Ocular Discomfort Research Articles

Chronic Kidney Disease Has No Impact on Tear Film Substance P Concentration in Type 2 Diabetes.

The study aimed to ascertain the potential effects of chronic kidney disease (CKD) on substance P concentration in the tear film of people with type 2 diabetes. Participants were classified into two groups: type 2 diabetes with concurrent chronic kidney disease (T2DM-CKD (n = 25)) and type 2 diabetes without chronic kidney disease (T2DM-no CKD (n = 25)). Ocular surface discomfort assessment, flush tear collection, in-vivo corneal confocal microscopy, and peripheral neuropathy assessment were conducted. Enzyme-linked immunosorbent assays were utilized to ascertain the levels of tear film substance P in collected flush tears. Correlation analysis, hierarchical multiple linear regression analysis, and t-tests or Mann-Whitney U tests were used in the analysis of data for two-group comparisons. There was no substantial difference between the T2DM-CKD and T2DM-no CKD groups for tear film substance P concentration (4.4 (0.2-50.4) and 5.9 (0.2-47.2) ng/mL, respectively; p = 0.54). No difference was observed in tear film substance P concentration between the low-severity peripheral neuropathy and high-severity peripheral neuropathy groups (4.4 (0.2-50.4) and 3.3 (0.3-40.7) ng/mL, respectively; p = 0.80). Corneal nerve fiber length (9.8 ± 4.6 and 12.4 ± 3.8 mm/mm2, respectively; p = 0.04) and corneal nerve fiber density (14.7 ± 8.5 and 21.1 ± 7.0 no/mm2, respectively; p < 0.01) were reduced significantly in the T2DM-CKD group compared to the T2DM-no CKD group. There were significant differences in corneal nerve fiber density (21.0 ± 8.1 and 15.8 ± 7.7 no/mm2, respectively; p = 0.04) and corneal nerve fiber length (12.9 ± 4.2 and 9.7 ± 3.8 mm/mm2, respectively; p = 0.03) between the low- and high-severity peripheral neuropathy groups. In conclusion, no significant difference in tear film substance P concentration was observed between type 2 diabetes with and without CKD. Corneal nerve loss, however, was more significant in type 2 diabetes with chronic kidney disease compared to type 2 diabetes alone, indicating that corneal nerve morphological measures could serve greater utility as a tool to detect neuropathy and nephropathy-related corneal nerve changes.

Postoperative trigeminal neuropathy outcomes following surgery for tumors involving the trigeminal nerve.

To observe the evolution and outcomes of postoperative trigeminal neuropathy following surgery of tumor involving the trigeminal nerve. A prospective observational study was conducted between October 2018 and February 2019 involving 25 patients with tumors confirmed to involve the trigeminal nerve during surgery by senior author. Pre- and postoperative trigeminal nerve function status and clinical data were recorded. This study included 18 cases of meningioma and seven of trigeminal schwannoma. Among the meningioma cases, 55.6% of the patients reported facial sensory dysfunction before surgery, 33.3% presented ocular discomfort, and 5.6% had masticatory muscle atrophy. Postoperatively, all patients experienced facial paresthesia, 94.4% complained of eye dryness, and one (5.56%) exhibited keratitis. Additionally, one patient (5.56%) showed new-onset masticatory weakness. During follow-up, 50.0% of patients reported improvement in facial paresthesia, and one (5.56%) experienced deterioration. Eye dryness resolved in 35.3% of patients, and keratitis remission was observed in one patient. However, one patient (5.56%) developed neurotrophic keratitis. Overall, 55.6% of patients displayed mild masticatory weakness without muscle atrophy. In the cases of schwannoma, 28.6% of patients had facial paresthesia before surgery, 42.9% showed ocular discomfort, and one (14.3%) complained of masticatory dysfunction. Postoperatively, 85.7% of patients reported facial paresthesia and eye dryness, with one patient (16.7%) experiencing keratitis. During follow-up, 66.7% of patients demonstrated improvement in facial paresthesia, 28.6% showed eye dryness remission, and one patient (16.7%) recovered from keratitis. However, one patient (16.7%) developed new-onset neurotrophic keratitis. One patient (16.7%) experienced relief of masticatory dysfunction, but 42.9% reported mild deterioration. Another patient (14.3%) had facial anesthesia that had not improved. Postoperative trigeminal neuropathy is a common complication with a high incidence rate and poor recovery outcomes after surgery for tumors involving the trigeminal nerve. When trigeminal nerve damage is unavoidable, it is essential to provide a multidisciplinary and careful follow-up, along with active management strategy, to mitigate the more severe effects of postoperative trigeminal neuropathy.

