Moisture Chamber Research Articles

Preventing corneal abrasions in critically ill children receiving neuromuscular blockade: A randomized, controlled trial

To determine the incidence of corneal abrasions in critically ill children requiring neuromuscular blockade (NMB) and to determine whether a moisture chamber over the eye is more effective in preventing corneal abrasions compared with standard therapy. Randomized controlled clinical trial. Three pediatric intensive care units at two free-standing, university-affiliated children's hospitals. Consecutive intubated, mechanically ventilated patients receiving NMB <36 hours, 2 weeks to 18 years of age. After confirming the absence of a corneal abrasion, patients' eyes were randomized to either control (Q6H lubrication and eye closure) or treatment (Q6H lubrication, eyelid closure and moisture chamber). Eyes were examined daily for 3 days then every other day until NMB was discontinued, a corneal abrasion developed, or on study day 9. Data were analyzed on an intention-to-treat basis. Two hundred thirty-seven patients were enrolled. Thirty patients exited the study before randomization (17 upon confirmation of a corneal abrasion on initial examination [7%; 95% confidence interval 4%-11%]; 12 upon discontinuation of NMB; 1 patient death). The remaining 207 patients were randomized and evaluated twice (median; interquartile range [IQR] 1-4 observations). Twenty-one patients developed a corneal abrasion over the course of the study (10%; 95%confidence interval 6%-15%). Median time from enrollment to abrasion was 2 days (IQR 1-3 days). The incidence of corneal abrasion was not different between the patient's control and treatment eyes; specifically, eight corneal abrasions developed in the control eye, five corneal abrasions in the treatment eye, and eight corneal abrasions in both eyes (McNemar's test; p = 0.58). The occurrence of corneal abrasions in critically ill children receiving NMB is not trivial. The additional use of a moisture chamber over the eye was no more effective than Q6H lubrication and eye closure alone in preventing corneal abrasions in this at-risk patient group.

Effects of Seed Moisture Content, Cooking Time, and Chamber Temperature on Nuña Bean (Phaseolus vulgaris L.) Popping

Nuña beans are a type of common bean (Phaseolus vulgaris L.) native to the Andean region of South America that possess the unusual property of popping; however, little is known regarding postharvest environmental effects on popping. Seed of a photoperiod-insensitive, temperate-adapted nuña bean breeding line, ‘PB24’, was produced at the Arlington Agricultural Research Station, Arlington, WI, and evaluated in a hot air popper. The experimental design was a factorial with three levels of popping time (60, 90, and 120 s), five levels of chamber temperature (101, 146, 208, 244, and 268 °C), and eight levels of seed moisture (2.5%, 3.2%, 5.2%, 6.6%, 8.3%, 12.0%, 15.3%, and 20%). Percentage of popped seed, sufficiently expanded to shed the seedcoat, was calculated. A curvilinear decrease in popping percentage was observed with increasing seed moisture content. In contrast, a curvilinear increase in popping percentage was observed with increasing chamber temperature and popping time. Larger mean squares were observed for main effects and first-order interactions associated with seed moisture content and chamber temperature compared with popping time. A combination of seed moisture below 5%, popping chamber temperature of 244 °C, and popping time of 90 s resulted in popping percentages greater than 90%.

Eye care in the intensive care unit: Narrative review and meta-analysis

Patients in the intensive care unit are at increased risk of exposure keratopathy. Untreated, this may progress to microbial keratitis and visual loss. A total of 20% to 42% of patients in the intensive care unit develop exposure keratopathy. The epidemiology of this underappreciated problem is reviewed. The pathophysiology of microbial keratitis is reviewed with special attention to the multiple risk factors unique to intensive care unit patients. The clinical presentation of exposure keratopathy is reviewed with tips for recognition for the practicing clinician, including suggestions for when ophthalmologic consultation is warranted. Studies and case series of screening and prevention are reviewed in detail. Two of the most studied methods of prevention, moisture chambers and lubricating ointments, are formally compared in a meta-analysis. Eight of 113 (7.1%) patients in the moisture chamber group vs. 32 of 151 (21.2%) patients in the lubrication group developed exposure keratopathy, with a summary odds ratio of 0.208 (95% confidence interval 0.090-0.479, p < 0.001). With application of simple protocols, exposure keratopathy can be prevented, thus improving patient care in the intensive care unit.

