Ocular Protection Research Articles

Potential Albumin-Based Antioxidant Nanoformulations for Ocular Protection against Oxidative Stress.

Amongst various drug administration methods, ophthalmic drug delivery has been a useful way for the treatment of eye-related diseases. However, therapeutic efficacy of ocular therapy for anterior or posterior eye segments through topical administration is considerably challenged by the number of anatomical and physiological barriers in the eyes affecting ocular bioavailability. In this respect, advanced biocompatible nanoformulations make it possible to improve drug delivery to the target sites and enhance ocular bioavailability of ophthalmic medicines. Various ocular diseases have been reported to be related to oxidative stresses in tissues, and polyphenolic compounds have been known for their antioxidant activities in various tissues, including the eyes. Despite drug efficacy, poor water solubility and intrinsic color of the compounds limit the drug’s inclusion into the development of ocular medicine. In the present study, we investigated the antioxidant protectant efficacy of rosmarinic or ursolic acid in the retinal epithelial cells, as compared to those of curcumin, by forming nanospheres with bovine serum albumin. Our results demonstrate that antioxidant-containing nanoformulations provide a significantly higher drug solubility and decreased ROS (reactive oxygen species) production in the retinal epithelial cells. Finally, we also found that albumin-based nanoformulations could improve bioavailability and increase antioxidant activity of rosmarinic or ursolic acid in the retina to be applied as efficient ocular protectant.

Protective effects of blue light-blocking shades on phototoxicity in human ocular surface cells

ObjectiveBlue light hazards for retina and ocular surface have been repeatedly described and many protective methods are introduced for retina; however, no study has been conducted on ocular surface protection....

Evaluation of the Ocular Surface Disease Index Questionnaire as a Discriminative Test for Clinical Findings in Dry Eye Disease Patients

ABSTRACT Purpose To investigate to what extent the OSDI can be utilized as a discriminative test for clinical findings. Methods One thousand and ninety patients with dry eye disease (DED) were consecutively included and examined for osmolarity, tear film break-up time (TFBUT), ocular protection index (OPI), ocular surface staining (OSS), Schirmer I test (ST), meibum expressibility (ME), meibum quality (MQ), and diagnosis of meibomian gland dysfunction (MGD). Receiver-operating characteristic curve (ROC) analysis considering optimum balanced sensitivity and specificity (close to 50%) was used for assessment. Results The present study on more than 1,000 patients indicates that the OSDI in the ROC curve analysis is a poor discriminator of pathological scores for TFBUT ≤ 5 (AUC = 0.553; p = .012) and ≤10 s (AUC = 0.608; p = .002), OSS ≥ 3 (AUC = 0.54; p = .043), ST ≤ 5 (AUC = 0.550; p = .032) and ≤10 mm/5 min (AUC = 0.544; p = .016), and ME ≥ 1 (AUC = 0.594; p = <0.001). Pathological scores for osmolarity >308 and >316 mOsm/L, OPI, OSS > 1, MQ, and MGD could not be discriminated by OSDI (p > .05). Conclusion Cut-off values for the OSDI can be defined to discriminate pathological TFBUT (≤5 and ≤10), OSS (≥3), ST (≤5 and ≤10) and ME, however, the discriminability was low. Our comprehensive study emphasises the importance of taking both symptoms and signs into account in DED management.

Perioperative Corneal Abrasions After Nonocular Surgery: A Systematic Review.

To perform a systematic review of the international literature evaluating the risk factors, preventative steps, and treatments for perioperative corneal injuries for nonocular surgery. PubMed, Embase, and Evidence-Based Medicine Reviews databases were searched on April 13, 2018. Two hundred four articles were identified with 16 meeting the inclusion criteria. All studies were evaluated for quality and level of evidence. Two types of studies were included. The first were primary epidemiological studies that looked at the rates of perioperative corneal injuries after nonocular surgery and the second were trials that either studied preventative steps or treatments. A statistical analysis was completed to reveal trends in perioperative corneal abrasions. Rates ranged from 0.01% to 59% with a cumulative rate of 0.64% (95% confidence interval 0.36%-1.35%). Primary risk factors were identified as longer procedures, general anesthesia, and advanced age. The most commonly associated ocular injuries were found to include chemical injury, conjunctivitis, blurred vision, and conjunctival congestion. Treatment strategies for corneal abrasion in the literature recommended erythromycin ointment and ample ocular lubrication for the fastest recovery. Education interventions alone, as studied in 2 of the 16 articles, demonstrated a significant decrease in the rate of corneal abrasions. Standardized ocular protection, reporting, and education initiatives were found to maximally decrease rates of perioperative corneal abrasions after nonocular surgery. However, no gold standard currently exists for intraoperative ocular protection. More research needs to be conducted on specific prevention strategies and content of educational initiatives in hopes of standard development across facilities nationwide.

