Effects of Recombinant Human Epidermal Growth Factor Eye Drops Combined with Phacoemulsification on Short- and Long-Term Visual Acuity Recovery and Related Dry Eye Complications in Patients with Senile Cataract

Objective

To investigate the effects of recombinant human epidermal growth factor eye drops combined with phacoemulsification on short- and long-term visual acuity recovery and related dry eye complications in patients with senile cataract.

Methods

Sixty patients with senile cataract cured from January 2019 to January 2021 were enrolled in our hospital. The patients in the control group were arbitrarily assigned into the control and the research group. The former group received phacoemulsification, and the latter group received recombinant human epidermal growth factor (RhEGF) eye drops combined with phacoemulsification. The curative effect, the incidence of xerophthalmia, short-term and long-term vision improvement, changes of corneal endothelial cells, serum factors, and life quality scores were compared.

Results

The effective rate of the research group was 90.00%, and the effective rate of the control group was 66.67%; the curative effect of the research group was higher than that of the control group (P < 0.05). The incidence of dry eye in the research group was lower than that in the control group (P < 0.05). The short-term and long-term visual acuity improvement effect of the research group was better than that of the control group (P < 0.05). After treatment, the density of corneal endothelial cells in the research group was higher than that in the control group, while the proportion of hexagonal cells and the coefficient of variation of corneal endothelial cells in the research group were lower than those in the control group (P < 0.05). After treatment, IL-6 and TNF-α in the research group were lower than those in the control group (P < 0.05). Compared with the control group, the physical function, psychological function, social function, and healthy self-cognition scores of the research group were all lower (P < 0.05).

Conclusion

Cataract is the leading cause of blindness in the world. With the continuous improvement of cataract phacoemulsification technology, the incidence of some serious complications has gradually lessened. Xerophthalmia is one of the most obvious and predictable complications after cataract surgery and may affect the recovery of postoperative visual acuity. Recombinant human epidermal growth factor eye drops can effectively enhance the visual acuity of patients, promote the curative effect, and strengthen the life quality.

Common inflammatory and infectious conditions of the eyelid

Patients with infection or inflammation of the eyelid will often first present to their primary care physicians with symptoms such as redness, swelling, tearing, itchiness, or a foreign body sensation. There are a variety of conditions that affect the eyelid which can cause such symptoms, and the exam and history can help a provider differentiate some of the more common conditions. This article will provide a comprehensive review of the background, diagnosis and management of dry eye disease, chalazion, hordeolum (stye), and preseptal cellulitis.

Influence of diabetes mellitus on anterior segment of the eye

Diabetes mellitus (DM) has been emerging as one of the most serious health problems worldwide. Ocular complications of DM are currently one of the major causes of blindness in developed countries, among which diabetic retinopathy is relatively well studied and understood. However, although ocular surface complications of DM are common, diabetic complications of anterior segment of the eye, such as, cornea, conjunctiva, and lacrimal glands, are often overlooked. DM is associated with progressive damage to corneal nerves and epithelial cells, which increases the risk of anterior segment disorders including dry eye disease, corneal erosion, persistent epithelial defects, and even sight-threatening corneal ulcer. In this review, the authors will discuss the association of DM with disorders of anterior segment of the eye. Studies indicating the value of corneal nerve assessment as a sensitive, noninvasive, and repeatable biomarker for diabetic neuropathy will also be introduced. In addition, treatment modalities of anterior segment disorders associated with DM is discussed. The studies introduced in this review suggest that early and periodic screening of the anterior segment of the eye, as well as the retina, is important for the optimal treatment of DM.

Dry Eye Disease: Prevalence, Assessment, and Management

Dry eye disease is a chronic condition of the corneal surface marked by persistent symptoms of irritation or burning that can cause inflammatory damage to the cornea and conjunctiva if untreated. Common risk factors for this syndrome include advancing age, female sex, low humidity environments, systemic medications, and autoimmune disorders. Treatments to relieve symptoms include tear replacement, humidification, improved nutrition, and anti-inflammatory ocular agents. Home healthcare nurses can identify signs and symptoms of dry eye syndrome and initiate strategies that range from warm compresses to physician referrals for more aggressive treatment. Consistent management of this condition improves quality of life and minimizes damage to the ocular surface.