Environmental Effects on Dry Eyes in Primary Sjogren&amp;apos;s Syndrome

Purpose: To investigate the effects of humidity, temperature, and fine particulate matter (PM&lt;sub&gt;2.5&lt;/sub&gt;) on dry eye disease (DED) parameters in primary Sjogren's syndrome patients.Methods: We retrospectively analyzed the medical records of 18 primary Sjogren's syndrome patients who underwent DED treatment and had more than two follow-up visits. Symptom Assessment in Dry Eye (SANDE) scores, tear secretion, tear film breakup times, ocular surface staining scores, and tear osmolarity were assessed. Temperature, humidity, and PM&lt;sub&gt;2.5&lt;/sub&gt; concentrations during the week before the patient visits were calculated using public data and their relationships with DED parameters were analyzed.Results: All patients were females, with an average age of 57.6 ± 12.4 years. High temperature was significantly correlated with humidity and PM&lt;sub&gt;2.5&lt;/sub&gt; concentration (&lt;i&gt;p&lt;/i&gt; = 0.004 and = 0.006, respectively). The high humidity, high temperature, and low PM&lt;sub&gt;2.5&lt;/sub&gt; groups had lower SANDE scores (&lt;i&gt;p&lt;/i&gt; = 0.017, = 0.063, and = 0.049, respectively) and tear osmolarity (&lt;i&gt;p&lt;/i&gt; &lt; 0.001, = 0.009, and &lt; 0.001, respectively). Multiple regression analysis showed that temperature and humidity had stronger correlations with tear osmolarity (&lt;i&gt;p&lt;/i&gt; = 0.005 and = 0.012, respectively) compared to PM&lt;sub&gt;2.5&lt;/sub&gt; concentrations.Conclusions: Ocular discomfort and tear osmolarity were correlated with temperature, humidity, and PM&lt;sub&gt;2.5&lt;/sub&gt; concentrations. Among the DED parameters, tear osmolarity was the most sensitive indicator of exposure to environmental factors.

Ocular surface in posterior segment surgery.

Nowadays, the technological breakthroughs of mini-invasive vitreo-retinal surgery improved the perioperative management and the outcomes of millions of patients. The most common procedures include pars plana vitrectomy, episcleral surgery, intravitreal injections, and laser photocoagulation. Potential sight and non-sight-threatening side effects have been reported during the follow-up period. Ocular surface disbalance can be induced by the aforementioned procedures, resulting in mild to severe ocular discomfort symptoms. This condition may recognize different causes such as pre-existing or concomitant diseases of the external eye, the surgical procedure damage of the anatomical or physiological structures of the ocular surface, the prolonged side effects induced by the chronic topical treatment that may be toxic to the external eye.In addition to the most frequent dry eye-related signs and symptoms, subconjunctival haemorrhages, corneal epithelium damage, partial loss of corneal sensitivity or changes in corneal nerve density could postoperatively affect our patients.In conclusion, any surgical trauma directed to the posterior segment of the eye may cause the loss of the ocular surface homeostasis. Ophthalmologists should not only recognise and treat, but possibly prevent, all patients' symptoms that could manifest in the postoperative time.

Ocular surface disease: a known yet overlooked side effect of topical glaucoma therapy.