Are orthopedic surgeons exposed to excessive eye irradiation? A prospective study of lens irradiation in orthopedics and traumatology

IntroductionNumerous studies in recent years highlighted an increased risk of pathologies related to ionizing radiation in caregivers. A new French decree was adopted on June 4, 2018, dividing by 7.5 the radiation dose authorized in the lens for exposed workers. HypothesisThe hypothesis of the present study was that ocular irradiation in orthopedic surgeons was below the new legal threshold. MethodThe equivalent dose (mSv) received by the lens was prospectively assessed in 10 orthopedic surgeons (5 senior, 5 residents), using 3 passive dosimeters placed at the forehead and either temple. Each intervention of each operator was recorded, with dose per area in the operating room at each use of the fluoroscope. ResultsAll equivalent doses to the lens at the end of the 4 month study period were well below threshold. Doses were not significantly different between forehead and either temple (p=0.7, p=0.6 for the 2 temples). There was no difference according to side of the head (p=0.3). The dose received in the lens correlated with the dose delivered in the room (p=0.004). There were no significant differences in irradiation according to the surgeon's experience (p=0.2) or trauma activity rate (p=0.4). DiscussionNo studies have reported equivalent doses to the lens exceeding the authorized limit. But none previously measured equivalent dose to the lens according to the axis of irradiation in the eyes. The present study showed that orthopedic surgeons received as much eye radiation laterally as frontally. Ocular radiation protection needs therefore to be as effective laterally as frontally. The surgeon's experience did not emerge as a protective factor against ocular irradiation.

Characteristic of eye disease on foreigners: a study of eye clinics in Bali

Eye health is important to support activities of traveling. Aim of this study is to determine the characteristics of eye diseases on foreign tourists traveling in Bali. This is a cross sectional study. Retrospective data collected from January - December 2017 at 6 private eye clinics in Bali (Wing Sanglah, Ra-Mata, Surya Husada Nusa Dua, Kasih Ibu Kedonganan, Prima Medika and Surya Husada Ubung). 149 foreign tourists experienced eye diseases during traveling in Bali; consisted of 86 male and 43 female. Most of age group 30-40 years. The most complaints is red eyes with acute conjunctivitis et causa virus, keratitis et causa contact lens, and dry eye is top three diagnosis. Men usually careless to hygiene sanitation than women; this is explain why men more have problem with eye diseases. The inappropriate use of contact lenses, high humidity in Bali, and temperatures in Bali are also factors due to keratitis et causa contact lens and dry eye. Changes of air humidity and temperature can affect eye moisture and tear production as ocular surface protection. Travelers should care about these to provide eye diseases.