[Professor ZHOU Yun-xian's experience of acupuncture combined with Chinese material medica for xerophthalmia]

Professor ZHOU Yun-xian's clinical experience of acupuncture combined with Chinese material medica for xerophthalmia is introduced. Her treatment for xerophthalmia is firstly focused on syndrome differentiation, indicating that different syndrome has different treatment of acupuncture and Chinese material medica. It is emphasized that by following the holistic concept of TCM, the local acupoints and whole-body acupoints cooperate closely, forming her special combination method of acupoints. In clinic, attention is focused on the application of many acupuncture techniques and extra points. With the combination of acupuncture and Chinese material medica, the treatment is flexible with superior clinical efficacy.

[Efficacy observation of xerophthalmia treated with acupuncture of warming-promotion needling technique]

OBJECTIVE

To observe the differences in the efficacy on xerophthalmia treated with the needling technique for warming-promotion at Fengchi (GB 20) as the main acupoint in comparison with the conventional needling technique.

METHODS

Thirty cases were randomly divided into a warming-promotion needling group (n = 15) and a routine needling group (n = 15). In warming-promotion needling group, the needling technique for warming-promotion was applied to Fengchi (GB 20). Additionally, the local and distal acupoints [such as the point beneath Cuanzu (BL 2), Neiguan (PC 6), Guangming (GB 37), Taichong (LR 3), Fulio (KI 7) and Sanyinjiao (SP 6)], as well as the scalp acupuncture (bilateral supraoccipital lateral line and supraoccipital midline) were selected and stimulated with even-needling technique by rotating the needle. In routine needling group, the acupoints were same as warming-promotion needling group and were stimulated with even-needling technique by rotating the needle. After 2 sessions of treatment, the efficacy, tear secretion volume and the total score of symptoms were compared between two groups.

RESULTS

The total effective rate was 86.7% (13/15) in warming-promotion needling group, which was superior to 66.7% (10/15) in routine needling group (P < 0.05). After treatment, the tear secretion volume and the total score of symptoms were all apparently improved in two groups (all P < 0.05), in which, the improvement in warming-promotion needling group was much obvious (all P < 0.05).

CONCLUSION

The therapeutic effect of warming-promotion needling technique is apparently superior to that of conventional one.

[Efficacy assessment of acupuncture and moxibustion on tear secretion in xerophthalmia]

OBJECTIVE

To compare the efficacy differences between acupuncture-moxibustion and medication in xerophthalmia.

METHODS

Eighty cases of xerophthalmia were randomly divided into an acupuncture-moxibustion group and a medication group, 40 cases in each group. In acupuncture-moxibustion group, acupuncture was applied to the local and distal points, such as Jingming (BL 1), Cuanzhu (BL 2), Taiyang (EX-HN 5) and Quchi (LI 11) etc., combined with non-smoking moxibustion. In medication group, Sodium Hyaluronate eye drops were administered, three times per day, 1 drop each time. Before and after treatment, tear secretion volume (Schirmer's test), break-up time (BUT), symptom score, visual function score and tear film grade were observed.

RESULTS

The total effective rate was 73.1% (57/78) in acupuncture-moxibustion group, and was 37.2% (29/78) in medication group, indicating significant statistical difference in comparison (P < 0.05). There was a significant difference in statistics in tear secretion volume between two groups after treatment (P < 0.05), in which, the result in acupuncture-moxibustion group was superior to that in medication group. The significant statistical differences presented in tear secretion volume, BUT, symptom score, visual function score and tear film grade in comparison before and after treatment in acupuncture-moxibustion group (all P < 0.05). The significant statistical difference presented in symptom score and tear film grade before and after treatment in medication group (both P < 0.05).

CONCLUSION

Acupuncture-moxibustion apparently relieves the symptoms of xerophthalmia, promotes tear secretion and improves the life quality of patients.

Ophthalmologist perceptions regarding treatment of moderate to severe dry eye: results of a physician survey

PURPOSE

To understand ophthalmologists' current perceptions and treatment of patients with moderate to severe dry eye syndrome (DED).

METHODS

An online survey was distributed to 7,882 ophthalmologists, including 51 corneal specialists, throughout the United States from October 9 to 21, 2008. The response rate was 3.1% (n = 245), typical for this type of survey. Those who treated 4 or more patients with moderate to severe DED per month (235 of 245 [96%]) were asked to complete the survey.