ASPECTOS EPIDEMIOLÓGICOS DA QUEIMA DAS FOLHAS DA CENOURA (Daucus carota L) CAUSADA POR Alternaria dauci (Kühn) Groves & Skolko: Efeito da Concentração de Inóculo e Determinação do Período de Geração de Alternaria dauci (Kühn) Groves & Skolko.

The effect of the concentration of conidial inoculum of Alternaria dauci (Kuhn) Groves & Skolko in relation to the degree of severity of occurrence of leaf blight on carrot (Daucus carota L.) cultivar Nantes Half Long at 67 - 70 days of age, was studied. The plants were cultivated under green-house conditions innoculated by atomizing with spore suspension, and afterwards, maintained for 72 hours in an incubation chamber with temperature controlled at 18 – 24°C and relative humidity of 100% (foggy). The spore concentrations tests were 0, 10², 10³, 5x10³ and 2x10^4 spores/ml. There were significant differences in the treatments at the 5% level in relation to severity of the leaf blight, the total weight of the plants, and the weight of the roots. The generation period of the fungus was 6-7, 5, 6 and 6 days, respectively, at 16, 20, 24°C and room temperature. Detached leaflets were innoculated individually, by using a small brush to spread the spores. After innoculation, the leaflets were maintained in a moisture chamber. The vitality of the inoculum, seems to be a highly important factor in the determination of the generation time of the of fungus.

Características culturais e severidade da mancha foliar de Quambalaria eucalypti sob diferentes regimes de temperatura, luz e período de molhamento foliar

Quambalaria eucalypti foi recentemente relatado como agente etiológico da mancha foliar e do anelamento da haste de Eucalyptus spp., no Brasil. Em vista do pouco conhecimento disponível sobre este patossistema, procurou-se, neste trabalho, avaliar o crescimento micelial e a esporulação do fungo em diferentes meios de cultura, determinar "in vitro" a temperatura ótima para o crescimento micelial, esporulação e a germinação de conídios, avaliar a influência do regime de luz sobre a germinação de conídios e determinar a influência do binômio temperatura - tempo de câmara úmida sobre a severidade da doença. As temperaturas de 25, 13 e 37 ºC foram respectivamente, ótima, mínima e máxima, para o crescimento. A temperatura ótima para esporulação foi de 25 ºC. A interação entre meios de cultura e isolados foi significativa, sendo que os meios de batata-dextrose-ágar (BDA), V8-ágar (V8) e caldo de vegetais-ágar foram os mais favoráveis ao crescimento micelial, seguidos de caseína hidrolizada ágar e ágar água. Todavia, para a esporulação, a interação entre meios de cultura e isolados não foi significativa e o meio de BDA foi o mais favorável à esporulação do patógeno. A temperatura e o regime de luz não afetaram significativamente a germinação de conídios, com uma taxa média de 85 % de germinação. A interação entre temperatura e tempo de permanência em câmara úmida não foi significativa para severidade da doença. O modelo quadrático foi o que melhor representou a severidade em função da temperatura, com ponto ótimo estimado igual a 27 ºC. O modelo exponencial foi o que melhor representou a severidade em função do tempo de câmara úmida.

