Development Of Dry Eye Syndrome Research Articles

Possibilities of using neural network analysis in the diagnosis of dry eye syndrome

The prevalence rate of dry eye syndrome varies from 6.5 to 95 %. Diagnostic criteria are based on different methods and/or their combinations and are characterized by heterogeneity.The aim of the study. To identify the risk factors for the development of dry eye syndrome in order to create a technology for early diagnosis of the degree of the disease in young people without concomitant ocular and general somatic pathology.Materials and methods. Fifty patients aged 24 [22; 27] years were examined. We carried out an ophthalmological examination, including autorefractometry, visometry, biomicroscopy, the Norn test, a survey using the author’s questionnaire, and an assessment of the degree of dry eye syndrome using the Ocular Surface Disease Index (OSDI). Three study groups were formed: control group (OSDI = 0–13 points); group 1 – patients with OSDI = 14–22 points; group 2 – patients with OSDI > 22 points.Results. When examining presented independent variables, screen time had the highest normalized importance (100 %), followed by tear film breakup time (58.4 %), smoking (24.3 %), night shifts (22.5 %) and using soft contact lenses (11.1 %). The technology for early diagnosis of the degree of dry eye syndrome is implemented on the basis of a multilayer perceptron, the percentage of incorrect predictions during its training process was 8.0 %. The structure of the trained neural network included 8 input neurons (the value of screen time and tear film breakup time, the presence or absence of smoking, night shifts and/or the use of soft contact lenses), two hidden layers containing 3 and 2 units, respectively, and 3 output neurons.Conclusion. The proposed neural network has no difficulties in assessing the early diagnosis of the severity of dry eye syndrome and can be used in clinical practice.

Predictive significance of genetic analysis of the development of dry eye disease of different origin

The aim of the study was to determine the prognostic significance of a panel of polymorphic gene markers in the development of dry eye syndrome in patients with primary Sjögren's syndrome and rheumatoid arthritis over a five-year follow-up period. Patients with a verified diagnosis of PSS and RA without signs of DED were examined (n=35 and n=42, respectively). The control group included 82 volunteers without AID and DED. The observation period was 5 years. Every year all study subjects underwent an ophthalmological clinical and functional examination. Dry eye disease had developed in groups of patients with AID with predisposing genotypes of polymorphic markers of the genes THBS1, MUC1, TRIM21, STAT4, PTPN22. The peak of DED development in these patients was in the third year of the follow-up. As a result of ROC analysis, it was found that the sensitivity and specificity of determining the predisposing genotypes of polymorphic markers of the THBS1, MUC1, TRIM21, STAT4, PTPN22 genes was 68 and 87%, respectively (p<0.0001). Genetic research methods are essential for minimally invasive early diagnosis of dry eye disease, and can subsequently become the basis for a personalized approach to its treatment.

Usage of 0.4% sodium hyaluronate in complex treatment of pediatric patients with dry eye syndrome against the background of allergic diseases of the organ of vision

Background. In recent years, the prevalence of allergic diseases of the anterior chamber of the eye has increased. They are often accompanied by the development of dry eye syndrome, which can complicate their course. Therefore, it is important to take a comprehensive approach to their diagnosis and treatment. The purpose was to study the effectiveness of 0.4% sodium hyaluronate (Gilays) in children with dry eye syndrome on the background of allergic diseases of the conjunctiva. Materials and methods. The study involved 42 patients (84 eyes) aged 3 to 18 years, who were examined and treated on the basis of Regional Eye Clinic. Patients were treated with local H-1 histamine blockers twice a day for 14 days, f necessary — with topical glucocorticoids by the scheme for 12 days. In the first group (21 patients, 42 eyes), the main treatment was added with the drugs containing 0.2% sodium hyaluronate, used topically 4 times a day for 14 days. In the second group (21 patients/42 eyes), 0.4% sodium hyaluronate (Gilays) was added to the treatment regimen. H-1 histamine blockers were not used systemically. Before starting therapy and 2 weeks later, the following values were evaluated: the changes in the anterior chamber of the eye using biomicroscopy, determination of lacrimal film rupture time, Schirmer 1 test, questionnaire. Conclusions. The use of sodium hyaluronate in the complex therapy of dry eye syndrome in allergic eye diseases is quite effective. The use of 0.4% sodium hyaluronate was more effective compared to the control group. It is advisable to use a questionnaire to communicate with the child, but it is necessary to refine the form of questions to eliminate as much as possible the subjectivity of the data.