RESULTS

Ninety-four percent of respondents agreed that more treatment options are needed for moderate to severe DED. Corneal specialists were more likely to strongly agree (63%) than general ophthalmologists (54%). Only 33% overall felt that current therapies were extremely or very effective for moderate DED, and only 5% for severe disease. Ninety-two percent agreed that multiple therapeutic agents are needed to manage moderate to severe DED. The respondents reported prescribing, recommending, or suggesting a mean of 3.2 different treatment approaches over the course of a year for patients with moderate DED and 4.9 for patients with severe DED. The most highly ranked goals in treatment of moderate to severe DED were maintaining and protecting the ocular surface (ranked 1 or 2 by 74%) and lubricating and hydrating the ocular surface (ranked 1 or 2 by 67%). Corneal specialists ranked maintaining and protecting the ocular surface even higher (ranked 1 or 2 by 82%).

CONCLUSIONS

Results reflected the difficulty of treating more serious moderate to severe cases, the importance of using multiple treatment approaches, the limitations of current treatment options, and the need for additional treatment options.

Stomatological approach to Sjögren's syndrome: diagnosis, management and therapeutical timing

Sjögren's syndrome is a chronic multisystem autoimmune disease characterized by the exocrine glands inflammation, with subsequent hypofunction. More frequently lachrymal and salivary glands are interested with subsequent xerophthalmia and xerostomia. Sjögren's syndrome can be present in an idiopathic type or in association with other autoimmune diseases as rheumatoid arthritis, systemic lupus erythematosus, schlerodermia, etc. It interests mainly the women (with a ratio F:M=9:1) with an age between 40 and 60 years old. The disease prevalence varies from 0.4% to 4.8%. The glandular lesions determine in the time a volume reduction and a secretum quality alteration. The most frequent oral manifestations are xerostomia, that allows the establishment of caries, gingivitises, periodontal disease and oral candidiasis. The aim of this work was to perform a thorough review of the literature on Sjögren's syndrome, illustrating the most internationally accredited diagnostic criteria, the patient's management and therapeutical approach in the odontostomatological discipline. The Authors conclude that it doesn't exist a resolutive treatment of the disease. The therapy is only palliative, and is turned to the treatment of xerostomia and xerophthalmia, through systemic and aspecific sialogogues drugs. From the odontostomatological point of view, particularly useful results the domiciliary and professional oral hygiene to contrast the xerostomia effect on the oral structures.

[Observation on therapeutic effect of moxibustion with thunder-fire herbal moxa stick on xerophthalmia of oligodacrya]

OBJECTIVE

To observe clinical therapeutic effect of moxibustion with thunder-fire herbal moxa stick on xerophthalmia of oligodacrya.

METHODS

Seventy cases were randomly divided into an observation group and a control group. The observation group (n=36) were treated with moxibustion with thunder-fire herbal moxa stick at Cuanzhu (BL 2), Yuyao (EX-HN 4), Tongziliao (GB 1), Taiyang (EX-HN 5), Sibai (ST 2), Jingming (BL 1), etc. and massage of acupoints and lacrimal gland around the eye. The control group (n=34) were treated with local dripping Leiran Diyanye. Changes of the main symptoms, tears secretion test, lacrimal membrane breaking time and corneal fluorescent staining before and after treatment were observed in the two groups.

RESULTS

After treatment, sensation of dryness and foreign body sensation in the eye, asthenopia and gross symptoms significantly improved (P<0.01) in the two groups, and the observation group in the improvement of the sensation of dryness and foreign body sensation in the eye and the gross symptoms was better than the control group (P<0.05); tears secretion test significantly improved and was better in the observation group than that in the control group (P<0.05); lacrimal membrane breaking time and corneal fluorescent staining were improved in the two groups (P<0.05), and the improvement of lacrimal membrane breaking time in the observation group was more obvious than that in the control group (P<0.05).

CONCLUSION

Moxibustion with thunder-fire herbal moxa stick has good therapeutic effect on xerophthalmia of oligodacrya.

Aspects of xerostomia prevalence and treatment among rheumatic inpatients

OBJECTIVES

The aim of the study was to evaluate the prevalence of xerostomia among inpatients with rheumatic disorders at the Hospital of Kaunas University of Medicine (HKUM) and its association with age, sex, and xerophthalmia. Determining adequate treatment for xerostomia was also important, because untreated xerostomia may become aggravated and thus significantly impair patient's quality of life.

