Abstract
Purpose: To evaluate the influence of ocular discomfort and meibomian gland dysfunction (MGD) on quality of life in patients with an ocular prosthesis. Methods: a prospective analysis was conducted on 18 patients with a unilateral ocular prosthesis. Evaluation of ocular discomfort symptoms, lid margin abnormalities (LMA), meibomian gland expression, meibography and a psychometric evaluation using the National Eye Institute Visual Function Questionnaire (NEI VFQ), Facial Appearance subscale of the Negative Physical Self Scale (NPSS-F), Hospital Anxiety and Depression Scale (HADS) and the DAS24 to evaluate anxiety and depression. Results: the statistically significant differences observed between normal and prosthetic eyes related to ocular symptoms and the meibography score (p = 0.0003). A negative correlation was reported between NEI VFQ score and meibography score (r = −0.509; p-value = 0.022). A positive correlation was detected with NPSS (r = 0.75; p-value < 0.0001), anxiety HADS score (r = 0.912; p-value = 0.001) and depression HADS score (r = 0.870; p-value > 0.0001). Conclusion: MGD represents the most common cause of evaporative dry eye disease, due to the reduction of the thickness of the lipid layer of the tear film. The occurrence of MGD in patients with prosthetic eyes is very common. Anxiety and depression were correlated to ocular discomfort and MGD, and this could affect the quality of life in patients with an ocular prosthesis.
Highlights
The loss of an eye presents severe emotional stress and commonly results in negative consequences to social behavior
The aim of this study is to evaluate the prevalence of meibomian gland dysfunction (MGD) in patients with ocular prostheses reporting symptoms of ocular discomfort, and their impact on quality of life
Significant statistical differences were noted between the normal eye and prosthetic eye related to ocular symptoms (p-value < 0.0001), lid margin abnormalities (LMA) (p = 0.0006), meibomian gland expression score (p = 0.0003), and in the meiboscore of the upper eyelid (p = 0.0004), lower eyelid (p = 0.0003) and total meiboscore (p = 0.0003)
Summary
The loss of an eye presents severe emotional stress and commonly results in negative consequences to social behavior. Patients with an ocular prosthesis reported a high level of anxiety and depression as a consequence of their changed appearance. In this sense, the use of an ocular prosthesis purposes to improve cosmetic appearance, as well as ameliorating social acceptance [1]. Ocular prosthesis can be stock or patient-customized, considering several factors, such as the anatomy and tissue bed of the socket, and individualized aesthetic requirements. Numerous techniques to improve the aesthetic results of the ocular prosthesis have been proposed, such as painting the sclera and iris, the use of transparent grids for proper orientation and the use of a digital image of the normal eye [2]. The principal causes for the need of an ocular prosthesis comprise tumors, congenital defects and malformations, irreparable trauma, end-stage eye diseases, and severe ocular diseases associated with uncontrolled pain, such as neovascular glaucoma, or an unattractive appearance, such
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