Ocular Complaints Research Articles

Overlap syndrome with rowell's syndrome, antiphospholipid syndrome, primary sterility, and sensorineural hearing loss: A case report, brief review, and analysis of cases of rowell's syndrome reported from India and Abroad

Rowell's syndrome (RS) is recognized since 1963 as a presentation of lupus erythematosus (LE) with erythema multiforme-like lesions and characteristic immunological changes. Antiphospholipid syndrome (APS) encompasses antibodies to phospholipids/phospholipid-binding cofactor proteins and/or circulating lupus anticoagulant with clinical manifestations of thrombosis such as recurrent spontaneous abortions, etc. A 32-year-old female with primary infertility since marriage (7 years) and sequential appearance, for the past 6 months, of various lupus-specific cutaneous lesions, “targetoid” lesions on palms, musculoskeletal, ocular and auditory (sensorineural hearing loss [SNHL]) complaints with positive serological profile for SMD-1, SS-A/Ro, SS-B/La, U1-snRNP, Ku, antiphospholipid and anticardiolipin antibodies, and histopathologically confirmed LE is presented as a case of concurrent overlap syndrome, RS and APS, primary infertility, and SNHL. A brief review of RS including analysis of data of cases reported from India hereto vis-a-vis that of cases worldwide up to 2012 has also been done.

Ocular surface symptoms among individuals exposed to ambient levels of traffic derived air pollution - a cross-sectional study.

Background: The ocular surface is separated by a thin layer of tear film from outdoor air pollutants making individuals exposed to outdoor air pollution prone to various ocular surface disorders. The aim of this study was to determine the magnitude of ocular surface disorders symptoms among traffic police officers of Kathmandu, Nepal. Methods: Two hundred traffic police officers working at different traffic police office branches of Kathmandu, Nepal were invited to the police headquarters for eye and vision examination. Among them, 91 individuals (95% males) completed the ocular surface disease index (OSDI) questionnaire and underwent Schirmer's I tear test. Results: Symptoms of ocular surface disorders were reported by over 80% of the individuals. Approximately two fifths of the individuals (38%) reported severe symptoms. Only 17% of the individuals' tear secretion was found to be below normal using the Schirmer's tear test. There was no association between the OSDI score and Schirmer's tear test scores (r = 0.008, p = 0.94). A weak but significant relationship was observed between the OSDI score and job duration (r=0.21,p = 0.04). Individual exposed to outdoor air pollution for more than 10 years had higher odds of reporting ocular surface complaints as compared to those who were exposed for less than 10 years (OR = 3.94, p = 0.02). Conclusion: Ocular surface disorder symptoms are common among traffic police officers of Kathmandu, Nepal. The duration of exposure appears to significantly contribute to the increased symptoms in this vulnerable population.

Epidemiology of Persistent Dry Eye-Like Symptoms After Cataract Surgery.

To evaluate the frequency and risk factors for persistent postsurgical pain (PPP) after cataract surgery, defined as mild or greater dry eye (DE)-like symptoms 6 months after surgery. This single-center study included 86 individuals who underwent cataract surgery between June and October 2016 and had DE symptom information available 6 months after surgery. Patients were divided into 2 groups: controls were defined as those without DE symptoms 6 months after surgery (defined by a Dry Eye Questionnaire 5 (DEQ5) score <6), cases were defined as those with mild or greater DE-like symptoms 6 months after surgery (DEQ5 ≥6). Mean age of the study population was 71 ± 8.6 years; 95% (n = 82) were men. DE-like symptoms were reported in 32% (n = 27) of individuals 6 months after cataract surgery; 10% (n = 8) reported severe symptoms (DEQ5 ≥12). Patients with DE-like symptoms after cataract extraction also had higher ocular pain scores and specific ocular complaints (ocular burning, sensitivity to wind and light) compared with controls with no symptoms. A diagnosis of nonocular pain increased the risk of DE-like symptoms after cataract surgery (odds ratio 4.4, 95% confidence interval 1.58-12.1, P = 0.005). Mild or greater PPP occurred in approximately 1/3 of individuals after cataract surgery. Prevalence of severe PPP is in line with that of refractive surgery, dental implants, and genitourinary procedures.

