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Milner MS, Beckman KA, Luchs JI, Allen QB, Awdeh RM, Berdahl J, Boland TS, Buznego C, Gira JP, Goldberg DF, Goldman D, Goyal RK, Jackson MA, Katz J, Kim T, Majmudar PA, Malhotra RP, McDonald MB, Rajpal RK, Raviv T, Rowen S, Shamie N, Solomon JD, Stonecipher K, Tauber S, Trattler W, Walter KA, Waring GO, Weinstock RJ, Wiley WF, Yeu E. Dysfunctional tear syndrome: dry eye disease and associated tear film disorders - new strategies for diagnosis and treatment. Curr Opin Ophthalmol 2017; 27 Suppl 1:3-47. [PMID: 28099212 PMCID: PMC5345890 DOI: 10.1097/01.icu.0000512373.81749.b7] [Citation(s) in RCA: 118] [Impact Index Per Article: 16.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
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.
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Affiliation(s)
- Mark S. Milner
- Yale University School of Medicine, New Haven
- The Eye Center of Southern Connecticut, Hamden, Connecticut
- Mark S. Milner, Kenneth A. Beckman, and Jodi I. Luchs are co-chairs
| | - Kenneth A. Beckman
- Ohio State University, Columbus
- Comprehensive Eye Care of Central Ohio, Westerville, Ohio
- Mark S. Milner, Kenneth A. Beckman, and Jodi I. Luchs are co-chairs
| | - Jodi I. Luchs
- Hofstra Northwell School of Medicine, Hempstead
- South Shore Eye Care, Wantagh, New York
- Mark S. Milner, Kenneth A. Beckman, and Jodi I. Luchs are co-chairs
| | | | - Richard M. Awdeh
- Bascom Palmer Eye Institute, Florida International University, and Center for Excellence in Eye Care, Miami, Florida
| | - John Berdahl
- Vance Thompson Vision, Sioux Falls, South Dakota
| | - Thomas S. Boland
- Northeastern Eye Institute, Scranton
- Commonwealth Medical College, Scranton, Pennsylvania
| | - Carlos Buznego
- Bascom Palmer Eye Institute, Florida International University, and Center for Excellence in Eye Care, Miami, Florida
| | | | - Damien F. Goldberg
- Jules Stein Eye Institute, Los Angeles
- Wolstan & Goldberg Eye Associates, Torrance, California
| | | | - Raj K. Goyal
- Rush University Medical Center, Chicago
- Chicago Eye Specialists
| | | | - James Katz
- Midwest Center for Sight, Des Plaines, Illinois
| | - Terry Kim
- Duke Eye Center, Durham, North Carolina
| | - Parag A. Majmudar
- Rush University Medical Center, Chicago
- Chicago Cornea Consultants, Ltd, Hoffman Estates, Illinois
| | - Ranjan P. Malhotra
- Washington University Department of Ophthalmology and Ophthalmology Associates, St. Louis, Missouri
| | - Marguerite B. McDonald
- NYU Langone Medical Center, New York, New York
- Tulane University School of Medicine, New Orleans, Louisiana
- Ophthalmic Consultants of Long Island, Lynbrook, New York
- The Center for Ocular Surface Excellence of New Jersey, Woodland Park, New Jersey
| | - Rajesh K. Rajpal
- Georgetown University Medical Center, George Washington University Medical Center, Washington, DC
| | - Tal Raviv
- New York Eye and Ear Infirmary of Mount Sinai and Eye Center of New York, New York, New York
| | - Sheri Rowen
- NVision EyeCenters of Newport Beach, Newport Beach, California
- University of Maryland, Baltimore, Maryland
| | - Neda Shamie
- Advanced Vision Care, Century City, California
- Keck School of Medicine, University of Southern California, Los Angeles
| | | | - Karl Stonecipher
- University of North Carolina and TLC Laser Eye Centers, Greensboro, North Carolina
| | | | - William Trattler
- Bascom Palmer Eye Institute, Florida International University, and Center for Excellence in Eye Care, Miami, Florida
| | | | - George O. Waring
- Storm Eye Institute and Magill Vision Center, Medical University of South Carolina, Charleston
- Clemson University, Mt. Pleasant, South Carolina
| | - Robert J. Weinstock
- University of South Florida, Tampa
- The Eye Institute of West Florida, Largo, Florida
| | - William F. Wiley
- Cleveland Eye Clinic, Clear Choice Custom LASIK Center, Brecksville, Ohio
| | - Elizabeth Yeu
- Eastern Virginia Medical School and Virginia Eye Consultants, Norfolk, Virginia, USA
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Quinto GG, Castro-Combs J, Li L, Gupta N, Campos M, Behrens A. Outcomes of different concentrations of human amniotic fluid in a keratoconjunctivitis sicca-induced mouse model. Int Ophthalmol 2016; 36:643-50. [PMID: 26767655 DOI: 10.1007/s10792-016-0180-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2013] [Accepted: 01/06/2016] [Indexed: 01/26/2023]
Abstract
To compare the effects of different concentrations of topical human amniotic fluid (HAF) in a mouse model of dry eye, forty C57BL/6 mice were divided into 4 treatment groups: 20 % HAF, 50 % HAF, 100 % HAF, and isotonic salt solution (control). Dry eye was induced by an injection of botulinum toxin B into the lacrimal gland. Tear production, ocular surface fluorescein staining, and blink rate were evaluated in each mouse at 5 time points during a 4-week period. Goblet cell density was assessed in stained histological sections. Regarding tear production, 20, 50, and 100 % HAF groups were all different from the control group (P < 0.001) at week 1. However, there were no statistically significant differences between the 20, 50, and 100 % HAF groups. At week 2, 20, 50, and 100 % HAF groups had significant improvement in staining score and were significantly different from the control group (P = 0.047, P = 0.005, and P = 0.001, respectively). No difference in spontaneous blink rate was observed between groups, at any time point. Goblet cell density was significantly decreased in the control group compared to the HAF treatment groups. All tested concentrations of topical HAF were effective and superior than the control in this keratoconjunctivitis sicca-induced mouse model. Further studies are needed to evaluate the effects of HAF on the human ocular surface.