MATERIAL AND METHODS

The authors designed a special questionnaire for conducting all study-related enquiries. Patients for this study were selected according to their case records ranging from 1998 to 2004. In total, there were 483 cases chosen based on prevalent rheumatic diseases, which were most conducive to xerostomia.

RESULTS

The results showed no significant evidence that the prevalence of xerostomia increased with age. Also, women were more susceptible to rheumatic diseases than men (W:M = 10:1) and are more likely to be affected by xerostomia and xerophthalmia (W:M = 2.5:1). A significant correlation was found between xerostomia and xerophthalmia. Only 17.7% of xerostomia-positive patients were treated for xerostomia, in comparison with xerophthalmia-positive patients who were treated for xerophthalmia in 84.8% of cases. It was shown that the modalities of treatment administered for xerostomia were neither sufficient nor up-to-date according to current recommendations found in medical literature.

CONCLUSIONS

Xerostomia is closely correlated with xerophthalmia in rheumatic diseases. Xerostomia is more prevalent in older segments of population, especially in women, but we failed to prove statistical significance of older age in prevalence of sicca symptoms. Treatment administered to rheumatic patients for xerostomia in the HKUM is neither sufficient nor adequate.

[Clinical observation on the method for nourishing blood and moisturizing eye on xerophthalmia]

OBJECTIVE

To observe therapeutic effect of the method for nourishing blood and moisturizing eye on xerophthalmia.

METHODS

Fifty-one cases of xerophthalmia were randomly divided into a treatment group and a control group. The treatment group were treated by acupuncture, moxibustion with Chinese medicine, and auricular point pressing, and the control group were treated with dripping of artificial tears. Local symptoms of eyes, tear secretion amount (Schirmer method) and BUT were observed before and after treatment.

RESULTS

The total effective rate of 88.5% in the treatment group was better than 52.0% in the control group (P<0.05).

CONCLUSION

The method for nourishing blood and moisturizing eye is a better therapy for xerophthalmia.

[Visual functions' detailed evaluating in patients with Sjögren's syndrome before and after intracanalicular implants' (Smart Plug) insertion--(first results)]

The aim of the study was to determine exact visual functions (log MAR [minimal angle of resolution] and CS [contrast sensitivity]) and to evaluate corneal topographic maps in patients with established (by means of laboratory and biopsy examinations) Sjogren's Syndrome, and to determine the difference in subjective symptoms before and after insertion of the intracanalicular implants as well.

PATIENTS AND METHODS

Twelve eyes (1 man, 6 women) with established Sjogren's syndrome were examined before and during two months after the insertion of the plugs. The best-corrected visual acuity (BCVA) was assessed on Landolt C rings optotypes. CS was measured on computer-controlled device (Neuroscientific Corp., U.S.A.) in 6 space-frequencies (0.74-29.55 c/deg). The corneal topographic changes (Keraton Opticon) were established by means of comparing total aberrations values before and after the intracanalicular implants' (Smart Plugs type) insertion. The control group for visual functions assessment consisted of 10 woman (20 eyes) of similar middle age.

RESULTS

The BCVA on log MAR optotypes was 0.84 (0.69-0.95) before and 0.88 (0.52-1.23) after the insertion, on both occasions, it was lower than in the control group. The CS was before the insertion in all of the spatial frequencies lower, the largest differences were in the frequencies range 1.97-7.29 c/deg (p < 0.01). After the treatment, the values grow but they don't reach the values of the control group. Subjective complains of the patients decreased markedly; in 100% they had relief, in 3 cases they referred improvement up to 50%; no patient observed tearing. The frequency of drops' application has decreased by 63%. The Schirmer test, in 100% positive before the treatment, was after the insertion in 75% negative; the height of the tear-meniscus was positive in 100% before the procedure, and after that, its measurement improved to 1 mm in 91%; in 9% it was 1.5 mm. We also noticed changes of the ocular surface by means of lissamine green staining; this test was before the procedure positive in 100%, the improvement after that was in 63%. The regularity of the corneal surface is the determining factor of visual functions in "dry eyes". The measurement of the corneal topography is useful in differential diagnosis and helps to distinguish mild and more serious conditions of dry eye. The improvement of BCVA and CS values after insertion corresponds with patients' subjective evaluating. The best value of the treatment is improvement of the patients' comfort; furthermore, after insertion of the permanent plugs they feel pronounced subjective relief and lowering of the frequency of drops application.