Ocular surface disease (OSD), a disorder affecting the lacrimal and meibomian glands and the corneal and conjunctival epithelium, is a well-known complication of topical glaucoma therapy. OSD can present as a new or pre-existing condition that virtually any anti-glaucoma formulation can exacerbate. As such, both glaucoma and OSD frequently coexist. Typical OSD symptoms include ocular discomfort, redness, burning, and dryness, whereas signs include periorbital and eyelid skin pigmentation, conjunctival scarring, and superficial punctate keratitis. Pressure-lowering eyedrops can cause toxic, allergic, and inflammatory reactions on the ocular surface. The latter can result from either preservatives or direct toxicity from the active molecule. Although usually mild, OSD can cause significant symptoms that lead to poor quality of life, decreased compliance to therapy, glaucoma progression, and worse visual outcomes. Given the chronic nature of glaucoma, lack of curative therapy, and subsequent lifelong treatment, addressing OSD is necessary. This manuscript aims to provide an up-to-date overview of OSD's signs, symptoms, and pathogenic mechanisms from glaucoma therapy toxicity.

Clinical Profile of Patients of Dry Eye- A Prospective Observational Study

Introduction: Dry eye syndrome (DES) is a disorder of the preocular tear film that results in damage to the ocular surface and is associated with symptoms of ocular discomfort. It may be helpful to know that “sicca” is part of the English word “desiccate.” The dry eye syndrome in which the eyes do not produce enough tears is also known as “Sjögren’s syndrome”. Objective: To assess the clinical profile of patients of dry eye. Methods: This was a prospective observational study was conducted at Department of Eye, Barind Medical College and Hospital, Rajshahi, Bangladesh from January to June 2022. Total 101 eyes of 51 patients with dry eye complaining of burning, itching, foreign body sensation, grittiness, redness and pain,. Dry eye diagnostic tests were done in all the patients. Results: There were 20 males and 31 females and the age group taken was 30 to 75 years. 15 patients belonged to the age group of 30 to 45 years, out of which 9 were males and 5 were females. 29 patients belonged to age group of 46 to 60 years, out of which 8 were males and 22 were females. 7 patients belonged to the age group of 61 to 75 years, out of which 2 were males and 5 were females. Most common presentation in dry eye patients is foreign body sensation in 38% patients followed by itching in 29% patients, burning sensation in 23% patients, redness in 6% patients and pain in 4% patients. Conclusion: Most common presentation of dry eye is foreign body sensation and itching followed by burning sensation. Dry eye diagnostic tests like Tear film break up time was positive in 64% patients and Schirmers test was positive in 52% of patients along with other dry eye diagnostic tests.

Correlation of Multiple Allergen Simultaneous Test with Nasal Provocation Test of House Dust Mite.

Objectives: Compared with the skin prick test, relationship between the multiple allergen simultaneous test (MAST) and nasal provocation test (NPT) has rarely been evaluated. We evaluated the relationship between the results of the MAST and NPT against house dust mites in the Korean population. Methods: Medical records of patients who underwent both MAST and NPT were reviewed. Positive MAST was diagnosed when the levels of immunoglobulin E (IgE) specific for Dermatophagoides farinae (DF) and Dermatophagoides pteronyssinus (DP) were ≥2 positivity or ≥0.70 IU/ml. During the NPT, changes in subjective symptoms, including nasal obstruction, rhinorrhea, sneezing, itching, ocular discomfort, and peak nasal inspiratory flow (PNIF), were measured. The correlation between NPT and MAST results was statistically analyzed. Results: A total of 96 participants were enrolled in this study: 26 were assigned to the MAST-positive group, and 70 were assigned to the MAST-negative group. Changes in subjective symptoms before and after the nasal allergen challenge were significantly associated with the MAST results. Changes in PNIF before and after the nasal allergen challenge were also significantly associated with the MAST results. We found that a cutoff value of "a subjective total nasal symptom change" of more than 17.5 had a sensitivity of 68.6% and a specificity of 69.2%, while a cutoff value of "a PNIF change" of more than 6.51 had a sensitivity of 67.1% and a specificity of 69.2%. Conclusion: NPT was significantly associated with MAST, and further studies regarding the relationship between NPT using various allergen conditions and MAST are warranted.