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Affiliation(s)
- Guilherme G Quinto
- Department of Ophthalmology, The Wilmer Ophthalmological Institute, The Johns Hopkins University School of Medicine, Baltimore, MD, USA
- Department of Ophthalmology, Vision Institute, Federal University of São Paulo, São Paulo, Brazil
| | - Juan Castro-Combs
- Department of Ophthalmology, The Wilmer Ophthalmological Institute, The Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Li Li
- Department of Ophthalmology, The Wilmer Ophthalmological Institute, The Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Navin Gupta
- Department of Ophthalmology, The Wilmer Ophthalmological Institute, The Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Mauro Campos
- Department of Ophthalmology, Vision Institute, Federal University of São Paulo, São Paulo, Brazil
| | - Ashley Behrens
- Department of Ophthalmology, The Wilmer Ophthalmological Institute, The Johns Hopkins University School of Medicine, Baltimore, MD, USA.
- The Wilmer Ophthalmological Institute, 400 N. Broadway Street, Smith Building Suite 455, Baltimore, MD, 21231, USA.
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Razumova II, Safonova TN, Komov VV, Fedorov AA. [Extracorporeal treatments for some autoimmune eye diseases]. Vestn Oftalmol 2010; 126:21-25. [PMID: 20608194] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/29/2023]
Abstract
Fifty-three patients with eye diseases caused by autoimmune disorders received complex treatment involving extracorporeal techniques, such as hemosorption, plasmapheresis, and double cascade plasma filtration in combination with pulse therapy. Clinical, laboratory, morphometric, and biochemical studies show the efficacy of hemosorption in relieving acute manifestations of an inflammatory process and the stabilizing action of these methods on ocular epithelial tissue, immunological activity, and systemic manifestations of the underlying disease.
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Wilczyński M. [The use of autologous serum in the treatment of the ocular surface diseases]. Klin Oczna 2009; 111:363-368. [PMID: 20169898] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Abstract
In the literature, there is evidence suggesting that autologous serum eyedrops can be helpful in the treating various ocular conditions. Using eyedrops containing the 20-100% solution of patient's own serum, centrifuged 3000-4000 rpm, diluted in either saline, BSS or chloramphenicol solution, is a relatively new therapeutic strategy. Nevertheless, in some publications, a positive influence of using autologous serum topically has been proven in numerous ocular diseases. It has been found, that using autologous serum eyedrops is safe, such eyedrops can be stored in temperature ranging from -30 degrees C to +4 degrees C. Moreover, effectiveness of this treatment has been proven for many diseases, e.g.: keratoconjunctivitis sicca, superior limbal keratoconjunctivitis, recurrent erosion syndrome and persistent epithelial defects. Although, complications of the treatment are possible, according to available data from the literature, they are not frequent. A unified standard of preparing the autologous serum eyedrops has not been elaborated and in various publications different modes of preparation of the solution have been used. It is important to document indications for this treatment appropriately, as well as to be cautious while preparing and using the solution.
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Affiliation(s)
- Michał Wilczyński
- Z Kliniki Chorób Oczu I Katedry Chorób Oczu Uniwersytetu Medycznego w Łodzi.
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Takahide K, Parker PM, Wu M, Hwang WY, Carpenter PA, Moravec C, Stehr B, Martin PJ, Rosenthal P, Forman SJ, Flowers ME. Use of fluid-ventilated, gas-permeable scleral lens for management of severe keratoconjunctivitis sicca secondary to chronic graft-versus-host disease. Biol Blood Marrow Transplant 2007; 13:1016-21. [PMID: 17697963 PMCID: PMC2168033 DOI: 10.1016/j.bbmt.2007.05.006] [Citation(s) in RCA: 77] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2007] [Accepted: 05/07/2007] [Indexed: 10/23/2022]
Abstract
Keratoconjunctivitis sicca (KCS) occurs in 40%-60% of patients with chronic graft-versus-host-disease (cGVHD) after allogeneic hematopoietic cell transplantation. Although immunosuppressive therapy is the primary treatment of chronic GVHD, ocular symptoms require measures to improve ocular lubrication, decrease inflammation, and maintain mucosal integrity. The liquid corneal bandage provided by a fluid-ventilated, gas-permeable scleral lens (SL) has been effective in mitigating symptoms and resurfacing corneal erosions in patients with KCS related to causes other than cGVHD. We report outcomes in 9 consecutive patients referred for SL fitting for cGVHD-related severe KCS that was refractory to standard treatments. All patients reported improvement of ocular symptoms and reduced the use of topical lubricants after SL fitting resulting from decreased evaporation. No serious adverse events or infections attributable to the SL occurred. The median Ocular Surface Disease Index improved from 81 (75-100) to 21 (6-52) within 2 weeks after SL fitting, and was 12 (2-53) at the time of last contact, 1-23 months (median, 8.0) after SL fitting. Disability related to KCS resolved in 7 patients after SL fitting. The use of SL appears to be safe and effective in patients with severe cGVHD-related KCS refractory to conventional therapies.
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Affiliation(s)
- Kikuchi Takahide
- Fred Hutchinson Cancer Research Center, University of Washington, Seattle, WA
| | - Pablo M. Parker
- Hematology and Hematopoietic Cell Transplantation, City of Hope National Medical Center, Seattle, WA
| | | | | | - Paul A. Carpenter
- Fred Hutchinson Cancer Research Center, University of Washington, Seattle, WA
- University of Washington, Seattle, WA
| | - Carina Moravec
- Fred Hutchinson Cancer Research Center, University of Washington, Seattle, WA
| | - Barbara Stehr
- Hematology and Hematopoietic Cell Transplantation, City of Hope National Medical Center, Seattle, WA
| | - Paul J. Martin
- Fred Hutchinson Cancer Research Center, University of Washington, Seattle, WA
- University of Washington, Seattle, WA
| | | | - Stephen J. Forman
- Hematology and Hematopoietic Cell Transplantation, City of Hope National Medical Center, Seattle, WA
| | - Mary E.D. Flowers
- Fred Hutchinson Cancer Research Center, University of Washington, Seattle, WA
- University of Washington, Seattle, WA
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Abstract
BACKGROUND The causes of keratoconjunctivitis sicca are multifarious. Major causes include eyelid anomalies, Sjögren's disease, injuries, radiation or mucin deficiency. In our case, nasal positive airway pressure due to muscular dystrophy is described as another possible cause. PATIENT A 32-year-old male patient with advanced Duchenne muscular dystrophy requires nasal continuous positive airway pressure ventilation due to loss of the auxiliary respiratory muscles. The patient presented because permanent air flow from the lower right lacrimal point resulted in epiphora and keratoconjunctivitis sicca on the right side. THERAPY We reversibly occluded the lower lacrimal duct with a punctum plug flow regulator. The lacrimal flow regulator is available in two sizes, 0.8 and 0.9 mm, and is designed to be inserted into the punctal aperture. The soft silicone plug is delivered with a disposable dilator and can be used on an outpatient basis. It is actually used for punctal occlusion in patients with chronic dry eye syndrome and regulates the flow of lacrimal fluid. After insertion of a 0.9 mm punctal plug, the patient reported marked improvement of the findings, which was confirmed in a follow-up after 4 and 8 weeks. On a visual analog scale of 1 to 10, the subjective status was given a rating of 8. CONCLUSION By occluding the right lower lacrimal point with a punctal plug, we were able to markedly reduce the unpleasant retrograde air flow and the subjective complaints of the patient with nasal continuous positive airway pressure ventilation.
