demodex counting(P=0.758. CONCLUSION: It is unnecessary to perform serum analysis when Demodex can be found in asymptomatic individuals. But treatment of reducing lashes Demodex infestation is necessary when patient with blepharitis was detected Demodex in eye lashes and positive serum immunoreactivity.
V. N. Trubilin
Full Text Available The second part of the article is focused on the issue of prevention and treatment of the most common clinical situations in which applicable therapeutic hygiene: seborrheic blepharitis; Staphylococcal blepharitis; Allergic blepharitis; barley and chalazion; prevention keratoconjunctival xerosis (during the preoperative and postoperative period, while wearing contact lenses, in computer vision syndrome, in remission after acute inflammation of the conjunctiva and cornea. There is an algorithm for the therapeutic care of eyelids and the basic mechanisms of action of this procedure. Until recently, the treatment of dry eye syndrome involves the use tearsubstitude therapy. Ten or fifteen years ago, 2–3 tearsubstitudes were presented at the domestic market. Currently, there are doses of different forms of artificial tears, while there are hundreds of them on the western pharmaceutical market. The rapid development in the search for new forms tearsubstitudes is not accident. This is due to the increasing number of patients suffering from disorders of the tear membrane stability, which achieves, according to different sources, up to 40–60% of the adult population. It should be noted that the primary cause of dry eye syndrome in 85–95% of patients is meibomian gland’s dysfunction, thus applying tearsubstitudes symptomatic therapy is treatment that does not solve the problem on the pathogenic level. For this reason, conducting therapeutic hygiene century (warm compresses + self-massage is an important component of the treatment of this group of patients. Objective evidence of relevance and effectiveness of therapeutic care age, in our opinion, is the rapid development of the pharmaceutical market in this area. There is a large number of new gels, lotions, wipes and other products for hygiene century every year. Clear algorithms that include therapeutic hygiene century (dates, the indications for the use of certain hygiene products is an actual
Full Text Available Osmo Kari1, K Matti Saari21Department of Allergology, Skin and Allergy Hospital, Helsinki University Central Hospital, Helsinki, Finland; 2Department of Ophthalmology, University of Turku, Turku, FinlandAbstract: Allergic diseases have greatly increased in industrialized countries. About 30% of people suffer from allergic symptoms and 40%–80% of them have symptoms in the eyes. Atopic conjunctivitis can be divided into seasonal allergic conjunctivitis (SAC and perennial allergic conjunctivitis (PAC. The treatment of SAC is simple; antihistamines, anti-inflammatory agents, or chromoglycate. In severe cases of SAC, subcutaneous or sublingual immunotherapy is helpful. PAC needs longer therapy, often year round, with mast cell stabilizers, antihistamines, and sometimes local steroids. Atopic keratoconjunctivitis is a more severe disease showing chronic blepharitis often connected with severe keratitis. It needs, in many cases, continuous treatment of the lid eczema and keratoconjunctivitis. Blepharitis is treated with tacrolimus or pimecrolimus ointment. Conjunctivitis additionally needs corticosteroids and, if needed, cyclosporine A (CsA drops are administered for longer periods. Basic conjunctival treatment is with mast cell-stabilizing agents and in addition, antihistamines are administered. Vernal keratoconjunctivitis is another chronic and serious allergic disease that mainly affects children and young people. It is a long-lasting disease which commonly subsides in puberty. It demands intensive therapy often for many years to avoid serious complicating corneal ulcers. Treatment is mast cell-stabilizing drops and additionally antihistamines. In relapses, corticosteroids are needed. When the use of corticosteroids is continuous, CsA drops should be used, and in relapses, corticosteroids should be used additionally. Nonallergic eosinophilic conjunctivitis (NAEC is a less known, but rather common, ocular disease. It affects mostly middle-aged and
Mansour, A M; Chan, C-C; Crawford, M A; Tabbarah, Z A; Shen, D; Haddad, W F; Salti, I; Ghazi, N G
To investigate a viral etiology in certain chalazia. A prospective study over 7.5 years of all newly presenting chalazia associated with diffuse follicular conjunctivitis but without any other aetiological factors. Patients were investigated for ocular or systemic infections by history, physical exam, slit-lamp exam, and/or histology of conjunctival biopsy (including transmission electron microscopy). A total of 27 patients developed follicular conjunctivitis without meibomian gland dysfunction, blepharitis, or sexually transmitted diseases. Evidence for a viral aetiology included: recent systemic viral illness (15/27), recent contact with subjects with chalazia or follicular conjunctivitis (5/27), preauricular lymphadenopathy (4/27), viral corneal disease (4/27), or viral particles by ultrastructure (4/4). Chalazia may be associated with viral conjunctivitis. Intralesional corticosteroids should be considered with great caution for viral-induced chalazia.
Full Text Available Five cases of ocular rosacea (one male and four females are reported in this paper. Two of the patients were with keratoconjunctivitis sicca, one with conjunctivitis chronica and blepharitis, one with conjunctivitis chronica and meibomitis, and one with reccurent corneal erosions with meibomitis and chordeloum. In four patients ocular symptoms preceded the occurence of skin lesions. The treatment with oral tetracyclines significantly improved the state of ocular rosacea in four patients, while in one case the changes of the anterior eye segment progressed in more severe state of ulcerative keratitis. It is considered that in almost 20% of the patients with rosacea ocular lesions may precede the skin changes, representing a diagnostic problem. Thus, in those cases multidisciplinary approach is suggested. Such approach is particularly important because of the decrease of morbidity and the prevention of the onset of the eye complications such as drastic worsening of visual acuity, i.e., the blindness.
McDonald, S E; Lowenstine, L J; Ardans, A A
During a 1-month period at a quarantine station, an epornitic of avian pox occurred in blue-fronted Amazon parrots (Amazona aestiva). Clinical signs included conjunctivitis, blepharitis, and varying degrees of anorexia and respiratory distress. Lesions included periocular ulcerations and scabs and necrotic plaques in the oral cavity. Histologically, the lesions consisted of epithelial hyperplasia, secondary inflammatory changes, and eosinophilic inclusions which, by electron microscopy, were shown to contain poxvirus. When chicken embryos were inoculated with material from eyelid scabs and pharyngeal plaques, lesions of avian pox developed on the chorioallantoic membrane. The death rate of infected birds was high because of secondary bacterial and fungal infections, but uncomplicated cases were usually self-limiting. Periocular lesions also developed in 2 other species of psittacine birds housed in the same facility.
Alsuhaibani, Adel H.; Carter, Keith D.; Abràmoff, Michael D.; Nerad, Jeffrey A.
Purpose To study the utility of meibography for the morphology of meibomian glands in normal eyelids and in various eyelid diseases. Design A cross-sectional study. Methods A newly designed transilluminator, fitting both the upper along with lower eyelids, and an infrared camera were used to obtain video clips of the meibomian glands for 60 asymptomatic subjects with normal eyelid margin. Parameters studied included, ocular surface, Schirmer test, and tear breakup time (TBUT). The meibomian glands of patients with meibomian glands’ abnormality secondary to infectious, inflammatory, malignant, congenital, or post-radiation therapy disease related etiologies were compared with normal patients. Still pictures were extracted from the video clips to evaluate the meibomian glands for gland dropout and gross morphological changes. Results In normal subjects, meibomian glands appeared to be thinner and longer in the upper eye lids than in the lower eye lids. Gland dropout occured with increased age, more in the lower eye lid and in females. Excessive gland drop out (> 75%) was seen in patients with history of trachoma, Stevens Johnson syndrome, severe blepharitis, and post-radiation for orbital tumors. Variable gland drop out was noticed in patients with floppy eyelid syndrome, and blepharitis. In patients with congenital distichiasis, partial or complete gland drop out at the part of the eyelid margins affected by distichiasis was noticed. Conclusions The newly designed transilluminator permitted the examination of both upper and lower eye lid meibomian glands with minimal discomfort. Evaluating the anatomical changes involving meibomian glands with meibography may help increase our understanding of the meibomian gland-related diseases, monitor the effects of treatment, and provide helpful information for patient education. PMID:23960903
Gebremariam, Tewelde Tesfaye
In East Africa, particularly in Ethiopia, bacterial keratitis is a major cause of blindness. The aims of this study were to identify risk factors of bacterial keratitis and the spectrum of bacterial etiologies, and to assess the in-vitro antimicrobial susceptibility of these bacterial isolates at Jimma University Specialized Hospital, Southwest Ethiopia. A prospective study was employed from January 2012 to June 2012 from which a total of 24 patients with bacterial keratitis were included in the study. Corneal scrapings were collected, transported and microbiologically processed using standard operating procedures. Four different predisposing factors for bacterial keratitis were identified: corneal trauma 9 (37.5%), blepharitis 7 (29.2%), herpetic keratitis, and use of contaminated medications 4. Bilateral corneal infection was found in 5 (20.8%) of the cases. A total of 24 corneal scrapings were collected for microbiological evaluation, of which 20 (83%) had bacterial growth. The isolated bacterial pathogens were Pseudomonas aeruginosa 10 (41.7%), Staphyloccus aureus 5 (20.8%), Serratia marcescens 3 (12.5%), followed by Streptococcus pneumoniae 2 (8.3%). Antimicrobial susceptibility testing revealed that 85% of Gram-negative bacilli were susceptible to gentamicin and ciprofloxacin, while 86% of Gram-positive cocci were susceptible to vancomycin and Ciprofloxacin. Corneal trauma was the most common risk factor for bacterial keratitis followed by blepharitis. Bacteriological analysis of corneal scrapings also revealed that P. aeruginosa was the most common isolate followed by S. aureus; the antibiotic with the highest susceptibility was ciprofloxacin. As drug resistance among bacterial pathogens is an evolving process, routine surveillance and monitoring studies should be conducted to provide an update and most effective empirical treatment for bacterial keratitis.