Tear Production Levels and Dry Eye Disease Severity in a Large Norwegian Cohort

ABSTRACT Purpose To determine if the Schirmer I test (without anesthesia) cut-off value is a predictor of dry eye severity in a large Norwegian cohort of dry eye disease (DED) patients, which are grouped into six levels of tear production. Methods Patients (n = 1090) with DED of different etiologies received an extensive dry eye work-up: osmolarity (Osm), tear meniscus height (TMH), tear film break-up time (TFBUT), ocular protection index (OPI), ocular surface staining (OSS), Schirmer I test (ST), meibum expressibility (ME), and meibum quality (MQ). Classification of dry eye severity level (DESL) and diagnosis of meibomian gland dysfunction (MGD) were also included. The cohort was divided into six groups: below and above cut-off values of 5 (groups 1 and 2), 10 (groups 3 and 4), and 15 mm (groups 5 and 6) of ST. Mann-Whitney test and Chi-Square test were used for group comparison of parameters (p ≤ 0.05). Results The groups 1, 3, and 5 had values indicating more severe DED than the groups 2, 4, 6 with significant difference in DESL, Osm, TFBUT, OPI, OSS, and TMH. Regardless of the choice of cut-off values, there was no statistically significant difference in ME, MQ, and MGD between groups below and above selected cut-off value. When gender difference was considered in each group, significant difference was only observed for DESL (groups 2, 4, and 5), TFBUT (groups 2, 4, and 5), OPI (groups 2 and 6), and ME (group1). Conclusions Schirmer I is a robust discriminator for DESL, Osm, TFBUT, OPI, OSS, and TMH, but not for ME, MQ, and MGD. Patients with lower tear production levels presented with more severe DED at all three defined cut-off values. Interestingly, the differences in the mean values of DESL were minimal although statistically significant. Thus, the clinical value of different Schirmer levels appears to be limited.

Cerebellotrigeminal Dermal Dysplasia (Gómez-López-Hernández Syndrome)

Cerebellotrigeminal dermal (CTD) dysplasia is a rare neurocutaneous disorder characterized by a triad of symptoms: bilateral parieto-occipital alopecia, facial anesthesia in the trigeminal area, and rhombencephalosynapsis (RES), confirmed by cranial magnetic resonance imaging. CTD dysplasia is also known as Gómez-López-Hernández syndrome. So far, only 35 cases have been described with varying symptomatology. The etiology remains unknown. Either spontaneous dominant mutations or de novo chromosomal rearrangements have been proposed as possible explanations. In addition to its clinical triad of RES, parietal alopecia, and trigeminal anesthesia, CTD dysplasia is associated with a wide range of phenotypic and neurodevelopmental abnormalities.Treatment is symptomatic and includes physical rehabilitation, special education, dental care, and ocular protection against self-induced corneal trauma that causes ulcers and, later, corneal opacification. The prognosis is correlated to the mental development, motor handicap, corneal–facial anesthesia, and visual problems. Follow-up on a large number of patients with CTD dysplasia has never been reported and experience is limited to few cases to date. High degree of suspicion in a child presenting with characteristic alopecia and RES has a great importance in diagnosis of this syndrome.

Comparison of the goblet cells’ density and the quality of tears in treatment with sodium hyaluronate 0.1% benzalkonium chloride preservative-free eye drops for patients with glaucoma and dry-eye syndrome: A double-blind randomized clinical trial

This study aims to compare the efficacy of benzalkonium chloride (BAK) on different goblet cells densities and to enhance the quality of tears in patients with glaucoma and dry-eye syndrome treated with preservative-free and preserved sodium hyaluronate (SH) 0.1% eye drops. In this double-blind, randomized clinical trial, we randomly assigned patients with glaucoma and dry-eye syndrome into two groups: group I, treated with SH 0.1% eye drops comprising BAK preservative (a positive comparator group); group II, treated with preservative-free SH 0.1% eye drops. We followed patients for 3 months after enrollment and assessed the quality of tears by examining symptoms and signs, including the Schirmer’s test, tear film break-up time (TFBUT), Ocular Protection Index (OPI), and conjunctival impression cytology pre- and post-treatment. Any ocular discomfort was assessed by using the Ora Calibra Ocular. We enrolled 40 eyes from 20 patients with glaucoma and dry-eye syndrome. Each group comprised 20 eyes of 10 patients. We observed increased values of the mean TFBUT, OPI, and Schirmer’s test pre- and post-treatment, with no significant difference between both groups. While the conjunctival impression cytology revealed similar results of goblet cells in both groups, we observed lower scale of the Ora Calibra Ocular. Both groups elicit a comparable improvement in the quality of tears as demonstrated by augmented results of the Schirmer’s test, TFBUT, OPI, and Ora Calibra Ocular Score of patients with glaucoma and dry-eye syndrome

Ocular morbidities in pediatric outpatient population at a tertiary care ophthalmic centre: a descriptive study