Role of Endoscopic Ultrasound in the Management of Tubercular Uveitis

ABSTRACTPurpose: To evaluate the role and safety of endoscopic ultrasound-guided fine-needle aspiration cytology (EUS-FNAC) in patients of tubercular uveitis.Design: Interventional case seriesMethods: Thirty patients suspected of tubercular uveitis that underwent EUS-FNAC were enrolled in the study. The patient details recorded were age, gender, systemic history, ocular complaints and clinical manifestations. The details of the investigations - skin test, X-Ray chest, CECT (contrast enhanced computed tomography) of chest and findings on EUS-FNAC were also recorded.Results: Thirty patients with suspected tubercular uveitis showed mediastinal lymphadenopathy on CECT-chest and underwent EUS-FNAC. A total of 27 patients showed tubercular lymphadenitis and three patients showed reactive lymphadenopathy. Ziehl–Neelsen (ZN) staining was positive for acid-fast bacilli in four cases and culture was positive in one case. There were no noted complications of EUS-FNAC.Conclusion: EUS-FNAC is a safe and efficacious procedure for confirming the diagnosis of tubercular uveitis and should be routinely employed wherever available.

Checkpoint inhibitor-induced uveitis: a case series.

Checkpoint inhibitors are now a common treatment modality for metastatic cancer. In this manuscript, we describe the clinical features and management of autoimmune non-infectious uveitis induced by this class of drugs. Seven patients undergoing checkpoint inhibitor treatment for metastatic cancer from uveitis practices at three tertiary referral centers. All seven patients developed various severities of ocular inflammatory disease while taking checkpoint inhibitors for metastatic disease. Checkpoint inhibitors may induce autoimmune uveitis. Ocular complaints should prompt an early evaluation by an ophthalmologist.

Light therapy: is it safe for the eyes?

Light therapy has become an increasingly popular treatment for depression and a range of other neuropsychiatric conditions. Yet, concerns have been raised about the ocular safety of light therapy. We conducted the first systematic review into the ocular safety of light therapy. A PubMed search on January 4, 2017, identified 6708 articles, of which 161 were full-text reviewed. In total, 43 articles reporting on ocular complaints and ocular examinations were included in the analyses. Ocular complaints, including ocular discomfort and vision problems, were reported in about 0% to 45% of the participants of studies involving light therapy. Based on individual studies, no evident relationship between the occurrence of complaints and light therapy dose was found. There was no evidence for ocular damage due to light therapy, with the exception of one case report that documented the development of a maculopathy in a person treated with the photosensitizing antidepressant clomipramine. Results suggest that light therapy is safe for the eyes in physically healthy, unmedicated persons. The ocular safety of light therapy in persons with preexisting ocular abnormalities or increased photosensitivity warrants further study. However, theoretical considerations do not substantiate stringent ocular safety-related contraindications for light therapy.

Ocular Lesions in Congenital Toxoplasmosis in Santa Isabel do Ivaí, Paraná, Brazil.

We verified clinical and psychopedagogic aspects of congenital cases with ocular sequelae, 13 years after toxoplasmosis outbreak in Santa Isabel do Ivaí, and current seroprevalence of this zoonosis in pregnant women. Audiologic and ophthalmologic evaluations were performed in congenital cases, in addition to collection of clinical and psychopedagogic data. In pregnant women, current seroprevalence was observed. Among affected teenagers, 2 of 5 are behind in school grade, and 4 of 5 reported learning difficulties, requiring psychopedagogic monitoring, as well as ocular complaints. We observed predominance of small, scarred, dispersed, type II chorioretinal lesions (hypopigmented halo and hyperpigmented central area), and 1 case of ocular relapse. All patients presented normal audiologic assessment. Among 131 pregnant women, 62 (47.3%) were seronegative and 39 (29.8%) were IgG reactive. Only 1 reported acquiring infection during the outbreak. This is one of the few studies in Brazil showing the outcome of congenital toxoplasmosis, a decade after infection, in one of the world's largest outbreaks.