Steven, Philipp; Augustin, Albert J; Geerling, Gerd; Kaercher, Thomas; Kretz, Florian; Kunert, Kathleen; Menzel-Severing, Johannes; Schrage, Norbert; Schrems, Wolfgang; Krösser, Sonja; Beckert, Michael; Messmer, Elisabeth M
Meibomian gland disease is generally accepted as the leading cause for evaporative dry eye disease (DED). In a previous study, perfluorohexyloctane, a semifluorinated alkane, has been demonstrated to significantly increase tear film breakup time and to reduce corneal fluorescein staining in patients with evaporative DED, thereby vastly reducing dry eye-related symptoms. This study was set up to evaluate perfluorohexyloctane in a larger population of patients with Meibomian gland dysfunction. Seventy-two patients with Meibomian gland disease and associated dry eye received 1 drop of perfluorohexyloctane 4 times daily during an observational, prospective, multicenter, 6-8-week study. Clinical assessment included best-corrected visual acuity, intraocular pressure, Schirmer test I, tear film breakup time, anterior and posterior blepharitis assessment, number of expressible Meibomian glands, meibum quality and quantity, ocular surface fluorescein staining, lid margin and symptom assessment, and Ocular Surface Disease Index (OSDI © ). From the 72 patients recruited, 61 completed the trial per protocol. Nine patients did not apply the medication as recommended and 2 patients were lost to follow-up. Tear film breakup time, corneal and conjunctival fluorescein staining, number of expressible Meibomian glands, and severity of anterior and posterior blepharitis significantly improved after 6-8 weeks of perfluorohexyloctane application. In addition, symptoms improved as demonstrated by a significant decrease of OSDI-values from 37 (±13) to 26 (±16). In concordance with previous findings, 6-8 weeks of topical application of perfluorohexyloctane significantly improves clinical signs of Meibomian gland disease and associated mild to moderate DED.
Full Text Available Jose M Benitez-del-CastilloOcular Surface and Inflammation, Department Ophthalmology, Hospital Clinico San Carlos, Madrid, SpainAbstract: Disorders of the lacrimal functional unit are common in ophthalmological practice, with meibomian gland dysfunction, blepharitis, and dry eye forming a significant part of the general ophthalmologist's practice. The eyelid and its associated structures form a complex organ designed to protect the fragile corneal surface and improve visual acuity. This organ is subject to a number of disorders, including meibomian gland dysfunction, dry eye syndrome, anterior blepharitis, allergic and dermatological conditions, and disorders associated with contact lens use. Although commonly described separately, disorders of the lacrimal function unit are better considered as a group of interacting pathologies that have inflammatory mediators as a central feature. Eyelid hygiene, in the sense of routine cleansing and massage of the eyelids, is well accepted in the management of many disorders of the eyelid. However, a broader concept of eyelid health may be appropriate, in which eyelid cleansing is but a part of a more complete program of care that includes screening and risk assessment, patient education, and coaching. The ophthalmologist has an important role to play in helping patients persist with routine eyelid care that may be long-term or lifelong. A number of preparations exist to make routine eyelid care both more effective and more pleasant, and might also improve compliance. Several such preparations have been devised, and are being assessed in clinical studies, and appear to be effective and preferred by patients over traditional soap and water or baby shampoo.Keywords: eyelid, disorders, health, lacrimal functional unit
Aaron W Kolb
Full Text Available Herpes simplex virus type 1 causes mucocutaneous lesions, and is the leading cause of infectious blindness in the United States. Animal studies have shown that the severity of HSV-1 ocular disease is influenced by three main factors; innate immunity, host immune response and viral strain. We previously showed that mixed infection with two avirulent HSV-1 strains (OD4 and CJ994 resulted in recombinants that exhibit a range of disease phenotypes from severe to avirulent, suggesting epistatic interactions were involved. The goal of this study was to develop a quantitative trait locus (QTL analysis of HSV-1 ocular virulence determinants and to identify virulence associated SNPs. Blepharitis and stromal keratitis quantitative scores were characterized for 40 OD4:CJ994 recombinants. Viral titers in the eye were also measured. Virulence quantitative trait locus mapping (vQTLmap was performed using the Lasso, Random Forest, and Ridge regression methods to identify significant phenotypically meaningful regions for each ocular disease parameter. The most predictive Ridge regression model identified several phenotypically meaningful SNPs for blepharitis and stromal keratitis. Notably, phenotypically meaningful nonsynonymous variations were detected in the UL24, UL29 (ICP8, UL41 (VHS, UL53 (gK, UL54 (ICP27, UL56, ICP4, US1 (ICP22, US3 and gG genes. Network analysis revealed that many of these variations were in HSV-1 regulatory networks and viral genes that affect innate immunity. Several genes previously implicated in virulence were identified, validating this approach, while other genes were novel. Several novel polymorphisms were also identified in these genes. This approach provides a framework that will be useful for identifying virulence genes in other pathogenic viruses, as well as epistatic effects that affect HSV-1 ocular virulence.
Full Text Available Purpose : To evaluate the microbial etiology and associated risk factors among patients with blebitis following trabeculectomy. Materials and Methods : A retrospective analysis of all culture-proven blebitis was performed in patients who underwent trabeculectomy between January 2004 and December 2008. A standardized form was filled out for each patient, documenting sociodemographic features and information pertaining to risk factors. Swabbing of the infected bleb surface was performed for all suspected cases and further subjected to microbiological analysis. Results : A total of 23 patients with culture-proven blebitis were treated during the study period, with a mean age of 59.2 years (59.2 ± SD: 12.8; range, 30-81 years. Duration of onset was early (≤36 months in six (26% cases and late (> 36 months in 17 (74% cases with a range between 15 and 144 months (mean, 82.91 months; SD: 41.89. All 23 blebs were located superiorly and of which, 21 (91% were microcystic avascular, 1 (4% diffuse avascular, and 1 (4% vascular flattened. The predominant risk factor identified was bleb leak (35%; 8 of 23 followed by thin bleb (22%; 5 of 23 and blepharitis (17%; 4 of 23. Bleb leaks (100% were recorded only in patients with late onset (≥ 9 years of infection (P< 0.001, while the incidence of ocular surface disease (100% occurred early (≤3 years (P< 0.001. Use of topical steroids was associated frequently with cases of thin blebs (80%; 4 of 5 (P< 0.001, while topical antibiotics showed bleb leaks (88%; 7 of 8 (P< 0.001. Coagulase-positive staphylococci were frequently recovered from blebitis with thin blebs (71%; 5 of 7 (P = 0.001, Coagulase-negative staphylococci (CoNS with bleb leak (100%; 8 of 8 (P< 0.001, Corynebacterium with blepharitis (100%; 3 of 3 (P = 0.001, and Streptococci with releasable sutures (75%; 3 of 4 (P = 0.001. Conclusion : Bleb leak is the principal risk factor responsible for late-onset blebitis, while early-onset blebitis could
Janjua, T.A.; Iqbal, Z.
Objective: This study was done to assess frequency of ocular diseases and causes of visual impairment in children of a school at Bannu. Study Design: Observational cross sectional survey. Place and Duration of Study: A local high school at Bannu from March 2009 to May 2009. Material and Methods: Students were asked to fill a structured questionnaire designed to encompass the symptoms of ocular diseases like history of impaired vision, use of glasses, headache and redness. Initial examination at school included assessment of visual acuity by Snellens chart, torch examination and cover uncover test. Subjects having unaided visual acuity less than 6/9 in worse eye, squint or redness were subjected to further examination including refraction and slit lamp biomicroscopy. SPSS version 15 was utilized to assess the data. Chi-square test was used to test differences in proportions. Results: The 304 students (76%) were male and 96 (24%) were female. Mean age was 10.7 +- 2.8 years. Eighty five subjects (21.2%) were diagnosed to be suffering from some ocular disease but only 6.5% had any previous ocular consultation. Twelve percent (48) students had decreased vision on examination but its frequency in those with history of headache was significantly high (20%) compared to those with negative history (9.5%) (p value < 0.05). Refractive error was the cause of decreased vision in more than half of the cases. Vernal keratoconjunctivitis (VKC) was diagnosed in 2.8 % but its frequency was significantly high in those complaining of redness (12%) as compared to those not complaining of redness (1.1%) (p value <0.05). Blepharitis was also found to be a common disease affecting 3.3% of subjects. Conclusion: Ocular diseases are very common in school going children of Bannu. Refractive errors, VKC and blepharitis constitute the majority of cases. Frequency of ocular consultation was quite low as compared to the load of eye diseases which necessitates consolidated effort to screen
Shenoy, Bhamy Hariprasad; Gupta, Amit; Sachdeva, Virender; Kekunnaya, Ramesh
Cornelia de Lange syndrome (CdLS), also called Brachmann-de Lange syndrome, is a multiple congenital anomaly syndrome characterized by a distinctive facial appearance, ophthalmological abnormalities, prenatal and postnatal growth deficiency, psychomotor delay, behavioral problems, and malformations of the upper extremities. Most common and consistent ophthalmic features reported are nasolacrimal duct obstruction, long and curly eyelashes, blepharitis, ptosis, synophrys, telecanthus, hypertelorism, microcornea, peripapillary pigment ring, and myopia. In this report we report a case of a 5-year old boy who presented to our institution with complaint of blurring of vision in the right eye since birth. A diagnosis of Cornelia de Lange syndrome was arrived at based on the characteristic external and ophthalmic examination. He was found to have a rare association of optic nerve head coloboma in the right eye and a novel finding of an optic disk pit in the left eye. The association of optic disk pit with CdLS has never been reported earlier. We aim to provide a thorough review of literature of this not so uncommon syndrome.
Bhamy Hariprasad Shenoy
Full Text Available Cornelia de Lange syndrome (CdLS, also called Brachmann-de Lange syndrome, is a multiple congenital anomaly syndrome characterized by a distinctive facial appearance, ophthalmological abnormalities, prenatal and postnatal growth deficiency, psychomotor delay, behavioral problems, and malformations of the upper extremities. Most common and consistent ophthalmic features reported are nasolacrimal duct obstruction, long and curly eyelashes, blepharitis, ptosis, synophrys, telecanthus, hypertelorism, microcornea, peripapillary pigment ring, and myopia. In this report we report a case of a 5-year old boy who presented to our institution with complaint of blurring of vision in the right eye since birth. A diagnosis of Cornelia de Lange syndrome was arrived at based on the characteristic external and ophthalmic examination. He was found to have a rare association of optic nerve head coloboma in the right eye and a novel finding of an optic disk pit in the left eye. The association of optic disk pit with CdLS has never been reported earlier. We aim to provide a thorough review of literature of this not so uncommon syndrome.