[Effect of integral syndrome differentiation acupuncture on the tear film stability in the patient of xerophthalmia]

OBJECTIVE

To probe into a treatment method for increasing clinical therapeutic effect on xerophthalmia.

METHODS

Forty-five cases were randomly divided into acupuncture group 1, acupuncture group 2 and control group. The acupuncture group 1 were treated with acupuncture based on syndrome types, and the acupuncture group 2 with acupuncture at local acupoints, and the control group with dripping of artificial tears. Local symptoms of eyes, S1T, BUT and FL were observed before and after treatment.

RESULTS

S1T and BUT increased after treatment in the two groups (P < 0.01, P < 0.05), but did not significantly change in the control group (P > 0.05). There were significant differences in change of FL as the control group compared with the acupuncture group 1 and 2. The total effective rate was 86.7%, 66.7% and 33.3% in the acupuncture group 1, 2 and the control group, respectively.

CONCLUSION

The integral syndrome differentiation acupuncture can improve secretion of tear, increase stability of tear film, improve local symptoms of eyes with a therapeutic effect better than acupuncture at local acupoints and artificial tears.

[Siccaprotect eye drop--results of treatment in clinical practice]

The authors introduce Siccaprotect drops, a product of Ursapharm Ltd., and evaluate its efficiency on group of 91 patients suffering from the "Dry Eye" syndrome, in the period from 1. 9. 2003 to 30. 4. 2004. They report high effectiveness of Siccaprotect eye drops, particularly in those cases of dry eye syndrome, where support of epithelization is needed, irrespective of origin of the epithelial microdefects, together with dissolvance of non-infectious inflammation.

Primary Sjögren's syndrome

This article aims to raise awareness of the chronic autoimmune rheumatological disorder Sjögren's syndrome. It describes the main symptoms, diagnosis and management of patients with primary Sjögren's syndrome. It is applicable to nurses working in primary and secondary care settings and offers advice on how they can support such patients with protective and preventive measures.

[Xerophthalmia: current data]

Xerophthalmia is a term covering a range of ophthalmologic manifestations due to vitamin A deficiency. This condition occurs in preschool children in tropical regions affected by protein-caloric malnutrition. Clinical manifestations of the disease have been summarized in the 1974 five-grade WHO classification. Clinical diagnosis was traditionally made using a slit lamp to detect the pathognomonic manifestations and consequences of corneal and conjunctival xerosis. Currently diagnosis is greatly facilitated by determination of plasma levels using a micromethod, especially the relative dose response (RDR) test, and by conjunctival impression cytology (CIC). CIC is a simple and reliable method which allows mass screening and thus more effective evaluation of the impact of xerophthalmia on public health in Africa. The relationship between xerophthalmia and measles is complex. Vitamin A deficiency promotes measles which can in turn hasten perforation of keratomalacia especially in undernourished children. Vitamin A has a beneficial effect on both xerophthamia and measles. Curative and prophylactic administration of vitamin A at doses recommended by the W.H.O. considerably reduces not only xerophthalmia-related morbidity but also child mortality in tropical areas.

GVHD dry eyes treated with autologous serum tears

Two cases of GVHD with severe dry eyes are reported where conventional therapy failed to control ocular signs and symptoms. Autologous serum tears, however, resulted in a beneficial clinical effect with marked attenuation of the symptoms. This therapy proved to be safe during 10 months of treatment. Bone Marrow Transplantation (2000).

[Gougerot-Sjögren syndrome. Diagnostic criteria and therapeutic methods]

CLASSIFICATION CRITERIA: Several systems of classification criteria have been developed for Sjögren's syndrome. These systems allow patient classification but do not constitute diagnostic criteria. The most widely used is based on the Fox criteria which are totally specific but have low sensitivity. The European criteria have satisfactory sensitivity and specificity.

IN CLINICAL PRACTICE

In all cases, the elements comprising the sicca syndrome must be identified. A labial biopsy for histology of the accessory salivary glands may be helpful. A less extensive search is sometimes sufficient if the aim is uniquely diagnostic. TREATMENT OF SJOGREN'S SYNDROME: Symptomatic treatment of the sicca syndrome with local procedures is aimed at reducing the functional disorder. The systemic route is used to treat the dysimmune component. As in most connective tissue diseases, most patients can be stabilized, limiting the functional consequences of the disease, but cure remains illusive.