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Affiliation(s)
- O Göktas
- Klinik und Poliklinik für Hals-Nasen- und Ohrenheilkunde, Charité--Universitätsmedizin Berlin.
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Abstract
Sjogren's Syndrome (SS) is a systemic autoimmune disease characterized by dry eyes (keratoconjunctivis sicca) and dry mouth (xerostomia). To fulfill diagnostic criteria, patients must have objective signs of dryness on examination and laboratory confirmation of an autoimmune process as evidenced by a positive autoantibody to SS-A antigen or a characteristic lip biopsy. SS may exist as a primary condition or in association with other systemic autoimmune disorders (termed secondary SS) such as rheumatoid arthritis, systemic lupus erythematous (SLE), progressive systemic sclerosis (scleroderma), or dermatomyositis. Exclusions to the diagnosis include pre-existing lymphoma, hepatitis C or HIV infection. Pathogenesis involves both genetic (especially HLA-DR) and environmental factors. Both T-cells and B-cells are involved in the generation of cytokines and chemokines within the glands. The epithelial cells of the glands also play a role in pathogenesis. The dermatologic manifestations range from drynessness (sicca) and its complications to vasculitis. There is a significant overlap in the clinical manifestations, as well as treatment, of SS and SLE. However, SS patients require special attention to the complications of ocular dryness (keratocojunctivitis sicca and blepharitis) and oral dryness (rapid tooth loss and oral candidiasis) SS patients have a markedly increased risk of lymphoma and enlarged lymph nodes or persistently enlarged parotid/submandibular glands that require further evaluation.
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Affiliation(s)
- Robert I Fox
- Rheumatology Clinic Scripps Memorial Hospital and Research Foundation, La Jolla, CA 92037, USA.
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Abstract
Sjögren's syndrome is an autoimmune disease of the exocrine glands characterized by the leading symptoms of keratoconjunctivitis and stomatitis sicca based on a complex pathogenesis. The prevalence is about 0.5-1%; primary Sjögren's syndrome is differentiated from secondary Sjögren's syndrome associated with other autoimmune disorders. The diagnosis is established by the presence of subjective complaints and objective evidence of sicca symptoms, anti-Ro(SSA)/La(SSB) antibodies, and/or focal lymphocytic infiltration of the glandular tissue. In addition to the typical sicca symptomatology, which is managed symptomatically by substitution and stimulation therapy, some patients exhibit extraglandular manifestations. Complaints involving the musculoskeletal system and inner ear dominate and are treated by the rheumatologist. The indication for base therapy is tailored to individual needs, but the efficacy of this approach has not been established in studies. About 5-10% of the patients with primary Sjögren's syndrome develop a B-cell non-Hodgkin's lymphoma. The disease requires interdisciplinary management including, among others, ophthalmologists, dentists, and otorhinolaryngologists, depending on the clinical picture.
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Affiliation(s)
- C Tomiak
- Reha-Zentrum Bad Aibling, Deutsche Rentenversicherung Bund, Rheumazentrum - AHB, Kolbermoorer Strasse 56, 83043 Bad Aibling, Deutschland.
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Li XM, Zhang J, Wang W. [Application of lacrimal plug for dry eye patients]. Zhonghua Yan Ke Za Zhi 2005; 41:1098-102. [PMID: 16409763] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/06/2023]
Abstract
OBJECTIVE To observe the availability and efficacy of Smart PLUG in lacrimal plug in the treatment of serious dry eye. METHODS Lacrimal plug was applied in 43 patients (72 eyes) in our clinic from July to October in 2004. Questionnaire was used in these patients before the surgery 3 days and repeated after surgery 1 week and 3 months. Slit lamp microscope examination, fluorescent staining for tear break-up time (BUT), Schirmer test I (STI), impression cytology (IC) were carried out at the same time. RESULTS Questionnaire indicated most patients complained about dry eye, foreinbody sensation, asthenopia and red eye. These symptoms were relieved obviously after the application of lacrimal plug. Compared with pre-operation, tear production was increased significantly on the surface of eyes and the defect of corneal epithelium was healed in 37 patients (62 eyes). Compared with pre-operation, BUT and STI were increased and elongated on these patients, IC suggests squamous metaplasia of epithelial layer of conjunctiva in these patients was improved. CONCLUSIONS Symptoms of patients suffered from dry eye were relieved obviously by using Smart PLUG. Therefore lacrimal plug can be used for patients with serious dry eye by improving tear volume and tear film stability.
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Affiliation(s)
- Xue-min Li
- Department of Ophthalmology, Beijing University Third Hospital, Beijing University Ophthalmology Center, Beijing 100083, China.
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Senchikhin MV. [Lacrimation blocking technique in the treatment of severe "dry eye" syndrome]. Vestn Oftalmol 2005; 121:39-41. [PMID: 16223044] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/04/2023]
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Nistor M, Nistor C. [Autologous serum utilization in patients with lacrimal hyposecretion and persistent epithelial defects of cornea--clinical study]. Oftalmologia 2005; 49:30-3. [PMID: 16408672] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/06/2023]
Abstract
Autologous serum was supposed to be efficient in the treatment of keratoconjunctivitis sicca and persistent epithelial defects. 14 of 24 eyes of patients with keratoconjunctivitis sicca improved fluorescein and rose Bengal scores. 3 of 6 eyes with persistent epithelial defects healed completely after this treatment and 2 improved fluorescein and rose bengal scores. All patients had been unsuccessfully treated with conventional treatment. Allergic or immune adverse reactions were not present and economical benefit was appreciated by some patients with poor socioeconomic condition.