Development and content validity assessment of the Dry Eye Disease Questionnaire in patients with dry eye disease, meibomian gland dysfunction, and Sjögren’s syndrome dry eye disease

BackgroundDry eye disease (DED), Meibomian gland dysfunction (MGD), and Sjögren’s syndrome dry eye disease (SS-DED) are eye dryness conditions that show significant overlap in various symptoms of ocular discomfort. The aim of this study was to qualitatively explore the patient experience and evaluate content validity of the newly developed Dry Eye Disease Questionnaire (DED-Q).MethodsSemi-structured interviews were conducted with 61 US adults who reported experiencing ocular symptoms due to their physician-confirmed primary diagnosis of DED (n = 21), MGD (n = 20), or SS-DED (n = 20). The open-ended concept-elicitation phase was followed by cognitive debriefing (CD) of the DED-Q to evaluate participants’ understanding and relevance of the instructions, items, response options, and recall periods. Interviews were also conducted with eight specialist healthcare professionals to assess clinical relevance of the concepts included. Verbatim interview transcripts were analyzed using thematic analysis in ATLAS.ti v8 software.ResultsA total of 29 symptoms and 14 impacts on quality of life were reported across participant interviews. Primary ocular symptoms reported included eye dryness (n = 61/61; 100%), eye irritation (n = 55/61; 90%), eye itch (n = 54/61; 89%), burning sensation (n = 52/61; 85%), and foreign body sensation (n = 51/61; 84%). The most impacted aspects of daily life were using digital screens (n = 46/61; 75%), driving (n = 45/61; 74%), working (n = 39/61; 64%), and reading (n = 37/61; 61%). CD findings showed most participants had good understanding of DED-Q items and confirmed most concepts were relevant to the lived experience of their condition. Aside from few minor changes to the items and examples to facilitate more accurate interpretation, the proposed instruction wording was modified for various symptom and impact modules to encourage participants to focus only on dry eye vision problems.ConclusionsThis research identified multiple prevalent symptoms and impacts of DED, MGD, and SS-DED, most of which were similar across the conditions. The DED-Q was confirmed to be a content-valid PRO measure suitable for use in clinical studies to assess the patient experience of DED, MGD, and SS-DED. Future work will focus on evaluating the psychometric properties of the DED-Q for use as an efficacy endpoint in clinical trials.

NLRP3 Inflammasome as a Potential Therapeutic Target in Dry Eye Disease.

Dry eye disease (DED) is a multifactorial ocular surface disorder arising from numerous interrelated underlying pathologies that trigger a self-perpetuating cycle of instability, hyperosmolarity, and ocular surface damage. Associated ocular discomfort and visual disturbance contribute negatively to quality of life. Ocular surface inflammation has been increasingly recognised as playing a key role in the pathophysiology of chronic DED. Current readily available anti-inflammatory agents successfully relieve symptoms, but often without addressing the underlying pathophysiological mechanism. The NOD-like receptor protein-3 (NLRP3) inflammasome pathway has recently been implicated as a key driver of ocular surface inflammation, as reported in pre-clinical and clinical studies of DED. This review discusses the intimate relationship between DED and inflammation, highlights the involvement of the inflammasome in the development of DED, describes existing anti-inflammatory therapies and their limitations, and evaluates the potential of the inflammasome in the context of the existing anti-inflammatory therapeutic landscape as a therapeutic target for effective treatment of the disease.