Tear Dynamics Model

Purpose: Quantitative understanding of tear dynamics may help in developing better ophthalmic drug delivery vehicles and dry eye treatments. This paper attempts to develop a comprehensive model that can predict the effect of physiological parameters on various issues related to tear dynamics. Methods: The model is based on mass balances of water and solutes such as glucose, sodium, potassium, and chloride. The mass balances require models for the drainage of fluid through the canaliculi and the transport of tears and solutes through the conjunctiva. The model parameters are obtained by simulating Ussing-chamber experiments. The differential equations for the unsteady balances are solved numerically. Results: The model predicts that under normal conditions, the tear volume, tear osmolarity and potential are 7.1 μl, 297.6 mM, and −15.1 mV, respectively. The model also predicts that the conjunctiva is secretory and contributes about 25% of the total tear production. We also predict the effect of evaporation on tear physiology and show that an increase in evaporation increases osmolarity, reduces tear volume, and increases conjuctival secretion. Additionally, the new tear dynamics model helps assess the effect of osmolarity of the instilled drops, insertion of punctum plugs and use of moisture chamber as treatments for dry eyes. Furthermore, the model is used to predict the effect of modulation of specific transport pathways, which is proposed as a potential remedy for dry eyes, on conjuctival secretion and total tear volume. Conclusions: Most of the predicted results agree with the reported experimental results, at least qualitatively. However, some predictions disagree with experiments suggesting that further improvements in the model are needed. The model developed in this paper can improve our understanding of tear dynamics and also serve as a tool to evaluate the efficacy of various modalities at treating dry eyes.

Use of Fluid-Ventilated, Gas-Permeable Scleral Lens (SL) for Management of Severe Keratoconjunctivitis Sicca Secondary to Chronic Graft-Versus-Host Disease.

Dry eyes or keratoconjunctivitis sicca (KCS) occur in 50 % of patients (pts) with chronic graft-versus-host-disease (cGVHD) after allogeneic hematopoietic cell transplantation (HCT) and may represent the only, or most significant, clinical manifestation of cGVHD in some pts. Artificial tears, long-acting ocular lubricants, punctal plugs, ophthalmic cyclosporine, topical corticosteroids, moisture chamber eyewear and oral cholinergic agents are the primary supportive therapies of ocular cGVHD. The liquid corneal bandage provided by a fluid-ventilated, gas-permeable scleral lens (Boston Scleral Lens, BSL) has been effective in mitigating symptoms and resurfacing corneal erosions in pts with a variety of causes of KCS refractory to conventional therapies. Here we report outcomes in 9 pts with cGVHD after related and unrelated HCT who had severe KCS treated by fitting a BSL because of debilitating ocular discomfort, visual impairment, or keratopathy despite systemic and local therapies and other supportive care. Diagnoses at time of HCT were CML (n=3), MDS (n=2), AML (n=1), AA (n=1), CLL (n=1) and MM (n=1). Median pt age at the time of SL fitting was 56 (range, 25–64) yrs. All pts had prior cGVHD involving multiple sites that required immunosuppression therapy (IS) with prednisone, +/− calcineurin inhibitors, +/− mycophenolate mofetil or other therapies. Manifestation of cGVHD other than eyes at the time of SL fitting were skin (n=2), mouth (n=5), liver (n=3), GI (n=1), lungs (n=1) and vagina (n=1). At the time of SL, 7 pts were receiving IS and 2 pts had discontinued all IS because of resolution of other manifestation of cGVHD. The response to the SL was assessed by patient-reported ocular disability and use of ancillary eye care, and by use of the Ocular Surface Disease Index (OSDI) in 5 pts. The OSDI is a valid and reliable tool used to assess severity of dry eye symptoms and vision-related function on a 0–100 scale, with higher scores correlating with increasing symptom severity and vision-related disability. Table below presents patients-reported outcomes. The use of the BSL led to ocular improvement in all cases. No serious adverse events or infections attributable to the BSL occurred. The median OSDI available improved from 87.7 to 20.8 within 2 weeks of BSL fitting and was 12.5 (4.2–52.7) at the time of last contact, 8–23 months (median, 15.2) after BSL fitting. Seven pts were no longer disabled by KCS after the BSL. All 9 pts reported reduced use of artificial tears, and 2 of 3 who were using moisture chamber eye glasses pre BSL were able to discontinue them. One pt had significant difficulty inserting the BSL, even with assistance. We conclude that BSL can be a safe and effective procedure for pts suffering from severe cGVHD-related KCS that is refractory to other therapies.No. of Patients9Artificial Tear Use (Times per day, N)- Before fitting Scleral Lens (SL)> 100- After fitting SL (median, range)3 (0–50)Punctal Plugs (times replaced, N)- Before fitting SL (median, range)3 (1–>6)- After fitting SL1 (1 pt)Subjective Assessment of Disability- Before fitting SLYes (7 pts)- After fitting SLYes (1 pt)

