Eye Signs Research Articles

ODP615 Emergence of Graves’ Ophthalmopathy in the Setting of Sudden Hypothyroidism: Possible Mechanisms Explored

Abstract Background Ninety percent of thyroid eye disease (TED) patients are hyperthyroid and at least 10% of TED occurs in the setting of euthyroidism or hypothyroidism. When Graves’ hyperthyroidism is diagnosed, 74% may not present with ophthalmopathy. Clinical Case A 58 year old woman diagnosed with Multinodular nontoxic goiter without nodule suspicious for malignancy was carefully monitored. No Levothyroxine treatment started. In 2017, patient had sudden onset of tremors, weight loss and palpitations. There were no signs of thyroid associated orbitopathy. Her TSH was <0. 009 uIU/ml (0.30-4) and FT4 29. 06pmol/L (10-22). Thyroid scan showed elevated 2- and 24-hours RAI uptake (as high as 80%) in both lobes. She was started on Methimazole but developed adverse reactions hence RAI (10 mci) was given. A month after RAI, she was rendered hypothyroid with of TSH 73.48uIU/ml (0.27-3.75), FT4 2.257pmol/L (8.8-44). She was maintained on Levothyroxine and remained euthyroid for four years. One year post RAI, ultrasound showed a small sized thyroid gland (right lobe: 3×0.6×1.5cm and left lobe: 2.2×0.3×1.3cm). May 2021, she followed up due to bulging eyes with scratchy sensation. She was noncompliant with Levothyroxine for several months. TSH was elevated to 46.19 uIU/ml (0.3-4. 00) and FT4 12.35 pmol/L (10.20-22.50). Levothyroxine dose was adjusted and repeat TSH was normal to 0.38 uIU/ml (0.30-4. 00) with FT4 of 22.40 pmol/L (10.20-22.50). Despite euthyroidism, there were progressive eye protrusion, conjunctival redness, pain and blurring of vision. TSHrAb was elevated to 21.62 U/L (N: <1 U/L). TSI was elevated to 6.59 IU/L (N: <0.10). . MRI of the orbit showed findings suggestive of Graves’ ophthalmopathy. She was started on Prednisone 60mg/day. Repeat TSHrAb was 9.85 U/L (<1U/L) after 3 weeks of steroids. Levothyroxine was stopped to check whether she had recurrence of Graves’ disease. When Levothyroxine was discontinued, there was worsening of eye disease and it was confirmed that patient was hypothyroid with TSH of 48.91 uIU/ml (0.55-4.78). Levothyroxine was resumed at 100mcg 1 tablet once daily and continued with Prednisone in tapering doses. Conclusion There were possible mechanisms that can lead to Graves’ ophthalmopathy in patients who had RAI and suddenly became hypothyroid. The rapid and protracted hypothyroidism caused increased secretion of TSH that stimulate antigen production by thyrocytes or induce proliferation in retro-orbital preadipocytes which express the TSH receptor. The protracted hypothyroidism can also be related to fluctuating TSHrAb post RAI. It was suggested that remission of TSH-receptor autoimmunity after RAI is less common. Clinicians should acquire baseline and monitoring of TSHrAb or ophthalmology consultation for all patients undergoing RAI regardless of whether they have eye signs or not. Maintenance of euthyroidism will help prevent emergence of Graves’ ophthalmopathy. Presentation: Saturday, June 11, 2022 1:00 p.m. - 3:00 p.m.

Analysis of Meibomian Glands in Juvenile Systemic Lupus Erythematosus Patients without Dry Eye Symptoms and Signs.

To evaluate meibomian gland loss and its possible association with disease duration and activity in Juvenile Systemic Lupus Erythematosus (JSLE) patients' without dry eye symptoms or signs. Prospective clinical study. Ten eyes of 10 JSLE patients were evaluated using the Systemic Lupus Erythematosus Disease Activity Index (SLEDAI) and 14 eyes of 14 healthy controls were also enrolled. Ocular Surface Disease Index (OSDI) questionnaire and Schirmer I test were performed. Lid margin score, meibum quality and expressibility scores were evaluated. Noninvasive first breakup time (NIF-BUT) and noninvasive average breakup time (NIAvg-BUT), meibomian gland dropout area (MGDA) and meibography scores were evaluated using non-contact meibography (Sirius; CSO). There was no significant difference between the JSLE patients and the healthy controls in the OSDI, NIF-BUT, NIAvg-BUT and Schirmer I tests. Also lid margin score, meibum quality and expressibility scores were not significantly different between the groups. However, JSLE patients had increased upper and lower lid MGDA and increased upper lid, lower lid and total meibography scores compared to the healthy subjects. Furthermore, the duration of JSLE showed a high positive correlation with upper and lower lid MGDA and meibography scores. Meibomian gland loss could be observed in JSLE patients with no clinical signs and symptoms of dry eye. Considering the longer life expectancy of children, the positive correlation of disease duration with the meibomian gland reveals the importance of routine eye examinations from the diagnosis of the disease.