Rare association of optic disk pits with myelinated retinal nerves

We report the case of a 9-year-old girl who presented for a routine change of glasses. On slit-lamp examination, no abnormality was detected; however, dilated fundus examination revealed profuse myelination of the retinal nerves around the disk of the right eye along with an optic disk pit inferotemporally. The left eye fundus also had an optic disk pit inferotemporally but no associated myelination. Visual acuity was 6/9 in each eye, and the patient had no other ocular or systemic complaints. To our knowledge, cooccurrence of myelinated retinal nerves and optic disk pits in the same eye, has not been previously reported.

Corneal sensitivity and tear production in 108 horses with ocular disease.

To compare corneal sensitivity and tear production in horses with keratitis to horses with other ocular disease. Retrospective medical record review was used to identify equine patients presented during a 1-year period for an ocular complaint who had Schirmer Tear Test (STT) or Corneal Touch Threshold (CTT) measured. Variables studied included patient age and sex; affected eye; category of presenting ocular complaint (keratitis vs. other ocular complaint); STT; and CTT. Patients with a complaint of ulcerative keratitis, immune-mediated keratitis, and stromal abscess were categorized in the keratitis group. Patients with a complaint of uveitis, as well as lid, lens, or retinal disease, were categorized in the group having other ocular disease. For patients presenting more than once in 2013, only the first visit at which STT or CTT was measured was included. For patients with bilateral disease, STT and CTT of both eyes were averaged. A total of 108 patients were included, 45 with keratitis and 63 with other ocular disease. Average age was 13.65 years, with more males (77) than females (31). Adjusted for age, STT in affected eyes did not differ significantly between the two groups (keratitis = 29.92 mm/min; other ocular disease = 27.96 mm/min), but CTT was significantly lower in patients with keratitis (33.78 mm) than in patients with other ocular disease (40.10 mm). Corneal sensitivity may be decreased in patients with keratitis. It is not known whether this is a cause or an effect of corneal disease.

The Effect of Tear Supplementation with 0.15% Preservative-Free Zinc-Hyaluronate on Ocular Surface Sensations in Patients with Dry Eye.

To evaluate the effect of tear supplementation with preservative free 0.15% zinc-hyaluronate on ocular surface sensations and corneal sensitivity in dry eye patients. Ocular surface sensations were assessed using the ocular surface disease index (OSDI) questionnaire and by recording ocular sensations during forced blinking in parallel with noninvasive tear film breakup time measurement in 20 eyes of 20 dry eye patients. Corneal sensitivity thresholds to selective stimulation of corneal mechano-, thermal- and chemical receptors were measured using the Belmonte gas esthesiometer. All baseline measurements were repeated after 1 month of treatment with 0.15% zinc-hyaluronate. After 1 month, a significant decrease in mean OSDI score (from 35.66 ± 12.36 to 15.03 ± 11.22; P < 0.001) and a significant improvement in tear film breakup time (from 3.83 ± 0.80 to 8.67 ± 4.50 s; P < 0.001) was observed compared to baseline. Sensory responses during the interblink period also significantly decreased after 1 month (P < 0.004). Corneal sensitivity thresholds to mechanical stimulation (90.61 ± 20.35 vs. 103.92 ± 17.97 mL/min; P < 0.025) and chemical stimulation (33.21 ± 0.51 vs. 33.58% ± 0.44% CO2; P < 0.025) significantly increased after 1 month, however sensitivity thresholds to thermal stimulation remained unchanged compared to baseline (P > 0.05). Prolonged use of 0.15% zinc-hyaluronate results in an improvement of tear film stability and a decrease of dry eye complaints. The decrease in corneal mechano-and polymodal receptor excitability suggests that zinc-hyaluronate helps to recover normal corneal sensitivity, and thus might have a beneficial additional effect on reducing ocular surface complaints in dry eye patients.