A Case of Full-thickness Macular Hole Formation Secondary to Laser Retinopexy

Purpose: To report a case of full-thickness macular hole (FTMH) formation secondary to demarcation laser retinopexy in a retinal break with localized retinal detachment patient.Case summary: A 59-year-old male visited our clinic with ocular discomfort in both eyes. Uncorrected visual acuity (UCVA) was 0.63 in right eye. Large retinal break in 1:30 o/c, localized retinal detachment and laser marking scars all around the right eye were found in fundoscopic exam. Posterior-vitreous detachment or vitreomacular traction was not observed in optical coherence tomography (OCT). Demarcation laser retinopexy was performed around the margin of retinal detachment and peripheral degenerative lesions. Three months after demarcation laser retinopexy, UCVA in right eye of the patient was decreased to 0.16 and full thickness macular hole was observed on OCT examination. Pars planar vitrectomy, internal limiting membrane peeling, and SF6 gas tamponade were performed in the right eye. One month after the surgery, closure of FTMH was observed. Three months after surgery, there were no recurrence of FTMH in the right eye.Conclusions: Demarcation laser photocoagulation of localized retinal detachments may predispose to FTMH formation. Even though it can be occurred rarely, follow-up check-up is necessary in consideration of the possibility of FTMH, which can cause serious visual loss.

Prolonged Face Mask Wearing Worsens Self-Reported Dry Eye Symptoms during the COVID-19 Pandemic in Dental Healthcare Practitioners.

The aim of the study was to evaluate self-reported MADE during the COVID-19 pandemic in dental healthcare practitioners and identify their possible risk factors. An anonymous questionnaire was sent to doctors of dental medicine in the time period from February 2022 to August 2022. The online questionnaire included demographic characteristics and clinical characteristics: presence and deterioration of DED symptoms while wearing the face mask, personal protective face equipment, use of contact lenses, history of eye surgery, current use of medications, number of hours wearing face mask, and evaluation of subjective DED symptoms using modified Ocular Surface Disease Index (OSDI). A total of 405 participants were included in the study and an overall prevalence of MADE was 29.1% (95% CI: 24.7 - 33.6). The participants who used masks more than 6 hours per day during the whole day reported a higher OSDI score (12.5 (IQR = 2.6 - 29.2)) compared to the participants who used masks less than 6 hours/day (6.25 (IQR = 0 - 22.92); Mann-Whitney U Test p = 0.066). Multivariable logistic regression revealed the following possible risk factors for self-reported MADE: age (older than 61 years) OR: 3.522 (95% CI 1.448 - 8.563); p=0.05, and wearing the face mask more than 6 h at work OR: 1.779 (95% CI 1.017 - 3.113); p=0.044. The prevalence of self-reported MADE among dental healthcare practitioners appears to be significant. The use of a face mask for a prolonged duration increases OSDI scores. MeSH Terms: face masks, dry eye, MADE, ocular discomfort, COVID-19, protective face equipment.

The diagnosis and treatment of contact lens-induced limbal stem cell deficiency

Objective: To analyze the clinical features and treatment outcomes of eyes with contact lens-induced limbal stem cell deficiency (CL-iLSCD). Methods: This cross-sectional study involved patients diagnosed with CL-iLSCD at the Eye, Ear, Nose & Throat Hospital of Fudan University between October 2018 and September 2022. A total of 17 patients (25 eyes) with a mean age of (36.4±6.9) years were enrolled. Among them, 14 were females (82.4%). Corneal and limbal abnormalities, especially the range of epitheliopathy, were observed under a slit lamp biomicroscope with fluorescein staining. Anterior segment optical coherence tomography and in vivo laser scanning confocal microscopy were performed to obtain the central corneal epithelial thickness, density of basal epithelial cells and corneal nerve fiber length. The clinical features of CL-iLSCD, along with their treatment outcomes and related risk factors, were analyzed. Results: All patients wore soft contact lenses, with an average daily wearing time of (10.5±2.5) hours and a median wearing duration of 10 (4 to 30) years. Ocular symptoms, including decreased vision, ocular discomfort or pain, redness, and photophobia, were present in 22 eyes (88.0%). The most characteristic clinical sign of CL-iLSCD was comb-or whorl-pattern late fluorescein staining under cobalt blue light, which was most commonly seen at the superior limbus (25/25, 100.0%). Additionally, reductions in central corneal epithelial thickness, basal cell density, and corneal nerve fiber length were observed. A comprehensive score was assigned to each eye based on clinical findings and in vivo imaging biomarkers. LSCD was mild, moderate, and severe in 5, 11, and 8 eyes, respectively. A history of misdiagnosis was found in 20 eyes (80.0%). After discontinuing the use of contact lenses and receiving medical treatment, significant improvement was observed in all eyes, with 13 eyes fully recovered. Conclusions: The symptoms and clinical signs of CL-iLSCD can be subtle at the early stage. Discontinuing contact lens wear and medication are effective to treat CL-iLSCD.