Eye Signs in Stroke.

A large part of the central nervous system is involved in the normal functioning of the vision, and hence vision can be affected in a stroke patient. Transient visual symptoms can likewise be a harbinger of stroke and prompt rapid evaluation for the prevention of recurrent stroke. A carotid artery disease can manifest as transient monocular visual loss (TMVL), central retinal artery occlusion (CRAO), anterior ischemic optic neuropathy or ocular ischemic syndrome (OIS). Stroke posterior to the optic chiasm can cause sectoranopias, quadrantanopias, or hemianopias, which can be either congruous or incongruous. Any stroke involving the dorsal stream (occipito-parietal lobe), or ventral stream (occipito-temporal lobe) can manifest with visuospatial perception deficits. Similarly, different ocular motility abnormalities can result from a stroke affecting the cerebrum, cerebellum, or brainstem. Among these deficits, vision and perception disorders are more difficult to overcome. Clinical, experimental, and neuroimaging studies have helped us to understand the anatomical basis, physiological dysfunction, and the underlying mechanisms of these neuro-ophthalmic signs.

Clinical Signs in Neuro-Ophthalmology: Eye Signs in Myasthenia Gravis.

A hallmark of myasthenia gravis (MG) is the variability and fatigability of striated muscles. The majority of people with MG have eye symptoms of ptosis and diplopia. This paper outlines the eye signs in MG, including practical tips on the examination technique relevant to MG, and pitfalls to avoid.

New, potent, small molecule agonists of tyrosine kinase receptors attenuate dry eye disease.

Nerve growth factor (NGF), brain-derived neurotrophic factor (BDNF), and neurotrophin3 (NT-3) bind to tyrosine kinase (Trk) receptors, TrkA, TrkB, and TrkC, respectively. This study investigated the efficacy of novel molecule agonists of Trk receptors in an in vivo model of dry eye disease (DED). Small molecule TrkC agonist (C1) and a pan-Trk agonist (pan) were synthesized for this. C57BL/6J mice were subjected to desiccating stress (DS) and received bilateral eye drops of C1, pan, or vehicle (2x/day). Dry eye signs, inflammation and expression of corneal barrier function, and conjunctival goblet cell (GC) densities were measured as part of the DED phenotype. Corneal epithelial lysates were collected for either western blot or RNA extraction. Extracted total RNAs were used for NanoString analyses. Immunofluorescent staining was performed on whole-mount corneas using anti-TNFAIP3 and anti-EP4 antibodies. Compared to vehicle, mice subjected to desiccating stress and treated with agonists pan and C1 showed improved corneal barrier function, while C1 also increased GC density. NanoString analyses revealed upregulation of specific mRNA transcripts (Ptger4, Tnfaip3, Il1a and Ptger4, Tlr3, Osal1) in pan- and C1-treated corneas compared to vehicle-treated corneas. Western blots showed that pan and C1 decreased vehicle-induced NFkB nuclear translocation after DS for one day and increased EP4 and TNFAIP3 protein levels after 5 days of DS in corneal epithelium lysates. We conclude that small-molecule agonists of Trk receptors improve DED by decreasing NFkB activation and increasing protein expression of anti-inflammatory molecules TNFAIP3 and EP4. Surprisingly, the most efficacious small molecule agonists were not TrkA selective but TrkC and panTrk, suggesting that wider exploration of TrkB and C and pan Trk agonists are warranted in efforts to treat DED.

Topical Steroid-Induced Cushing's Syndrome in a Newborn Following Goniotomy for Glaucoma.