Background: Ocular problems in children are unique and different from adults, because of their inability to express their problems and potential to develop amblyopia. Screening at the level of schools cover school age going children only while congenital and infantile disorder can cause significant morbidity if remain untreated . Hence the present study was conducted to determine the pattern of Ocular morbidities in children uptil 15 years of age.Methods: It is a hospital based retrospective study. Outpatient department (OPD) records of all new patients aged 15 years and younger were reviewed. The age at presentation, sex and clinical diagnosis were recorded from OPD records. Data was recorded and analyzed.Results: Total of 480 children was enrolled with ocular problems. Majority belong to 11-15 years of age group. Conjunctival morbidity was most commonly encountered in 146 (30.41%) children followed by refractive error 82 (17.07%) and lid problems in 81 (16.87%) patients. Ocular trauma constitutes 54 (11.25%) children of the total.Conclusions: In view of high prevalence of Conjunctival and refractory errors in pediatrics population, there is a need of health counseling of parents regarding ocular hygiene, protection and regular refraction of children to identify the ocular morbidity at the earliest and prevent the long term complications.

Myotarsal flap – a versatile entity for lower eyelid reconstructions

ABSTRACTThe purpose is to present a new surgical technique using myotarsal (MT) flap for reconstruction of small to subtotal full thickness defects - up to 8 mm in height - of lower eyelids, without needing concomitant supplementary procedures. MT flap consists of a 3 mm tarsal strip with attached levator complex. It does not have conjunctival lining or pedicle. Versatility of the flap extends to correction of mild to severe ptosis, and retraction of upper eyelids. This is a retrospective personal series of 163 patients, who underwent surgical reconstruction with MT flap overlaid with quilted skin graft (modified myotarsal flap) after excision of malignant tumours of lower eyelid. Surgery was on day case basis under LA. Patients were assessed for aesthetic and functional outcome, and complications. No patient had any complication. Assessment of outcome included corneal and ocular surface health and protection, eye closure, tear secretion, and lid contours. These were aesthetically and functionally satisfactory. Histology confirmed complete tumour clearance, and clinical diagnosis. There was no recurrence of tumour. An astounding, new, unique and original observation of the study is that cornea and ocular surface remained undamaged throughout, despite absence of conjunctival lining of MT flap. This goes against all current tenets of oculoplasty. Use of the modified MT flap is a safe, versatile, and effective procedure yielding satisfactory aesthetic and functional results for reconstruction of the lower eyelid.

Theissenolactone C Exhibited Ocular Protection of Endotoxin-Induced Uveitis by Attenuating Ocular Inflammatory Responses and Glial Activation.

The aim of this study was to investigate the effects of a natural component, theissenolactone C (LC53), on the ocular inflammation of experimental endotoxin-induced uveitis (EIU) and its related mechanisms in microglia. Evaluation of the severity of anterior uveitis indicated that LC53 treatment significantly decreased iridal hyperemia and restored the clinical scores. Additionally, the deficient retina functions of electroretinography were improved by LC53. LC53 significantly reduced levels of tumor necrosis factor (TNF)-α, monocyte chemoattractant protein-1, protein leakage and activation of matrix metalloproteinases in the anterior section during EIU. Moreover, LC53 treatment decreased the oxidative stress as well as neuroinflammatory reactivities of GFAP and Iba-1 in the posterior section. Furthermore, LC53 decreased the phosphorylation of p65, expression of HSP90, Bax, and cleaved-caspase-3 in EIU. According to the microglia studies, LC53 significantly abrogated the productions of TNF-α, PGE2, NO and ROS, as well as inducible NO synthase and cyclooxygenase-2 expression in LPS-stimulated microglial BV2 cells. The microglial activation of IKKβ, p65 phosphorylation and nuclear phosphorylated p65 translocation were strongly attenuated by LC53. On the other hand, LC53 exhibited the inhibitory effects on JNK and ERK MAPKs activation. Our findings indicated that LC53 exerted the ocular-protective effect through its inhibition on neuroinflammation, glial activation, and apoptosis in EIU, suggesting a therapeutic potential with down-regulation of the NF-κB signaling for uveitis and retinal inflammatory diseases.