Синдром сухого глаза у пациентов с подагрой

Purpose. To determine and study the features of the development of dry eye syndrome (DES) in gout, depending on urate-lowering therapy, the duration of the gout disease and the concentration of uric acid in the tear. Material and methods. The study involved 149 male patients (261 eyes) aged 35 to 75 years (mean age 60.63 ± 11.00 years). Among them, 110 people (202 eyes) with an established diagnosis: "Cataract with concomitant gout disease" and 39 people (59 eyes) with cataracts without clinical and laboratory signs of gout. All patients underwent both standard ophthalmological examinations and special ones. The concentration of uric acid in tears was determined by high performance liquid chromatography (HPLC). The diagnosis of gout was confirmed according to the criteria recommended by ACR / EULAR (2016). Results. In patients with gout who do not take a urate-lowering drug, DES occurs more often (82.1%) than in patients without gout (23.1%). With an increase in the concentration of uric acid in the tear, there is a high tendency to a shortening of the tear film rupture time (strong correlation coefficient r=-0.51, p&lt;0.001) and to a decrease in tear production (Schirmer I test) (strong correlation coefficient r=-0.59, p&lt;0.001). Conclusion. The data obtained indicate clear changes in the functional parameters of total tear production (Schirmer I's test) and the stability of the pre-corneal tear film (Norn's test) in patients with gout. This can be considered as a fact of the predisposition of this category of patients to the development of DES. A strong dependence of changes in tear production and HRVP on the concentration of uric acid in the tear was established. There is an obvious need for additional examination of this category of patients and an adequate choice of therapy, as well as the timely appointment of "artificial tear" drugs. Key words: dry eye syndrome, uric acid, gout.

Новый взгляд на фотопротекцию и кросслинкинг в эксимерлазерной коррекции зрения

Purpose. To develop approaches to excimer laser keratorefractive surgery based on a new view of the photoprotective function of the cornea, ablation-induced secondary radiation, photoprotective and side effects of crosslinking. Material and methods. The literature data and our own 32-year clinical observations of complications in excimer laser vision correction, methods of their treatment and prevention have been analyzed. Particular emphasis was placed on the analysis of works on photoprotection and crosslinking in photorefractive surgery. New approaches to excimer laser keratorefractive surgery are based on studies on the use of riboflavin for photoprotection and laser-induced crosslinking in corneal ablation (598 operations). Corneal crosslinking was assessed by computed keratotopography, optical coherence tomography, and corneal densitometry. Long-term results were followed up to 8 years. Results. Complications in excimer laser refractive surgery were associated with the development of dry eye syndrome, the formation of subepithelial or intrastromal fibroplasia. Ablation-induced secondary radiation played an important role in the development of complications of excimer laser refractive surgery. It negatively affected keratocytes, nerves and increased oxidative stress in the cornea. To protect against secondary radiation, a new technology of keratoablation with 0.25% isotonic riboflavin solution has been developed. This reduced oxidative stress and aseptic inflammatory response. According to OCT and densitometric studies, a decaying effect of crosslinking with the formation of a membrane structure on the ablation surface was revealed. Local photoprotection during ablation with riboflavin and the effect of crosslinking in combination with postoperative spectacle spectral UV photoprotection accelerated the stabilization of optical-refractive and visual results, increased the photoprotective and strength properties of the thinned cornea. This reduced the risks of keratoectasia and earlier development of cataracts. Conclusion. A new look at photoprotection and crosslinking in excimer laser refractive surgery provides for keratoablation with riboflavin in combination with postoperative spectacle spectral photoprotection from external UV radiation. Key words: excimer laser refractive surgery, dry eye, fibroplasia, keratoectasia, riboflavin, photoprotection, crosslinking.

Патофизиологическое обоснование специфики заболеваемости офтальмологического профиля в Арктическом регионе