Al Fahaad H
Full Text Available Hamad Al FahaadDepartment of Dermatology, College of Medicine, Najran University, Najran, Saudi ArabiaIntroduction: Keratitis–ichthyosis–deafness (KID syndrome is a rare congenital multisystem disorder affecting certain tissues of ectodermal origin such as epidermis, cochlea, and cornea, leading mainly to palmoplantar hyperkeratosis, ichthyosiform scaling, deafness, and blindness. The author reports for the first time in the Middle East three family members suffering from KID syndrome in the southwestern part of Saudi Arabia.Case presentation: Three patients from one family (ages 26, 16, and 14 years of apparently normal parents, with the two eldest being females and the youngest being male. All three patients were referred from a peripheral hospital to our dermatology clinic due to recurrent cutaneous fungal infections on their trunk, forearms, legs, and nails. On full assessment, they also found to have nearly similar cutaneous problems manifested by palmoplantar hyperkeratosis, generalized ichthyosiform scaling, subungual hyperkeratosis, and nail dystrophies. All patients suffered from total hearing loss in both ears since childhood as confirmed by pure tune audiometry. However, there was no blindness in any case; blepharitis with marked photophobia was the only ocular complaint. All these features are classically suggestive of KID syndrome.Keywords: connexin 26, GJB2, ichthyosis, KID syndrome, palmoplantar hyperkeratosis
Watkinson, Susan; Seewoodhary, Ramesh
Red eye is a common ocular presentation in primary care, and there are several challenges that healthcare practitioners may encounter when caring for such patients. The main ocular conditions that can give rise to red eye are: primary acute angle closure glaucoma, acute iritis, dry eye, blepharitis and conjunctivitis. Red eye can be classified as sight-threatening or non-sight-threatening. Many patients presenting with painless red eye and normal vision usually recover well. However, when red eye is associated with pain, photophobia, watering and blurred vision, it is potentially sight-threatening and must be addressed urgently. Therefore, it is vital for healthcare practitioners to be able to undertake a careful assessment of the patient and make an accurate diagnosis early. This article provides an overview of the common causes of red eye encountered in general practice or an eye clinic. It discusses the nurse's role in the care and management of patients with red eye, with reference to patient assessment, the skills required to make an accurate diagnosis, treatment and health promotion. ©2017 RCN Publishing Company Ltd. All rights reserved. Not to be copied, transmitted or recorded in any way, in whole or part, without prior permission of the publishers.
Full Text Available Hirohiko Kakizaki1, Yasuhiro Takahashi2, Shinsuke Kinoshita1, Kunihiko Shiraki2, Masayoshi Iwaki11Department of Ophthalmology, Aichi Medical University, Aichi, Japan; 2Department of Ophthalmology and Visual Sciences, Osaka City University Graduate School of Medicine, Osaka, JapanAbstract: This study aimed to examine the rate of symptomatic improvement of congenital nasolacrimal duct obstruction (CNLDO in Japanese infants treated with conservative management within the 1st year of age. Thirty-five lacrimal ducts in 27 patients diagnosed with CNLDO were included in the study. During the observational period, lacrimal ducts were massaged. As well, antibiotic eye drops, to be administered 4 times a day, were sometimes prescribed for obvious conjunctivitis. Two lacrimal ducts in 2 patients were probed before the 1st year of age because of dacryocystitis or severe blepharitis; these patients were included in the unimproved group. Twenty-nine lacrimal ducts in 21 patients resolved during the period (82.9%; with 16 lacrimal ducts resolving before six months of age. Therefore, a comparatively high percentage of resolution for CNLDO (82.9% following conservative management was shown before the 1st year of age in Japanese infants.Keywords: congenital nasolacrimal duct obstruction, symptomatic improvement, conservative management, massage, probing
The ciliary margins of the lower lids have been vital stained by the lipid-specific Sudan III powder, fluorescein 0.1% and the bottom of the lacrimal river (Marx's line) by lissamine green 1% in 100 cases. The Meibomian orifices are situated in a straight row just in front of the Marx's line in the lipid phase. With increasing age (greater than 50 years) the orifices are more often displaced and also discharge their lipid in the depth of the aqueous phase. The number averaged 21.5 in the lipid phase and 1.7 in the aqueous phase. Active orifices staining with lipid were found in 45% of all orifices in normals, independent of age, and were increased in conjunctivitis in the lipid phase. Lissamine green-stained orifices were independent of age, phase and diagnosis. The anterior edge of Marx's line may run an irregular course in elderly normals (greater than 50 years), significantly more often in conjunctivitis and blepharitis.
Gerber, D M; Meyer, P; Messerli, J O; Piffaretti, J M; Haefliger, I O
Demonstration of the importance of surgical excision and histological examination in presence of an apparently harmless tumoral alteration of the eyelids. We report the case of a 65 year old patient suffering from systemic lupus erythematosus who noted a tumoral lesion on his left lower eyelid. Suspecting a chalazion, his dermatologist simply performed a cauterization. Six weeks later, a recurrence of the tumor appeared at the same location, and again, cauterization was done. A few weeks later, the patient consulted our clinic with a polycyclic tumor of 5 mm in diameter, involving the lid margin of the temporal part of the lower left eyelid. The patient had only moderate signs of blepharitis. There were no palpable preauricular and cervical lymph nodes. Suspecting a malignant tumor, the entire tumoral lesion was removed surgically. The histopathologic examination showed a highly differentiated sebaceous gland carcinoma, most probably originating from a meibomian gland. The margins of the excision were found to be tumor-free. Sebaceous cell carcinoma is a rare entity. Depending on its histological differentiation it can be highly malignant. Infiltrative, and can metastasize. The mortality may reach 30% if low differentiation is present. As illustrated in the present case, the lesion may masquerade a chalazion. Therefore, in case of atypical lesion of the eyelid region complete surgical removal followed by a histopathological examination should be performed.
Nemet, Arie Y; Vinker, Shlomo; Kaiserman, Igor
Chalazion may be associated with some local and systemic conditions. We studied the prevalence of various conditions among patients with chalazion. A retrospective observational case-control study of all the members who were diagnosed with chalazion in the Central District of Clalit Health Services in Israel (years 2000-2008; n = 9119) and 9119 age- and gender-matched controls randomly selected from the district members. We calculated the prevalence of various ocular, systemic, and demographic conditions as risk factors for chalazion. Demographically, a significant (P chalazion was found in the population of lower socioeconomic class, in the population living in urban areas, in young females (10-29 years), in older men (older than 60 years), and in non-Ashkenazi Jews. The following risk factors of chalazion were statistically significant: blepharitis [odds ratio (OR), 6.2], rosacea (OR, 2.9), gastritis (OR, 1.4), anxiety (OR, 1.5), irritable bowel syndrome (OR, 1.7), and smoking (OR, 1.2). Diabetes (OR, 0.8) and hypothyroidism (OR, 0.8) were significantly less prevalent among chalazion patients. Some systemic conditions are significantly more prevalent and some are significantly less prevalent among patients with chalazion. Better understanding of the pathophysiological association between those diseases and chalazion may help in its treatment and prevention.
Full Text Available Background: Demodex is a genus of mites living predominantly in mammalian pilosebaceous units. They are commonly detected in the skin of face, with increasing numbers in inflammatory lesions. Causation between Demodex mites and inflammatory diseases, such as rosacea, blepharitis, perioral and seborrhoeic dermatitis or chalazion, is controversially discussed. Clinical observations indicate a primary form of human Demodex infection. The aim of this review was to highlight the biological aspects of Demodex infestation and point out directions for the future research.Methods: We conducted a broad review based on the electronic database sources such as MEDLINE, PubMed and Scopus with regard to the characteristics of the Demodex species, methods of examination and worldwide epidemiology, molecular studies and its role in the complex human ecosystem.Results: Demodex mites are organisms with a worldwide importance as they act in indicating several dermatoses, under certain conditions. However, correlations between Demodex and other parasites or microorganisms occupying one host, as well as interactions between these arachnids and its symbiotic bacteria should be considered. There are few methods of human mites' examination depending on purpose of the study. Nevertheless, paying attention must be needed as polymorphism of Demodex species has been reported.Conclusion: Overall, the present review will focus on different aspects of Demodex mites’ biology and significance of these arachnids in human’s health.
Joseph S Bertino Jr
Full Text Available Joseph S Bertino Jr1,21College of Physicians and Surgeons, Columbia University, New York, N Y, USA; 2Principal, Bertino Consulting, Schenectady, NY, USAPurpose: This article reviews the effects of the increase in bacterial resistance on the treatment of ocular infections.Design: Interpretive assessment.Methods: Literature review and interpretation.Results: Ocular bacterial infections include conjunctivitis, keratitis, endophthalmitis, blepharitis, orbital cellulitis, and dacryocystitis. Treatment for most ocular bacterial infections is primarily empiric with broad-spectrum antibiotics, which are effective against the most common bacteria associated with these ocular infections. However, the widespread use of broad-spectrum systemic antibiotics has resulted in a global increase in resistance among both Gram-positive and Gram-negative bacteria to a number of the older antibiotics as well as some of the newer fluoroquinolones used to treat ophthalmic infections. Strategies for the prevention of the increase in ocular pathogen resistance should be developed and implemented. In addition, new antimicrobial agents with optimized pharmacokinetic and pharmacodynamic properties that have low toxicity, high efficacy, and reduced potential for the development of resistance are needed.Conclusions: New antimicrobial agents that treat ocular infections effectively and have a low potential for the development of resistance could be a part of strategies to prevent the global increase in ocular pathogen resistance.Keywords: ocular infections, emerging pathogen drug resistance, fluoroquinolones, besifloxacin
Creavin, Alexandra L; Brown, Ray D
A comprehensive review of the available literature was performed to determine the common ophthalmic disorders in children aged 0 to 16 years with Down syndrome. The UK National Library for Health interface was used to search seven electronic databases, including MEDLINE and EMBASE. Terms related to Down syndrome, ophthalmology, and pediatrics were combined in the search strategy, which yielded 230 articles. Application of exclusion criteria left 23 articles to include in the review. Literature synthesis demonstrated that children with Down syndrome are at risk for several ocular disorders. Refractive error was a common finding, particularly hyperopia. Strabismus was also reported regularly, particularly esodeviation. Other frequent findings included poor visual acuity, nystagmus, and blepharitis, whereas cataract and glaucoma were less common but had potentially serious implications for future vision. Only one study compared routine pediatric examination to that of a pediatric ophthalmologist. The findings of this review confirm the need for an ophthalmic screening program for children with Down syndrome. Additional work should investigate how such a program could be best implemented and ascertain how to involve different professionals in such a service.