Pediatric ocular injuries: a 3-year review of patients presenting to an emergency department in Canada

BackgroundOcular traumas represent the most common cause of noncongenital blindness in children. Sports are the second most common cause in children less than 14 years old in Canada. To our knowledge, there have not yet been any reports regarding the causes of pediatric ocular trauma in the Quebec population. The goal of our study was to gather data from the Quebec pediatric population to determine high-risk age groups, sports, or other activities. MethodsA retrospective study evaluating all patients younger than 18 years who presented with ocular trauma to the Ste-Justine Hospital emergency department between 2007 and 2010. Data obtained included age, sex, activity at the time of injury, mechanism of injury, and visual outcomes. ResultsTrauma was more common in males (65%). The mean age was 7.2 years. Injuries occurred more often in the 5–9 year age group, at home, and during free play. Sports-related injuries occurred more often in the 10–18 year age group, with hockey being associated most often with injuries. Visual acuity at presentation was variable, but final acuity was 20/30 or better in 86.7% of cases. In 89% of cases, there was no mention of ocular protection and prevention of injuries in the chart by emergency physicians. ConclusionOur study suggests that ocular injuries may be prevented by better supervision and parental education in the younger population and by mandating ocular protection for sports in high school–aged patients.

Efficiency of ocular UV protection by clear lenses.

Ocular UV doses accumulate all-day, not only during periods of direct sun exposure. The UV protection efficiency of three clear lenses was evaluated experimentally, validated by simulation, and compared to non-UV protection: a first spectacle lens with a tailored UV absorber, a second spectacle lens, minimizing UV back reflections, as well as a third spectacle lens, combining both. A tailored UV-absorber efficiently reduced overall UV irradiance to 7 %, whereas reduction of back-reflections still left UV irradiance at 42 %. Thus, clear lenses with a tailored UV absorber efficiently protect the eye from UV, supplementing sun glasses wear to an all-day protection scenario.

Theissenolactone C exhibited ocular protection in endotoxin-induced uveitis by attenuating ocular inflammatory responses and glial activation

Theissenolactone C exhibited ocular protection in endotoxin-induced uveitis by attenuating ocular inflammatory responses and glial activation

Short wavelengths filtering properties of sunglasses on the Canadian market: are we protected?

BackgroundExposure to solar radiation is a risk factor for multiple ocular pathologies. Ultraviolet (UV) radiation is involved in ocular diseases, including pterygium, ocular surface squamous neoplasia, and cataracts. High-energy visible light (HEV) is associated with age-related macular degeneration. Ocular protection against solar radiation seems essential to protect our eyes against the adverse effects of those harmful rays. Australia, New Zealand, Europe, and the United States are the only regions with mandatory standards for UV transmission for sunglasses. Adherence to Canadian standards by sunglasses manufacturers is not mandatory. In this study, we evaluated the UV and visible transmission of sunglasses in the Canadian market to test their compliance with Canadian standards. MethodsThe transmittance of 207 pairs of sunglasses, divided in 3 categories according to their price range, was measured. ResultsWe show that close to 100% of the sunglasses tested respect the Canadian standards. The average HEV transmittance is around 10%, regardless the price range. ConclusionsOur study demonstrated that even if following Canadian standards is optional, most sunglasses sold on the Canadian market follow national and international standards. We also found that sunglasses filter around 90% of HEV. With the recent findings on the potential effects of HEV in retinal pathologies, we can ask whether this filtering capacity is sufficient to protect eyes from harmful HEV light. More work needs to be done to determine acceptable HEV light transmission limits to the existing Canadian standards.

The Relationship between Symptomatic Assessment and Clinical Signs of Dryness in Dry Eye Subjects

Introduction: There was no previous study to assess relationship between dry eye symptoms and signs in the local population. The purpose of this study is to evaluate the relationship of symptomatic assessment and clinical signs of dryness in dry eye subjects. Materials and method: A Cross-sectional study with convenient sampling involving 321 subjects with 642 eyes was done. Subjects were divided into non-dry eye (NDE) and dry eye (DE) groups. The division of NDE and DE groups were done using two types of classification. In Classification 1(symptoms-based), DE was defined if the score of Ocular Surface Disease Index (OSDI) score was more than 33. The value of tear film break-up time (TFBUT) less than 5 seconds and Schirmer test with anaesthesia (STA) less than 5mm/5 minutes were considered as DE for Classification 2 (signs based). Results: There were poor correlations between OSDI and clinical signs of dryness in all subjects involved (p &gt; 0.05). Similar findings were also noted within NDE subjects in Classification 1 and Classification 2. OSDI score was also not significantly correlated with the signs of dryness within DE subjects except with ocular protection index (OPI) (r = - 0.14, p = 0.047) in Classification 1 and with conjunctival lissamine green staining (CLGS) (r = 0.23, p = 0.040) in Classification 2. Conclusion: There were no significant correlation between the symptoms of dry eye and the clinical signs of dry eye. Therefore, the clinical diagnosis of dry eye can be made based on either just on the symptoms or the signs.

