Eyelid Hyperemia Research Articles

Meibomian gland secretion quality association with ocular parameters in university students during COVID- 19 restrictions

PurposeTo determine if the Meibomian Gland (MG) secretion quality is associated with symptoms of ocular discomfort, hours of Video Display Terminals (VDT) use, eyelid margin abnormalities, conjunctival hyperemia, and Meibomian Gland Loss Area (MGLA) in a sample of university students.MethodsAn online survey that included an Ocular Surface Disease Index (OSDI) questionnaire and an extra question about hours of VDT use recruited an initial sample of 183 participants. Only 120 participants that fulfilled the inclusion criteria were scheduled for a battery of ocular surface and MG specific exam. The tests include: 1) meibometry, 2) slit lamp exploration of eyelid margin abnormalities (irregularity, hyperemia and MG orifices plugging), MG secretion quality and conjunctival hyperemia, and 3) Meibography.ResultsSignificant positive correlations between the MG secretion quality and eyelid margin hyperemia, MG orifices plugging, MGLA, nasal conjunctival hyperemia, and temporal conjunctival hyperemia (Spearman Rho; all r>0.186, p<0.042) were found. Multivariate regression found association between OSDI with hours of VDT use (B=0.316, p=0.007), and eyelid hyperemia (B=0.434, p≤ 0.001). A statistical association between MG secretion quality and eyelid margin hyperemia, MG orifices plugging, MGLA and conjunctival hyperemia (Fisher’s exact; all p<0.039) were found. Multivariate regression found association between MG secretion quality with MG orifices plugging (B=0.295, p=0.004) and meibometry (B=-0.001, p=0.029).ConclusionParticipants with higher values in MG secretion quality have higher values in eyelid margin hyperemia, MG plugging, MGLA, and conjunctival hyperemia. No direct relationship between MG secretion quality and hours of VDT use or OSDI were found.

Meibomian gland loss area and its relationship with eyelid margin hyperemia and meibomian gland orifice plugging

Purpose: The aim of the present study was to state a relationship between the meibomian gland loss area (MGLA), eyelid hyperemia and meibomian gland (MG) orifices plugging in a sample of university students. Material and methods: A total of 74 participants were recruited. Meibography images were obtained with the OCULUS® Keratograph 5M and MGLA was calculated using the ImageJ software; also, MGLA was categorized following the Meiboscale into 4 groups: group 1 (<25%), group 2 (25-50%), groups 3 (50-75%), and group 4 (>75%). An exhaustive slit lamp examination of both eyelids was performed. Eyelid margin hyperemia and MG orifices plugging of each eyelid were categorized following Arita et. al grading scales. Results: A significant statistical relationship was found between MG orifices plugging and MGLA for both eyelids (Fisher’s exact test; both p < 0.019). Also, correlations were obtained between lower MGLA and lower MG orifices plugging (Cramer-V = 0.583, p ≤ 0.001); and between upper MGLA and upper eyelid margin hyperemia (Cramer-V = 0.418, p = 0.023), and upper MG orifices plugging (Cramer-V = 0.413, Fisher’s exact test: p = 0.042). Conclusion: MGLA varies depending on MG orifices plugging in upper and lower eyelids; also, in upper eyelids MGLA was correlated with eyelid hyperemia.

Lower Eyelid Horizontal Tightening in Prostaglandin Associated Periorbitopathy.

To determine the effect of chronic topical use of prostaglandin analogs for glaucoma on lower eyelid tension. A prospective case-control study was performed. Lower eyelid tension was measured in a group of glaucoma patients (73 eyelids) using prostaglandin analogs and a paired control group (87 eyelids). Seven glaucoma patients with unilateral use of prostaglandin analogs had the lower eyelid tension of the exposed side compared with the contralateral eyelid. Eyelid tension was digitally measured in photographs in neutral position and after manual downward traction in the center of the eyelid (modified distraction test). Duration of drug exposition, age, use of other topical medication and other prostaglandin-associated periorbitopathy signs as long eyelashes, eyelid hyperemia, eyelid pigmentation, and deepening of upper eyelid sulcus were recorded for analysis. Mean lower eyelid tension in prostaglandin group was significantly higher than in control group: distraction 5.26 mm (SD 1.52) versus 6.80 mm (SD 1.29) (p < 0.001). On the unilateral prostaglandin use intragroup comparison, mean lower eyelid distraction in prostaglandin side was 4.24 mm (SD 1.80) and in control side was 6.79 mm (SD 1.63) (p < 0.012). Beta blocker and carbonic anhydrase inhibitor concomitant use was associated with lower eyelid tension measures in prostaglandin users. Presence of long eyelashes was associated with higher eyelid tension. All other measured variables did not demonstrate interaction with eyelid tension. Chronic topical use of prostaglandin analogs for glaucoma is associated with lower eyelid tightening.