Awareness Assessment of Diabetic Eye Health in a Tertiary Hospital in Saudi Arabia

Background: Saudi Arabia is considered as the seventh highest rate in the world in terms of diabetes incidence, with about 3.4 million people having been diagnosed with diabetes in 2015. The recent estimate of the disease showed that 24.4% of the adult population is suffering from Diabetes Mellitus (DM). Objective of the Study: Due to this high prevalence of diabetes and its complications in Saudi Arabia, there was a need to perform studies especially in large hospitals of central region to estimate the awareness of consequences due to diabetes mellitus among the population in addition to provide the participants extra knowledge for its ocular and non-ocular complications. Materials and Methods: This is a prospective, descriptive, and observational study conducted among Saudi population aged ≥12 years of age who attended endocrine and family medicine clinics in King Faisal Specialist Hospital and research centre (KFSH&amp;RC) in Riyadh, Saudi Arabia. 559 printed questionnaire forms were distributed for all diabetic and non-diabetic patients attending both clinics in the month of October 2016. The patients who completed the data and signed the approval consent of participation were included in the study. 317 participants were distributed into 2 groups (group 1: 175 diabetic patients and group 2 (control group): 142 non- diabetic one. The questionnaire form comprised the following data: File number, age, sex, the presence of diabetes or any other associated systemic diseases and its duration, Address, level of education, approximate distance (km) from home to nearby eye clinic. Level of awareness of DM and its complications was graded from 1(unaware) to 3 (fully aware) according to number of hospital visits per year, regular follow up or visiting the hospital upon ocular complaint, any previous ocular interventions, or non-elective admissions to hospital. Results: Age of the patients ranged from 13- 88 years (mean:55.33 years) with an average duration of diabetes 8±2.86 years. 140 patients (44.16%) were from rural areas, 159 patients (50,15%) were males, 124 patients (39.11%) finished at least intermediate or secondary education, 193 (60.88%) were graduates or above. Level of awareness of DM and its ocular complications (level 2-3) was detected in 264 patients (83.28%). 143 diabetic patients (81.71%) valued the importance of at least one ocular examination per year. Only 32 patients of the diabetic group (18.28%) had never underwent ocular check up in the last 12 months. Conclusion: In our study, although 44.16% of the patients were from rural areas and 39.11% were school educated, 83.28% of the participants were aware that diabetes can affect the eyes indicating that the Kingdom of Saudi Arabia had achieved a notable economic growth and improvement in life quality. The study revealed high level of awareness about importance of monitoring DM among studied population, with no significant difference between graduate or school educated persons.

Awareness Assessment of Diabetic Eye Health in a Tertiary Hospital in Saudi Arabia

Background: Saudi Arabia is considered as the seventh highest rate in the world in terms of diabetes incidence, with about 3.4 million people having been diagnosed with diabetes in 2015. The recent estimate of the disease showed that 24.4% of the adult population is suffering from Diabetes Mellitus (DM). Objective of the Study: Due to this high prevalence of diabetes and its complications in Saudi Arabia, there was a need to perform studies especially in large hospitals of central region to estimate the awareness of consequences due to diabetes mellitus among the population in addition to provide the participants extra knowledge for its ocular and non-ocular complications. Materials and Methods: This is a prospective, descriptive, and observational study conducted among Saudi population aged ≥12 years of age who attended endocrine and family medicine clinics in King Faisal Specialist Hospital and research centre (KFSH&amp;RC) in Riyadh, Saudi Arabia. 559 printed questionnaire forms were distributed for all diabetic and non-diabetic patients attending both clinics in the month of October 2016. The patients who completed the data and signed the approval consent of participation were included in the study. 317 participants were distributed into 2 groups (group 1: 175 diabetic patients and group 2 (control group): 142 non- diabetic one. The questionnaire form comprised the following data: File number, age, sex, the presence of diabetes or any other associated systemic diseases and its duration, Address, level of education, approximate distance (km) from home to nearby eye clinic. Level of awareness of DM and its complications was graded from 1(unaware) to 3 (fully aware) according to number of hospital visits per year, regular follow up or visiting the hospital upon ocular complaint, any previous ocular interventions, or non-elective admissions to hospital. Results: Age of the patients ranged from 13- 88 years (mean:55.33 years) with an average duration of diabetes 8±2.86 years. 140 patients (44.16%) were from rural areas, 159 patients (50,15%) were males, 124 patients (39.11%) finished at least intermediate or secondary education, 193 (60.88%) were graduates or above. Level of awareness of DM and its ocular complications (level 2-3) was detected in 264 patients (83.28%). 143 diabetic patients (81.71%) valued the importance of at least one ocular examination per year. Only 32 patients of the diabetic group (18.28%) had never underwent ocular check up in the last 12 months. Conclusion: In our study, although 44.16% of the patients were from rural areas and 39.11% were school educated, 83.28% of the participants were aware that diabetes can affect the eyes indicating that the Kingdom of Saudi Arabia had achieved a notable economic growth and improvement in life quality. The study revealed high level of awareness about importance of monitoring DM among studied population, with no significant difference between graduate or school educated persons