Aim. To carry out a pathophysiological substantiation of the specificity of diseases of the organ of vision, developing under the influence of a complex of climatic and geographical factors of the Arctic region. Materials and methods. Using a retrospective epidemiological method of case-control study on the basis of branch No. 8 of FGKU 1469 VMKG of the Ministry of Defense of Russia, an analysis of the morbidity structure by ophthalmological profile for a three-year period (2018-2020) among military personnel aged 18 to 45 years military service in the Novaya Zemlya archipelago, Belushya Guba village. The method of analytical observation and data recording was used to assess the complex of unfavorable climatic and geographical factors of the Arctic region on the example of the Novaya Zemlya archipelago, Belushya Guba village. On the basis of an integral assessment of epidemiological and climatogeographic observations, a pathophysiological substantiation of the specificity of nosological groups of diseases of the organ of vision, developing under the influence of a complex of unfavorable factors of the Arctic region, is given. Results. The study involved 237 people. During the study period, 540 requests for ophthalmological help were registered. Of these, 64.26% are pathologies of inflammatory genesis, 32.6% are refractive disorders, 3.14% are diseases, the pathogenesis of which is associated with metabolic disorders in the body. The pathophysiological substantiation of the revealed morbidity structure according to the ophthalmological profile is due to the influence of a complex of unfavorable climatic and geographical factors of the Arctic region. Under the influence of wind and low temperatures, the structure of the tear film changes, the secretion of the meibomian glands becomes more viscous, as a result of which its concentration in the tear fluid decreases, and the eyes lose their protective barrier. The congealed secret clogs the ducts of the meibomian glands, which leads to their inflammation – meibomyitis. In turn, the insufficiency of the tear film provokes a decrease, and in more severe cases, a complete loss of natural tear production and the development of dry eye syndrome. The development of acute and chronic conjunctivitis is facilitated by a decrease in the reactivity of the body due to hypovitaminosis against the background of exposure to irritating climatic factors. With inflammation of the mucous membrane of the eyelids, the frequency of inflammatory diseases of the lacrimal ducts and the lacrimal gland increases, which causes obstruction of the lacrimal tubules and hyperfunction of the lacrimal glands. On a polar night, the perception of bright lighting is aggravated, a long stay near which provokes the development of a spasm of accommodation and subsequently its habitual excessive stress. Lack of natural light during the polar night is a predisposing factor for the development of myopia. In addition, during the polar night, there is a high probability of developing A-vitamin deficiency, which results in impaired night vision, damage to the conjunctiva, and in more severe cases, the cornea. In the spring or early summer, when there is snow, and solar activity is high, the ultraviolet rays reflected from the snow enter the eyes, causing a retinal burn, ultraviolet ophthalmia develops. Conclusion. The impact of a complex of climatic and geographic factors of the Arctic region on the body provokes a restructuring of regulatory physiological processes and the launch of pathogenetic mechanisms leading to the emergence and development of inflammatory diseases of the eye and its accessory apparatus, refractive disorders, as well as pathology, which is based on metabolic disorders.

Особенности развития синдрома сухого глаза при подагре

Purpose. To determine and study the features of the development of dry eye syndrome in gout, depending on urate-lowering therapy, the duration of the gout disease and the concentration of uric acid in the tear. Materials and methods. The study involved 149 male patients (261 eyes) aged 35 to 75 years (mean age 60.63 ± 11.00 years). Among them, 110 people (202 eyes) with an established diagnosis: «Cataract with concomitant gout disease» and 39 people (59 eyes) with cataracts without clinical and laboratory signs of gout. All patients underwent both standard ophthalmological examinations and special ones. The concentration of uric acid in tears was determined by high performance liquid chromatography (HPLC). The diagnosis of gout was confirmed according to the criteria recommended by ACR / EULAR (2016). Results. In patients with gout who do not take a urate-lowering drug, DES occurs more often (82.1%) than in patients without gout (23.1%). With an increase in the concentration of uric acid in the tear, there is a high tendency to a shortening of the tear film rupture time (strong correlation coefficient r=-0.51, p&lt;0.001) and to a decrease in tear production (Schirmer I test) (strong correlation coefficient r=-0.59, p&lt;0.001). Conclusions. The data obtained indicate clear changes in the functional parameters of total tear production (Schirmer I's test) and the stability of the pre-corneal tear film (Norn's test) in patients with gout. This can be considered as a fact of the predisposition of this category of patients to the development of DES. A strong dependence of changes in tear production and HRVP on the concentration of uric acid in the tear was established. There is an obvious need for additional examination of this category of patients and an adequate choice of therapy, as well as the timely appointment of «artificial tear» drugs. Key words: dry eye syndrome, uric acid, gout.