Eye care in ICU

Context: Patients in intensive care units have impaired ocular protective mechanisms, resulting in a high risk of developing eye complications. Various eye care protocols are being used, but none is proven to be absolutely effective. Aims: To compare the efficacy of using a combination of ocular lubricants and securing tape over the eyelids (Open chamber method), with use of swimming goggles and regular moistening of eyelids with gauze soaked in sterile water (Closed chamber method), to prevent corneal epithelial breakdown in the sedated and semiconscious intensive care adult patient. Settings and Design: A randomized clinical study was performed. Patients with Glasgow coma scale score of £ 10/15, admitted into the Medical ICU of a large teaching hospital, over a four month duration, were studied. Materials and Methods: Patients were examined daily by an Ophthalmologist, using a portable slit lamp and the patient's corneas were tested daily using 1% Fluorescein drops. Standard grading scales were used to record eyelid position and corneal and conjunctival changes. Statistical analysis used: Quantitative variables were described in terms of their relative frequencies in proportions. Null hypothesis was applied to derive the statistical significance of the observed variations in both the treatment groups. Chi-square test for relationships was used to assess the effect of specific variables on the development of keratopathy. Results: Sixty one patients (122 eyes) in the open chamber group and 63 (126 eyes) in the closed chamber group, were analyzed. Incomplete lid closure was seen in 74 eyes (30%). Exposure keratopathy was noticed in 39 eyes (32%) in open chamber group and ten (8%) in closed chamber group and was more severe in the former group. There was no difference in the incidence of conjunctival oedema in both groups. Incomplete lid closure and use of muscle relaxants, were significant risk factors for developing keratopathy. Conclusions: Use of swimming goggles and regular moistening of eyelids with gauze soaked in sterile water providing a moisture chamber, is more effective than using a combination of ocular lubricants and securing tape over the eyelids, in preventing corneal epithelial breakdown in sedated and semiconscious intensive care unit patients.

Moisture Diffusion Coefficient of Amaranth Seeds determined by the Regular Regime Method

In this work the dependence of moisture diffusivity of amaranth seeds on water concentration is studied. An expression for the moisture diffusion coefficient as a function of temperature and moisture content was determined departing from experimental drying curves obtained in a moisture chamber and employing the regular regime method developed elsewhere. A weak, but noticeable, dependence of this parameter on the moisture concentration was found. The diffusivity values obtained with the method applied in this work were similar to those previously reported and based on an Arrhenius-type expression for the moisture diffusion coefficient of amaranth seeds as a function of temperature.

Mold colonization during use of preservative-treated and untreated air filters, including HEPA filters from hospitals and commercial locations over an 8-year period (1996–2003)

High efficiency particulate arrestance (HEPA; 99.97% efficient at 0.3 microm) filters, filters with ASHRAE particulate arrestance rating of 90-95% at 1 mum (90-95% filters), and lower efficiency cellulosic-polyester filters from air conditioning systems in hospitals and commercial buildings were removed from the systems and examined microscopically for mold colonization. Cellulosic-type filters from systems with water entrainment problems typically were colonized, or became colonized upon incubation in moisture chambers. Species of Acremonium, Aspergillus, and Cladosporium were most common. With air filters of all types, treatment of filter media with an antimicrobial preservative tended to reduce or delay colonization. Mold colonization of HEPA and 90-95% filters was observed most often on the load surfaces, but two untreated HEPA filters were permeated with fungi, one with Aspergillus flavus, the other with Cladosporium sp. Air filters in heating, ventilating, and air conditioning (HVAC) systems, particularly those with chronic or periodic exposure to moisture, may serve as point sources for indoor molds.