Shields, Jerry A; Saktanasate, Jarin; Lally, Sara E; Carrasco, Jacqueline R; Shields, Carol L
Sebaceous carcinoma is a malignancy arising in the periocular region that can lead to blindness and tumor-related metastases. This study is a review of published literature and personal experience. This malignancy can arise from the sebaceous units in the tarsus (meibomian glands), in association with the cilia (Zeis glands), in the brow, and in the caruncle. There is a tendency for diffuse intraepithelial growth (pagetoid spread) that can be clinically invisible. Detection before lymph node metastasis is critical. This malignancy often masquerades as chronic unilateral conjunctivitis or blepharitis, typically in older patients. Management includes a 2-step approach with step 1 focused on eyelid and conjunctival map biopsies to determine the full extent of solid deep tumor and pagetoid spread. After complete review of all biopsies, step 2 is performed using local resection for all deep tumor, cryotherapy to pagetoid disease, and reconstruction. In most cases, the posterior lamella of eyelid is sacrificed with tumor removal, whereas the anterior lamella of the eyelid can be saved. After removal and cryotherapy, immediate reconstruction, using clean instruments, with buccal membrane graft for the posterior lamella and skin flap for the anterior lamella, is developed. For persistent or recurrent pagetoid disease, cryotherapy, topical mitomycin C, or plaque radiotherapy is provided. Exenteration is sometimes necessary. Sebaceous carcinoma, if detected early, can be managed with carefully planned map biopsy to determine tumor extent, followed by local resection, cryotherapy, and eyelid reconstruction. Orbital exenteration is occasionally necessary.
Richter; Schaarschmidt-Kiener; Krudewig
A case of leishmaniasis with predominantly ocular signs in a cat living in Switzerland and it's treatment is reported. The cat was imported from Spain 4 years earlier and was initially presented with chronic uveitis. Laboratory test results were negative for feline immunodeficiency virus (FIV), feline infectious peritonitis (FIP), feline leukaemia virus (FeLV) and Toxoplasma gondii, as well as for Bartonella haenselae and Leishmania spp. Twenty-one months later the cat was presented again because of development of keratitis and granulomatous blepharitis. Blood cell count revealed severe Pancytopenia; Cytology of fine needle aspirates of granulomatous lesions on both upper eyelids and of a corneal smear revealed intracytoplasmatic microorganisms. A preliminary diagnosis of leishmaniasis was supported by positive polymerase chain reaction from bone marrow and eyelid samples for Leishmania infantum DNA and by a high serum antibody titer for Leishmania spp. Treatment with Allopurinol (10 mg/kg, BID) orally led to rapid improvement of ocular signs, general condition and blood cell count with complete remission of lid and corneal lesions within 2 months of treatment.
Panahi, Yunes; Roshandel, Danial; Sadoughi, Mohammad Mehdi; Ghanei, Mostafa; Sahebkar, Amirhossein
Sulfur mustard (SM; mustard gas) is a classic chemical warfare agent that has been used in several wars and is still a potential threat especially in the Middle-East region. Victims experience acute symptoms in airexposed organs including skin, respiratory tract and the eyes. Survivors of the acute stage might develop chronic or delayed-onset complications in the exposed organs. The exact mechanism(s) of SM-induced tissue damage is still unknown, however DNA alkylation and oxidative damage are the most relevant mechanisms. Eye is the most sensitive organ to the SM vapor and ocular symptoms usually precede other manifestations. Ocular findings including blepharitis, dry eye disease, corneal vascularization, persistent epithelial defects, limbal ischemia, limbal stem cell deficiency, corneal thinning, corneal opacity and corneal innervation abnormalities have been reported several years after SM exposure. In this review, mechanisms of acute and chronic/delayed ocular manifestations of SM and their current management and potential future therapies have been discussed. We have also included recent advances in amniotic membrane transplantation, cultivated stem cell transplantation and anti-angiogenic therapies which might be considered as therapeutic options in SM-induced ocular damage in the future. Copyright© Bentham Science Publishers; For any queries, please email at firstname.lastname@example.org.
Full Text Available A 4-year-old Rahmani breed ewe was presented for surgery to the Veterinary Teaching Hospital, South Valley University, Egypt with enlargement and protrusion of the eye ball, blepharitis and congestion of the conjunctiva. On examination, a cyst 2.5 cm x 3.5 cm in diameter containing sandy fluid was detected in the perioptic nerve fat. Histopathological examination revealed that the epithelial lining of the conjunctiva was necrotic and severely infiltrated by neutrophils. The underlying connective tissue was oedematous, hyperaemic and severely infiltrated by neutrophils. Desquamation of the corneal epithelium was seen, together with oedema of the stroma. The tissue surrounding the cyst was compressed and the lacrimal glands revealed pressure atrophy. The muscular tissue was atrophied and infiltrated by fat cells. The cyst wall was lined with white scolices protruding from the inner wall. Based on the gross and histopathological characteristics of the cyst observed, the cyst was diagnosed as Coenurus cerebralis. This is the first report of orbital coenurosis in a sheep.
Gokturk, Bahar; Topcu-Yilmaz, Pinar; Bozkurt, Banu; Yildirim, Mahmut Selman; Guner, Sukru Nail; Sayar, Esra Hazar; Reisli, Ismail
To identify the ocular features of children diagnosed as having 22q11.2 deletion syndrome in a Turkish population, which is the most common microdeletion syndrome with a wide range of facial and ocular abnormalities. Sixteen children aged between 4 months and 18 years with a microdeletion in chromosome 22q11.2 underwent a detailed ophthalmological examination including uncorrected and best corrected visual acuity testing, stereoscopic vision examination, biomicroscopic and indirect fundus examination, and ocular motility testing. All patients had at least one ocular abnormality. The major abnormalities were eyelid abnormalities (eye hooding, narrow palpebral fissure, telecanthus, hypertelorism, sparse and thin eyebrows and eyelashes, blepharitis, and distichiasis), posterior embryotoxon, and tortuous retinal vessels in at least half of the patients. Other ophthalmological disorders were refractive errors, iris remnants, and strabismus. The chromosome 22q11.2 deletion syndrome is associated with a wide range of ocular disorders, which necessitates a comprehensive eye examination for appropriate treatment and follow-up. Ocular findings sometimes can provide a clue to the diagnosis of 22q11.2 deletion. [J Pediatr Ophthalmol Strabismus. 2016;53(4):218-222]. Copyright 2016, SLACK Incorporated.
Novy, Pavel; Davidova, Hana; Serrano-Rojero, Cecilia Suqued; Rondevaldova, Johana; Pulkrabek, Josef
Eyebright, Euphrasia rostkoviana Hayne (Scrophulariaceae), is a medicinal plant traditionally used in Europe for the treatment of various health disorders, especially as eyewash to treat eye ailments such as conjunctivitis and blepharitis that can be associated with bacterial infections. Some Euphrasia species have been previously reported to contain essential oil. However, the composition and bioactivity of E. rostkoviana oil are unknown. Therefore, in this study, we investigated the chemical composition and antimicrobial activity of the eyebright essential oil against some organisms associated with eye infections: Enterococcus faecalis, Escherichia coli, Klebsiella pneumoniae, Staphylococcus aureus, S. epidermidis, Pseudomonas aeruginosa, and Candida albicans. GC-MS analysis revealed more than 70 constituents, with n-hexadecanoic acid (18.47%) as the main constituent followed by thymol (7.97%), myristic acid (4.71%), linalool (4.65%), and anethole (4.09%). The essential oil showed antimicrobial effect against all organisms tested with the exception of P. aeruginosa. The best activity was observed against all Gram-positive bacteria tested with the minimum inhibitory concentrations of 512 µg/mL. This is the first report on the chemical composition of E. rostkoviana essential oil and its antimicrobial activity. PMID:26000025
Full Text Available Eyebright, Euphrasia rostkoviana Hayne (Scrophulariaceae, is a medicinal plant traditionally used in Europe for the treatment of various health disorders, especially as eyewash to treat eye ailments such as conjunctivitis and blepharitis that can be associated with bacterial infections. Some Euphrasia species have been previously reported to contain essential oil. However, the composition and bioactivity of E. rostkoviana oil are unknown. Therefore, in this study, we investigated the chemical composition and antimicrobial activity of the eyebright essential oil against some organisms associated with eye infections: Enterococcus faecalis, Escherichia coli, Klebsiella pneumoniae, Staphylococcus aureus, S. epidermidis, Pseudomonas aeruginosa, and Candida albicans. GC-MS analysis revealed more than 70 constituents, with n-hexadecanoic acid (18.47% as the main constituent followed by thymol (7.97%, myristic acid (4.71%, linalool (4.65%, and anethole (4.09%. The essential oil showed antimicrobial effect against all organisms tested with the exception of P. aeruginosa. The best activity was observed against all Gram-positive bacteria tested with the minimum inhibitory concentrations of 512 µg/mL. This is the first report on the chemical composition of E. rostkoviana essential oil and its antimicrobial activity.
Detection of Acanthamoeba on the ocular surface in a Spanish population using the Schirmer strip test: pathogenic potential, molecular classification and evaluation of the sensitivity to chlorhexidine and voriconazole of the isolated Acanthamoeba strains.
Rocha-Cabrera, Pedro; Reyes-Batlle, María; Martín-Navarro, Carmen María; Dorta-Gorrín, Alexis; López-Arencibia, Atteneri; Sifaoui, Ines; Martínez-Carretero, Enrique; Piñero, José E; Martín-Barrera, Fernando; Valladares, Basilio; Lorenzo-Morales, Jacob
Pathogenic strains of Acanthamoeba are causative agents of a sight-threatening infection of the cornea known as Acanthamoeba keratitis, which is often associated with the misuse of contact lenses. However, there is still a question remaining to be answered, which is whether these micro-organisms are present on the ocular surface of healthy individuals. Therefore, the aim of this study was to determine the presence of Acanthamoeba on the ocular surface in healthy patients and also in those with other ocular surface infections. Sterile Schirmer test strips were used to collect samples from a group of patients who attended an ophthalmology consultation at the Hospital del Norte, Icod de los Vinos, Tenerife, Canary Islands. Most of the patients (46 individuals, 79.31 %) presented ocular surface pathologies such as blepharitis or conjunctivitis; the rest did not present any pathology. None of the patients included in the study wore contact lenses. The collected samples were cultured in 2 % non-nutrient agar plates and positive plates were then cultured in axenic conditions for further analyses. Molecular analysis classified all isolated strains as belonging to Acanthamoeba genotype tbl4, and osmotolerance and thermotolerance assays revealed that all strains were potentially pathogenic. Furthermore, all strains were assayed for sensitivity against voriconazole and chlorhexidine. Assays showed that both drugs were active against the tested strains. In conclusion, the Schirmer strip test is proposed as an effective tool for the detection of Acanthamoeba on the ocular surface.