Changes in Rabbit Conjunctival Mucins Following Exposure to Sulfur Mustard

Sulfur mustard (SM) is a vesicating chemical warfare agent that is relatively easy to synthesize, stockpile, and deliver. It is known to cause severe injury to the eye damaging both the conjunctiva and cornea; developing approaches to counter SM-induced acute and chronic ocular toxicities is a high priority. In the present studies, we characterized the ocular effects of SM in New Zealand white rabbits. Within one day of exposure to SM, edema and hazing of the cornea were observed, followed by neovascularization which persisted for at least 28 days. This was associated with upper and lower eyelid hyperemia, edema and conjunctival inflammation. The conjunctiva is composed of a proliferating epithelium largely consisting of stratified columnar and squamous epithelial cells overlying a well-defined dermis. Superficial layers of the conjunctival epithelium expressed keratin 1, a marker of differentiating squamous epithelium, while keratin 17, a marker of proliferating stratified squamous epithelium, was expressed in cells overlying the basement membrane. SM treatment increased the number of keratin 17 expressing epithelial cells. Mucin 5AC producing goblet cells were interspersed within the superficial layers of the conjunctival epithelium. Alcian blue/periodic acid-Schiff staining revealed that these cells generated both acidic and neutral mucins. SM was found to increase the number of goblet cells producing neutral mucins. SM also increased expression of membrane-associated mucin 1 and mucin 4 in the superficial layers of the conjunctiva. These data demonstrate that ocular exposure of rabbits to SM causes significant damage not only to the cornea, but to the eyelid and conjunctiva, altering conjunctival mucins which are important in protecting the eye from injury. Multiple targets within the eye should be assessed when evaluating the efficacy of potential SM ocular countermeasures.

Clinical features and outcomes of IgG4-related idiopathic orbital inflammatory disease: from a large southern China-based cohort.

To investigate the clinical features and treatment outcomes of IgG4-related ophthalmic disease (IgG4-ROD) among idiopathic orbital inflammatory disease (IOID) patients. The medical records of 165 biopsy-proven IOID patients were retrospectively reviewed. Biopsy specimens were immunostained to detect IgG4 and IgG, and data regarding the clinicopathologic features, treatment outcomes, and recurrence were analyzed. Among the 165 IOID patients enrolled, 100 (60.6%) were histopathologically IgG4-positive. The IgG4-positive patients had a lower rate of painful swelling or mass (17.0% versus 33.8%, p = 0.013), a longer symptom duration (p = 0.070), and a lower proportion of eyelid hyperemia (39.0% versus 58.5%, p = 0.014) than the IgG4-negative patients. Increased Ki-67 expression (15.02 ± 6.86%, p < 0.001) was observed in the IgG4-positive patients with characteristic pathological manifestations (more lymphocyte infiltration, nodular plasma cell infiltration, and follicular hyperplasia). IgG4-positive group had a higher recurrence rate in the subgroup of patients treated with surgery plus oral glucocorticoids (p = 0.046), and combined radiotherapy group has a higher cumulative proportion with recurrence (p = 0.011). Over 60% of biopsy-proven IOID were classified as IgG4-ROD with a stronger proliferation potential. Additional radiotherapy after surgical debulking with oral corticosteroids still has a higher relapse rate, and more effective treatments are needed to prevent recurrence.

Clinical efficacy of Fox surgery, improved Fox surgery and modified orbicularis oculi muscle fold surgery for the patients of entropion

Objective To analyze the clinical efficacy of patients with lower eyelid entropion after the treatment of Fox surgery, modified Fox surgery and modified orbicularis oculi muscle fold surgery. Methods 250 patients with lower eyelid entropion were retrospectively analyzed. The modified orbicularis oculi muscle fold surgery (group A), Fox surgery (group B), and modified Fox surgery (group C) were used for lower eyelid entropion. Results Postoperatively, No skin redness and swelling occured in group A, and mild skin redness appeared in 8 and 2 cases in groups B and C, respectively; the difference was statistically significant between the three groups (P<0.05); No eyelid hyperemia was found in groups A and C, but 6 cases presented with eyelid margin hyperemia in group B; the difference was statistically significant between the three groups (P<0.05). Long term follow-up showed that the satisfaction score of group A was (8.23±1.08), B group was (7.54±1.09), C group was (9.26±1.94), and the difference between three groups was statistically significant (P<0.05). In addition, the long-term recurrence rate showed that the recurrence rate in group C was the lowest, followed by group A, and the recurrence rate in group B was the highest, and the differences between various groups were statistically significant (P<0.05). Conclusions The improved Fox surgery has better satisfaction and lower recurrence rate in patients with lower eyelid entropion, and especially the long-term effect is more definite. Key words: Fox surgery; Improved Fox surgery; Improved orbicularis oculi muscle fold; Lower eyelid entropion; Satisfaction