Pharmacological safety of using medicinal drugs in patients with dry eye syndrome and in patients with the risk of dry eye syndrome development

The dry eye syndrome (DES) belongs to the group of tear film disorders, which are caused by either lowering of tear secretion or by the tear film instability. DES lowers the working capacity, worsens the quality of life and, if its symptoms are ignored for a long time, may lead to serious vision disorders, including blindness. The influence of environmental factors may be one of the reasons for intensification of the DES caused symptoms. In addition, there is a concept of iatrogenic DES, caused by a systemic and local use of medicinal drugs, by contact lenses, and by ophthalmological surgical and non-surgical manipulations.&#x0D; The purpose of the research was to study the clinical-pharmacological characteristics of medicinal drugs in terms of peculiarities of their application in patients with DES who have adjoining disorders as well as to determine medicines that may contribute to DES occurrence and exacerbation causing secondary lowering of tear production and sensor glandular secretion, inflammation of Meibomian glands or direct irritation.&#x0D; Materials of the research included the data of the medicinal drugs’ register, the search database of medicinal drugs Compendium, prescribing information and labelling of the drugs. Methods of research: biblio-semantic, content-analysis, segmenting, graphic, system analysis.&#x0D; It has been determined that 194 medicinal drugs, which in accordance to the 1st level of ATC-classification system belong to 10 pharmaco-therapeutic groups, have certain treatment peculiarities in patients with dry eye syndrome. DES is mentioned in different sections of prescribing information and labelling of the drugs: «side effects» – 172 drugs, «peculiarities of use» – 21 drug, «drug-to-drug interaction» – 1 drug. Segmentation of the market by the type of medicinal form demonstrated a significant prevalence of eye drops and pills (34.02% and 33.50% respectively).&#x0D; Taking into consideration the prevailing share of eye drops among other medicinal forms, which cause iatrogenic DES, further research is required to study their composition and define the correlation between the content of excipients and the risk of development of side effects in the form of dry keratoconjunctivitis of local ophthalmological medicinal drugs.&#x0D; The results of the conducted complex research determine the groups of medicinal drugs that should be prescribed with special caution for pharmacotherapy of various organs and systems in patients with the risk of DES acquisition or exacerbation. The most numerous among them are such groups as S01E – Antiglaucoma drugs and myotics, L01X – Antineoplastic drugs and N02B – Analgesics and antipyretics, which account for 21.13%, 12.37% and 9.79%, respectively.&#x0D; Presence of information about the risk of DES development as a result of drug-to-drug interaction in only 1 of 194 prescribing information and labelling of the drugs signifies an extremely low level of attention to the issue of medicinal drugs’ synergy in terms of their side effects.

Разработка и анализ эффективности клинико-математической системы прогнозирования развития ятрогенного синдрома «сухого глаза» после факоэмульсификации возрастной катаракты

Purpose . Development and analysis of effectiveness of predictive clinical-mathematical system of development of dry eye syndrome (DES) after phacoemulsification (PE) of senile cataract (SC). Material and methods . 120 patients (120 eyes) after SC surgery: 52 men and 68 women. Age: from 62 to 83 years (average 69.3±6.4 years). The main selection criteria for study were the absence of objective and subjective signs of DES, the presence of initial or immature SC and optimal conditions for surgery – absence of corneal pathology and mydriasis of 6 mm or more. Standard preoperative examination; 3 months after PE – Schirmer 1 test, tear break-up time, OCT mapping (Avanti RTVue XR, Optovue, USA). The above indicators were selected as potential predictors for development of algorithms for predicting of development of DES after PE of SC. Patients were divided into groups: 1st group consisted of 31 patients (31 eyes) with DES developed after PE, 2nd group consisted of 89 patients (89 eyes) without signs of DES. Results . Based on peculiarities of induced damage to structures of ocular surface in treatment of SC, two algorithms were developed to predict DES after FE of SC, which shown high prognostic characteristics: sensitivity – 80–90% and specificity – 80–87%, allowing to consider them reasonable and informative. Conclusion . The analysis of the developed clinical and mathematical system for predicting the development of DES after PE of SC showed its high efficiency. Application of developed technique in ophthalmic practice is advisable to ensure maximum medical and social rehabilitation of patients with SC.