Comparative study of tear substitutes and their immediate effect on the precorneal tear film

Dry eye patients present with instability of the precorneal tear film which breaks up much earlier than normally. The instability of the precorneal tear film leads to dry eye symptoms such as the sensation of sand in the eye, recurrent blurred vision, itching, smartness, and the sensation of dryness. The stability of the precorneal tear film can be evaluated by the break-up-time test (BUT). The aim of treatment of dry eye is to increase the precorneal tear film stability. Tear substitutes are the most frequent medication for dry eye patients, who request life-long treatment. Therefore, we estimated the influence of tear substitutes on the precorneal tear film stability. The influence of unpreserved artificial tear substitute containing 0.1% sodium hyaluronate (Healon 0.1%) was compared with that of 7 different available tear substitute preparations containing preservatives. The results of the present study show that Healon 0.1% has the best influence on the precorneal tear film stability. These data were found to be independent of the viscosity property of Healon 0.1%.

Cannalicular occlusion with cyanoacrylate adhesive: a new treatment for the dry eye

One hundred microlitres (0.1 ml) of N-butyl cyano-acrylate adhesive was injected into the inferior cannaliculus of 8 patients with dry eye. The adhesive induced total (upper and lower) cannalicular occlusion in each patient which has not resolved to date (mean follow-up 15.2 months, range 11-19 months). Complications were minor and not specific to use of this adhesive. It is hoped that its ultimate reversibility will make the technique suitable for younger patients with dry eye.

Prevalence of xerophthalmia and efficacy of vitamin A prophylaxis in preventing xerophthalmia co-existing with malnutrition in rural Indian children

Data of 4302 children, 0-6 years old were analysed to study the prevalence of vitamin A deficiency and the efficacy of vitamin A prophylaxis in preventing xerophthalmia co-existing with malnutrition. Manifestation of ocular signs of vitamin A deficiency were seen in 10 per cent children. The prevalence of xerophthalmia was higher in the normal and mild to moderately malnourished children, and lowest in the severely malnourished ones. The ability of vitamin A prophylaxis to curb xerophthalmia was greatest at the extreme ends of the nutritional grade spectrum. These findings have important implications for the existing national Vitamin A Prophylaxis Programme, and suggest that: (a) normal and mild to moderately malnourished children less than 6 years old, should be preferably considered for vitamin A mega dosing; (b) in the management of protein energy malnutrition, vitamin A status of the children should be monitored; and (c) the coverage should be improved as most children are in the mild and moderate degrees of malnutrition.

Xerophthalmia, vitamin A supplementation and morbidity in children

The relationship between ocular manifestation of vitamin A deficiency and children's anaemic/morbidity status as well as the efficacy of vitamin A prophylaxis in preventing these conditions was determined. The prevalence of xerophthalmia in morbid children with anaemia and history of worm infestation, measles, and diarrhoea was higher as compared to their non-morbid counterparts. The relative risk (RR) of anaemic children with eye signs was significantly higher (1.5), but the chances of having anaemia were similar in both vitamin A receivers and non-receivers. The RR of history of worm infestation, measles, and severe diarrhoea was 1.4, 1.0, and 1.2, respectively, in children with eye signs and 1.2, 0.8, and 1.3, respectively in children who did not receive vitamin A prophylaxis. The RR for occurrence of diarrhoea along with vitamin A deficiency was as high as 1.9. It appears xerophthalmia and anaemia co-exist and vitamin A supplementation helps in curbing these conditions among 1-6-year-old children.

[Noninfectious bilateral corneal ulceration associated with Sjögren's syndrome: report of a case]

A case of noninfectious bilateral corneal ulceration in a 46 year old patient with Sjögren's syndrome is reported. The clinical evolution is commented and the available therapeutic measures for this complication are discussed.

[Tear substitutes. Experimental and clinical observations]

Dry-eye conditions do not represent an etiologically homogeneous clinical picture, and therapy is therefore difficult. Tear substitution by means of artificial tears of various viscosities has been common practice, and the use of highly viscous artificial tears is considered appropriate therapy in many cases of dry eye because of their prolonged contact time on the ocular surface. A clinical study with a gel made of cross-linked polymers of acrylic acid with a high molecular weight (Thilo-Tears) showed that both the subjective and objective effects were good. Clinical parameters and data describing the differences in contact times of the highly viscous preparations and a low-viscosity solution (2% PVP), Schirmer's test, Jones's test, and BUT are described and assessed in detail. Furthermore, an attempt is made to supplement and corroborate the clinical findings and the rationale of using highly viscous solutions by presenting experimental results on the preocular film. In particular, considerations pertaining to the relevance and the formation of the glycocalyx from vesicles of corneal epithelial cells are discussed, and the interaction of the epithelial cell membranes with the preocular film is emphasized.

