Ocular Symptoms Research Articles

Metastatic nose and paranasal sinus masses – A case series

Metastases to the nose and paranasal sinuses are unusual. These tumors are commonly seen in the 4th to 6th decades of life. The clinical presentation may be analogous to that of primary sino-nasal tumors. They usually present with common nasal and ocular symptoms due to which diagnosis may be missed and delayed. Hence, high level of suspicion is necessary for patients with known malignancies presenting with inconsistent or repeated nasal and ocular symptoms. Otorhinolaryngologists should be familiar with these metastases to paranasal sinuses from unusual primary elsewhere in the body, to evaluate and manage these tumors. Retrospective data was collected from the hospital records from 2020-2023. A total 14 cases of sino-nasal malignancies were identified. On further analysis three cases were found to be having distant metastases from primary sites such as kidney, breast and lymph nodes. We are reporting three metastatic malignancies. Each was systematically evaluated, confirming their origin as metastases from other primary sites. They were then managed appropriately. Keywords: metastases; paranasal sinuses, renal cell carcinoma; breast carcinoma; non-Hodgkin’s lymphoma; sinus surgery

Is Meibomian Gland Dysfunction One Disease? Heterogeneity Among Phenotypes.

The purpose of this study was to examine ocular surface symptoms, tear metrics, and tear cytokines by Meibomian gland dysfunction (MGD) features. Symptom questionnaires and an ocular surface evaluation were performed on 40 individuals with varied MGD signs (Meibomian gland [MG] plugging, eyelid vascularity, meibum quality, and MG dropout). Tear proteins were extracted off Schirmer strips and analyzed for 23 human inflammation-related proteins. Statistical analysis was performed to examine associations between dry eye metrics inflammatory proteins and MGD features. The study involved 40 South Florida veterans with a mean age of 61 ± 13 years; most individuals were male (95%), White (31%), and non-Hispanic (85%). MGD features differentially related to dry eye signs. Eyelid vascularity, meibum quality, and MG dropout, but not MG plugging, correlated with higher corneal staining and lower tear production. MGD features also differentially related to tear cytokines. Eyelid vascularity most closely related to inflammation with significant correlations for interferon-gamma-γ (r = 0.36, P = 0.02), interleukin-4 (IL-4) (r = 0.43, P = 0.006), IL-17A (r = 0.42, P = 0.007), matrix metalloproteinase-2 (r = 0.39, P = 0.01), C-X-C motif chemokine ligand 5 (Regulated upon Activation, Normal T-Cell Expressed and presumably Secreted [RANTES]) (r = 0.32, P = 0.04), and tumor necrosis factor α (r = 0.36, P = 0.02). The other 3 MGD signs were less related to inflammation. Multivariable models revealed IL-4 to be most closely related to eyelid vascularity (standardized β = 0.39, P < 0.0001). Eyelid vascularity was the MGD sign most closely related to inflammatory cytokines, suggesting that different MGD features may be driven by different pathophysiological mechanisms.

Isolated Bilateral Triceps Weakness in Myasthenia Gravis

Purpose: Myasthenia gravis (MG) is the most common autoimmune disease that affects the neuromuscular junction and can cause weakness in various muscle groups. The most commonly affected muscles are the eye, facial, and neck flexors. Focal or dominant weakness of the triceps muscle is rare. In this case, we aimed to describe a rare form of MG consisting of selective or dominant triceps muscle weakness. Case report: We present a 45-year-old male patient whose initial complaints were diplopia and ptosis. Acetylcholine receptor antibody was positive. After 10 years of well-being following thymectomy, bilateral triceps weakness was added to his ocular symptoms despite regular medication (pyridostigmine and prednisone). Repetitive nerve stimulation (RNS) showed decremental responses in the right triceps muscles. Conclusion: It is important to recognize this type of myasthenia gravis to facilitate diagnosis and appropriate treatment and to avoid unnecessary investigations and treatments.

Comparison of the effect of 2 mL versus 3 mL sub-Tenon xylocaine injection on akinesia and analgesia in cataract patients at the University of Ilorin Teaching Hospital, Nigeria.