Iatrogenic Cushing's syndrome is a life-threatening condition which requires an early diagnosis multidisciplinary approach. Despite reports of iatrogenic Cushing's syndrome following nasal or inhaled steroids, its development after topical betamethasone eye drops for a short duration is a less frequently reported or anticipated condition. We describe a 6-week-old infant who developed exogenous Cushing's syndrome following topical steroids after bilateral goniotomy for newborn glaucoma. The child was kept under observation and managed with a physiological dose of hydrocortisone. Parental counselling regarding the proper method of eye drop instillation and signs of steroid toxicity is of vital importance in all cases of pediatric ocular surgeries, especially where bilateral surgeries are undertaken.

The Impact of Probiotics and Prebiotics on Dry Eye Disease Signs and Symptoms.

Dry eye is considered an inflammatory disease. Gut microbiota are important in the regulation of low-grade chronic inflammation, including in the eye. Probiotics and prebiotics are increasingly used to regulate chronic-disease-associated gut dysbiosis. Therefore, this double-masked, randomized controlled clinical trial aimed to explore the potential of oral probiotics and prebiotics in the management of dry eye disease. In total, 41 participants with dry eye received probiotic and prebiotic supplements (treatment group, n = 23) or respective placebos (control group, n = 18) for 4 months. Dry eye symptoms and signs were evaluated using the Ocular Surface Disease Index (OSDI), Dry Eye Questionnaire 5, osmolarity, non-invasive keratograph break-up time (NIKBUT), ocular surface staining, tear meniscus height (TMH), lipid layer thickness, and conjunctival redness. After 4 months, the average OSDI score of the treatment group was significantly better compared to that of the controls (16.8 ± 5.9 vs. 23.4 ± 7.4; p < 0.001). The NIKBUT and TMH did not change significantly with treatment (p = 0.31 and p = 0.84) but reduced significantly for controls on average by −5.5 ± 1.0 secs (p = 0.03) and 0.2 ± 0.1 mm (p = 0.02). These data suggest that probiotics and prebiotics might be effective in the management of dry eye disease.

Trigeminal Nerve Affection in Patients with Neuro-Sjögren Detected by Corneal Confocal Microscopy

Background: Patients with Sjögren’s syndrome and polyneuropathy more frequently develop cranial nerve affection when compared to patients with chronic inflammatory demyelinating polyneuropathy (CIDP). We therefore aimed to analyze trigeminal corneal nerve fibre characteristics in both patient groups. Methods: A total of 26 patients with Sjögren’s syndrome associated neuropathy and 29 patients with CIDP were recruited at our university hospital and compared to 6 healthy controls. Dry eye symptoms and signs were assessed via clinical examination and the Ocular Disease Surface Index questionnaire. Trigeminal corneal nerve fibres were analyzed via corneal confocal microscopy (CCM) as a non-invasive in vivo microscopy. Results: CCM revealed significantly reduced corneal nerve fibre density and corneal nerve fibre main branch density in the Neuro-Sjögren group when compared with healthy controls. There were no significant group differences between the Neuro-Sjögren and the CIDP group for any of the microscopic parameters. Dry eye assessment showed similarly reduced scores for both patient groups, while healthy controls showed better results for objective dry eye signs. There was no correlation between microscopic parameters of the corneal confocal microscopy and parameters of dry eye assessment. Conclusions: Our data revealed trigeminal corneal nerve affection in patients with neuropathy associated with Sjögren’s syndrome and patients with CIDP detected by CCM. No difference was found between both neuropathy groups indicating that CCM is not able to distinguish between both entities.

The Wernicke-Korsakoff encephalopathy: An updated review

Wernicke's encephalopathy is responsible for an acute neuropsychiatric syndrome that is associated with significant morbidity and mortality. It is most frequently due to alcoholism but can also be the result of chronic diseases, mainly systemic tumours, leading to thiamine deficiency. In the non-thiamine treated patients Korsakoff’s syndrome is the residual complication of the encephalopathy. The clinical diagnosis of Wernicke encephalopathy in alcoholics requires two of the following four signs: dietary deficiencies, eye signs, cerebellar dysfunction, and either disturbed mental state or mild memory impairment. These symptoms are less specific in the non-alcoholic patients. Korsakoff's syndrome is the residual condition in none thiamine treated patients. It is predominantly characterized by global amnesia, and in the more severe cases also by cognitive and behavioral dysfunction. Magnetic resonance imaging of the brain can detect the specific lesions and be helpful for the diagnosis. Treatment with 2500 mg thiamine intravenously is recommended as soon as possible.