Influence of Nasal Tear Osmolarity on Ocular Symptoms Related to Dry Eye Disease

To investigate relationships between local tear osmolarity and tear film characteristics and dry eye disease (DED) symptoms. Prospective, cross-sectional, observational study. Nasal and temporal tear osmolarity were measured in subjects with DED. The difference between nasal and temporal tears (OSM difference) was then calculated. Ocular symptoms were evaluated and tear break-up time (TBUT), corneal fluorescein staining score (CFSS), eyelid hyperemia, and tear production were measured. Correlations between DED symptoms and nasal tear osmolarity, temporal tear osmolarity, OSM difference, and tear film characteristics were evaluated using Pearson correlation analyses. Subjects were divided into 3 groups based on OSM difference: the temporal group had a temporal osmolarity > nasal osmolarity, the nasal group had a temporal osmolarity < nasal osmolarity, and the equal group had an OSM difference < 10 mOsm/L. Forty-eight eyes of 48 subjects were included. Eleven eyes were in the temporal group, 17 eyes were in the equal group, and 20 eyes were in the nasal group. Temporal osmolarity, nasal osmolarity, and OSM difference were not correlated with TBUT, CFSS, lid hyperemia, or tear production. Nasal tear osmolarity was correlated with cold sensitivity frequency (r= 0.298, P= .040), foreign body sensation severity (r= 0.293, P= .043), and light sensitivity severity (r= 0.293, P= .043). Additionally, OSM difference was correlated with daily symptom frequency (r= 0.339, P= .019). Nasal tear osmolarity and OSM difference play an important role in DED symptoms. Lid hyperemia, TBUT, CFSS, and tear secretion volume are not significantly affected by tear osmolarity. It is important to measure both nasal and temporal tear osmolarity when evaluating patients with DED.

Evaluation of patients with orbital infections.

Orbital tissue infections are common infections of childhood that can lead to severe complications. Herein, we aimed to evaluate the etiologic factors, diagnosis, follow-up, and treatment procedures in pediatric patients with orbital infections. This study was performed retrospectively between January 2014 and December 2015 in Cerrahpasa Medical Faculty Pediatric Infectious Disease Unit. Patients were studied for age, ophthalmologic examination features, laboratory and radiology results, treatment modalities, and the response to these treatments. Thirty-six patients (21 males, 15 females) with an average age of 71.43±42.24 months (5-168 months) participated in the study in the two-year period. Thirty-two patients (88.9%) had preseptal cellulitis, and four (11.9%) had orbital cellulitis. All patients had eyelid hyperemia, edema, and ocular pain, with chemosis in seven and proptosis in four cases. Twenty-five patients were admitted with fever. All cases were unilateral and 44.4% occurred secondary to paranasal sinusitis. All cases were treated with intravenous cefazolin-amikacin. The mean of duration of hospitalization was 12.02±8.75 days (range, 3-28 days) and the duration of parental antibiotics was 12.83±8.18 days (range, 7-21 days). All patients recovered without any vision loss, only one patient experienced subdural empyema complicating preseptal cellulitis. Most orbital tissue infections occur secondary to paranasal sinusitis in childhood. Orbital tissue infections can be complicated by brain abscess, cavernous sinus thrombophlebitis, and vision loss. Early diagnosis and proper antibiotic treatment are essential to prevent these life-threatening complications.

Oral Azithromycin for Treatment of Posterior Blepharitis

To evaluate the effects of oral azithromycin in patients with posterior blepharitis. Twenty-six eyes of 13 patients with posterior blepharitis diagnosed by a qualified ophthalmologist were enrolled in this study. Patients were instructed to use oral azithromycin 500 mg per day for 3 days in 3 cycles with 7-day intervals. Subjective clinical outcomes were graded and scored 1 day before and 30 days after the end of the treatment (53 days after initiating the treatment) based on severity scores of: (1) eyelid debris; (2) eyelid telangiectasia; (3) swelling of the eyelid margin; (4) redness of the eyelid margin; and (5) ocular mucus secretion. For the assessment of global efficacy, patients were asked by the investigator to rate the subjective symptoms (eyelid itching, ocular itching, eyelid hyperemia, ocular hyperemia, ocular mucus secretion, photophobia, foreign body sensation, and dry eye sensation) on a scale of 0 (no symptoms) to 5 (severe symptoms). Break-up time, Schirmer I test, corneal fluorescein staining score, and rose bengal staining score were also performed in all patients. All clinical outcomes scoring showed statistically significant improvement after oral azithromycin, except for eyelid swelling. Average subjective symptom grading improved statistically after treatment with oral azithromycin, except for eyelid hyperemia, photophobia, and foreign body sensation. Average tear film break-up time values showed statistically significant improvement after the treatment with oral azithromycin. No statistically significant improvement was observed on average values of Schirmer I test, corneal fluorescein staining score, and rose bengal staining score. The combination of multiple clinical parameters shown in this study supports the clinical efficacy of pulsed oral azithromycin therapy for the management of posterior blepharitis.

