Dry eye signs and symptoms in aromatase inhibitor treatment and the relationship with pain

PurposeAromatase inhibitors (AIs) limit the synthesis of oestrogen in peripheral tissues thus lowering levels of oestrogen. The primary aim was to evaluate whether women treated with AIs have altered dry eye symptoms and signs. A sub-aim was to investigate whether symptoms of dry eye in postmenopausal women were associated with symptoms of non-eye pain, ocular pain and self-rated pain perception.MethodsThis cross-sectional, observational, single visit study recruited 56 postmenopausal women (mean age 64.1 + 7.9 years) and 52 undergoing AI treatment (mean age 66.6 + 9.0). Ocular symptoms (OSDI, MGD14) and pain questionnaires (PSQ, OPAS) were administered and signs of dry eye and meibomian gland dysfunction were evaluated.ResultsAlmost half of each group reported dry eye symptoms, defined as OSDI>12 (48% control, 46% AI). The PSQ score was significantly higher in the AI group (p = 0.04). Neither frequency or severity of dry eye (or MGD) symptoms scores were significantly different between groups. In the AI group, meibomian gland expressibility score was worse (p = 0.003); there were no differences in any other signs. Higher OSDI scores were associated with higher OPAS eye-pain scores (r = 0.49, p < 0.001), but not OPAS non-eye pain (r = 0.09, p = 0.35). Pain perception (PSQ) showed a moderate positive association with OPAS eye-pain (r = 0.30, p = 0.003).ConclusionsIn this study elevated ocular symptoms were observed in both the AI treated and the untreated groups, with no difference between the groups. Women undergoing AI treatment for early stage breast cancer had worse meibum expressibility score and increased pain perception compared to an untreated group of women.     

Terapia de luz pulsada intensa regulada: un tratamiento complementario prometedor para la enfermedad de ojo seco

ObjectiveTo propose the Intense Pulsed Light (IPL) therapy as a helpful supplementary treatment in patients with dry eye disease.Material and methodsRetrospective cross sectional design. Medical records of patients in whom dry eye disease symptoms were not satisfactorily controlled with medical therapy alone and who underwent additional IPL with at least three sessions completed. Data were analyzed before therapy and 3 weeks after its completion to asses improvement. Determination of symptoms, through a visual analog scale; tear film stability, through tear Break Up Time (tBUT); measurement of tear secretion, through Schirmer Test; and ocular surface staining with Van Bijsterveld score were evaluated. SPSS software and nonparametric analysis of repeated measures were used. The study was approved by the ethics committee.Results50 eyes from 25 subjects were reviewed. There were 9 males (36%) and 16 females (64%), with a median age of 59 years (IQR 52-64). The median of the symptoms scale was 8 (IQR 8-9) and 3 (IQR 2-4) before and after the therapy respectively (P < .05). The median of BUT was 4 (IQR 3-5) and 10 (IQR 8-11), Schirmer test was 13 (IQR 12-15) and 15 (IQR 13-20), and Van Bijsterveld score was 3 (RIC 3-4) and 2 (IQR 2-3) before and after the therapy respectively (P < .05, for all measurements).ConclusionIPL treatment has excellent results regarding both: dry eye disease symptoms improvement and in office objective tests such as tBUT, Schirmer test and Van Bijsterveld score; IPL could be considered as an effective adjunct for dry eye disease.     

中药熏蒸联合人工泪液治疗干眼症的临床观察及对患者视觉相关生命质量的影响

目的:探究中药熏蒸联合人工泪液治疗干眼症的临床疗效,分析其对患者视觉相关生命质量的影响。方法:选取2014年11月至2016年12月北京市健宫医院收治的干眼症患者72例作为研究对象,按照随机数字表法随机分为对照组和观察组,每组36例(72只患眼),对照组给予人工泪液治疗,观察组在对照组的基础上联合中药熏蒸治疗,2周为1个疗程,2组均连续治疗2个疗程。统计2组临床疗效;比较2组患者治疗前后主要中医症状积分、泪液分泌量、泪膜破裂时间;采用美国国家眼科研究所视觉相关生命质量量表(NEI-VFQ-25)评价并比较2组患者治疗前后视觉相关生命质量。结果:治疗后观察组总有效率为90. 28%,较对照组的63. 89%显著升高(P 0. 01);与治疗前比较,治疗后2组患者患眼疲劳感、干涩感、异物感及烧灼感等症状积分均显著降低,且观察组显著低于对照组(P 0. 01);与治疗前比较,治疗2周后至治疗4周后2组泪液分泌量呈逐渐升高趋势(P 0. 01),泪膜破裂时间呈逐渐延长趋势(P 0. 05),且治疗后2组间差异有统计学意义(P 0. 05或P 0. 01);与治疗前比较,治疗后2组患眼一般健康状况、活动障碍及视力障碍评分均显著升高(P 0. 01),且观察组显著高于对照组(P 0. 01)。结论:中药熏蒸联合人工泪液治疗干眼症可有效缓解患眼临床症状,促进患眼泪液分泌并增强泪膜稳定性,同时还可显著改善患眼视觉相关生命质量,疗效显著优于人工泪液单用。     

眼动仪在精神分裂症诊断方面的发展和研究

本文主要介绍了精神科用医用眼动仪的发展历程。阐述了眼电法眼动仪、角膜反光法眼动仪以及瞳孔-角膜反射向量法医用眼动仪的工作原理和眼动仪在精神分裂症诊断方面的临床应用效果,介绍了国内外眼动仪研究现状,且结合实际工作提出了未来医用眼动仪的设计发展趋势。     

Salivary gland transplantation for dry eye disease: Indications,techniques, and outcomes

The transplantation of salivary glands to the eye serves as a substitute for restoring tear volume in patients with severe dry eye disease. The lacrimal gland and salivary glands share similar acinar-ductal organization with some differences in the nature of secretions. This review summarizes the comparative anatomy of salivary and lacrimal glands, various salivary gland transplantation techniques, their indications, outcomes and complications along with future perspectives. Autologous microvascular submandibular gland transplantation (SMGT) into the temporal fossa with duct placement into the conjunctival fornix improves tear volume considerably but provides a hyposmolar tear film, which can induce corneal edema (in 3.5-40% of eyes). The transplanted submandibular graft improves tear volume and stability but visual acuity and conjunctival inflammation remain unchanged. The transplanted submandibular gland maintains stable function in the long-term and can have hypersecretion in 24–60% secondary to persistent autonomic innervation. Partial SMGT, gland reduction surgery, topical atropine gel or Botulinum Toxin A injection are options for treatment of postoperative epiphora. Minor salivary gland transplantation (MSGT) into the upper and/or lower conjunctival fornix results in an average improvement of 2–4 mm in Schirmer values compared to 16 to > 30 mm observed in eyes after SMGT. Reflex epiphora is rarely a problem in MSGT. Both MSGT or SMGT can improve the ocular surface and quality of life of patients with severe, debilitating dry eye disease. However, postoperative visual acuity and outcomes of corneal transplantation are still inconsistent. More studies and additional technical improvements are needed to further improve the results of these procedures.     

Topical glaucoma medications – Clinical implications for the ocular surface

Glaucoma is a leading cause of irreversible blindness. The use of topical eye drops to reduce intraocular pressure remains the mainstay treatment. These eye drops frequently contain preservatives designed to ensure sterility of the compound. A growing number of clinical and experimental studies report the detrimental effects of not only these preservatives but also the active pharmaceutical compounds on the ocular surface, with resultant tear film instability and dry eye disease. Herein, we critically appraise the published literature exploring the effects of preservatives and pharmaceutical compounds on the ocular surface.