TREATMENT OF DEGENERATIVE CHANGES IN THE EPITHELIUM OF THE OCULAR SURFACE WITH "DRY EYE" SYNDROME

According to recent studies, the prevalence of dry eye syndrome makes up 14% of cases in patients under the age of 50 years and 65-75% in patients over 50 years of age. Risk factors for the development of dry eye syndrome include aging, stress, side effect of frequent instillations of eye preparations, exposure to radiant energy, and diabetes mellitus. Therefore, the purpose of this study is to investigate the possibility of using “Delargin”, an antioxidant medicine, in the treatment of dry eye syndrome. 50 patients (100 eyes) aged 30-70 years were examined at the Department of Ophthalmology and then divided into three groups depending on the treatment used. Group 1 included 10 patients (20 eyes), who were prescribed to instil Oksial eye drops. Group 2 included 10 patients (20 eyes), who received basic therapy by instilling a solution of sodium salt of hyaluronic acid 0.0015 g / ml. Group 3 involved 20 patients (40 eyes), who instilled Delargin and hyaluronic acid. Monitoring the effectiveness of the treatment was carried out using the following methods: to assess basal tear production, a Schirmer 1 test was performed using the Ophthalic Test diagnostic bands (India); a Norn test was performed to control the stability of the tear membrane. Fluorescence test (staining of the cornea with 1% sodium fluorescein solution) was applied to detect corneal defects; Lipcof test was used to assess the degree of lid-parallel fold formation of the bulbar conjunctiva relative to the costal margin of the lower eyelid. As a result of the treatment, the patients of the Group 1 demonstrated that the Norn test scores increased to some extent from 6.8 ± 0.1 s up to 7.5 ± 0.1 s; in the patients of the Group 2 following the treatment, it was 8.5 ± 0.2 s and in the Group 3, the Norn test values were 11.2 ± 0.2 s (P&lt;0.05). The frequency of blinking movements decreased significantly and approached the normal. It has been found out that the therapy of dry eye syndrome that includes the antioxidant Delargin, can significantly promotes normalizing of parameters typical for this process.

Preparation and Properties of Lysozyme-Containing Eye Drops for Tear-Substitutive Therapy

Lysozyme incorporated in polymer solutions is shown to be stabilized during prolonged storage at low temperatures (0 – 4°C) for 12 months with 96% preservation of the hydrolytic activity. Variations of the pH and temperature activity profiles of the enzyme incorporated in polymer solutions promotes its activation under physiological conditions during acidosis associated with inflammations of various etiologies and upon development of dry eye syndrome. Investigation of the biochemical and physicochemical properties of a lysozyme-containing solution showed that the developed eye drops met requirements applicable to them (density, viscosity, osmolality, refractive index, sterility). Ophthalmic safety studies showed that the solution was non-allergenic.

Current Concepts about the Etiology of Dry Eye Syndrome

The revolution in understanding the etiology and clinical manifestations of the disruption of the tearing process and the development of dry eye syndrome (CVS) has occurred in last 20–30 years. It has been established that the loss of the tear film homeostasis can occur not only because of a violation of systemic and autoimmune disorders, but also as a result of a blinking disorder and distribution of the tear film over the ocular surface. Therefore, new pathogenetic disease development mechanisms have been identified. The prevalence of diseases of the ocular surface and CVD in recent years has increased significantly. It is mostly caused not only by scientific discoveries in the field of understanding, for example, the etiological and pathophysiological role of the neurosensory mechanism of development of CVS. An important aspect is the emergence of new risk factors that potentiate the development of ocular surface diseases and CVL. These factors include the use of various drugs — antidepressants, antihistamines, hormone therapy, and others; instillation of eye drops — antiglaucoma drugs, etc., as well as the appearance of little-studied factors such as cosmetology procedures (eyelids tattooing, eyelash extensions, botulinum toxin injections for aesthetic purposes, etc.). They are carried out in proximate close to the eye and eyelids, causing multiple pathological reaction. The experience of observing patients, literature data, and the conducted study have showed that various cosmetological effects in the periorbital zone, whose popularity has increased in recent years, may cause the appearance of iatrogenic dry eye syndrome. The following most vivid clinical examples will help, encountered in our practice, to illustrate the data presented. Collecting the anamnesis, it is necessary to identify the presence of risk factors for the development of diseases of the ocular surface and CVD, to eliminate them, if possible, and to carry out adequate pathogenically based therapy.

Evaluation of meibomian glands loss and tear film breakup time in patients with varying period of soft contact lenses wearing

Purpose: To determine whether the wearing time of contact lenses affects the condition of the meibomian glands and the tear film breakup time. Material and methods: This is a cross-sectional study involving 150 eyes ( 75 patients) with an age between 18 to 65 years. Five groups were allocated, with distribution criteria being the soft contact lenses wearing time: up to 5 years, from 6 to 10 years, from 11 to 20 years and more than 20 years. All subjects used soft contact lenses daily, at least 5 hours a day and 4 days a week. All patients underwent a thorough ophthalmic examination and non invasive tear film breakup time (NIBUT), and meibomian gland loss (MGL) investigated with Oculus Keratograph 5 M. Results: A statistically significant relation with the soft contact lenses wearing time has been found for the indicator MGL,% (U) (p = 0.025). In the general study of male and female patients, a significant association was only observed in female patients (p = 0.04). A statistically significant relation to the soft contact lenses wearing time has been found for the indicators NIBUT 1, s ( P=0.035) и NIBUT Av, s ( P=0.023). The same relation has been found only in female patients - NIBUT 1, s ( P=0.035] и NIBUT Av, s ( P=0.023). Conclusion: Long-term contact lenses wearing is proportional to the change in gland function and may contribute to the development of dry eye syndrome.