Eye signs in a child with ROBO3 gene mutation.

Eye signs in a child with ROBO3 gene mutation.

Determining the Best Management Strategy for Preventing Short-Term Effects of Digital Display Use on Dry Eyes.

To assess and compare the effectiveness of four main management strategies for preventing short-term effects of digital display use on dry eye signs and symptoms. The ocular surface, tear film, and visual fatigue of 47 healthy individuals were assessed before and after reading on a laptop computer for 20 min under five different experimental conditions: control, instillation of artificial tears, taking a brief break, using a blue light screen filter, and blink control. Measurements included the Ocular Surface Disease Index (OSDI) Questionnaire, 5-item Dry Eye Questionnaire (DEQ-5), tear meniscus height (TMH), noninvasive keratograph break-up time (NIKBUT), bulbar conjunctival redness, and pupil size. Worse results were obtained after the control and blue light filter conditions in all variables (P≤0.037). A higher post-task DEQ-5 score (P=0.013) and TMH (P<0.0005) were obtained when taking a brief break compared with pretask, although the increase in symptoms was significantly smaller than that observed in the nonmanagement control condition (P≤0.036). Similarly, a smaller increase in OSDI and DEQ-5 was obtained with the use of artificial tears and blink control in comparison with the control condition (P≤0.008), whereas a greater increase in DEQ-5 and decrease in NIKBUT was obtained for the blue light filter condition in comparison with the instillation of artificial tears (P=0.017) or blink control (P=0.008), respectively. Finally, a significantly lower post-task pupil size was obtained for all the conditions (P≤0.027). The instillation of artificial tears and blink control were the best management strategies for preventing short-term effects of digital display use on dry eyes. Conversely, using a blue light filter did not offer any benefits.

OCULAR SURFACE AND TEAR FILM CHANGES AFTER MANUAL SMALL INCISION CATARACT SURGERY

BACKGROUND: Manual small incision cataract surgery (MSICS) continues to be the mainstay of cataract surgeries in developing countries like India. Dry eye related symptoms like constant foreign body sensation, ocular surface discomfort, redness, watering are frequent phenomenon after cataract surgery. SICS may worsen lid margin anatomy, cause corneal denervation, cause reduction in number of Goblet cells and perpetuate tear lm instabilities of a patient's eye after surgery. To analyzeOBJECTIVE: changes in tear lm indices after SICS This is a prospective observational study of 12 months duration from April 2020 toSTUDY DESIGN: March 2021 done on 110 different patients undergoing cataract surgery 45-70 years age group by MSICS method . 110 (48 male,METHODS: 62 female) patients who underwent MSICS during the aforementioned period were selected for the study. Tear Meniscus Height (TMH), Schirmer's Test 1(ST1), Tear Film Break Up Time (TBUT) evaluation was done 1 day preoperatively, 1 week, 1 month and 3 month post operatively and the values were noted. Collected data was analyzed by paired t test using MS EXCEL and SPSS V23. The mean ageRESULTS: of the 110 patients was 60.21years. The mean preoperative values of the tear lm indices ST1, TBUT, TMH were found to be respectively 19.15 ± 8.59 mm, 16.70 ± 5.27 seconds, 0.39 ± .13 mm. 1 month and 3 month post operatively mean ST1 values were found to be 14.89 ± 6.15 and 14.40 ± 5.48 mm; mean TBUT values were 13.37 ± 4.76 and 12.93 ± 4.74 seconds; mean TMH was found to be 0.30 ± 0.10 and 0.29 ± 0.09. The progressive deterioration of tear lm indices over our study period was found to be statistically signicant. SICS causesCONCLUSION: signicant deterioration of tear lm indices and perpetuates ocular surface discomfort and dry eye disease post operatively. Operating surgeons must pay attention to dry eye signs, symptoms post operatively even in a well operated healthy eye to ensure optimal post-operative comfort to the patient.

Elevated Neuropeptides in Dry Eye Disease and Their Clinical Correlations.