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Abstract
AIM To evaluate the effects of acupuncture in patients with keratoconjunctivitis sicca (KCS). MATERIAL AND METHODS Twenty-five patients (20 women, five men) with KCS were randomly assigned to an acupuncture treatment group or a control group. The effects of acupuncture were evaluated by a questionnaire on symptoms, visual analogue scale recordings, registration of drop frequency, and dry eye tests. Ten acupuncture sessions were given. Follow-up was carried out after 2-3 weeks and again after a mean period of 8 months. RESULTS Patients receiving acupuncture felt better at the first follow-up compared with the control group (p = 0.036). However, no statistical significance could be found concerning any change, or difference, in the total number of subjective symptoms, dosage frequency or, as indicated by the dry eye tests, tear quality, tear secretion and ocular surface disease. CONCLUSION The results indicate that acupuncture has subjective beneficial effects in patients with KCS and could therefore be tried as a complement to ordinary treatment.
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Affiliation(s)
- Marita Andersson Grönlund
- Institute of Clinical Neuroscience, Section of Ophthalmology, Sahlgrenska Academy at Gothenburg University, Sweden.
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Noble BA, Loh RSK, MacLennan S, Pesudovs K, Reynolds A, Bridges LR, Burr J, Stewart O, Quereshi S. Comparison of autologous serum eye drops with conventional therapy in a randomised controlled crossover trial for ocular surface disease. Br J Ophthalmol 2004; 88:647-52. [PMID: 15090417 PMCID: PMC1772131 DOI: 10.1136/bjo.2003.026211] [Citation(s) in RCA: 188] [Impact Index Per Article: 9.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/14/2003] [Indexed: 11/03/2022]
Abstract
AIMS To evaluate the efficacy of 50% autologous serum drops against conventional treatment in ocular surface disorders refractory to normal treatments in a prospective randomised crossover trial. METHOD Patients fulfilling ophthalmological and haematological entry criteria were randomised to either 3 months of autologous serum 50% followed by 3 months of their conventional treatment, or 3 months of conventional treatment, followed by 3 months of autologous serum. Clinical assessments, including Schirmer's test, rose Bengal, and fluorescein staining, were carried out on entry and at monthly intervals. Impression cytology was performed at entry, 3 and 6 months. Grading was carried out on degrees of squamous metaplasia and goblet cell density. Subjective comfort was recorded daily using the "faces" scale. These categorical scores were converted to linear measurement using Rasch analysis. Statistical analysis was carried out using Wilcoxon's signed rank test and ANOVA. RESULTS 16 patients were recruited with 31 eyes studied. The ocular surface diseases chiefly included Sjögren's syndrome (n = 6) and keratoconjunctivitis sicca (n = 5). Impression cytology available in 25 of 31 eyes showed significant improvement on serum treatment, p<0.02. Rasch weighted faces scores were statistically significantly better with serum, p<0.01. CONCLUSION The results of this randomised study provide further evidence of the beneficial effects of autologous serum in severe ocular surface disorders. For most of these patients, autologous serum was superior to conventional treatment for improving ocular surface health and subjective comfort.
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Affiliation(s)
- B A Noble
- Department of Ophthalmology, Clarendon Wing, The General Infirmary at Leeds, Belmont Grove, Leeds LS2 9NS, UK.
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14
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Sheppard JD. Guidelines for the treatment of chronic dry eye disease. Manag Care 2003; 12:20-5. [PMID: 14723110] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 04/28/2023]
Abstract
Keratoconjunctivitis sicca (KCS), also known as dry eye syndrome, dry eye disease, chronic dry eye disease, or keratitis sicca, refers to disorders of the tear film caused by reduced tear production, poor tear quality, or excessive tear evaporation. These disorders are associated with such symptoms of ocular discomfort as irritation, foreign body sensation, or redness, and may cause disease of the ocular surface.
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Abstract
PURPOSE To review the incidence, underlying pathophysiology, and clinical features of filamentary keratitis and to identify evidence-based best-practice strategies for managing filamentary keratitis. METHODS A comprehensive review of published literature was undertaken. Recommendations for best-practice management strategies were based on the available evidence. Three cases are presented to illustrate the clinical findings and management of patients with chronic filamentary keratitis. RESULTS Although the evidence base is limited by the absence of well-designed studies, current evidence indicates the following: (1) Aqueous-deficient dry eye (keratoconjunctivitis sicca) is the most common ocular condition associated with filamentary keratitis. (2) Current best-practice management of filamentary keratitis involves treating the underlying dry eye and specific treatments for the corneal filaments. Proposed treatments include nonpreserved lubricants, topical steroidal and nonsteroidal anti-inflammatory agents, and punctal plugs for aqueous-deficient dry eye as well as mechanical removal of filaments, hypertonic saline, mucolytic agents, and bandage contact lenses for the filaments. (3) Filamentary keratitis can be induced or exacerbated by contact lens wear and ocular surgical procedures such as cataract surgery and corneal graft surgery. Pre- and postoperative ocular surface management strategies should be considered in the surgical planning of patients with, or who are susceptible to, filamentary keratitis. Filamentary keratitis can also be induced and/or exacerbated by chronic use of ocular and/or systemic medications, and alternate medications or additional measures to manage the tear film and ocular surface may be required in these cases. CONCLUSIONS Filamentary keratitis can be a chronic, recurrent, and debilitating condition. With a systemic approach to diagnosis and management, the condition can be effectively controlled and the incidence and severity of recurrences minimized.
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Affiliation(s)
- Julie Albietz
- Centre for Eye Research, Queensland University of Technology, O Blocj, QUT Kelvin Grove, Victoria Park Road, Kelvin Grove 4059, Australia.