Milner, Mark S.; Beckman, Kenneth A.; Luchs, Jodi I.; Allen, Quentin B.; Awdeh, Richard M.; Berdahl, John; Boland, Thomas S.; Buznego, Carlos; Gira, Joseph P.; Goldberg, Damien F.; Goldman, David; Goyal, Raj K.; Jackson, Mitchell A.; Katz, James; Kim, Terry; Majmudar, Parag A.; Malhotra, Ranjan P.; McDonald, Marguerite B.; Rajpal, Rajesh K.; Raviv, Tal; Rowen, Sheri; Shamie, Neda; Solomon, Jonathan D.; Stonecipher, Karl; Tauber, Shachar; Trattler, William; Walter, Keith A.; Waring, George O.; Weinstock, Robert J.; Wiley, William F.; Yeu, Elizabeth
Dysfunctional tear syndrome (DTS) is a common and complex condition affecting the ocular surface. The health and normal functioning of the ocular surface is dependent on a stable and sufficient tear film. Clinician awareness of conditions affecting the ocular surface has increased in recent years because of expanded research and the publication of diagnosis and treatment guidelines pertaining to disorders resulting in DTS, including the Delphi panel treatment recommendations for DTS (2006), the International Dry Eye Workshop (DEWS) (2007), the Meibomian Gland Dysfunction (MGD) Workshop (2011), and the updated Preferred Practice Pattern guidelines from the American Academy of Ophthalmology pertaining to dry eye and blepharitis (2013). Since the publication of the existing guidelines, new diagnostic techniques and treatment options that provide an opportunity for better management of patients have become available. Clinicians are now able to access a wealth of information that can help them obtain a differential diagnosis and treatment approach for patients presenting with DTS. This review provides a practical and directed approach to the diagnosis and treatment of patients with DTS, emphasizing treatment that is tailored to the specific disease subtype as well as the severity of the condition. PMID:28099212
KLINE, ANTONIE D.; GRADOS, MARCO; SPONSELLER, PAUL; LEVY, HOWARD P.; BLAGOWIDOW, NATALIE; SCHOEDEL, CHRISTIANNE; RAMPOLLA, JONI; CLEMENS, DOUGLAS K.; KRANTZ, IAN; KIMBALL, AMY; PICHARD, CARMEN; TUCHMAN, DAVID
Observations about the natural history of aging in Cornelia de Lange syndrome (CdLS) are made, based on 49 patients from a multidisciplinary clinic for adolescents and adults. The mean age was 17 years. Although most patients remain small, obesity may develop. Gastroesophageal reflux persists or worsens, and there are early long-term sequelae, including Barrett esophagus in 10%; other gastrointestinal findings include risk for volvulus, rumination, and chronic constipation. Submucous cleft palate was found in 14%, most undetected before our evaluation. Chronic sinusitis was noted in 39%, often with nasal polyps. Blepharitis improves with age; cataracts and detached retina may occur. Decreased bone density is observed, with occasional fractures. One quarter have leg length discrepancy and 39% scoliosis. Most females have delayed or irregular menses but normal gynecologic exams and pap smears. Benign prostatic hypertrophy occurred in one male prior to 40 years. The phenotype is variable, but there is a distinct pattern of facial changes with aging. Premature gray hair is frequent; two patients had cutis verticis gyrata. Behavioral issues and specific psychiatric diagnoses, including self-injury, anxiety, attention-deficit disorder, autistic features, depression, and obsessive-compulsive behavior, often worsen with age. This work presents some evidence for accelerated aging in CdLS. Of 53% with mutation analysis, 55% demonstrate a detectable mutation in NIPBL or SMC1A. Although no specific genotype–phenotype correlations have been firmly established, individuals with missense mutations in NIPBL and SMC1A appear milder than those with other mutations. Based on these observations, recommendations for clinical management of adults with CdLS are made. PMID:17640042
Angmo, Dewang; Patil, Bharat; Agarwal, Rohit; Mohanty, Kuldeep; Singh, Archita
Ichthyosis is known to have ocular associations such as blepharitis, hypertrophic conjunctivitis, corneal vascularization, ectropion, lagophthalmos, etc. However, no reports of its association with glaucoma are there, to the best of our knowledge. We report a unique case of juvenile open-angle glaucoma (JOAG) with lamellar ichthyosis. A 16-year-old male child presented with a gradual, painless progressive diminution of vision in both eyes over a period of 3 years. Systemic examination revealed stunted body growth with knock-knees, suggestive of late-onset rickets. Generalized dry scaly lesions with erythema, along with hyperkeratosis of the palms and the soles, suggestive of lamellar ichthyosis were present. On ocular examination, the intraocular pressure was 36 mm Hg; optic nerve head examination revealed a horizontally oval disc with near total cupping in the right eye and total cupping in the left eye, with extensive neuroretinal rim thinning and pallor. Gonioscopy showed wide open angles with prominent iris processes. Screening of JOAG-associated genes (MYOC, NTF4, WDR36, and CYP1B1) and ichthyosis-associated gene (TGM1) was performed by the direct PCR-sequencing method. A diagnosis of JOAG with advanced glaucomatous optic neuropathy with lamellar ichthyosis and rickets was made. The patient underwent right followed by left eye trabeculectomy with 0.2 mg/dL MMC (for 1 min). Postoperatively, the intraocular pressure was 8 mm Hg at 1 week, and 12 to 14 mm Hg at the 6-week, the 3-month, and the 6-month follow-up, and the visual acuity was maintained in the right eye. No mutations in MYOC, NTF4, WDR36, CYP1B1, and TGM1 were observed in the patient and his family. An association of glaucoma with ichthyosis should be kept in mind. Therefore, a detailed baseline ocular examination in children with ichthyosis is required, as early detection of glaucoma could prevent irreversible blindness.
Full Text Available PURPOSE: Fluoroquinolones are antimicrobial agents that have a broad spectrum of activity and are widely used against many of the ocular pathogens, responsible for conjunctivitis, blepharitis, corneal ulcers etc. The aim of our study was to evaluate the ocular pharmacokinetics of sparfloxacin (0.3% w/v in the aqueous humour of rabbits. MATERIALS AND METHODS: Pharmacokinetics of topically administered sparfloxacin were determined after a single application of 50 µl topically. The aqueous humour samples were collected at 0, 0.25, 0.5, 1, 2, 3, 4, 5 or 6 hours after instillation. High Performance Thin Layer Chromatographic method was used to analyse the drug concentration in the aqueous humour samples. RESULTS: Fifteen minutes after the instillation of 50 µl of sparfloxacin 0.3% solution, the mean concentration in aqueous humour was found to be 1.4 µg/ml, which reaches the peak level of 3.7 µg/ml after 1.3 hours. At 6 hours, the sparfloxacin aqueous levels were 0.562 µg/ml. The clinical efficacy was predicted based on the Maximum Concentration (Cmax: Minimum Inhibitory Concentration (MIC and Area Under the Concentration-time curve (AUC:MIC ratios. CONCLUSION: The sparfloxacin levels in aqueous humour of rabbits are sufficiently high up to the 6 hours after instillation in the conjunctival sac to provide bactericidal effect against most of the ocular pathogens. Both Cmax:MIC and AUC:MIC ratios are high enough to provide bactericidal effect against most of the ocular pathogens. Sparfloxacin (0.3% ophthalmic preparation has excellent penetration through cornea.
Kanda, Yoshiko; Kayama, Tomoko; Okamoto, Shinji; Hashimoto, Masako; Ishida, Chiemi; Yanai, Tomoko; Fukumoto, Mitsuru; Kunihiro, Eiichi
Levofloxacin 0.5% ophthalmic solution is an antibacterial formulation, which was approved and marketed for the treatment of ocular infections in Japan in 2000. This study was designed to investigate the safety and efficacy of levofloxacin 0.5% ophthalmic solution in patients who received treatment for external ocular bacterial infections in regular clinical practice. Patients were recruited from more than 800 medical facilities in Japan, in accordance with Japanese Ministry of Health, Labour and Welfare ordinance guidelines. They were followed during three distinct time periods: April 2000 to December 2001, January 2002 to June 2003, and July 2003 to December 2004. Information from 6760 patients receiving levofloxacin for the treatment of a variety of ocular infections was collected. Levofloxacin was well tolerated: adverse drug reactions (ADRs) were reported in 42 of 6686 patients (0.63%), with no serious ADRs reported. The most commonly reported ADRs were ocular disorders such as blepharitis, eye irritation, and punctate keratitis. The incidence of ADRs did not differ significantly with age, but it was significantly higher in females (0.82%) than in males (0.36%; p = 0.028). A clinical response was observed in 95.5% of patients receiving levofloxacin, with no difference in response between the three time periods. The rate of response to levofloxacin by bacterial disease ranged from 97.4% in keratitis to 88.3% in dacryocystitis. The rate was lower in patients with dacryocystitis, elderly patients, patients with a long duration of illness, and relapsing cases (all p marketing surveillance of levofloxacin, conducted over 4 years, confirms the safety and efficacy of levofloxacin in regular clinical use and highlights that levofloxacin is a promising treatment for a variety of external ocular bacterial infections.
Full Text Available AIM: To investigate the relationship between chronic epiphora and meibomianitis, and to explore the efficacy of the meibomianitis treatment to improve chronic tearing.METHODS: One thousand chronic epiphora patients chart review in Casey eye institute during 2000-2009. Review of 206(20.6%chronic epiphora patients who underwent slit lamp examination were diagnosed meibomianitis. Diagnostic criteria were meibomian gland dysfunction, blepharitis, lid margin telangiectasia and hyperaemia punctuate superficial keratopathy. Treatment included maintenance of lid hygene, use of artificial tears, systemic and topical antibiotics, warm and moist compresses, topical corticosteroid and diet supplementation with Omega-3 fatty acids.RESULTS: Among all the patients, 206(20.6%meibomianitis patients(average age 65.8 years, average tearing time 2.78 years. White patients 196(95%; female 106(51.5%, male 100(48.5%. Average follow up time was 5.07mo. 152(73.79%of 206 meibomianitis patients with tearing got improved through treatments. 43(20.87%patients were treated without improvement. The failure reasons cannot be found in 14(6.81%of 43 patients. 29(14.08%of 43 pateients with chronic epiphora do not want to treat for a long time, which cause the treatment failure. 11(5.34%of 206 meibomianitis patients lost to follow up.CONCLUSION: The patients who presented to our office for the tearing 20.6% had meibomianitis. Through treatment of meibomianitis, tearing improved 73.78%. So patients with meibomianitis should treat it actively. Some tearing patients after the surgery still tearing should pay attention to treat meibomianitis.