Dry Eye Disease: Focus on Prescription Therapy

Objective To review the pharmacotherapy of prescription drugs approved for treatment of chronic dry eye disease (DED). A brief background on DED management and the pharmacist's role for care is included. Data Sources Articles indexed in PubMed (National Library of Medicine), Iowa Drug Information Service, Cochrane Reviews and Trials, and Google Scholar in the past 10 years using the key words "dry eye," "dry eye and treatment," "cyclosporine," "lifitegrast," and "varenicline." Current guidelines and manufacturers' prescribing information were reviewed. Primary sources were used to locate additional resources. Study Selection/Data Extraction Sixty-five publications were reviewed, and criteria supporting the objectives identified useful resources. Data Synthesis Selected literature included practice guidelines, review articles, research articles, product prescribing information, and drug information databases. Conclusion Patient education, eliminating causative factors, improving the daily environment for eye health, and using ocular lubricants are the first steps in DED management. A therapeutic mainstay is ocular lubricants; preservative-free formulations are recommended for chronic or repeated daily use. The Food and Drug Administration approved prescription medications for chronic use for DED, cyclosporine ophthalmic emulsion and solution, lifitegrast ophthalmic solution, and varenicline nasal spray, all improve signs and symptoms but do not cure DED. The ophthalmic products all cause ocular discomfort upon instillation. As a nasal spray, varenicline does not cause ocular discomfort, but it can cause sneezing, cough, and throat and nose irritation in some patients. Pharmacists have an opportunity to provide patient education regarding lifestyle modifications to mitigate DED and provide counseling on available products. Emerging therapies may provide advances in DED treatment.

Lubricating drops for contact lens discomfort in adults

Objectives This is a protocol for a Cochrane Review (intervention). The objectives are as follows: To determine the efficacy and safety of lubricating drops for ocular discomfort associated with contact lens wear in adults.

Ocular and Visual Activities-related Complaints among Healthy Smokers: a Cross-sectional Study

Smoking and the harmful compound in smoke has been associated with many deleterious effects on the eye. Yet, the ocular and visual-related complaints that may arise due to physiological changes are inadequately explored. This study aimed to investigate the effect of smoking behaviour on ocular symptoms. A self-administered questionnaire describing the ocular surface discomfort and visual-related activities was distributed to healthy smokers. Majority of smokers reported severe dry eye symptoms and often complained of glare disability. A comparison of reported symptoms between groups showed older-aged, dual smokers, longer duration of smoking, and current-daily smokers obtained significantly higher scores (p&lt;0.005).

Randomized Controlled Study of Cooled vs Room-Temperature Artificial Tears for Reducing Ocular Surface Irritation After Intravitreal Injection.