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Garweg JG. [Dry eye? Causes and methods for treatment of keratoconjunctivitis sicca]. Med Monatsschr Pharm 2003; 26:195-203; quiz 203-4. [PMID: 12840955] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 03/03/2023]
Affiliation(s)
- Justus G Garweg
- Abteilung für Erkrankungen der hinteren Augenabschnitte, Universitäts-Augenklinik Bern, Inselspital, CH-3010 Bern
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Nepp J, Tsubota K, Goto E, Schauersberger J, Schild G, Jandrasits K, Abela C, Wedrich A. The effect of acupuncture on the temperature of the ocular surface in conjunctivitis sicca measured by non-contact thermography: preliminary results. Adv Exp Med Biol 2003; 506:723-6. [PMID: 12613984 DOI: 10.1007/978-1-4615-0717-8_102] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Affiliation(s)
- Johannes Nepp
- Department of Ophthalmology, University of Vienna Medical School, Vienna, Austria
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Farrell J, Patel S, Grierson DG, Sturrock RD. A clinical procedure to predict the value of temporary occlusion therapy in keratoconjunctivitis sicca. Ophthalmic Physiol Opt 2003; 23:1-8. [PMID: 12535050 DOI: 10.1046/j.1475-1313.2003.00081.x] [Citation(s) in RCA: 34] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
PURPOSE To evaluate the effects of dissolvable collagen punctal plugs on the symptoms, tear stability and volume in aqueous deficient dry eyes. METHODS Sixty-two aqueous deficient dry eye patients of mixed aetiology underwent lacrimal punctal occlusion with dissolvable collagen plugs. The subjects were randomly allocated to one of two treatment groups: group I (n = 36) had their lower puncta occluded and group II (n = 26) had both their upper and lower puncta occluded. The effectiveness of this treatment was clinically assessed by (1). scoring subject symptoms and (2). measuring the tear parameters of tear thinning time (TTT) and tear meniscus height (TMH) as indicators of tear stability and volume, respectively. Following baseline measurements, patients were reviewed at time intervals of 5 and 12 days post-occlusion. A group of age- and gender-matched normals (n = 45) was recruited for comparison (group III). RESULTS Tear volume and stability were significantly higher in group III compared with I and II at baseline. In the treated groups on both days 5 and 12: (1). symptom score reduced significantly from a median value of 7 to 3 (p = <0.001); (2). tear stability increased significantly from a median value of 3 to 5 s by day 5 (p <or= 0.001); reduced between days 5 and 12 (p < 0.05) and remained below the stability in group III at all times; (c). tear volume increased significantly by day 5 in both treatment groups from a median value of 0.13 to 0.20 mm (p<or=0.001), remained stable by day 12 in group II but reduced in group I (p < 0.05); (d). the increase in tear volume was negatively correlated with pre-treatment tear volume; (e). symptom score correlated with both baseline tear volume and stability. CONCLUSION Collagen plugs improved tear status in the aqueous deficient dry eyes. Occluding both upper and lower puncta with temporary collagen plugs offers no practical beneficial gain compared with occluding just the lower punctum.
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Affiliation(s)
- J Farrell
- Department of Vision Sciences, Glasgow Caledonian University, Cowcaddens Road, Glasgow, UK.
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19
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Dahlmann AH, Chew CKS. Application of eye drops by patients with rheumatoid arthritis. J Rheumatol 2002; 29:850. [PMID: 11950032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/24/2023]
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20
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Poon AC, Geerling G, Dart JK, Fraenkel GE, Daniels JT. Autologous serum eyedrops for dry eyes and epithelial defects: clinical and in vitro toxicity studies. Br J Ophthalmol 2001; 85:1188-97. [PMID: 11567963 PMCID: PMC1723716 DOI: 10.1136/bjo.85.10.1188] [Citation(s) in RCA: 222] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
BACKGROUND/AIMS Autologous serum drops have been reported to be beneficial in keratoconjunctivitis sicca (KCS) and persistent epithelial defects (PED). A clinical pilot study was carried out to examine these potential uses and in vitro toxicity testing on corneal epithelial cell cultures was performed to compare the effect of serum drops with unpreserved hypromellose (hydroxypropylmethylcellulose 0.3%). METHODS Patients with KCS and PED, unresponsive to conventional treatment were recruited. Patients were examined before treatment, at 1 and 2 weeks after initiation, and then 2 weekly until treatment ceased. Symptoms were assessed at each visit. Clinical examination included Schirmer's test without anaesthesia, rose bengal staining, and fluorescein staining. Epithelial defects were measured with the slit beam. In the laboratory, cultured human corneal epithelial cells were exposed to serum drops and hypromellose, and their viability evaluated with fluorescent viability staining (Calcein AM ethidium homodimer) and an ATP assay. RESULTS Autologous serum was used in 15 eyes of 13 patients with PED and 11 eyes of nine patients with KCS. In two patients serum drops were started after penetrating keratoplasty (PK). The PKs were performed for perforations secondary to PEDs. Of the 15 eyes with PED, nine healed at a mean of 29 days and six failed. The mean duration of PED before the use of serum drops was 48.2 days. Of the 11 eyes with KCS, six had improved subjective scores and fluorescein scores, and five had improved rose bengal scores after the use of serum drops. For the two patients who used serum eyedrops post-PK, there was a stable and intact epithelium at 1 week. Cessation of serum drops during the postoperative period led to deterioration in the subjective and objective scores in both patients. One developed a PED that responded to reinstitution of serum drops. The morphology and ATP levels of cultured epithelial cells exposed to serum were better maintained than those exposed to hypromellose. CONCLUSION Autologous serum drops are useful for PED and KCS. This effect may be related to a number of active factors in serum including growth factors, fibronectin, vitamin A, and anti-proteases. In vitro toxicity testing demonstrated that serum drops have reduced toxicity compared with unpreserved hypromellose. Currently regulatory restrictions in the UK have prevented the establishment of a prospective randomised controlled trial examining the efficacy of autologous serum drops for the management of this group of ocular surface disorders.
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Affiliation(s)
- A C Poon
- Moorfields Eye Hospital, London, UK
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21
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Tsvetkov AL, Tereshchenkova TF. [Surgical rehabilitation of a patient with corneal perforation in keratoconjunctivitis sicca syndrome]. Vestn Oftalmol 2001; 117:48-9. [PMID: 11339045] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/20/2023]
Abstract
The authors describe effective surgical rehabilitation of a female patient with corneal perforation and subsequent complicated cataract developing against the background of chronic deficiency of lacrimal production associated with Sjogren's syndrome which developed in the presence of rheumatoid arthritis. Treatment with artificial tears during complex pre- and postoperative therapy prevented serious complications and made unnecessary the preliminary interventions aimed at inhibition of lacrimal production. Long remission of the underlying disease and stability of visual functions during 2 years evidence the efficiency of rehabilitative measures.
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Abstract
Sjögren syndrome is a chronic systemic disease characterized by polyglandular tissue destruction leading to keratoconjunctivitis sicca (KCS) and xerostomia. Patients with primary Sjögren syndrome show evidence of KCS and xerostomia, whereas patients with secondary Sjögren syndrome suffer from KCS, xerostomia, and an autoimmune disease, most commonly rheumatoid arthritis. Certain factors cause autoimmune dysregulation leading to destruction of the acinar cells and ductal epithelia with subsequent dry eyes and dry mouth. Activated lymphocytes in patients with autoimmune diseases appear to have selective homing into the lacrimal and salivary glands leading to tissue damage. Understanding the factors involved in the immune dysregulation may improve our diagnostic and therapeutic approaches in Sjögren syndrome. Current therapeutic measures include means to increase secretion, relieve symptoms, and repair damage of the ocular surface.