Bowen, Randy C; Koeppel, Jan N; Christensen, Chance D; Snow, Karisa B; Ma, Junjie; Katz, Bradley J; Krauss, Howard R; Landau, Klara; Warner, Judith E A; Crum, Alison V; Straumann, Dominik; Digre, Kathleen B
Eye pain is a common complaint, but no previous studies have determined the most common causes of this presenting symptom. Our objective was to determine the most common causes of eye pain in 2 ophthalmology and neurology departments at academic medical centers. This was a retrospective cross-sectional analysis and chart review at the departments of ophthalmology and neurology at the University Hospital Zurich (USZ), University of Zürich, Switzerland, and the University of Utah (UU), USA. Data were analyzed from January 2012 to December 2013. We included patients aged 18 years or older presenting with eye pain as a major complaint. Two thousand six hundred three patient charts met inclusion criteria; 742 were included from USZ and 1,861 were included from UU. Of these, 2,407 had been seen in an ophthalmology clinic and 196 had been seen in a neurology clinic. Inflammatory eye disease (conjunctivitis, blepharitis, keratitis, uveitis, dry eye, chalazion, and scleritis) was the underlying cause of eye pain in 1,801 (69.1%) of all patients analyzed. Although only 71 (3%) of 2,407 patients had migraine diagnosed in an ophthalmology clinic as the cause of eye pain, migraine was the predominant cause of eye pain in the neurology clinics (100/196; 51%). Other causes of eye pain in the neurology clinics included optic neuritis (44 patients), trigeminal neuralgia, and other cranial nerve disorders (8 patients). Eye pain may be associated with a number of different causes, some benign and others sight- or life-threatening. Because patients with eye pain may present to either a neurology or an ophthalmology clinic and because the causes of eye pain may be primarily ophthalmic or neurologic, the diagnosis and management of these patients often requires collaboration and consultation between the 2 specialties.
Singh, Veer; Malik, K P S; Malik, V K; Jain, Kirti
This study aims to evaluate the prevalence and to make a comparison between the ocular morbidity pattern in school going children of urban and rural areas of West Uttar Pradesh. A school-based cross-sectional study design was adopted to examine children aged 5-15 years in randomly selected urban and rural schools of West Uttar Pradesh from June 2012 to August 2014. An optometrist did the vision and refraction, and a detailed ophthalmic examination was done by an ophthalmologist. Children needing further assessment were referred to a higher center. Interpretation and analysis of the data were done using Epi Info Software and t-test. A total of 4838 students (2271 males and 2567 females) were screened. The prevalence of ocular morbidity was 29.35% (28.65% urban, 30.05% rural). Refractive error (17.36%) was the major cause of ocular morbidity followed by convergence insufficiency (2.79%), blepharitis (2.11%), Vitamin A deficiency (2.09%), allergic conjunctivitis (1.92%), bacterial conjunctivitis (0.95%), amblyopia (0.41%), stye (0.31%) and squint (0.27%). There was an increase in ocular morbidity with age, especially in refractive error and convergence insufficiency. On comparing urban and rural schools, Vitamin A deficiency showed a significantly higher prevalence (P prevalence of visual impairment was 4.9/1000 children, and prevalence of blindness was 0.62/1000 children. This study was the first of its kind in West Uttar Pradesh, reporting a considerable high prevalence (29.35%) of pediatric ocular morbidity, which was more in rural as compared to the urban sector. Since most of this morbidity is either preventable or treatable, school screening forms an effective method to reduce this load.
Baser, Gonen; Yildiz, Nurdan; Calan, Mehmet
Purpose/Aim of the study: The purpose of this study was to evaluate the interaction between Polycystic ovary syndrome (PCOS) and Meibomian gland dysfunction (MGD) and obesity, to reveal whether there is a correlation between the testosterone levels and body-mass index (BMI) levels and the dry-eye complaints of these patients. The study included 92 patients with PCOS and 52 healthy patients from March 2013 to March 2014. All patients underwent a physical examination, pelvic ultrasound, and clinical and biochemical tests, including free testosterone levels to confirm the diagnosis of PCOS. The BMIs of all subjects were recorded. In addition, the presence of posterior blepharitis, as an indicator of MGD, was recorded. All patients underwent the dry-eye tests including Schirmer 1 and tear film break-up time (BUT). Complaints of dry-eye of the patients were evaluated with the ocular surface disease index (OSDI) questionnaire. The scores of both groups were compared. The presence of MGD was 72.82% in the PCOS group and 61.53% in the control group. There was no correlation between the testosterone levels and study parameters in both groups. BUT levels negatively correlated with BMI in subjects without PCOS (r = -0.520, p = 0.001), whereas positively correlated with MGD and OSDI scores (r = 0.610, p = 0.632; p = 0.001, p = 0.001; respectively). Tear film instability due to MGD is common in PCOS and in subjects with high BMI. The MGD in PCOS patients is independent of the BMI.
Full Text Available Vladimir Vsevolodovich Brjesky,1 Yury Fedorovich Maychuk,2 Alexey Vladimirovich Petrayevsky,3 Peter Gerrievich Nagorsky41Department of Ophthalmology, Pediatric State Medical Academy, Saint Petersburg, 2Moscow Research Institute of Eye Diseases, Moscow, 3Department of Ophthalmology, Volgograd State Medical University, Volgograd, 4Novosibirsk Branch of the Federal State Institute MNTK Eye Microsurgery, Novosibirsk, Russian Federation, RussiaAbstract: Artificial tear preparations are important in the management of dry eye syndrome. We present the findings from four recently published studies conducted in Russia assessing Hylabak® (marketed as Hyabak® in Europe, a preservative-free hyaluronic acid preparation, for the treatment of dry eye syndrome. All studies had an open, noncomparative design, but one compared the findings with those from 25 patients treated with Tear Naturale® in previous studies. A total of 134 children and adults were enrolled, and the etiologies of dry eye syndrome included contact lens use, intensive office work, adenovirus eye infection, postmenopausal status, persistent meibomian blepharitis, Sjögren's syndrome, phacoemulsification with intraocular lens implantation, and refractive surgery. The patients were treated with Hylabak for 2 weeks to 2 months. All studies showed that Hylabak resulted in marked improvement as assessed by subjective sensations/complaints, Schirmer's test, Norn’s test, impression cytology and biomicroscopy, staining, and tear osmolarity. Greater benefits were also reported compared with Tear Naturale, including a faster onset of action. Hylabak was well tolerated. In conclusion, Hylabak provided rapid and safe relief from the signs and symptoms of dry eye syndrome, as well as improvement in objective measures, in a wide range of patients.Keywords: dry eye, eye drops, artificial tears, hyaluronic acid, Hylabak®, preservative-free
Liu, Yang; Kam, Wendy R.; Ding, Juan; Sullivan, David A.
Drug-induced phospholipidosis (PLD) is a common adverse effect which has led to the termination of clinical trials for many candidate pharmaceuticals. However, this lipid-inducing effect may be beneficial in the treatment of meibomian gland dysfunction (MGD). MGD is the major cause of dry eye disease (DED), which affects 40 million people in the USA and has no cure. Azithromycin (AZM) is a PLD-inducing antibiotic that is used off-label to treat MGD, and is presumably effective because it suppresses the MGD-associated conjunctival inflammation (i.e. posterior blepharitis) and growth of lid bacteria. We hypothesize that AZM can act directly to promote the function of human meibomian gland epithelial cells by inducing PLD in these cells, characterized by the accumulation of lipids and lysosomes. Immortalized human meibomian gland epithelial cells (HMGEC) were cultured with or without azithromycin for 5 days. Cells were evaluated for cholesterol (Filipin) and neutral lipid (LipidTox) staining, as well as the appearance of lysosomes (LysoTracker) and lamellar bodies (transmission electron microscopy, TEM). The lipid composition of cellular lysates was analyzed by high performance thin-layer chromatography. Our findings demonstrate that AZM stimulates the accumulation of free cholesterol, neutral lipids and lysosomes in HMGEC. This AZM-induced increase of neutral lipid content occurred predominantly within lysosomes. Many of these vesicles appeared to be lamellar bodies by TEM, which is the characteristic of PLD. Our findings also show that AZM promotes an accumulation of free and esterified cholesterol, as well as phospholipids in HMGECimmortalized. Our results support our hypothesis and confirm the beneficial effect of PLD induced by AZM on HMGEC. Our discovery reveals a new potential use of PLD-inducing drugs, and makes this adverse effect a beneficial effect
İlkay Kılıç Müftüoğlu
Full Text Available Objectives: To report the clinical features, treatment options and complications in patients with ocular rosacea. Materials and Methods: The records of 48 eyes of 24 patients with ocular rosacea were retrospectively reviewed. Patients’ ocular signs and symptoms were scored between 1 and 4 points according to disease severity; tear film break-up time (BUT and Schirmer’s test results were recorded before and after the treatment. Preservative-free artificial tears, topical antibiotic eye drops/ointments, short-term topical corticosteroids, topical 0.05% cyclosporine and oral doxycycline treatment were applied as a standard therapy to all patients. Additional treatments were given as needed. Complications were recorded. Results: Twenty-four patients with a mean age of 48.5±35.4 (32-54 years were followed for a mean 15±9.4 (8-36 months. Ocular findings included meibomitis in 100% of cases, anterior blepharitis in 83% (40 eyes, punctate keratopathy in 67% (32 eyes, chalazia in 50% (24 eyes, corneal neovascularization in 50% (24 eyes and subepithelial infiltrates in 16.6% (8 eyes. Significant improvement of symptoms and clinical findings were achieved in all patients with treatment. The increases in Schirmer’s test and BUT were 3.3±1.5 and 4.5±2.8, respectively (p<0.05. Descemetocele and small corneal perforation occurred in 2 eyes; re-epithelialization was achieved in both eyes with tissue adhesive application (1 eye and additional amniotic membrane transplantation (1 eye. Four eyes of three patients showed significant regression of corneal neovascularization with topical bevacizumab therapy. Conclusion: Ocular rosacea may present with a variety of ophthalmic signs. It is possible to control the ophthalmic disease with appropriate therapeutic modalities including topical corticosteroids, topical cyclosporine and systemic doxycycline.