Evidence of central sensitisation in those with dry eye symptoms and neuropathic-like ocular pain complaints: incomplete response to topical anaesthesia and generalised heightened sensitivity to evoked pain

ObjectiveTo evaluate how closely neuropathic-like ocular pain (NOP) symptoms align with a metric of central sensitisation (ie, the presence of persistent ocular pain after topical anaesthetic placement) in individuals with...

Assessment of the effect of academic examination stress on binocular vision functions among secondary school-aged children

Background: Binocular single vision involves the simultaneous use of both eyes with bifoveal fixation, and this process helps individuals to use their both eyes for reading, writing, and other near activities; the stress on this system could lead to ocular complaints and affect the near task for the school-aged children. Aim: The aim of this study was to assess the effect of academic examination stress on binocular vision functions among secondary school-aged children in Khartoum State of Sudan. Materials and Methods: This is an experimental study of 148 secondary school-aged children, selected randomly from Alfath Secondary School, and their ages ranged from 13 to 17 years with a mean age of 14.6 ± 1.13 years. Investigation was performed before and after the academic examinations in 2017. The clinical examinations include visual acuity measurements using Snellen vision testing chart, refraction using autorefractometer, dissociated near phoria by Maddox Wing, associated near phoria by Mallet Fixation Disparity Test, amplitude of accommodation and near point of convergence (NPC) measured by R.A.F rule, and near positive fusional vergence (PFV) and near negative fusional vergence by prism bar. All these investigations were done before 15 days of academic examinations and on the day after the students finished their academic examinations. Results: The findings indicated that most of the students (62.8%) before the academic examinations reported that they were free from any ocular complaints, whereas 37.2% had ocular symptoms. After stress due to examinations, the percentage of students who had ocular complaints increased to 71.6, whereas those free of ocular complaints decreased to 28.4. The mean of amplitude of accommodation before taken the examinations was 9.81 ± 2.16, and after the examination, the mean of amplitude of accommodation decreased to 8.77 ± 1.97 (P Conclusion: The academic examination stress had a major effect on binocular vision functions, result in decompensated heterophoria, as well as decline in amplitude of accommodation, and NPC. Thus, comprehensive eye examination including binocular vision function assessment should be made annual for school-aged children.

Computer vision syndrome among mobile phone users in Al-Ahsa, Kingdom of Saudi Arabia

Background: The growing number of mobile phone users or video display terminals (VDTs) puts them at hazards of computer vision syndrome (CVS) resulting in ocular surface damage, eye strain, exhaustion, and muscular complaints as result of improper usage of VDTs. Objectives: To determine the prevalence of CVS and to get a baseline data about this syndrome among inhabitants of Al-Ahsa, Saudi Arabia. Materials and Methods: A cross-sectional study was conducted for the duration of 1 month in Al Ahsa Saudi Arabia. Convenience sampling was used with a validated questionnaire to measure the CVS symptoms and to collect data. Consequently, Chi-square test was performed to observe the prevalence of CVS with its risk factors using SPSS version 22. Results: This study showed the prevalence of CVS among Al-Ahsa population to be 43.5% of the screened sample; this was significance results in the term of blurred vision (P = 0.002), dry eye (P = 0.011) and ocular discomfort (P = 0.013) among individuals suffer from CVS. Regarding extraocular complaint, there was a significant result seen in the presence of neck and shoulder pain (P = 0.008) and dizziness (P = 0.045) in individual developed CVS. Conclusion: The study found significant results in term of ocular and nonocular complaints among individuals who developed CVS from Al-Ahsa. Further longitudinal studies are required to study the effect of VDTs on ocular health.