Purpose: To evaluate the efficacy of cooled vs room-temperature artificial tears in reducing ocular discomfort after intravitreal injections (IVIs). Methods: Patients receiving a standard intravitreal injection in the retina clinic who met the eligibility criteria and provided informed consented were enrolled in the study. Patients were randomized to the cooled tears or room-temperature tears intervention group. Both groups rated their ocular discomfort following IVI after cooled or room-temperature tears were administered. Results: The cooled group comprised 48 patients and the room-temperature group, 61 patients. There was no significant difference in the reduction of ocular discomfort between the cooled vs room-temperature artificial tears groups (P = .387). In addition, there was a similar level of reduction in ocular discomfort after either intervention (P = .681) regardless of whether or not the patients routinely used artificial tears after previous IVIs. Conclusions: Cooled tears provided no additional benefit in reducing ocular discomfort post-IVI compared with room-temperature tears. Baseline tear use after an IVI may have no true benefit other than a potential placebo effect, recall bias, or both.

A Comparative Study of Dry Eye Disease in Diabetics and Non-Diabetic Population at National Eye Centre, Kaduna

Background: Dry eye is a multifactorial pathology caused by a progressive dysfunction of the lacrimal and Meibomian glands which often leads to reduced aqueous tear production and increased tear evaporation. All these disorders are associated with ocular discomfort such as watering and redness of the eyes resulting from irritation of the ocular surface particularly the cornea. Dry eye is identified as one of the complications of diabetes. Diabetes mellitus is a systemic risk factor for dry eye disease. Objective: To determine the prevalence of dry eye disease in diabetics compared to non-diabetics at National Eye Centre Kaduna. Methods: This study is a comparative cross-sectional study. The study population comprised of types 1 and 2 diabetic patients who are 18years and above attending National Eye Centre Kaduna and non-diabetics age and sex matched subjects. The ocular surface disease index (OSDI) questionnaire was used to subjectively identify subjects with DED. All participants underwent Schirmer’s test and a Tear break-up time to objectively make a diagnosis of DED. Results: A total of 200 participants were assessed in this study. Their ages ranged from 32-74 years (mean 53.2±9.7). Respondents within the age range of 56-65 years had higher frequency of dry eye disease (DED) 43.5%. More females had DED 61.35%. Those with secondary educational status had the highest frequency of DED 40.3%. Diabetic subjects within the age range of 56-65 years old had higher frequency of DED 88.6%. Females have higher rates of DED 80.8%, as against 61.8% among males’ non-Diabetic subjects. Subjects with secondary educational status had the highest frequency of DED 87.5% in diabetic subjects while 71% in non-diabetic. The housewives had the highest percentage of DED 89.5% in diabetic subjects while 95% in non-diabetic subjects. The result further revealed the prevalence of 76% among diabetic patients while prevalence of 48% for non-diabetic patients. A significant positive correlation between subjective assessment and objective clinical tests. Conclusion: Patients with diabetes have a higher prevalence of DED than non-diabetic population in National Eye Centre, Kaduna. Women were found to have a higher prevalence. There was a significant association between DED and duration diabetes. There is a correlation between objective clinical tests and subjective assessment in both diabetic and non-diabetic population.

All in All Anterior to Posterior Segment Ocular Diseases in a Single Individual

Significance: Anterior to posterior ocular diseases in the eye is possible, although rare. Visual disturbances and ocular discomfort may contribute to several factors. Purpose: The purpose of this case report was to describe the possibility of multiple ocular diseases that may present in the eye, making it imperative for optometrists to perform a comprehensive eye examination daily. Case report: A 57-year-old, female presented with a severe gritty sensation in the right eye. The patient underwent Laser Assisted In-situ Keratomileusis (LASIK) 30 years ago and her medical history reveals newly diagnosed Hypertension. The patient has mild bilateral blepharoptosis, and on slit lamp examination with fluorescein staining, the ocular surface reveals multiple Superficial Punctate Keratitis (SPK) possibly due to Post-LASIK. Further, mild clouding of the crystalline lenses was noted suggestive of Nuclear Sclerosis (NS). Dilated eye examination, reveals tiny multiple yellowish-white reflecting particles which were Asteroid Hyalosis (AH) and flame-shaped hemorrhages extended from the optic disc to the macula that is suggestive of Central Retinal Vein Occlusion (CRVO). All in all anterior to posterior segment ocular diseases in this patient were managed accordingly by Optometrist and Ophthalmologist. The diagnosis made were bilateral aponeurotic ptosis, severe dry eyes, NS, AH, and CRVO. The patient was treated with topical cyclosporine and Anti-vasular endothelial growth factor (anti-VEGF) scheduled. Conclusion: This case demonstrates the role of patient history, clinical findings, diagnosis, and treatment of blepharoptosis, chronic dry eye, NS, AH, and CRVO. It emphasizes the importance of evaluating the anterior to posterior segment ocular structures and managing such cases requires close collaboration and teamwork with ophthalmologists. Careful examination and systemic evaluation are vital in such a scenario. It is important to educate patients that any sudden vision loss is not normal and they should consult an eye care professional immediately.