Singh, Veer; Malik, K P S; Malik, V K; Jain, Kirti
Aim of the Study: This study aims to evaluate the prevalence and to make a comparison between the ocular morbidity pattern in school going children of urban and rural areas of West Uttar Pradesh. Materials and Methods: A school-based cross-sectional study design was adopted to examine children aged 5–15 years in randomly selected urban and rural schools of West Uttar Pradesh from June 2012 to August 2014. An optometrist did the vision and refraction, and a detailed ophthalmic examination was done by an ophthalmologist. Children needing further assessment were referred to a higher center. Interpretation and analysis of the data were done using Epi Info Software and t-test. Results: A total of 4838 students (2271 males and 2567 females) were screened. The prevalence of ocular morbidity was 29.35% (28.65% urban, 30.05% rural). Refractive error (17.36%) was the major cause of ocular morbidity followed by convergence insufficiency (2.79%), blepharitis (2.11%), Vitamin A deficiency (2.09%), allergic conjunctivitis (1.92%), bacterial conjunctivitis (0.95%), amblyopia (0.41%), stye (0.31%) and squint (0.27%). There was an increase in ocular morbidity with age, especially in refractive error and convergence insufficiency. On comparing urban and rural schools, Vitamin A deficiency showed a significantly higher prevalence (P < 0.05%) in the rural (3.03%) as compared to the urban sector (1.15%). The prevalence of visual impairment was 4.9/1000 children, and prevalence of blindness was 0.62/1000 children. Conclusion: This study was the first of its kind in West Uttar Pradesh, reporting a considerable high prevalence (29.35%) of pediatric ocular morbidity, which was more in rural as compared to the urban sector. Since most of this morbidity is either preventable or treatable, school screening forms an effective method to reduce this load. PMID:28643716
Full Text Available Aim of the Study: This study aims to evaluate the prevalence and to make a comparison between the ocular morbidity pattern in school going children of urban and rural areas of West Uttar Pradesh. Materials and Methods: A school-based cross-sectional study design was adopted to examine children aged 5–15 years in randomly selected urban and rural schools of West Uttar Pradesh from June 2012 to August 2014. An optometrist did the vision and refraction, and a detailed ophthalmic examination was done by an ophthalmologist. Children needing further assessment were referred to a higher center. Interpretation and analysis of the data were done using Epi Info Software and t-test. Results: A total of 4838 students (2271 males and 2567 females were screened. The prevalence of ocular morbidity was 29.35% (28.65% urban, 30.05% rural. Refractive error (17.36% was the major cause of ocular morbidity followed by convergence insufficiency (2.79%, blepharitis (2.11%, Vitamin A deficiency (2.09%, allergic conjunctivitis (1.92%, bacterial conjunctivitis (0.95%, amblyopia (0.41%, stye (0.31% and squint (0.27%. There was an increase in ocular morbidity with age, especially in refractive error and convergence insufficiency. On comparing urban and rural schools, Vitamin A deficiency showed a significantly higher prevalence (P < 0.05% in the rural (3.03% as compared to the urban sector (1.15%. The prevalence of visual impairment was 4.9/1000 children, and prevalence of blindness was 0.62/1000 children. Conclusion: This study was the first of its kind in West Uttar Pradesh, reporting a considerable high prevalence (29.35% of pediatric ocular morbidity, which was more in rural as compared to the urban sector. Since most of this morbidity is either preventable or treatable, school screening forms an effective method to reduce this load.
Liu, Yang; Kam, Wendy R; Ding, Juan; Sullivan, David A
Drug-induced phospholipidosis (PLD) is a common adverse effect which has led to the termination of clinical trials for many candidate pharmaceuticals. However, this lipid-inducing effect may be beneficial in the treatment of meibomian gland dysfunction (MGD). MGD is the major cause of dry eye disease (DED), which affects 40 million people in the USA and has no cure. Azithromycin (AZM) is a PLD-inducing antibiotic that is used off-label to treat MGD, and is presumably effective because it suppresses the MGD-associated conjunctival inflammation (i.e. posterior blepharitis) and growth of lid bacteria. We hypothesize that AZM can act directly to promote the function of human meibomian gland epithelial cells by inducing PLD in these cells, characterized by the accumulation of lipids and lysosomes. Immortalized human meibomian gland epithelial cells (HMGEC) were cultured with or without azithromycin for 5 days. Cells were evaluated for cholesterol (Filipin) and neutral lipid (LipidTox) staining, as well as the appearance of lysosomes (LysoTracker) and lamellar bodies (transmission electron microscopy, TEM). The lipid composition of cellular lysates was analyzed by high performance thin-layer chromatography. Our findings demonstrate that AZM stimulates the accumulation of free cholesterol, neutral lipids and lysosomes in HMGEC. This AZM-induced increase of neutral lipid content occurred predominantly within lysosomes. Many of these vesicles appeared to be lamellar bodies by TEM, which is the characteristic of PLD. Our findings also show that AZM promotes an accumulation of free and esterified cholesterol, as well as phospholipids in HMGECimmortalized. Our results support our hypothesis and confirm the beneficial effect of PLD induced by AZM on HMGEC. Our discovery reveals a new potential use of PLD-inducing drugs, and makes this adverse effect a beneficial effect. Copyright © 2014 Elsevier Ireland Ltd. All rights reserved.
Jones, Sophie M; Weinstein, Joel M; Cumberland, Phillippa; Klein, N; Nischal, Ken K
To describe the cause, management, and effect of chronic blepharokeratoconjunctivitis (BKC) on the cornea and visual function in children. Noncomparative, interventional, retrospective case series. Twenty-seven children with BKC. Presenting age, best-corrected visual acuity (BCVA), refractive error, and any corneal or eyelid pathologic features were recorded. Treatment included modified lid hygiene, topical antibiotics, and steroids. Systemic therapy included oral antibiotics and, from 2003 onward, flaxseed oil as an alternative to long-term antibiotics. Amblyopia therapy included refractive correction, occlusion, or atropine therapy. Corneal and eyelid status, visual acuity (VA), and refractive error at final examination. Mean age at presentation was 6.9 years (range, 7 months-15.9 years), and mean follow-up was 2.3 years (range, 5 months-6.1 years). All patients had discomfort, conjunctival injection, and signs of posterior blepharitis at presentation. Photophobia was reported in 14 patients (52%), whereas anterior eyelid inflammation was noted in 6 (22%). Acne rosacea was confirmed in 3 patients (11%). Corneal involvement occurred in 44 eyes (81%), and a history of recurrent chalazia was seen in 18 patients (67%). Median monocular BCVAs in affected eyes were 0.28 logarithm of the minimum angle of resolution (logMAR) units (interquartile range [IqR], 0.02-0.40) at presentation and 0.02 logMAR units (IqR, 0.00-0.18) at last visit. Best-corrected VA improved in 70% of affected eyes and remained unchanged in 30%. Superimposed amblyopia was present and treated in 15 patients (48%). All 8 patients (20%) who failed to achieve VA of 0.2 logMAR units or better at the final examination had bilateral corneal involvement at presentation. One child experienced a systemic side effect from oral antibiotics. No child had significant side effects from topical treatment. Twelve patients (44%) received flaxseed oil as part of their tapering regimen. A 2-year lag between symptom
Full Text Available Yusuke Shimizu,1 Hiroshi Toshida,1 Rio Honda,1 Asaki Matsui,1 Toshihiko Ohta,1 Yousuke Asada,2 Akira Murakami2 1Department of Ophthalmology, Juntendo University Shizuoka Hospital, Shizuoka, Japan; 2Department of Ophthalmology, Juntendo University School of Medicine, Tokyo, Japan Purpose: To investigate the microbial isolates from patients with ocular infections and the trend in the emergence of levofloxacin-resistant strains over the past four years from 2006 to 2009 retrospectively. Patients and methods: The subjects were 242 patients with ocular infections or traumas treated in our hospital including outpatients, inpatients, and emergency room patients. Most of them needed urgent care presenting with eye complaints, traumas, or decreased vision. Clinical samples were obtained from discharges, corneal, conjunctival tissues or vitreous fluid or aqueous humor, and cultured. Items for assessment included the patient’s age, the diagnosis, the prevalence of isolated bacteria, and the results of susceptibility tests for levofloxacin (LVFX cefamezin (CEZ, gentamicin (GM and vancomycin. This information was obtained from the patients’ medical records. Results: There were 156 male patients and 86 female patients who were aged from 2 months old to 94 years old and mean age was 56.8 ± 24.2 years. Of the 242 patients, 78 (32.2% had positive cultures. The culture-positive rate was significantly higher in male patients than female in total (P = 0.002 and in patients with corneal perforation (P = 0.005. Corneal perforation was the highest culture-positive rate (60.0%, followed by orbital cellulitis (56.5%, blepharitis (50.0%, dacryoadenitis (45.5%, conjunctivitis (38.2%, infectious corneal ulcer (28.5% and endophthalmitis (24.7%. LVFX-resistant strains accounted for 40 out of a total of 122 strains (32.8%, and the minimum inhibitory concentration (MIC was significantly higher in LVFX and GM compared with the other antibiotics. There were no vancomycin
day, may be beneficial in the treatment of MGD, mainly by improving tear stability. Keywords: blepharitis, dry eye, ocular inflammation, eye discomfort, surface disease
Meera Suresh Joshi
blepharitis. Almost, 10% children with cerebral palsy had optic atrophy and 25% of those with Down syndrome had cataracts. CONCLUSION Ocular disorders are commonly seen in children with developmental delay. Refractive errors and strabismus are commonest and can easily be treated. Early diagnosis, prompt intervention and a close follow up are essential in order to prevent amblyopia.
Zhang, Lili; Su, Zhitao; Zhang, Zongduan; Lin, Jing; Li, De-Quan; Pflugfelder, Stephen C.