Sub-Tenon anesthesia is a form of local anesthetic techniques used in ophthalmic procedures, especially in cataract surgery. Few studies in our environment have reported the effects of sub-Tenon anesthesia on akinesia and analgesia as well as optimum volumes of anesthetic agents that are required for effective analgesia and akinesia. The objective of this study is to determine and compare the level of analgesia and akinesia and the effect of ocular compressions after sub-Tenon injection of 2 mL versus 3 mL of xylocaine among patients booked for cataract surgery in the University of Ilorin Teaching Hospital (UITH). A cross-sectional comparative study among cataract patients booked for surgery in the Department of Ophthalmology at UITH was carried out from March 2017 to August 2017. A total of 200 cataract patients that met the inclusion criteria were recruited into the study over 6 months. Lists of cataract patients booked for surgery formed the sampling frame. Questionnaires were administered to obtain information on sociodemographic, ocular symptoms, and other histories. Visual acuity was checked, and ocular examination was done with a pen-torch, ophthalmoscope, and slit-lamp examination with 78D. Tonometry and optic nerve assessments were done to exclude any patient with preexisting glaucoma or suspicious disc. About 200 patients were randomly allocated into one of two volume groups (Group 1 had 2 mL sub-Tenon xylocaine injection whereas Group 2 had 3 mL); level of analgesia and akinesia was checked 12 min and 15 min, respectively. The age range was 20-107 years; mean age for Group 1 was 63.8 ± 12.64, whereas the mean age of Group 2 was 64.14 ± 14.14. There was a slight female preponderance given a M:f of 1:1.4 and more than half of the patients presented with right eye (RE) cataract. Levels of analgesia 12 min after sub-Tenon injections in both groups were similar. However, two patients were found to have severe pain in Group 1, and no patients had severe pain in Group 2. The level of akinesia which was assessed 15 min after injection in both groups was found to be significantly better in Group 2. There was a slight female preponderance with about two-third of the total patients being female and the percentage of females who had no pain was more than the male, more than 50% of the patients had RE cataracts. Sub-Tenon anesthesia whether with 2 mL or 3 mL led to a statistically significant rise in intraorbital pressure (IOP); however, with ocular compression, the IOP was found to decrease below the preinjection pressure in both groups. Levels of analgesia were similar in the two groups, whereas akinesia was statistically better in the group that had 3 mL injection.

Vergence-Accommodation Conflict: Increased Presbyopia in Virtual Reality.

Performance and symptoms in completing a visual search task on a PC monitor and using a head-mounted display (HMD) were compared for different viewing conditions and between users of different ages. Twenty-three young (M = 30 y, SD = 7 y) and 23 older (M = 52 y, SD = 5 y) participants performed a visual search task presented on a PC monitor. The task was repeated using an HMD for a near and a far virtual viewing distance. Reaction times (RT), detection sensitivity (d'), and symptoms were recorded for the three different viewing conditions. RT and d' were not affected by the viewing condition (p > 0.05). In contrast, symptoms significantly depended on the viewing condition but were, in part, not significantly affected by age. It is interesting to note that although not significant, young participants reported more ocular symptoms than older participants in the near vision task carried out using the HMD. HMD increases visual symptoms. However, HMD could be, in part, a remedy to problems when using visual aids for near work, in particular for presbyopes.

Central retinal vein occlusion with concurrent paracentral acute middle maculopathy secondary to honeybee sting

We report the case of a 45-year-old male who presented with complaints of sudden decreased vision in the right eye (RE) associated with redness and lid swelling. He gave a history of honeybee stings 1 week ago to the right periorbital area. On examination, the patient’s best-corrected visual acuity in RE was 4/60. The anterior segment examination was normal. However, fundus examination and imaging revealed central retinal vein occlusion (CRVO) with paracentral acute middle maculopathy (PAMM) and macular edema. The patient’s routine blood tests were negative for any abnormalities that could have caused the vascular occlusion. The patient was prescribed topical steroids and advised to receive an intravitreal injection of ranibizumab. However, 2 weeks later, the patient returned with improved visual acuity and resolution of macular edema. His transient hypercoagulable state could have been the cause of his ocular symptoms. Few cases of central retinal artery occlusion (CRAO) secondary to bee venom have been reported, but none with CRVO and associated PAMM.