Diagnosis and treatment of filamentary keratitis in a patient with Demodex infestation––an overlooked risk factor: a case report

BackgroundFilamentary keratitis is an ocular condition that is tricky to handle for the difficulty to find the underlying cause. Here we report a case of filamentary keratitis associated with Demodex infestation which highlights the importance of Demodex mites as an easily-overlooked risk factor.Case presentationA 63-year-old woman had recurrent symptoms of foreign body sensation and sometimes painful feelings in her left eye soon after her surgical correction of ptosis in this eye. She was then diagnosed as conjunctivitis and given antibiotic eye drops. After one week, the patient complained of aggravation of symptoms with small corneal filaments in the left eye under slit-lamp examination. Despite the removal of filaments and addition of topical corticosteroids and bandage contact lenses, the patient’s condition persisted with enlarged filaments and severe ocular discomfort. 3 days later, eyelashes with cylindrical dandruff were noticed and Demodex infestation was confirmed by microscopic examination of these eyelashes at our clinic this time. She was asked to use tea tree oil lid scrub twice daily. After 3 weeks, her filamentary keratitis was resolved with a dramatic improvement in symptoms and signs. And no recurrence of filamentary keratitis was noticed during the one-year follow-up.ConclusionsIn this case, filamentary keratitis was resolved only with treatment of Demodex infestation while conventional treatment failed. Considering the fact that Demodex infestation is a common but easily overlooked condition, it may be suggestive to take Demodex infestation into account as a risk factor of filamentary keratitis, especially in refractory cases.

Graves' ophthalmopathy and dry eye syndrome

Graves ophthalmopathy present different signs and symptoms, in particular ocular surface disease that is the most frequent cause of ocular discomfort. This pathology can lead to increased ocular surface exposure and evaporative dry eye disease, tear-film changes and ocular surface expression of pro-inflammatory cytokines. Patients with ocular surface disease complain of several symptoms from foreign body sensation, blurred vision, dryness, or conjunctival injection, at an estimated prevalence of 65-95%. The most useful assessment is the Ocular Surface Disease Index, which has been shown to be significantly increased in active thyroid-related ophthalmopathy patients. Every increase in clinical activity score of one, double the index values. A careful ocular examination should be performed to assess the severity of the pathology. Superior limbic keratoconjunctivitis, superficial keratopathy and obstructive Meibomian gland disease represent the structural pathological changes; tear break-up time, increase in lacrimal osmolarity and presence of inflammatory cytokines represent the functional changes. Management of dry eye syndrome associated to Graves ’ophthalmopathy can be challenging. Moderate disease may be handled with artificial tears, ointments, and night-time moisture chambers. Topical or oral steroids can be considered to treat the inflammatory component. Surgical intervention consists of early punctual occlusion with temporary punctual plugs. If the patient progresses to sight-threatening ophthalmopathy, surgical intervention may become necessary to reduce exophthalmos and lagophthalmos. Standardized treatment guidelines are not available, and the management depends on patient’s disease activity and severity. A stepwise approach must be applied, ranging from conservative management to surgical intervention combined with topical or systemic therapy.