Osteoporosis and dry eye syndrome: A previously unappreciated association that may alert active prevention of fall

ObjectiveOsteoporosis is a multifactorial disease associated with inflammation and hormone imbalance. It is noteworthy that dry eye syndrome shares a similar pathophysiology with osteoporosis. Both diseases are more prevalent among the elderly and females. Dry eye syndrome can result in impaired vision, which increases the risk of fall and fracture when osteoporosis exists. In this study, we investigated whether osteoporosis is associated with an increased risk of developing dry eye syndrome.MethodsClaims data from the National Health Insurance Research Database (NHIRD) of Taiwan were used to conduct a retrospective population-based cohort study covering the period from January 1, 2000, to December 31, 2011. Multiple logistic regression was used to determine whether osteoporosis is an independent factor in the risk of developing dry eye syndrome, with risk estimates presented in the form of odds ratios (ORs).ResultsThe exclusion of patients with specific autoimmune diseases and those younger than 50 years old resulted in 42,365 patients in the osteoporosis group and 147,460 patients in the comparison group during the study period. The number of patients newly diagnosed with dry eye syndrome was 6,478 (15.29%) in the osteoporosis group and 15,396 (10.44%) in the comparison group. The crude OR of patients with osteoporosis developing dry eye syndrome was 1.55 and the 95% confidence interval (95% CI) was 1.50–1.60. After adjusting for patients’ age, sex, and underlying comorbidities, the adjusted OR was 1.26 and the 95% CI was 1.22–1.30. Subgroup analysis revealed this association in each age group and among females but not among males.ConclusionsOur results demonstrate that osteoporosis is a risk factor for the subsequent development of dry eye syndrome. Clinicians should be aware of the early symptoms of dry eye syndrome in osteoporotic patients in order to prevent further complications.

The Functional State of Meibomian Glands and Tear Production in Pregnant Women

Pregnant women are objects of special medical attention due to the fact that the new life — the life of her child — depends on the health and quality of life of the future mother. Pregnancy is a physiological load. It makes temporary changes in the functional state of all organs and systems, including the organ of vision. This study was aimed at identifying risk factors for the occurrence of disturbances in the tear-producing system — dysfunction of the Meibomian glands and/or dry eye syndrome (SSH), as well as to develop recommendations for compensating of disturbance. The study showed that physiological pregnancy does not affect to the condition of the ocular surface in case of absence of dry eye syndrome manifestations and Meibomian gland dysfunction before pregnancy. However, there is a predisposition for the development of the symptom complex of dry eye syndrome — a reliable decrease Schirmer test indicators of the test of in the group of pregnant women, it requires preventive control, — reduction in the mode of wearing contact lenses, which are a risk factor for the development of dry eye syndrome. It was determined that in vitro fertilization (IVF) affects to the condition of the ocular surface, namely, on the occurrence of dysfunction of Meibomian glands and dry eye syndrome, and is accompanied by corresponding complaints. There is a direct correlation between the duration of gestation, age indicators, the severity of complaints and their relationship to pregnancy. A direct was established, with a noticeable tightness of communication, between taking thyrotrophic drugs and complaints on dryness and discomfort. Therefore, special attention should be given to pregnant patients taking thyrotrophic medications and using contact lenses, since both of these factors provoke the development of the dry eye symptom complex. Patients with IVF pregnancy and accompanied by taking thyrotrophic drugs are recommended to limit the mode of wearing contact lenses, in case of complaints on dryness, discomfort, it is necessary to conduct therapeutic and prophylactic effects in the form of non-conserved tear-replacement therapy and eyelid hygiene. Timely diagnosis and subsequent prevention of Meibomian glands and dry eye syndrome in pregnant women will improve the quality of life of this patients group and prevent the development of complications related to this condition.