An interesting case of facial en coup de sabre presenting with optic neuritis in the contralateral eye: A rare presentation

Ocular involvement in morphea or en coup de sabre (ECS) is relatively infrequent, observed in approximately 2–3% to 14% of cases. The intricate pathogenesis underlying these ocular manifestations remains elusive. Within this context, we present a rare case in a young female patient, wherein, ECS manifested with optic neuritis in the eye contralateral to the linear scleroderma lesion, a phenomenon, hitherto, unreported in the literature. This unique case affirms the importance of comprehensive ophthalmological evaluations, not only at the initial presentation but also in the ongoing care of ECS patients. The recommendation is particularly emphasized in instances where patients perceive the emergence of new ocular symptoms. This approach aims to enhance our understanding of the ocular complexities associated with ECS and improve the overall management of this intriguing condition.

Levels of IgE sensitization drive symptom thresholds in allergic rhinitis

BackgroundAllergic rhinitis (AR) is a common respiratory disease encompassing a variety of phenotypes. Patients can be sensitized to 1 or more allergens. There are indications that polysensitization is associated with more severe disease. However, the extent to which the level of sensitization is associated with clinical disease variability, underlying the distinct nature of AR from AR+ conjunctivitis or AR+ asthma, is not known. ObjectiveTo evaluate phenotypical differences between monosensitized and polysensitized patients with AR and to quantify their symptomatic variability. MethodsA total of 565 patients with a confirmed diagnosis of AR were included in this cross-sectional study. Of those, 155 were monosensitized and 410 were polysensitized. Interactions between sensitization levels and the reporting of different symptoms of AR and co-morbidities, disease duration, and impact were assessed. Furthermore, patients were stratified into monosensitized, oligosensitized, and polysensitized to assess whether the effect of sensitization on the phenotype was ranked. ResultsPolysensitized patients reported itchy eyes significantly more often (P = .001) and had a higher number of ocular (P = .005), itch-related (P = .036), and total symptoms (P = .007) than monosensitized patients. In addition, polysensitized adults and children more often reported wheeze (P = .015) and throat-clearing (P = .04), respectively. Polysensitization was associated with more burdensome AR based on a visual analog scale (P = .005). Increased sensitization level was reflected in more itchy eyes, a higher number of ocular, itch-related, and total number of symptoms, and disease burden. ConclusionWith an increasing number of sensitizations, patients with AR experience an increased diversity of symptoms. Multimorbidity-related symptoms increase with sensitization rank, suggesting organ-specific thresholds.

Computer Vision Syndrome in Medical Students - Knowledge, Attitude, Practice (KAP) Study

BACKGROUND&#x0D; The use of computers and visual display devices has become an integral part of our lives. As a result, a large number of people around the world are suffering from various ocular symptoms, including dry eyes, ocular strain, eye irritation, and ocular redness. All of these ocular symptoms are commonly called computer vision syndrome. The purpose of this study was to determine the prevalence, community knowledge, and pathophysiology of computer vision syndrome, as well as the factors associated with and preventing CVS.&#x0D; METHODS&#x0D; A cross-sectional study was conducted among 150 medical students and the data was collected through a structured, web-based, and self-administered questionnaire, which was pre tested and pre-validated.&#x0D; RESULTS&#x0D; In this study, 38.7% had a pre-existing knowledge on CVS. 94.67% of the respondents reported having mild to moderate symptoms of dry eyes. It is found that people use screens mostly for social media and entertainment. Long hours spent on the small screen led to sleep disturbances in about 56% of the students. According to our survey, 54% of the students used spectacles and frequent change of spectacles was present. About 40% of the students used topical eye drops prescribed by ophthalmologist.&#x0D; CONCLUSIONS&#x0D; The increasing use of digital screen and prevalence of computer vision syndrome. When combined with increased screen time, dry eyes and good quality sleep can lead to serious health problems like learning difficulties and operative errors, which may pose a challenge in the modern era. Right education, attitude and practice regarding CVS are required to all the medical students due to their increased dependency on digital devices. Proper practice and preventive measures are necessary for a doctor /surgeon for health benefit of the patients and community.