Traditional eye medicine use among ophthalmic patients attending a secondary health care center in Southeast Nigeria

Introduction: The perceived high cost of eye care services has been implicated as one of the reasons for the use of traditional eye medications (TEMs) in the country. Other factors including distance, tradition, ignorance, and failure of medical treatment among others have also been documented as determinants of TEM use. TEMs constitute a wide range of unorthodox therapies utilized for treatment of ocular disorders. They have been reported to have no beneficial effect rather causing more harm than good. Aim: This study sought to determine the prevalence, types, and ocular indications for TEM use in the study population. Methods: This was a cross-sectional study in which a structured questionnaire was used to collect relevant data from consecutive patients attending the eye clinic during the study. Results: At a prevalence of 15.8%, the highest use of TEM was noted among artisans, those in the seventh decade of life, with low level of education, ocular complaints of poor vision, and illness of <1 year duration. Its use though high, was not significantly associated with age, sex, education, occupation and illness duration. Roots and herbs were the most common types of TEM used. Conclusion: There was a high prevalence of use of TEM in this study. The deleterious effect of its use is known and has been reported in literature. Education and enlightenment of the public are needed and highly recommended.

Eye changes among HIV positive patients on antiretroviral therapy in Nepal.

To find out eye findings among HIV positive patients in the era of antiretroviral therapy. Method This Hospital based cross sectional descriptive study was carried at B. P. Koirala Lions Centre for Ophthalmic Studies. Patient profile, WHO clinical stage, CD4+ cell count, duration of HIV, antiretroviral therapy, and systemic diseases were recorded. All the cases underwent ocular examination as per the study protocol and the findings were noted in a proforma developed for the study. The results were analysed with SPSS 14.0. Of 100 HIV positive cases (including 55 antiretroviral therapy patients) 62% patients were male and 38% were female. The mean age of presentation was 27.72 years. Heterosexual transmission (62%) was the commonest mode of transmission of HIV. Thirty seven percent patients were illiterate. Systemic disease was present in 20% cases. Ocular complaint was present in 53% patients. Ocular disease was present in 40% HIV positive patients. Almost 55% of these cases were on antiretroviral therapy. Moderate to lower CD4 count patient had frequent eye disease. Patients in WHO Stage III and IV also had frequent eye problems. Anterior segment and external ocular disorder was present in 25% patients. The commonest manifestation was conjunctivitis in10% of total cases. Posterior segment manifestation was present in 11%, neuro-ophthalmic lesion in 4% and orbital lesion in 1% patient. Anterior segment manifestation is still common ocular manifestations in HIV positive patients in Nepal. Patients in WHO Stage III and IV are more vulnerable for eye changes. Young aged male and migrant workers are at risk of acquiring HIV in developing country like Nepal. Eye findings even in patientson antiretroviral therapy are similar. However, large sample size and long follow up study is required to have final disclosure.

Conjunctival Acute Graft-versus-Host Disease in Adult Patients Receiving Allogeneic Hematopoietic Stem Cell Transplantation: A Cohort Study.