Thermal and Moisture Diffusion Properties of Amaranth Seeds

The physical characteristics, thermodynamic and transport properties of amaranth seeds relevant to the modelling and simulation of the drying processes of these seeds were studied. The water activity as a function of the temperature and moisture content was modelled by means of the Henderson's expression from water activity experimental data. The desorption–vaporisation heat was also calculated. From the solution to Fick's second law for a spherical geometry and assuming equilibrium conditions at the solid–gas interface, an effective diffusion coefficient was evaluated from experimental drying curves obtained in a moisture chamber. The effect of taking into account more than one term in the Fourier series solution was analysed and it is concluded that the diffusion coefficient corresponding to two terms in the series leads to better agreement with the experimental results for short times.

THE DEVELOPMENT OF A CONSERVATION TREATMENT APPROACH FOR ISLAMIC MINIATURES

This paper describes the preliminary results of a study on the conservation of Islamic miniature paintings. The goal of the project is to evaluate traditional methods that are currently being used in the South Asian subcontinent, Iran and Central Asia to restore Islamic miniatures, and to explore the possibility of more appropriate treatment methods drawn from the Japanese scroll mounting tradition (Hyōgu), and from the repertoire of paper conservation techniques currently practised in the west. Information was gathered on the materials and techniques used in the production of Islamic miniature paintings, and the type of damage which they suffer. Surrogate objects prepared with traditional materials were used for testing purposes. In many cases, sophisticated techniques and equipment were not available and simple substitutes were employed, including visual assessment of test results. The project is still in progress but materials and techniques which show particular promise for the treatment of Islamic miniature paintings and manuscripts include funori (a seaweed-based adhesive) for the consolidation of flaking and friable paint layers, the ultrasonic mister for paint consolidation, the moisture chamber or dome used in association with a suction table for humidification, and the karibari (drying board) for flattening.

Development of an incubation system for an inverted microscopy for long-term observation of cell cultures using chamber slides

Trifunctional bispecific antibodies open up new immunological possibilities in tumour treatment. Prior to clinical application, comprehensive investigations using animal models and in vitro examinations need to be done. To investigate long-term interactions between various immunologically active blood cells and individual tumour cells in the presence of antibodies, we developed an incubation system for experimental cell cultures on an inverted microscope. The system consists of a perspex box with a central moisture chamber with integrated water reservoir, external air circulation heating, and a CO2 supply. The sterile cell cultures are located in the wells of a slide positioned within a depression in the water reservoir. The newly developed incubation system enables continuous observation over the long term of experiments under optimal cell cultures conditions in combination with modern video techniques.

Moisture Chamber for Management of Corneal Ulcer due to Graves' Ophthalmopathy

Moisture Chamber for Management of Corneal Ulcer due to Graves' Ophthalmopathy

Upper eyelid gold weight implantation in the Asian patient with facial paralysis.

Patients with facial paralysis may develop ophthalmic complications. Poor eyelid closure and lagophthalmos place the patient at increased risk for the development of corneal problems such as epithelial defects, stromal thinning, bacterial infection, and even perforation. Initial treatment should be conservative and include the use of ocular lubricants, moisture chambers, and taping of the lower eyelid into proper position. Surgical intervention may be required in patients who have failed medical therapy or in whom the facial paralysis is not expected to improve. Gold weight implantation in the upper eyelid has become a popular procedure to correct upper eyelid retraction and to improve corneal coverage. Previous descriptions of gold weight placement in the upper eyelid have focused on Caucasian eyelid anatomy. However, there are distinct anatomic differences between the Caucasian and Asian eyelids, which dictate the overlying aesthetic differences. We describe our technique for placement of a gold weight in the Asian upper lid, with attention to the maintenance of symmetric eyelid creases. We reviewed the charts of six Asian patients with facial paralysis who underwent gold weight placement in the upper eyelid for the correction of lid retraction. All patients did well functionally and aesthetically, and none developed an extrusion of the implant with this approach.