Bimatoprost 0.03% gel for cosmetic eyelash growth and enhancement

To evaluate a bimatoprost gel for enhancing eyelash growth, adverse effects, and change in intraocular pressure (IOP). Prospective, double-masked, randomized controlled study. Fifty-two patients without ocular disease were assigned a control or bimatoprost 0.03% gel to apply to the eyelid margin once a day. The adjusted mean change in eyelash length from baseline to 6 months was 0.77 mm in the bimatoprost group and -0.12 mm in the control group (P = 0.004). Adverse effects were experienced by 2 of 16 patients (12.5%) in the control group and 9 of 36 patients (25%) in the bimatoprost gel group. Mean change in IOP from baseline to 6 months was 0.685 mmHg in the control group and -2.04 mmHg in the bimatoprost group (P = 0.009). Bimatoprost gel was effective in enhancing eyelash growth. The most common adverse effect for the bimatoprost gel was conjunctival and eyelid hyperemia, while the most severe was recurrent anterior uveitis. Mean IOP was reduced in subjects using the bimatoprost gel.

Control of Inflammation and Prophylaxis of Endophthalmitis after Cataract Surgery: A Multicenter Study

To compare two different postcataract surgery antibiotic/steroid therapeutic combinations, for clinical results as well as patient satisfaction. Prospective randomized clinical trial of patients with bilateral operative cataract. Postoperatively, for 15 days one eye was randomly assigned to therapy with the combination chloramphenicol 0.25%-betamethasone 0.13% gel three times a day (Group 1) and the other to the combination tobramycin 0.3%-dexamethasone 0.1% eyedrops four times a day (Group 2). A total of 142 patients (284 eyes) completed the study. The authors could not detect any significant difference between Group 1 and Group 2 concerning preoperative evaluation, surgical procedure, and complications. Pertaining to the two therapeutic regimens, efficacy, side effects, and clinical findings such as uncorrected visual acuity, intraocular pressure, edema or hyperemia of eyelids and/or conjunctiva, conjunctival and/or ciliary vessels congestion, decreased corneal transparency, corneal edema, Descemet folds, anterior chamber Tyndall and depth, and posterior synechiae were also comparable. Postoperative subjective pain and dry eye sensation were comparable between the two groups, while the gel preparation elicited a significantly more pleasant sensation in the patients (p=0.04). The motivation for use of a gel is to prolong the permanence of associated drugs on the ocular surface, increasing potency and decreasing concentration of the drug and rate of administration. This in order to improve compliance and decrease potential side effects. Chloramphenicol 0.25%-betamethasone 0.13% gel combination proved to have comparable efficacy, tolerance, and better acceptance by the patients than an aqueous tobramycin 0.3%-dexamethasone 0.1% preparation.

Intraorbital Arteriovenous Fistula Secondary to Penetrating Injury.

To describe the clinical and radiologic features and management of an intraorbital arteriovenous fistula secondary to penetrating injury. Interventional case report and literature review. We describe a 13-year-old girl with a history of penetrating orbital injury who presented with proptosis, eyelid hyperemia, and orbital venous congestion. Computed tomography showed a large foreign body in the superiormedial orbit and an enlarged superior ophthalmic vein (SOV). Doppler ultrasonography revealed arterialized flow in the SOV. Removal of the foreign body did not alter the orbital symptoms. Carotid angiography disclosed a fistula between the ophthalmic artery and the SOV. The patient underwent an attempted coil embolization of the fistula through the femoral vein, which was unsuccessful, but she developed profound thrombosis of the SOV, which propagated through the orbital venous system. Although orbital venous congestive symptoms were acutely exacerbated, they regressed spontaneously within 1 month. The patient was followed for 23 months without recurrence. Penetrating injury of the orbital apex may lead to the formation of an arteriovenous fistula, transvenous embolization of which may be complicated by thrombosis of the SOV. In our case, this unintentional result facilitated the resolution of the fistula.