Роль хронических блефаритов и блефароконъюнктивитов в развитии ССГ и изменении глазной поверхности, основные принципы лечения (обзор литературы)

Роль хронических блефаритов и блефароконъюнктивитов в развитии ССГ и изменении глазной поверхности, основные принципы лечения (обзор литературы)

Evaluation of Accessory Lacrimal Gland in Muller’s Muscle Conjunctival Resection Specimens for Precursor Cell Markers and Biological Markers of Dry Eye Disease

ABSTRACTPurpose: The accessory lacrimal glands (ALGs) are an understudied component of the tear functional unit, even though they are important in the development of dry eye syndrome (DES). To advance our understanding of aging changes, regenerative potential, and histologic correlates to human characteristics, we investigated human ALG tissue from surgical samples to determine the presence or absence of progenitor cell markers and lacrimal epithelial markers and to correlate marker expression to relevant patient characteristics.Materials and Methods: ALG tissues obtained from Muller’s muscle conjunctival resection (MMCR) specimens were created using tissue microarrays (TMAs). Immunofluorescence staining of MMCR sections was performed using primary antibodies specific to cell protein markers. Cell marker localization in TMAs was then assessed by two blinded observers using a standardized scoring system. Patient characteristics including age, race, and status of ocular surface health were then compared against expression of stem cell markers.Results: Human ALG expressed a number of epithelial markers, and in particular, histatin-1 was well correlated with the expression of epithelial markers and was present in most acini. In addition, we noted the presence of precursor cell markers nestin, ABCG2, and CD90 in ALG tissue. There was a decrease in precursor cell marker expression with increasing age. Finally, we noted that a negative association was present between histatin-1 expression and DES.Conclusions: Thus, we report for the first time that human ALG tissues contain precursor marker-positive cells and that this marker expression may decrease with increasing age. Moreover, histatin-1 expression may be decreased in DES. Future studies will be performed to use these cell markers to isolate and culture lacrimal epithelial cells from heterogeneous tissues, determine the relevance of histatin-1 expression to DES, and isolate candidate precursor cells from ALG tissue.

Hydration, fluid regulation and the eye: in health and disease.

Variation in systemic hydration status, namely chronic systemic hypohydration or dehydration, can influence the development of several chronic non-ophthalmic diseases. Owing to the eye's high water content and unique system of fluid regulation, we hypothesized that hydration status may affect the eye in health and disease states. Therefore, we performed a systematic review of the current evidence implicating changes in hydration and their association with ocular physiology and morphological characteristics. We also reviewed relevant clinical correlations of changes in hydration and major common eye diseases. Our findings suggest that systemic hydration status broadly affects a variety of ocular pathophysiologic processes and disease states. For example, dehydration may be associated with development of dry eye syndrome, cataract, refractive changes and retinal vascular disease. On the other hand, excessive hydration is associated with some ocular diseases. Tear fluid osmolarity may be an effective marker of systemic hydration status. Recent studies implicate chronic renin-angiotensin-aldosterone system activation in the pathogenesis of diabetic retinopathy and glaucoma but also suggest its antagonism may be a useful therapeutic target. Our findings indicate that assessment of hydration status may be an important consideration in the management of patients with chronic eye diseases and undergoing eye surgery. Further research investigating the role of acute and chronic changes in hydration in individuals with and without ocular disease is warranted.