First Report of Phomopsis Fruit Rot of Strawberry in Ohio.

During spring (May and June) 1999, ≈30% of the fruit in a 0.5-ha commercial planting of strawberry (Fragaria × ananassa 'Allstar') was lost to an unknown fruit rot. The planting was established on black plastic (plasticulture) during summer 1998. Plasticulture is a relatively new system of perennial strawberry production in Ohio that is rapidly gaining popularity among growers (2). It was observed that the plastic beneath the plants in the plasticulture planting was covered with a layer of dead leaves from the previous season's growth, and virtually all rotted fruits were in contact with dead leaves. Fruit rot was rarely observed on fruits that were not in direct contact with dead leaves, and fruits of the same cultivar grown in the traditional matted-row system in an adjacent field did not show rot symptoms. It was postulated that infested dead leaf material could serve as an inoculum source for infection. Fruit rot symptoms were identical to those described for Phomopsis soft rot (1). Isolations were made from infected berries. Berries were soaked in 70% ethanol for 60 s, and tissue sections were placed on potato dextrose agar and incubated at room temperature (≈20 to 22°C). A fungus was isolated consistently from infected tissue. The fungus produced pycnidia in culture, and the fruiting structure and conidia conformed to the description of Phomopsis obscurans (Ellis & Everh.) Sutton (synamorph Dendrophoma obscurans (Ellis & Everh.) H.W. Anderson). Pathogenicity studies were conducted by placing one drop (20 μl) of a conidial suspension (9 × 106 conidia per ml) obtained from 2-week-old cultures on each of five ripe (red) and five immature (pink) detached strawberry fruits. Inoculated fruits were placed on screens in plastic moisture chambers. Five uninoculated fruits served as controls. Within 3 days, whitish lesions appeared on all inoculated fruit; within 8 days, the symptoms observed in the field were reproduced, and lesions were covered by pycnidia. No fruit rot developed on control fruit. The fungus was reisolated from infected fruit to complete Koch's postulates. Although the incidence of Phomopsis leaf blight is increasing in many Ohio strawberry plantings and is becoming a concern to growers, this is the first observation and report of Phomopsis fruit rot in Ohio. Unlike leaf blight, for which it is difficult to directly relate economic loss to disease incidence or severity, losses due to fruit rot can be high, as in this field. As the number of strawberry plantings under plasticulture continues to increase, the importance of Phomopsis leaf blight and fruit rot also may increase.

First Report of Cercospora traversiana on Trigonella coerulea in Bulgaria.

In the spring of 1996, diseased plants of Trigonella coerulea were noted in an experimental area at Kazanlak, Bulgaria. The primary symptoms were leaf spots 8 to 2 mm in diameter, light brown then becoming gray and slightly zonate, and surrounded by a diffuse chlorotic margin. When single lesions occur the disease normally develops as a typical leaf spot. However, the development of more than one spot is followed rapidly by yellowing and withering of entire leaflets. Stem lesions usually begin at the point of leaf attachment, extend both directions about 15 to 20 mm, and often encircle the stems. Isolations on potato dextrose agar (PDA) yielded a slow-growing, gray fungus. Conidia from the isolated fungus when inoculated at 3.104 spores per ml on potted T. coerulea seedlings and kept in a moisture chamber for 48 h caused foliar spots in 5 to 8 days and sporulating structures similar to those seen in field observations. Simultaneous inoculation of T. foenum-graecum (fenugreek) plants produced similar symptoms, but the percentage of successfully inoculated leaves (3.6%) was lower than in T. coerulea (27.6%). Conidiophores of the fungus are dark, arising in clusters, unbranched, septate (1 to 3), and have small conidial scars. Conidia are hyaline, straight, multicelled (1 to 17), tapering at the base, and measured 30 to 212 × 4 to 6 μm. The pathogen was identified as Cercospora traversiana Sacc. and this is the first report of its occurrence in Bulgaria.