IMPORTANCE Topical application of azithromycin suppresses expression of proinflammatory mediators while restoring transforming growth factor β1 (TGF-β1) levels as evaluated by eyelid margin and conjunctival impression cytology. OBJECTIVE To explore the effects of azithromycin therapy on expression of proinflammatory and anti-inflammatory mediators in meibomian gland disease (MGD). DESIGN, SETTING, AND PARTICIPANTS Case-control study performed in a clinic setting from August 17, 2010, to December 31, 2010. Sixteen patients with posterior blepharitis and conjunctival inflammation due to MGD were treated with azithromycin, 1%, drops for 4 weeks. Impression cytology of the lower eyelid margin and tarsal conjunctiva to measure cytokine expression by quantitative real-time polymerase chain reaction as well as tear collection to measure matrix metalloproteinase 9 (MMP-9) activity were performed once in 8 asymptomatic healthy control participants and 5 times in the 16 symptomatic patients (every 2 weeks for 8 weeks), before, during, and after azithromycin treatment. EXPOSURE Azithromycin, 1%, drops for 4 weeks. MAIN OUTCOMES AND MEASURES Cytokine expression in the eyelid margin and conjunctiva, and MMP-9 activity in tears. RESULTS Compared with a 1-time measurement of 8 healthy participants, among 16 symptomatic patients, the mean (SD; 95% CI) fold change of expression of proinflammatory mediators interleukin 1β (IL-1β), IL-8, and MMP-9 increased to 13.26 (4.33; 11.14–15.38; P Azithromycin, 1%, caused a change in the expression pattern of these mediators toward normal levels during 4 weeks of treatment. Levels of IL-1β, IL-8, and MMP-9 mRNA remained suppressed, although they rebounded toward pretreatment values 4 weeks after azithromycin withdrawal. Expression of TGF-β1 increased during treatment and remained at levels similar to the healthy controls after drug withdrawal. Change in tear MMP-9 activity was similar to the pattern of MMP-9 transcripts. CONCLUSIONS
Full Text Available BACKGROUND Diseases of skin, mucous membrane and mucocutaneous junctions may also affect the eyes. Physical findings of dermatological disorders and eyes overlap due to three factors- (i Genodermatoses often affects both skin and eyes because of origin from embryonic ectodermal layers, (ii Acquired dermatological disorders may affect the mucocutaneous tissue of periorbital regions, (iii Systemic diseases can manifest as diseases of skin and periocular mucocutaneous tissue because of their superficial anatomical locations. The aim of the present study was observation and interpretation of changes in the eye in different mucocutaneous disorders and correlation of the eye changes with severity of the diseases. MATERIALS AND METHODS A prospective study was undertaken in the Department of Ophthalmology, M.K.C.G. Medical College and Hospital, Berhampur, South Orissa, during the period of 2014 to 2016 including the referred patients after being diagnosed with mucocutaneous disease from Department of Dermatology, Paediatric and Medicine from the same hospital. A case study of 204 patients (M- 164, F-40 was done. All patients underwent detailed ophthalmic examination inclusive of ocular movements, VA, IOP, S/L exam, blood and urine investigation and fundus examination. RESULTS Out of 204 patients examined, i.e. 164 males and 40 females, the ocular involvement found was 132, i.e. 64%. Majority of patients having ocular lesions were affected by herpes (72.2% and leprosy (78.57%. Most common mucocutaneous syndrome in the study was herpes (35.29% and leprosy (27.45%. Most common ocular lesions in various mucocutaneous ocular syndrome was found to be conjunctivitis (45.4%, blepharitis (34.8% and periorbital vesicles (30.3%. The least common was found to be trichiasis and conjunctival membrane each 3%. After follow-up of 3 months, the following ocular sequelaes were observed, i.e. dry eye (9%, symblepharon (7.5%, corneal scar (4.5%, corneal vascularisation (3
Chu, Edward R; Weinstein, Scott A; White, Julian; Warrell, David A
Venom ophthalmia caused by venoms of spitting elapid and other snakes: report of ten cases with review of epidemiology, clinical features, pathophysiology and management. Chu, ER, Weinstein, SA, White, J and Warrell, DA. Toxicon XX:xxx-xxx. We present ten cases of ocular injury following instillation into the eye of snake venoms or toxins by spitting elapids and other snakes. The natural history of spitting elapids and the toxinology of their venoms are reviewed together with the medical effects and management of venom ophthalmia in humans and domestic animals including both direct and allergic effects of venoms. Although the clinical features and management of envenoming following bites by spitting elapids (genera Naja and Hemachatus) are well documented, these snakes are also capable of "spraying" venom towards the eyes of predators, a defensive strategy that causes painful and potentially blinding ocular envenoming (venom ophthalmia). Little attention has been given to the detailed clinical description, clinical evolution and efficacy of treatment of venom ophthalmia and no clear management guidelines have been formulated. Knowledge of the pathophysiology of ocular envenoming is based largely on animal studies and a limited body of clinical information. A few cases of ocular exposure to venoms from crotaline viperids have also been described. Venom ophthalmia often presents with pain, hyperemia, blepharitis, blepharospasm and corneal erosions. Delay or lack of treatment may result in corneal opacity, hypopyon and/or blindness. When venom is "spat" into the eye, cranial nerve VII may be affected by local spread of venom but systemic envenoming has not been documented in human patients. Management of venom ophthalmia consists of: 1) urgent decontamination by copious irrigation 2) analgesia by vasoconstrictors with weak mydriatic activity (e.g. epinephrine) and limited topical administration of local anesthetics (e.g. tetracaine) 3) exclusion of corneal abrasions
Gil Patrus PENA
Full Text Available Although usually considered a non-pathogenic parasite in parasitological textbooks, Demodex folliculorum has been implicated as a causative agent for some dermatological conditions, such as rosacea-like eruptions and some types of blepharitis. Several anecdotal reports have demonstrated unequivocal tissue damage directly related to the presence of the parasite. However, this seems to be exceedingly rare, in contrast with the marked prevalence of this infestation. We have had the opportunity to observe one of such cases. A 38-year-old woman presented with rosacea-like papular lesions in her right cheek. Histopathological examination revealed granulomatous dermal inflammation with a well-preserved mite phagocytized by a multinucleated giant cell. This finding may be taken as an evidence for the pathogenicity of the parasite, inasmuch as it does not explain how such a common parasite is able to produce such a rare disease.Embora geralmente considerado um parasita não patogênico nos livros-texto de parasitologia, Demodex folliculorum tem sido implicado como agente causal de algumas condições dermatológicas, como erupções tipo rosácea e alguns tipos de blefarite. Vários relatos isolados têm demonstrado alterações teciduais sem dúvida relacionadas diretamente à presença do parasita. Entretanto, esses achados são extremamente raros, ao contrário da enorme prevalência da infestação. Tivemos a oportunidade de observar um destes casos. Paciente do sexo feminino, com 38 anos, apresentou lesões papulosas rosaceiformes, na região zigomática direita. O exame histopatológico revelou inflamação dérmica granulomatosa, com um ácaro bem preservado, fagocitado por uma célula gigante. Esse achado pode ser considerado como evidência a favor da patogenicidade do parasita, embora não explique como um parasita tão comum pode ser capaz de produzir alteração tão rara.
bacterial eradication scores. ISV-502 was superior to 1.0% azithromycin in clinical cure and superior to 0.1% dexamethasone in bacterial eradication. Keywords: blepharitis, inflammation, eye
Manifestações oculares do paciente infectado pelo HIV atendido no Departamento de Oftalmologia da Universidade Federal de São Paulo Ocular manifestations of the HIV infected Patients at the Ophthalmology Department of São Paulo Federal University
K. T. F. Matos
hazy, 64 (5.82% with ocular pain, 186 (16.9% with inespecific complaints, and 235 (21.36% with no complains. The most frequent ocular manifestations were: CMV retinitis in 246 (22.36%, cotton wool spots in 110 (10%, blepharitis in 51 (4.64%, and toxoplasmosis in 48 (4.36%. CONCLUSION: The increase of disease ratio was observed among heterossexual and females in this specific population. Patients with ocular complains were 79.42% . The most frequent ocular manifestations was CMV retinitis, in 246 (22.36%. We found also 10% of cotton wool spots.
Effects of ethyl-cyanoacrylate and octyl-cyanoacrylate on experimental corneal lesions in rabbits Efeitos do etil-cianoacrilato ou do octil-cianoacrilato sobre lesões corneais experimentais em coelhos
Full Text Available The use of ethyl-cyanoacrylate and octyl-cyanoacrylate were clinically and histopathologically compared on the corneas of 36 rabbits after lamellar keratectomy (standardized diameter and depth. The animals were distributed into two groups, one for each type of adhesive. From each group, six subgroups were histopathologically evaluated on the 3rd, 7th, 14th, 21st, 30th, and 60th day post-operative. General (daily and ophthalmic (days 0, 1, 3, 5, 7, 14, 21, 30, 44, and 60 evaluations clinically indicated that there were significant differences for the variables water intake, attitude, blepharitis, corneal edema, and fluorescein test. The adhesive permanence time for octyl-cyanoacrylate (17.22 days was greater than that for ethyl-cyanoacrylate (7.66 days. With respect to the histopathological evaluation, corneal epithelization and collagen organization occurred without severe complications. However, treatment with ethyl-cyanoacrylate led to a moderate inflammatory reaction in the initial phases. With octyl-cyanoacrylate, re-epithelization and collagen organization proceeded more slowly with a discrete inflammatory reaction in the initial phases. From clinical and histopathologic points of view, octyl-cyanoacrylate showed advantages over ethyl-cyanoacrylate, whereas wound healing was achieved in both groups without major complications.Comparou-se o uso do etil-cianoacrilato e do octil-cianoacrilato em córneas de 36 coelhos após ceratectomia lamelar (diâmetro e profundidade padronizados. Os animais foram distribuídos em dois grupos, segundo o tipo de adesivo, e redistribuídos em seis subgrupos com três animais cada, para as avaliações histológicas aos 3, 7, 14, 21, 30 e 60 dias de pós-operatório. As avaliações clínicas gerais (diárias e as oftálmicas (dias 0, 1, 3, 5, 7, 14, 21, 30, 44 e 60, indicaram diferença entre os dois grupos, quanto ao consumo de água, atitude, blefarite, edema da córnea e teste da fluoresceína. O Tempo de
Giovanni André Pires Viana
was composed of 25 patients who were submitted to conservatively standard fat-resection lower eyelid blepharoplasty, and routine lateral canthal support. The Surgical Group 2 (experimental group was represented by 25 patients submitted to lower eyelid blepharoplasty with periorbital fat mobilization and arcus marginalis redrape, and routine lateral canthal support. The self-esteem of all patients was compared with those in 25 age-matched volunteers from the general population. The parameters of the Rosenberg Self-Esteem Scale were determined preoperatively and at 6-month interval postoperatively. Standardized photographs obtained before and after surgery were evaluated by three independent observers. RESULTS: The median follow-up was 395 days (range 364 to 547 days. The mean age was 48.8 years, the population's gender was predominantly female (96%. Analysis of preoperative and postoperative photographs showed that 96% patients achieved significant improvement. Self-esteem scores improved from baseline preoperative mean levels of 5.1 (Standard Deviation = 4.1 to a mean level of 3.6 (Standard Deviation = 3.5 at 6 months post-surgery (p=0.001. No patients had orbital hematoma, blepharitis, lagophthalmos or ectropion. CONCLUSIONS: The authors concluded that both procedures are safe and effective with low complication rates, and marked improvement in self-esteem was observed in patients at 6-month follow-up.