The goal of this study was to assess neuropeptide levels in patients with dry eye disease (DED) and investigate their correlations with clinical characteristics. This study included 38 eyes of 38 patients diagnosed with DED (DED group) and 38 eyes of 38 healthy volunteers without DED (control group). Ocular surface evaluation was performed. The severity of dry eye symptoms and signs in the DED group was graded. Neuropeptides [substance P (SP), alpha-melanocyte-stimulating hormone (α-MSH), β-endorphin, neurotensin, and oxytocin] and inflammatory cytokines levels were measured in basal tears. The link between neuropeptides and clinical parameters was investigated using Spearman rank correlation. Overall, 76.3% of patients in the DED group showed dry eye symptoms and signs that were inconsistent in severity. Compared with the control group, the DED group showed higher levels of SP, α-MSH, and oxytocin in tears (P = 0.012, P = 0.030, and P = 0.006, respectively), but similar levels of β-endorphin and neurotensin (P = 0.269 and P = 0.052). The levels of SP, α-MSH, and oxytocin were elevated in DED patients with higher grading of symptoms than clinical signs (all P < 0.05). SP, α-MSH, and oxytocin levels in tears were positively correlated with Ocular Surface Disease Index scores, frequency of sensitivity to light, and frequency of blurred vision (all P < 0.05). The increased tear levels of SP, α-MSH, and oxytocin may be linked to ocular discomfort in DED. Neuropeptides may play a key role in the development of DED, especially in DED patients with more severe symptoms than clinical signs.

Two ophthalmic presentations of chronic myeloid leukaemia.

Chronic myeloid leukaemia (CML) is a myeloproliferative neoplasm that accounts for 15% of newly diagnosed cases of leukaemia in adults [1]. In the developed world, 50% of patients are asymptomatic at diagnosis with the disease picked up on routine examination and blood testing. At presentation, 90%–95% of patients have chronic phase CML during which signs and symptoms typically result from anaemia and splenomegaly [2]. Ophthalmic presentations of CML are uncommon, nonetheless clinicians should be alert to CML presenting with eye signs and the pathophysiology that underpins these findings. The first case (Figure 1) is of a 53-year-old man who reported 10 days of bilateral blurred vision and palpitations on exercise. He had no significant past medical history. His visual acuities were 6/7.5 right and 6/12 left. Fundus examination revealed peripheral perivascular sheathing and florid bilateral Roth spots (Figure 1A,B). He had cystoid macular oedema and leukaemic infiltrates, confirmed on optical coherence tomography. His white blood count (WBC) was 391.4 × 109/l, haemoglobin 83 g/l and platelets 200 × 109/l. The second case (Figure 2) is of a 17-year-old man who described a 10-month history of headaches and lethargy. He had no significant past medical history. He was tachycardic (heart rate 120/min), and the ophthalmic examination revealed visual acuities of 6/6 in both eyes, bilateral optic disc swelling with corresponding blind spot enlargement on visual field testing and tortuous congested retinal vessels. His WBC was 645.8 × 109/l, haemoglobin 72 g/l and platelets 589 × 109/l, and a CT head was reported as showing no intracranial pathology. In both cases, the peripheral blood film was consistent with CML, and cytogenetic analysis of the bone marrow aspirate detected the Philadelphia chromosome. The patients received oral hydroxycarbamide and underwent leukapheresis. They were treated with nilotinib and imatinib respectively, resulting in haematological remission and improvement of their eye signs at 4 and 6 weeks, respectively (Figures 1C,D and 2C,D). The fundus findings illustrate two pathophysiological responses to CML. The first case depicts decompensated leukaemic retinopathy. Hyperviscosity and endothelial dysfunction leads to vessel rupture, intra-retinal haemorrhage and fibrin-platelet plugging at the site of rupture (ie Roth Spots), as well as perivascular sheathing and cystoid macular oedema. The second case demonstrates a hyperdynamic retinal circulation and optic disc swelling, which are likely to be an adaptive (and fully compensated) local circulatory response to the patient's chronic anaemia. The detection of Roth spots or optic disc swelling should lead to systemic work-up of the patient. Clinicians are alerted to the fact that these findings may be indicative of leukaemic disease requiring prompt, potentially lifesaving, treatment. The authors acknowledge the patients who allowed us to present their cases. The authors declare that there is no conflict of interest that could be perceived as prejudicing the impartiality of the research reported. The report adhered to the ethical principles outlined in the Declaration of Helsinki as amended in 2013.

Is pre-operative imaging of external angular dermoid cysts in children necessary?