093 Putative Sources in Strawberry for Resistance to Bacterial Angular Leafspot

Bacterial angular leafspot disease (BALD) of strawberry, caused by Xanthomonas fragariae Kennedy &amp; King, has dramatically affected commercial fruit and plant production throughout the world. Leaf lesions may kill leaves, while lesions on sepals make fruit unmarketable. The bacterium can kill stolon-tip plantlets that are being rooted for transplanting. Since plants become systemically infected, there is no adequate chemical control for BALD under conditions that favor development and spread of the disease. Strawberry is the only host and no cultivars or advanced selections have proven resistant to this disease. We screened 23 Fragaria ×ananassa, 13 F. chiloensis, 56 F. virginiana, and 2 F. vesca genotypes for resistance to two pathogenic isolates of X. fragariae (ATCC-33239, the original strain from Minnesota and Xf-3 from North Carolina). Leaves were inoculated by forcing bacterial suspensions into leaves under pressure with a syringe barrel and plunger. Plants were incubated in a moisture chamber for 3 days, followed by 1 week under mist and then placed on a greenhouse bench. Experiments were done twice for obviously susceptible reactions and three and four times for questionable and resistant reactions, respectively. Only two genotypes were found to show a resistant reaction: 80-4-38 (`Earliglow' (F. virginiana clone SG-26 from Georgia) and F. virginiana clone SG-89 (=Luby MS 7-7 from Minnesota). Each of these genotypes exhibited typical hypersensitive responses by walling-off inoculation areas. All other genotypes exhibited typical BALD symptoms 5 weeks after inoculation with both isolates.

Modified moisture chamber

Moisture chambers can protect the eye in corneal lubrication or eyelid closure disorders. However, in cases with protrusio bulbi or pronounced chemosis conjunctivae direct damaging contact of the cornea or conjunctiva on the one hand and the inside of the moisture-chamber-bandage on the other hand are possible. Since commercial moisture-chamber-bandages are not available with different internal radii, new methods are necessary to increase the distance between the bandage and the eye. A special pressure relieving foam dressing used in the therapy and prophylaxis of decubitus was prepared in such a way that a periocular attachment was enabled and an opening for the eye was left blank. This central opening was covered with a commercial moisture-chamber-bandage. Five test persons and two ventilated patients with protrusio bulbi and manifest lagophthalmus were treated with the modified moisture chamber. The relative humidity within the bandage was measured. The modified moisture chamber allows an individual adaptation to the periocular shape of the face and rises the level of the monoculus for about 7 mm. The internal relative humidity was for eight hours at 98% in both test persons and patients. All test persons felt more comfortable with the modified moisture chamber on their skin. The presented modified moisture chamber is a derivative of the commercial monoculus bandage for patients with sensitive protrusio bulbi.

New methods for the treatment of loss of eyelid closure in reversible facial paralysis

For prophylaxis or therapy of lagophthalmic keratopathy ointment application or hour glass dressing is indicated. The hour glass dressing has the disadvantage of a continuous visual impairment by steaming up of the moisture chamber. The main problem for the patients is the strong subjective feeling of physical handicap. A therapeutic alternative is the gravity dependent lidloading, which is known as gold implantation in cases of irreversible lagophthalmos. By lead weights of 0.8 to 2.0 g, which are fixed to the upper lid by a foil glueing on both sides (Tesafix) or in allergic patients by an adhesive layer, well tolerated by the skin (Combihesive), the lidclosure can become restored without impairment of lid-opening. In a controlled study the described method was first tested on 10 normal persons and than applied to 22 patients with lagophthalmos. Meanwhile the new method was applied to 32 further patients. The "liddynamic" procedure is effective and well tolerated; it is more accepted, especially during the day, because of better visual function and better cosmetics. The hour glass dressing, is still of importance in serious cases of keratopathy during the night. "lidloading" with lead weights, which are glued by an adhesive layer to the upper lid, can be recommended as a new method in cases of reversible lagophthalmos or as a preparing step before a gold implantation.