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Affiliation(s)
- K F Tabbara
- Department of Ophthalmology, College of Medicine, King Saud University, Riyadh, Saudi Arabia.
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23
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Aguilar AJ. [The punctal plug]. Arch Soc Esp Oftalmol 2000; 75:721. [PMID: 11151258] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/18/2023]
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24
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Kabbani O. [Nonpreserved topical steroids and lacrimal punctal occlusion for severe keratoconjunctivitis sicca]. Arch Soc Esp Oftalmol 2000; 75:751-756. [PMID: 11151264] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/18/2023]
Abstract
PURPOSE To analyze the efficacy of topical nonpreserved steroids before punctal occlusion in the treatment of severe keratoconjunctivitis sicca associated with Sjögren's syndrome. METHODS We performed a prospective study including 15 patients, 30 eyes, (group 1) treated with topical nonpreserved steroids for 2 weeks and then punctal occlusion, and 15 patients, 30 eyes, (group 2) treated directly with punctal occlusion. Symptom severity (0-3+) and corneal fluorescein staining (0-9+) were evaluated after a week and after two months, and results were statistically compared between both groups with the t Student test. RESULTS Symptom severity was negative in 67% of patients of group 1 and in 27% of patients of group 2 (p=0.0001 ) after a week, and in 80% of patients in group 1 and in 33% of patients of group 2 (p=0.0003) after 2 months. Corneal fluorescein staining was negative in 67% (OD) and 73% (OI) of patients of group 1 and in 33% (AO) of patients of group 2 (p=0.0001, AO) after a week, and in 80% (AO) of patients of group 1 and in 60% of patients of group 2 (AO) (p=0.0001, AO) after 2 months. There were no patients with side effects or complications. CONCLUSIONS Topical nonpreserved steroid therapy for two weeks before punctal occlusion is effective in controlling symptoms and corneal fluorescein staining in patients with severe keratoconjunctivitis sicca associated with Sjögren's syndrome.
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25
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Whitcup SM. The double-edged ocular immune response: the Cogan lecture. Invest Ophthalmol Vis Sci 2000; 41:3243-8. [PMID: 11006209] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/17/2023] Open
Affiliation(s)
- S M Whitcup
- Allergan, Inc., Irvine, California 92612-1599, USA.
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26
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Abstract
Many patients with symptomatic eye conditions present initially to their primary care physician. Comprehensive treatment of such conditions as dry eye syndrome, blepharitis, styes, chalazia, conjunctivitis, congenital nasolacrimal duct obstruction, superficial foreign bodies, corneal abrasion, and subconjunctival hemorrhage can often be provided in the primary care setting. Patients with persistent or severe conditions, particularly those involving foreign bodies and corneal abrasions due to high-velocity injuries, should be referred for immediate care by an ophthalmologist.
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27
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Nepp J, Derbolav A, Haslinger-Akramian J, Mudrich C, Schauersberger J, Wedrich A. [Effect of acupuncture in keratoconjunctivitis sicca]. Klin Monbl Augenheilkd 1999; 215:228-32. [PMID: 10572884 DOI: 10.1055/s-2008-1034704] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
BACKGROUND Conjunctivitis sicca is a chronic disease of the ocular surface. The substitution of tear deficiency with artificial tears is not satisfying in many patients. In a series of patients successfully treated with acupuncture we observed very different effects on each patient. In this study we evaluate the correlation between the effect of acupuncture and the etiology of the dry eyes treated. PATIENTS AND METHODS 102 patients (87 women, 15 men) with dry-eye syndrome have been needed 10 sessions, once per week, for 30 minutes. We recorded causal factors according to the traditional chinese medicine (TCM): external and internal factors. External factors were: toxic, allergic, drug-induced, ocular surface inflammation and infection, contact lens and generally external irritations. Internal factors were disorders of hormones, immune system, psychic, and vitamin-A deficiency. Ophthalmologic observation included the slit-lamp examination, Schirmers test II, break-up time of tear film (BUT) and a drop-frequency protocol--before and 1 week after acupuncture treatment. RESULTS There was a statistically significant difference (p < 0.001) in Schirmers test, BUT and drop frequency between before and after acupuncture. There was no significant difference between internal and external factors, but the effect on external induced sicca was better. The best effect of acupuncture was found in external factors after inflammation and in patients with imbalance of the autonomic nervous system, the least effects in Sjögren Syndrome. The effect was better in younger then in patients over 50 years. CONCLUSION The study demonstrate, according DeLa Fuye that the best effect of acupuncture is seen on functionally disorders.
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Affiliation(s)
- J Nepp
- Universitätsklinik für Augenheilkunde und Optometrie, Wien.
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28
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Bialasiewicz AA. [Sicca syndrome: neuroimmuno-endocrine aspects and acupuncture]. Klin Monbl Augenheilkd 1999; 215:209-10. [PMID: 10572881 DOI: 10.1055/s-2008-1034701] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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29
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Ceraulo S, Buzzanca ML. [Diagnostic criteria of Sjögren syndrome]. Minerva Stomatol 1999; 48:79-85. [PMID: 10368574] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/12/2023]
Abstract
The present knowledge about Sjögren classification, diagnosis, therapy and its prognosis is reviewed. Some researchers about immunological and histological factors are also underlined. Finally, a complete picture of this syndrome is given.