The treatment of aqueous-deficient dry eye with removable punctal plugs. A clinical and impression-cytologic study

Punctal plugs were placed in 18 dry eye patients of the aqueous-deficiency type who were on maximally tolerable medical therapy and who had Schirmer testing with topical anesthetic measuring less than 6 mm. Pretreatment and posttreatment evaluations included rose Bengal and fluorescein staining, Schirmer testing, and conjunctival impression cytology. Six weeks after plug placement, 11 of 18 patients had subjective improvement and were able to decrease dependency on tear supplements; all of these patients have successfully worn plugs for at least 8 months. Although these 11 patients improved clinically, impression cytologic abnormalities persisted 6 weeks after plug placement. Three patients did not improve clinically after punctal plug therapy, and four patients improved subjectively but extruded plugs within 2 weeks of placement. Three of the patients who extruded plugs had marked lid laxity and dilated puncta before placement. Reversible punctal occlusion by plugs may significantly decrease dependency on tear supplements in selected patients.

An improved method for the delivery of artificial tears using an infusion pump

Patients with markedly decreased or absent tear duct production require the frequent instillation of artificial tear preparations. Through animal experiments, a new method has been developed for the continuous infusion of these solutions. In this procedure, the canalicular system is intubated with fenestrated silastic tubing, which is subcutaneously tunnelled and then attached to a miniaturized and computerized pumping device. This makes it possible for a predetermined volume of solution to be automatically and continuously delivered. Using this technique, artificial tear solution was instilled at a rate of 1.75 microliter/min, a rate approximately the normal basic tear secretion rate (0.5-2.2 microliters/min). This resulted in a 14% increase in tear flow from preoperative values. This represents a 74% increase in tear secretion rates for patients with keratoconjunctivitis sicca. None of the experimental animals developed subcutaneous infections, dacryocystitis, or corneal ulcers. By utilizing the normal anatomy of the lacrimal drainage system, this new technique: does not compromise the conjunctival cul-de-sac or the salivary system, avoids the inconvenience of previous external devices, and allows for the automatic instillation of predetermined volumes of artificial tear solutions.

Common eye problems in the older woman

Dry eye syndrome, cataracts, glaucoma, and macular degeneration are the four most common eye problems affecting elderly women. The cause, symptomatology, treatment, and prognosis of each condition are discussed.

ABC of nutrition. Malnutrition in the Third World--II

Images

[The dry eye]

Dry eye, or keratoconjunctivitis sicca, is a pathologic condition which, today, needs to be more precisely defined. The moisture in the eye, which is essential for optical and physiological reasons, is maintained by three factors: a) the secretion of mucus by the conjunctiva, rendering uniform distribution of the aqueous phase of the lacrimal film on the corneal surface possible; b) the secretion of aqueous humor by the lacrimal and conjunctival glands; and c) the secretion of lipids from the skin and meibomian glands. Accordingly, an insufficiency of the lacrimal film may be due to insufficient secretion of lipids from the skin or meibomian glands, insufficiency of the aqueous phase of the lacrimal film (as is the case in Gougerot-Sjögren syndrome), or insufficiency of the mucus secretions (as in the case of pemphigoid syndrome). The complaints which lead patients to consult an ophthalmologist, as well as the objective findings on examination, are described here. The methods of examination by which lacrimal insufficiency can be confirmed are discussed: Schirmer's test (I and II), Jones' test, Norn's dilution test, break-up time, tests with dyes such as fluorescein, rose bengal, and lissamine green 1%. The conjunctival imprint gives indications without which no clear diagnosis can be made. The treatment of dry eye consists primarily of instillations of artificial tears. If this treatment fails the lacrimal puncta can be closed. Thirdly, pathogenic treatments can be used in certain cases. Fourthly, one can prescribe closed frames which create a wetting chamber. Finally, in particularly severe cases, surgery can be considered.(ABSTRACT TRUNCATED AT 250 WORDS)