Polyunsaturated FAs show modest benefits for dry eye disease

Dry eye disease, also known as keratoconjunctivitis sicca (KS), commonly occurs in postmenopausal women, especially as they age. Many diseases and drugs can cause dry eye disease by altering the production or composition of tears, as well as producing abnormalities on the surface of the eye and eyelids. Patients may complain of their eyes burning, a feeling of grittiness, and/or the sensation of a foreign body in their eyes. In addition to these complaints, patients may experience visual disturbances, and over time, inflammation and ulceration of the cornea may develop. Vision may be significantly reduced if dry eye disease remains untreated.■Although female sex and increasing age are important risk factors, smoking, dry environments, and diet may also contribute to the development of dry eye syndrome.■Taking FA supplements or adding fish oil to the diet may provide subjective benefits for dryness and eye pain. ■Although female sex and increasing age are important risk factors, smoking, dry environments, and diet may also contribute to the development of dry eye syndrome.■Taking FA supplements or adding fish oil to the diet may provide subjective benefits for dryness and eye pain. The prevalence of this condition is about 7% in women and 4% in men aged 50 and older.1.Schaumberg D.A. Sullivan D.A. Buring J.E. et al.Prevalence of dry eye syndrome among US women.Am J Ophthalmol. 2003; 136: 318-326Abstract Full Text Full Text PDF PubMed Scopus (856) Google Scholar Although female sex and increasing age are important risk factors, smoking, dry environments, and diet may also contribute to its development. Dry eye syndromes are frequently part of autoimmune diseases such as Sjögren syndrome. Beta-blockers, preservatives used in some ophthalmic products, and drugs with anticholinergic properties can cause dry eye syndromes, as can natural products such as niacin, echinacea, and kava. The diagnosis of dry eye disease is a complex process. Lacrimal duct functioning is assessed, along with the aqueous and mucin content of tear film. In addition, ocular epithelial cells and markers of inflammation are evaluated. The treatment of dry eye disease is based on the specific underlying etiology, although artificial tears remain a core therapy for most patients. Nonpharmacologic measures such as the use of humidifiers may be helpful. Natural products have been promoted for dry eye disease, with studies focusing on the use of essential fatty acids (FAs) containing eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA), as well as the omega-6 FAs linoleic acid (LA) and gamma linoleic acid (GLA). Three studies of patients with dry eye disease with different causes have evaluated the use of LA (57 mg to 224 mg daily) and GLA (30 mg to 300 mg daily). Although symptoms improved, more objective measures have demonstrated only modest and more variable effects. The mechanism by which omega-6 FAs might benefit the condition is unclear, as these substances traditionally were believed to be proinflammatory, although animal models have not shown this result. Supplements containing omega-3 FAs, including alpha linoleic acid (ALA), have also shown modest benefits. In animal models, an endogenous compound derived from EPA, resolvin E1, may be involved in the resolution of ocular inflammation. Several studies of combination omega-3 and -6 FAs have shown modest effects. Of note, studies with FAs have used different patient populations, short durations, and varying amounts and sources of DHA, EPA, and GLA, making direct comparisons difficult. Recently, in a 6-month study of moderate to severe KS, 38 patients were randomized to an oral daily supplement of black currant seed oil (1,570 mg containing 15% GLA and 12%-15% ALA), 170 mg of DHA plus EPA, and antioxidant vitamins or to matching placebo capsules. The commercial supplement used was HydroEyes. The study used the Ocular Surface Disease Index (OSDI) questionnaire and other clinical and biochemical assessments standard for the disease. At 12 weeks and 24 weeks, the OSDI scores in the active treatment group were significantly better than those of the placebo group. Several parameters appeared to worsen in the placebo group over the study period, including lid margin erythema, CD11c staining, HLA-DR staining, and one measure of corneal smoothness. The use of artificial tear solutions was similar in the two groups. Dry eye disease can be serious and should not be ignored. When the use of artificial tears increases, patients should be evaluated by their primary care provider or ophthalmologist. Taking FA supplements or adding fish oil to the diet may provide subjective benefits for dryness and eye pain. The optimal amount and type of FAs remain unknown.

Ocular Complications in Children Within 1 Year After Hematopoietic Stem Cell Transplantation

It is essential to have insights into the risk of ocular involvement after hematopoietic stem cell transplantation (HSCT) in the pediatric population because young and severely ill children are unaware of their ocular problems. To study the development of ocular complications in children within 1 year after HSCT. This prospective study includes all consecutive patients who had undergone an HSCT at the Wilhelmina Children's Hospital, University Medical Center Utrecht, Utrecht, the Netherlands, in 2009 and 2010. Forty-nine consecutive patients underwent systematic ophthalmologic evaluations before HSCT, before leaving the HSCT unit after HSCT, and 3, 6, and 12 months after HSCT. Additional examinations were performed during systemic viral reactivations. Development of ocular complications, including uveitis, hemorrhagic complications, optic disc edema, and dry eye syndrome. Thirteen patients (27%) developed an ocular complication after HSCT. These complications included DES (n = 7 [14%]), (sub)retinal hemorrhage (n = 6 [12%]), optic disc edema (n = 3 [6%]), chorioretinal lesions (n = 2 [4%]), vitritis (n = 1 [2%]), and increased intraocular pressure (n = 1 [2%]). Median time to the development of dry eye syndrome was 5 months after HSCT, whereas all other ocular complications were detected within the first 3 months after HSCT. In most cases, the symptoms were mild and self-limiting. Children with malignant disease had a higher risk of the development of ocular complications compared with children with nonmalignant disease. Ocular complications in pediatric HSCT patients are common, although mostly mild. The risk of viral uveitis development during systemic viral reactivations is low; however, the potential risk of vision-threatening complications in this population cannot be ruled out.