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Affiliation(s)
- S Ceraulo
- Istituto di Odontostomatologia, Università degli Studi, Palermo
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30
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Nepp J, Wedrich A, Akramian J, Derbolav A, Mudrich C, Ries E, Schauersberger J. Dry eye treatment with acupuncture. A prospective, randomized, double-masked study. Adv Exp Med Biol 1998; 438:1011-6. [PMID: 9635004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Affiliation(s)
- J Nepp
- University Eye Clinic of Vienna, Austria
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31
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Donshik PC, Nelson JD, Abelson M, McCulley JP, Beasley C, Laibovitz RA. Effectiveness of BION tears, Cellufresh, Aquasite, and Refresh Plus for moderate to severe dry eye. Adv Exp Med Biol 1998; 438:753-60. [PMID: 9634964 DOI: 10.1007/978-1-4615-5359-5_106] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Affiliation(s)
- P C Donshik
- Eye Physician Associates of Hartford, Connecticut, USA
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32
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Rieger G. Color discrimination in patients with keratoconjunctivitis sicca before and after artificial tear application. Wien Klin Wochenschr 1998; 110:296-7. [PMID: 9615962] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
BACKGROUND The precorneal tear film is of decisive importance for the optical quality of the cornea. Poor stability of this film causes not only dry eye symptoms, but also has negative effects on optical functions of the eye, as previous studies on visual acuity, field test performance and contrast sensitivity have shown. METHODS 60 patients with dry eyes randomized into 2 groups of 30 underwent color vision testing with the Lanthony Desaturated 15 Hue test before and after instillation of artificial tear (test group) or physiological saline (control group) drops. RESULTS The improvement in color discrimination in the group given artificial tear treatment was found to be slightly better than in the saline group but in both groups this improvement was not of statistical significance. CONCLUSION Even though an unstable tear film adversely affects the optics of the eye and even mildly degraded optics can affect spatial visual tasks, color discrimination performance on tasks such as the Lanthony D-15 test does not appear to be markedly impaired.
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Affiliation(s)
- G Rieger
- Department of Ophthalmology, Paracelsus Institute, Bad Hall, Austria
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33
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Spiera H, Asbell PA, Simpson DM. Botulinum toxin increases tearing in patients with Sjögren's syndrome: a preliminary report. J Rheumatol Suppl 1997; 24:1842-3. [PMID: 9292815] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
Three patients with Sjögren's syndrome (SS) who had severe xerophthalmia and blepharospasm received botulinum toxin injections for the treatment of their blepharospasm. They had a remarkable increase in tearing, measured by Schirmer's test, and a decrease in signs and symptoms of dry eyes after botulinum toxin injection periorbitally for blepharospasm. The mechanism for this increased tearing is unclear, but suggests a potential treatment for patients with severe xerophthalmia with SS.
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Affiliation(s)
- H Spiera
- Department of Medicine, Mount Sinai Medical Center, New York, NY 10029-6574, USA
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34
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Curl A. Keratoconjunctivitis sicca. Primary care response to a common eye problem. Adv Nurse Pract 1997; 5:37-8. [PMID: 9459953] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Affiliation(s)
- A Curl
- Pate-DesChamps Medical Associates P.C., Bishopville, S.C., USA
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35
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Wright M, Dhillon B. Diagnosis and treatment of dry eyes. Practitioner 1997; 241:210-216. [PMID: 9206292] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/22/2023]
Affiliation(s)
- M Wright
- Princess Alexandra Eye Pavilion, Edinburgh
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36
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Abstract
PURPOSE To evaluate the extent of psychosomatical complaints in patients with primary keratoconjunctivitis sicca (pKCS). METHODS 20 patients (m:f = 1.19; mean age 49 +/- 7 years) with pKCS were rated according to the von Zerssen Symptom List (psychosomatical discomfort), the Maudsley Personality Inventory (MPI)-N (emotional status) and -E (extroverted-introverted) and to Beck Depression Inventory (BDI). 54 subjects (m:f = 35:17; mean age 46 +/- 17 years) without any ocular or general chronic disease were used as control group. RESULTS In comparison to the control group the patients with pKCS showed significantly (p < 0.0001) more complaints (von Zerssen Symptom List), were more (p < 0.0001) emotionally unstable (MPI-N) and more (p < 0.0001) depressive (BDI). No group differences were found regarding extroversion-introversion (MPI-E). CONCLUSION Our results demonstrate that many patients with pKCS showed psychological problems and disturbances. We therefore recommend an additional psychological treatment (e.g. autogenic training) for these patients to stabilize their emotional condition, which may even have a positive effect on their dry eye problems.
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Affiliation(s)
- C Erb
- Universitäts-Augenklinik Tübingen
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37
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Rothschild BM. Sjögren's syndrome. Compr Ther 1996; 22:39-43. [PMID: 8654023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
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38
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Abstract
BACKGROUND In facial palsies with lagophthalmic keratopathy an hour-glass dressing is indicated, which has the disadvantage of a moisture chamber with visual impairment by steaming up. After weeks of placement dermal irritations are possible. An alternative is the gravity dependent lidloading, using gold implantation in cases of irreversible lagophthalmos. METHODS AND PATIENTS Lead weights of 0.8 to 2.0 g are glued to the upper lid with an adhesive layer, that is well tolerated by the skin (Combihesive*), or by a simple foil that is glued on both sides (Tesafix). This results in a lidclosure without impairment of lid opening. After tests on 10 normal persons the described method was placed on 22 patients with lagophthalmos and compared with hour-glass dressing. The new method was applied to 36 additional patients. RESULTS The dynamic lead weight is effective and well-tolerated. It was more accepted cosmetically especially during the day because of better cosmetic appearance and better visual function than was the hour-glass dressing. These latter dressings are still important for use in serious cases during the night. CONCLUSION lidloading with lead weights that are glued by an adhesive layer to the upper lid can be recommended as a new method in cases of reversible lagophthalmos or as a preparatory step before gold implantation.
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39
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Rai A, Zaphiropoulos GC. Treatment of keratoconjunctivitis sicca: the use of a simple self-administered eye irrigation system. Br J Rheumatol 1994; 33:1190. [PMID: 8000754 DOI: 10.1093/rheumatology/33.12.1190] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
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40
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Rieger G. Contrast sensitivity in patients with keratoconjunctivitis sicca before and after artificial tear application. Graefes Arch Clin Exp Ophthalmol 1993; 231:577-9. [PMID: 8224932 DOI: 10.1007/bf00936521] [Citation(s) in RCA: 19] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023] Open
Abstract
Poor stability of the precorneal tear film causes dry eye symptoms and has detrimental effects on the optical function of the eye. In 50 patients with dry eyes the local instillation of artificial tears significantly improved contrast sensitivity (P < 0.001), using the Vision Contrast Test System 6500. In the untreated eyes no significant changes were found to occur (P = 0.56).