Preparation and evaluation of novel chitosan: gelrite ocular system containing besifloxacin for topical treatment of bacterial conjunctivitis: scintigraphy, ocular irritation and retention assessment

This study was aimed to prepare, characterize and evaluate in situ gel formulations based on a blend of chitosan (CS), polyvinyl alcohol (PVA) and gellan gum (Gelrite™) for a sustained ocular delivery of besifloxacin (BSF). The developed formulations were evaluated for physicochemical properties, gelation time (Tsol-gel), rheological behaviour, antimicrobial efficacy, pharmacokinetic assessment, gamma scintigraphy study and ocular irritation. The results showed BSF sol-gel system were found to be sensitive enough which underwent instantaneous phase transition upon getting physiological stimulation. The ex vivo permeation experiments indicated that the developed formulation was able to enhance the retention of BSF at corneal surface. The HET-CAM confirmed the non-irritancy of developed formulation and also demonstrated the ability of ocular protection against strongly irritant substances. The results of gamma scintigraphy study revealed the higher concentration of drug retains at the corneal surface. In addition, optimized BSF sol-gel system showed enhanced anti-bacterial activity compared to BSF suspension.

Manitoba Oculo-tricho-anal Syndrome: Complex Surgical Correction of an Extensive Upper Lid Coloboma with Congenital Symblepharon

Manitoba Oculo-tricho-anal Syndrome (MOTA) is a rare autosomal recessive disorder characterized by eyelid coloboma, cryptophthalmos, anophthalmia or microphthalmia, abnormal hair growth from scalp to eyebrow, bifid or broad nasal tip, and gastrointestinal anomalies including omphalocele and anorectal malformations.[1, 2] We describe a multi-stage surgical approach to repair a right upper lid coloboma with an extensive congenital superomedial symblepharon obscuring the pupil in the context of MOTA. Surgical steps included reconstitution of the eyelid’s anatomical landmarks with dissection of the symblepharon invading the opacified cornea, freeing the pupillary axis, creation of a superior fornix, advancement of myocutaneous/periosteal flaps, and insertion of an implant to recreate the absent eyelid. This resulted in significant improvement of ocular surface protection, quality of life, and allowed for amblyopia treatment.

Modern scleral lenses: Mini versus large.

The evolution of scleral lenses has led to new formulations of scleral fitting concepts and designs. The diameters of modern scleral lenses have been overhauled too and they are smaller comparing to the original ones. Nowadays, prescription of mini-sclerals supposedly seems in major extension and it appears indeed the necessity of some practitioner to differentiate the smaller mini-scleral lenses from larger mini-scleral lenses empathizing that they are the "smaller" ones. Therefore, it is maybe, necessary a definition of mini-scleral lenses referring to the landing zone width in relation to the horizontal visible iris diameter (HVID) and the limbus extension. The choice of the total diameter is crucial for a successful fitting and it depends majorly on patient's topographic patterns and anatomic factors. However, there are other important criteria for the selection of the scleral lens diameter based on oxygen supply, bubbles formation, mechanical stress on a toric sclera, ocular surface disease protection, entity of the vault over the cornea and distribution of the lens weight on the sclera. The advantages of mini-scleral lenses are various nonetheless in some cases large lenses are necessary. This paper presents a review of the benefits and disadvantages of both mini and large scleral lenses analyzing the conditions in which it may be better to prefer one diameter to another. A suggestion may be that to start fitting the smallest lens as possible, depending on the dimension of HVID and limbus width and consider larger lenses only when issues occur.