Patients' values and preferences for health states in allergic rhinitis-An artificial intelligence supported systematic review.

Allergic rhinitis (AR) impacts patients' physical and emotional well-being. Assessing patients' values and preferences (V&P) related to AR is an essential part of patient-centered care and of the guideline development process. We aimed to systematically summarize the information about patients' V&P on AR and its symptoms and impact on daily life. We conducted systematic review in a MEDLINE, Embase, PsychInfo, and CINAHL databases. We included studies which quantitatively assessed patients' V&P for specific outcomes in AR by assessing utilities, applying discrete choice approaches, or rating and ranking outcomes. We grouped outcomes as AR symptoms, functional status, and care-related patient experience. Study selection and data extraction were supported by the Laser AI tool. We rated the certainty of evidence (CoE) using the GRADE approach. Thirty-six studies (41 records) were included: nine utility studies, seven direct-choice studies and 21 studies of rating or ranking outcomes. Utilities were lower with increased AR severity and with the concomitant presence of asthma, but not with whether AR was seasonal or perennial (CoE = low-high). Patients rated AR symptom-related outcomes as more important than those related to care-related patient experience and functional status (CoE = very low-moderate). Nasal symptoms (mainly nasal congestion) followed by breathing disorders, general and ocular symptoms were rated as the symptoms with the highest impact. This systematic review provides a comprehensive overview of V&P of patients with AR. Patients generally considered nasal symptoms as the most important. Future studies with standardized methods are needed to provide more information on V&P in AR.

Potential New Target for Dry Eye Disease-Oxidative Stress.

Dry eye disease (DED) is a multifactorial condition affecting the ocular surface. It is characterized by loss of tear film homeostasis and accompanied by ocular symptoms that may potentially result in damage to the ocular surface and even vision loss. Unmodifiable risk factors for DED mainly include aging, hormonal changes, and lifestyle issues such as reduced sleep duration, increased screen exposure, smoking, and ethanol consumption. As its prevalence continues to rise, DED has garnered considerable attention, prompting the exploration of potential new therapeutic targets. Recent studies have found that when the production of ROS exceeds the capacity of the antioxidant defense system on the ocular surface, oxidative stress ensues, leading to cellular apoptosis and further oxidative damage. These events can exacerbate inflammation and cellular stress responses, further increasing ROS levels and promoting a vicious cycle of oxidative stress in DED. Therefore, given the central role of reactive oxygen species in the vicious cycle of inflammation in DED, strategies involving antioxidants have emerged as a novel approach for its treatment. This review aims to enhance our understanding of the intricate relationship between oxidative stress and DED, thereby providing directions to explore innovative therapeutic approaches for this complex ocular disorder.

Ocular and orbital manifestations in VEXAS syndrome

BackgroundVEXAS (Vacuoles, E1 enzyme, X-linked, Autoinflammatory, Somatic) is a hematoinflammatory disease that typically affects adults. It results from a somatic mutation of the E1 ubiquitin conjugating enzyme encoded by the UBA1 gene. VEXAS is frequently accompanied by myelodysplastic syndrome (MDS). The purpose of this study is to describe the ocular and orbital manifestations of VEXAS patients in a case series in our medical centre.MethodsA retrospective chart review was performed for all patients who were diagnosed with VEXAS syndrome in a tertiary medical centre over two years.ResultsEight patients were identified with VEXAS. In six patients, the diagnosis was confirmed by genomic sequencing. Two patients were identified based on their phenotype. All patients were males. The mean age at diagnosis was 78.7 years. In two patients, the ocular manifestation was the presenting symptom for VEXAS. Seven patients (87.5%) had history of MDS. Systemic inflammation manifestations include: skin rash (n = 5), recurrent fevers (n = 2), relapsing polychondritis (n = 2), pleuritis and pleural effusion (n = 2), poly arteritis nodosa- PAN (n = 1) and thrombophlebitis (n = 1). Seven (87%) patients were presented with periorbital oedema. Three patients showed orbital inflammation. Dacryoadenitis was observed in two patients, and extraocular muscle (EOM) myositis was detected in two patients. Four patients demonstrated ocular inflammation such as: episcleritis, scleritis and anterior uveitis.Conclusionocular manifestations in VEXAS include orbital inflammation, dacryoadenitis, myositis, uveitis, scleritis, episcleritis and periorbital oedema. We recommend that in old male patients, with history of haematological disorder, presenting with ocular symptom, VEXAS investigation should be taken into consideration.