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Affiliation(s)
- G Rieger
- Department of Ophthalmology, Paracelsus Institute, Bad Hall, Austria
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41
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Heijn A. [Conjunctivitis sicca (KCS)]. Tijdschr Diergeneeskd 1993; 118:420. [PMID: 8322367] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
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42
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Friedlaender MH. Ocular manifestations of Sjögren's syndrome: keratoconjunctivitis sicca. Rheum Dis Clin North Am 1992; 18:591-608. [PMID: 1496163] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
As part of the triad of Sjögren's syndrome (SS), keratoconjunctivitis sicca (KCS) can be found in virtually all SS patients. This term emphasizes not only the reduced tear production but also the pathologic changes in the epithelial cells of the ocular surface. The symptoms of dry eye may vary from one patient to another depending on the severity of dryness, the ability of the diminished tear film to moisten the ocular surface, and the patient's tolerance for ocular discomfort. Treatment of the dry eyes is remarkably effective, and most patients benefit from moisturizing eyedrops to replace their own deficient tears. Major issues include the pathogenesis of decreased tear flow and ocular surface disturbances, as well as the roles of wound healing agents and anti-inflammatory medications in KCS therapy.
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Affiliation(s)
- M H Friedlaender
- Division of Ophthalmology, Scripps Clinic and Research Foundation, La Jolla, California
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43
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Abstract
A 68-year-old woman with severe radiation-induced keratoconjunctivitis sicca became progressively unresponsive to conventional medical treatment. Her left eye deteriorated rapidly and required total tarsorrhaphy. In an attempt to stabilize the right eye and preserve some functional vision, we glued a high-Dk rigid, gas-permeable contact lens with tissue-grade cyanoacrylate adhesive to Bowman's membrane. This glued-on contact lens induced rapid and dramatic improvement of the patient's comfort and sight. Recent developments in high-permeability, rigid, contact-lens materials now make artificial replacement of the epithelium a potentially useful treatment for severe ocular surface disease when conventional treatment has failed.
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Affiliation(s)
- H J Ingraham
- Department of Ophthalmology, North Shore University Hospital, Manhasset, New York 11030
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44
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Abstract
57 patients with dry eye syndrome of various etiology were treated with a preservative-free hydrogel in an open clinical trial. All patients enrolled in the 12 weeks study had a history of pretreatment with usual commercial tear substitutes which was either insufficient for relief of complaints or caused hypersensitivity. Detailed analysis of patients self assessment of their condition (by means of a linear scale), tear film break-up time, Schirmer Test, and physician's assessment of therapeutical results revealed that in about 90% of cases existing patient complaints and findings related to dry eye syndrome were significantly improved by symptomatic therapy with this preservative-free gel.
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Affiliation(s)
- H Brewitt
- Augenklinik, Medizinischen Hochschule Hannover
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45
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Kowalik BM, Rakes JA. Filamentary keratitis--the clinical challenges. J Am Optom Assoc 1991; 62:200-4. [PMID: 1813523] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
Filamentary keratitis, while appearing to be a simple entity, can be a clinical challenge. Earlier investigators failed to understand the complexities of filament formation and its association with a variety of ocular and systemic conditions. Through trial and error a variety of treatment modalities were employed, ranging from the use of topical drops to the application of electrical current. In most cases filaments resolve with conventional therapy, but in other cases it can become chronic, eventually resulting in vascularization of the cornea.
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46
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Hańczyc P. [Ultrastructure of the lacrimal film and the "dry eye" syndrome]. Klin Oczna 1991; 93:91-3. [PMID: 1870308] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Affiliation(s)
- P Hańczyc
- Kliniki Okulistycznej Am we Wrocławiu
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47
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Snibson GR, Greaves JL, Soper ND, Prydal JI, Wilson CG, Bron AJ. Precorneal residence times of sodium hyaluronate solutions studied by quantitative gamma scintigraphy. Eye (Lond) 1990; 4 ( Pt 4):594-602. [PMID: 2226990 DOI: 10.1038/eye.1990.83] [Citation(s) in RCA: 83] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Abstract
Sodium hyaluronate solutions have been advocated in the management of a variety of dry-eye states. By virtue of their non-Newtonian rheological properties, formulations exhibiting high zero-shear viscosities may be used as an artificial tear with the expectation of prolonged precorneal residence times and improved tolerance. Quantitative gamma scintigraphy was used to evaluate the residence times of 0.2% and 0.3% sodium hyaluronate solutions and a polymer-free solution of buffered saline in 12 patients with keratoconjunctivitis sicca and a group of six normal volunteers. Using several indices of residence time, mean values for the sodium hyaluronate solutions were significantly longer than those for buffered saline. Parallel changes in tear film thickness were also demonstrated using a technique based on laser interferometry.
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Affiliation(s)
- G R Snibson
- Department of Ophthalmology, University of Oxford
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48
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Spurlock SL, Spurlock GH, Wise M. Keratoconjunctivitis sicca associated with fracture of the stylohyoid bone in a horse. J Am Vet Med Assoc 1989; 194:258-9. [PMID: 2917892] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
Keratoconjunctivitis sicca developed in a mare with fracture of the stylohyoid bone. Treatment was directed at preserving the health of the globe while local inflammation at the fracture site was resolved.
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Affiliation(s)
- S L Spurlock
- Marion duPont Scott Equine Medical Center, Virginia-Maryland Regional College of Veterinary Medicine, Leesburg 22075
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Kern TJ, Erb HN, Schaedler JM, Dougherty EP. Scanning electron microscopy of experimental keratoconjunctivitis sicca in dogs: cornea and bulbar conjunctiva. Vet Pathol 1988; 25:468-74. [PMID: 3212890 DOI: 10.1177/030098588802500610] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
Keratoconjunctivitis sicca was produced experimentally in 16 beagles by bilateral surgical removal of the lacrimal and nictitans glands; four dogs were not treated, and 12 received tear-replacement therapy on post-operative days 7 through 28. Keratoconjunctivitis sicca was verified by reduction in Schirmer tear test values by post-operative day 6, and there was no response on day 28 to tear-replacement therapy. Corneas of both normal and tear-deficient dogs had polygonal squamous epithelial cells of light and dark electron density by scanning electron microscopy. Light cells had more microvilli and microplicae than dark cells. Conjunctivae were similar to corneas, except for numerous goblet cells on the surface. Corneal dark-cell density and goblet cell density were not different between groups. Goblet cells most often occurred singly in normal dogs, while they were in clusters in tear-deficient dogs. A hypothesis that petrolatum/mineral oil ointment should provide more effective artificial tear replacement than hydroxymethylcellulose drops for tear-deficient dogs could not be confirmed by objective analysis of corneal dark-cell density or conjunctival goblet cell density.
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Affiliation(s)
- T J Kern
- Department of Clinical Sciences, New York State College of Veterinary Medicine, Cornell University, Ithaca
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