BackgroundTo investigate the incidence, risk factors and survival of conjunctival acute graft-versus-host disease (aGVHD) in adult patients undergoing allogeneic hematopoietic stem cell transplantation (HSCT)MethodsThis retrospective study included a total of 139 patients undergoing allogeneic HSCT between January 2012 and December 2014 at a tertiary referral hospital. Patients with ocular complaints after allogeneic HSCT or first donor lymphocyte infusion were evaluated by ophthalmologists. The risk factors for conjunctival aGVHD were analyzed using the Cox proportional hazards model. The overall survival was evaluated using Kaplan-Meier estimates.ResultsThirteen (9.4%) patients developed conjunctival aGVHD, including eight patients with pseudomembranous conjunctivitis. The cumulative incidence of conjunctival aGVHD was 2.1 cases per 10,000 person-day. The median age at HSCT was 47 years (range, 18 to 66) in all patients and 42 years (range, 24 to 58) in the 13 patients with conjunctival aGVHD. Median time of follow-up after allogeneic HSCT was 353 days (range, 11 to 1184). In univariate analysis, grades II-IV skin aGVHD (P = 0.002) and advanced systemic aGVHD except skin aGVHD (overall grades III-IV) (P = 0.001) were significant predictors for conjunctival aGVHD. In multivariate analysis, grades II-IV skin aGVHD was a significant risk factor (P = 0.04). The severity of conjunctival aGVHD was generally correlated with the systemic aGVHD (P = 0.001). Overall survival was significantly shorter in patients with grades II-IV aGVHD compared to those with grade 0-I (P = 0.01). Survival in patients with conjunctival aGVHD did not differ significantly from those without this complication (P = 0.94). In the subgroup analysis of patients with grades III-IV aGVHD, survival was significantly longer in patients with conjunctival involvement than those without (P = 0.03).ConclusionsThe severity of conjunctival aGVHD is correlated with systemic aGVHD, but not with inferior overall survival.

The eye and tick-borne disease in the United States.

Tick-borne diseases are increasing in incidence and geographic distribution. Several diseases endemic to the United States have ophthalmic manifestations, including the most common tick-borne disease, Lyme borreliosis. As ocular complaints may lead a patient to seek medical evaluation, it is important to be aware of the systemic and ophthalmic manifestations of tick-borne diseases in order to make the correct diagnosis. Vision-threatening ophthalmic manifestations are relatively common in Lyme disease and Rocky Mountain spotted fever. Ocular involvement is rare in babesiosis, tick-borne relapsing fever, Powassan encephalitis, ehrlichiosis, anaplasmosis, and Colorado tick fever.There are clear guidelines for diagnosis and treatment of Lyme disease; however, confusion and misinformation among the general public as well as controversy about chronic or late-stage Lyme disease can impact the evaluation of ophthalmic disease. Furthermore, there are many gaps in our knowledge regarding the pathophysiology of ocular borreliosis although it seems likely that Lyme uveitis is rare in the United States. Knowledge of systemic and ophthalmic manifestations combined with an understanding of the epidemiology of disease vectors is crucial for the diagnosis of tick-borne diseases.

Ophthalmologic evaluation in geriatric patients: Assessment of consistency between patients’ complaints and ocular diagnoses

PurposeThis study aimed to assess the consistency between patients’ complaints and their eye diseases. DesignCross-sectional study. Methods•Setting: Institutional.•Study population: 1084 eyes of 544 elderly (≥65 years) patients.•Observation procedure: The eyes of the patients who had only ocular surface complaints were classified as group 1, those who wanted to renew their glasses and had no other complaints were classified as group 2, and those who complained about decrease in vision were classified as group 3.•Main outcome measures: Frequency of visual impairment and visually important ocular diseases. ResultsThe frequencies of at least one newly diagnosed visually important ocular disease were 25.9%, 27.0%, and 45.3% in groups 1, 2, and 3, respectively (p<0.001). The same frequencies were significantly higher in patients >75 years of age compared with the younger group (59.1% vs. 22.0%, p<0.001). Although these values were statistically significant in patients ≤75 years of age (p<0.001), they were insignificant in patients >75 years of age according to type of complaints (p=0.773). Patients with diabetes mellitus exhibited significantly lower vision, higher rate of visually important ocular diseases, and higher intraocular pressure readings than patients without diabetes mellitus (p=0.009, 0.015, and 0.002, respectively). ConclusionsVisually important ocular diseases were diagnosed approximately in a quarter of patients who had no complaints about decrease in vision and in more than half of the oldest geriatric patients (>75years) irrespective of the type of complaints.