To investigate the frequency and modality of pre-operative imaging in children with an external angular dermoid cyst and whether this influenced subsequent management. A retrospective study was undertaken to assess the presentation, investigation, treatment and outcomes in children aged less than 16 years with an external angular dermoid cyst. All children who underwent external angular dermoid cyst excision between January 2008 and April 2021 at a regional children's hospital were analysed. Sixty-one patients (32 boys) were identified. Fifty-four were managed by paediatric surgeons and seven by ophthalmic surgeons. Pre-operative imaging was performed in 19 (31%) patients, including plain radiographs (3), ultrasound scan (14), computerised tomography scan (1), and magnetic resonance imaging scan (2). None of these investigations showed evidence of an intracranial or orbital extension of the cyst or changed management. All cysts were excised under day-case general anaesthesia. There was one minor postoperative complication and two recurrences. External angular dermoid cysts rarely communicate through the bone with the orbit or anterior cranial fossa. Routine pre-operative imaging is unnecessary unless there are clinical features such as an atypical location (e.g. temporal), eye signs (e.g. strabismus, proptosis and globe displacement) or a draining sinus.

Wearing face masks and possibility for dry eye during the COVID-19 pandemic

This population-based observational, cross-sectional, and descriptive survey was to investigate the relationship of increased face mask usage in the coronavirus disease (COVID-19) era with mask-associated dry eye (MADE). Participants aged 6–79 years old with formal school education were selected. All participants finished the 19-item questionnaire online, distributed through different social media platforms. From 6925 participants who submitted eligible questionnaires, MADE was reported in 547 participants, which included 419 participants who developed new dry eye symptoms after wearing face masks and 128 participants whose pre-existing dry eye symptoms worsened with mask wearing. Longer time of face mask wearing, nonstandard wearing of face masks, reduced outdoor time, decreased daily reading time, shortened visual display terminals time, and dry environment were positively associated with MADE. There were significant associations between perceived MADE and age, female sex, education, use of glasses and contact lenses, and pre-existing dry eye. MADE was more common in adults aged > 20 years than those aged ≤ 20 years or juveniles. MADE incidence increased. Standard wearing of face masks was suggested as a protective factor for MADE. Awareness about the possible risk of MADE should also be created and the clinical dry eye signs should be verified.Clinical trial registration number: NCT04744805.

Digital display use and contact lens wear: Effects on dry eye signs and symptoms.

To assess the potential additive effects of short-term display use and contact lens (CL) wear on the ocular surface and tear film. Thirty-four healthy volunteers (20.87±2.33years old) participated in this study. Participants' dry eye symptoms, ocular surface, tear film and pupil size were assessed before and after executing a 20-min reading task on a computer and a smartphone with and without CL wear, or with CL wear and artificial tear instillation. Measurements included the Ocular Surface Disease Index (OSDI) questionnaire; 5-item Dry Eye Questionnaire (DEQ-5); tear meniscus height (TMH); noninvasive keratograph break-up time (NIKBUT); bulbar conjunctival redness (BR) and pupil size. Higher symptoms were reported after reading on both displays with and without CLs (p≤0.001) for short periods. BR was higher and NIKBUT shorter after reading on the computer regardless of wearing CLs (p≤0.02 and p≤0.02, respectively), while TMH increased for all conditions (p≤0.02) except for CL computer reading (p=0.23). Reading with CLs did not lead to greater signs of dry eye (BR, NIKBUT) and symptoms compared with reading unaided (p>0.05), although a smaller increase in TMH was observed when reading on the computer with CLs (p=0.005). Artificial tear instillation during CL wear led to a smaller increase in symptoms (p≤0.02), a smaller increase in BR (p≤0.04) and a decrease in NIKBUT (p=0.02) compared to reading without correction. Disposable CL wear had no additive effects on signs and symptoms of dry eye when using digital devices for short periods. The instillation of artificial tears is an effective strategy for reducing the impact of display use in CL wearers.

Idiopathic intracranial hypertension in children with obesity.

Obesity is an under-recognised risk factor for raised intracranial pressure in the paediatric population. The pathophysiology remains unclear. The aim of our study was to investigate the association between idiopathic intracranial hypertension (IIH) and weight in children. Patients diagnosed with IIH at a tertiary children's hospital were retrospectively identified between April 2017 and April 2019. Information regarding the patients' body mass index, presentation, investigation and treatment was collected and analysed. In total, 18 patients (M:F 7:11) were identified with a mean age of 11years (±3.3SD; range: 6-15years). The mean BMI was 30.3kg/m2 and mean BMI SDS was +2.5. Twelve (66.6%) patients presented with both headaches and eye signs. Three patients were asymptomatic, with papilloedema noted on routine optician review. Of the 18 patients, 15 were treated medically, two had long-term neurosurgical interventions and one patient was managed conservatively. The results show that the majority of children with obesity who develop IIH were female. Awareness regarding IIH secondary to obesity needs to be highlighted to ensure detailed clinical evaluation takes place so that raised intracranial pressure can be diagnosed and managed earlier, to avoid more serious complications such as permanent visual loss.

Real-World Effectiveness, Tolerability and Safety of Cyclosporine A 0.1% Cationic Emulsion in Severe Keratitis and Dry Eye Treatment.

IntroductionThe PERSPECTIVE study evaluated, in routine clinical practice, the effectiveness, tolerability and safety of cyclosporine A (CsA) 0.1% cationic emulsion (CE) in controlling severe keratitis in adults with dry eye who remained insufficiently controlled despite artificial tear (AT) use.MethodsA prospective, multicenter, observational study was conducted at 44 ophthalmology clinics across Finland, Germany, Norway, Sweden and the UK. Adults treated with ATs for severe keratitis and dry eye received CsA 0.1% CE therapy (1 drop in both eyes at bedtime) and were followed up at weeks 4, 12 and 24 and at month 12. Primary endpoint was mean [standard deviation (SD)] change from baseline in corneal fluorescein staining (CFS; Oxford Grade Scale) at month 12 following CsA 0.1% CE initiation. Secondary endpoints examined ocular sign and symptom severity and adverse events (AEs).ResultsThe full analysis set included 472 adults (75.9% female). Mean (SD) age was 61.9 (15.41) years. Mean (SD) CFS score was significantly reduced from baseline [2.56 (1.10)] at month 12 [1.10 (SD 1.13); P < 0.0001]. CFS score reductions were statistically significant from week 4, with further incremental decreases reported at study visits through month 12 (P < 0.0001). Severity of eyelid and conjunctival erythema was significantly reduced from baseline at week 4 and maintained through month 12 (P < 0.001). Tear film breakup time increased significantly from baseline at all study visits through month 12 (P < 0.001). Ocular symptom severity was significantly reduced from baseline at all study visits through month 12 (P < 0.001). Overall, 101 treatment-related AEs were reported. Most were mild/moderate (83.6%) and resolved by month 12 (73.3%).ConclusionsIn routine clinical practice, CsA 0.1% CE provided statistically significant reductions in dry eye signs and symptoms. Improvements were seen at week 4 and maintained over 12 months. Treatment tolerability was good and consistent with previous CsA 0.1% CE clinical studies.Trial registrationEU PAS register number: EUPAS 22376.Supplementary InformationThe online version contains supplementary material available at 10.1007/s40123-022-00487-x.

Current scenario of ocular morbidity in severe acute childhood malnutrition in central part of India

The study aimed to assess the prevalence of ocular involvement in children 6 months to 5 years attending tertiary care centre with Severe Acute Malnutrition and to detect the associated risk factors for ocular morbidity in severe acute malnutrition.: This hospital based observational study was carried out at Gandhi Medical College, during the study period of 2 years on children diagnosed with SAM belonging to 6 months to 5 years of age. Detailed history was obtained and physical, systemic and ocular examination was done. : A total of 100 severe acute malnourished children were included. Prevalence of ocular involvement in severe acute malnourished children was 72%. Conjunctival pallor was observed in 71.5% eyes and retinal hemorrhages were most common posterior segment finding. Vitamin A deficiency signs were observed in 17 eyes (8.5%). Higher birth order and number of sibling was significantly associated with higher incidence of ocular manifestations (p&amp;#60;0.05). However, other variables showed no significant association between other variables and ocular manifestations (p&amp;#62;0.05). Training should be given to health workers at the primary health care level and health centers on counseling mothers on feeding, growth monitoring, the preventable eye blinding diseases and hygiene during the vaccination sessions and early referral of children with eye signs to hospitals. Also education of couple regarding proper nutrition of mother and child should be encouraged and couples should be insisted to have not more than two children.