Effectiveness Of E-Backnshou Exercise To The Improvement Of Neck, Shoulder And Back Pain In Computer Vision Syndrome Patient

BACKGROUND : Extra-ocular complaints of Computer Vision Syndrome (CVS) are neck, shoulder, back pain. The 20-20-20 rule and E-BACKNSHOU exercise are expected to improve accommodative mechanisms, ocular surface of the eye and extra ocular symptoms of CVS. AIMS : Proving the effectiveness of E-BACKNSHOU exercise for the improvement of neck, shoulder and back pain in CVS patient. METHOD : The research design was Pre-Post Test with Control Design. Subjects were 30 medical students of Faculty of Medicine, Diponegoro University, Semarang, Indonesia who experienced CVS and neck, shoulder and back pain. The treatment group got the 20-20-20 rule and E-BACKNSHOU exercise and the control group got the 20-20-20 rule for 1 month. Pain was measured by Visual Analogue Scale (VAS). Statistical test was conducted using paired t-test, unpaired t-test and chi square. Value of significance p&lt;0.05. RESULT : There were significant differences in VAS score of neck, shoulder, upper back pain (p=0.00), and low back pain (p=0.022) before and after the intervention in the treatment group and VAS score of neck (p=0,002), shoulder (p=0.020), upper back (p=0.011), and low back pain (p=0.019) in the control group. Delta VAS score of the treatment group was greater than the control group and there was a significant difference in delta VAS score of shoulder pain (p=0,030), but there were no significant differences in delta VAS score of neck (p=0,934), upper back (p=0,356), and low back pain (p=0,150). CONCLUSION : The effectiveness of 20-20-20 rule and E-BACKNSHOU exercise is better than the 20-20-20 rule alone on treating neck, shoulder and back pain in CVS patient.

Dry Eye-Like Ocular Surface Dysfunction in Post-Vitreoretinal Surgery Eyes

Objective: Dry eye is associated with reduced QoL and with the relevant social and economic costs. We evaluated the prevalence of dry eye signs and symptoms in a group of patients who underwent vitreoretinal surgery for epiretinal membrane removal for at least 6 months. Method: Fourty-one consecutive patients were enrolled. Ocular surface symptoms were evaluated using a structured form and a Visual Analogue Scale (VAS). Blink completeness, Break-Up Time (BUT), fluorescein and lissamine green staining and thickness of the lower tear meniscus were also assessed. Lissamine green staining was used to evaluate the mucocutaneous junction. Results: Symptoms were present up to 1 year from surgery in 80% of population. Foreign body and burning sensations were reported by 14 (34.1%) and 11 (26.8%) patients. Blinking was incomplete in 36.8% of patients; eyelid mucocutaneous junction was abnormal in 68.3% of patients. Mild or moderate eyelid injection were reported by 29 (70.7%) and 12 (21.3%) patients; moderate and peri-keratic hyperemia were reported by 22 (53.7%) and 15 (36.6%) patients. Only 26.2% of patients showed a normal BUT (&gt;10 s). Corneal sensitivity was absent in 4 patients (9.8%) and strongly decreased in 2 patients (7.3%). The lower tear meniscus was &lt;0.2 mm in 21 patients (51.2%). Fluorescein staining of the cornea was positive in 56% of patients. Conclusion: Patients who underwent vitreoretinal surgery showed, in the long-term, signs and symptoms of ocular surface dysfunction (dry eye) with a frequency that is more than double the expected frequency of the disease.

Evaluation of therapeutic efficacy of Emustil drops for ocular discomfort and tear film osmolarity using different treatment management modes under dry environmental conditions

BackgroundWe aimed to check the efficacy of Emustil (oil in water emulsion) drops on tear film index and ocular surface dynamics in dry environments through protection and relief treatment modalities.MethodsThe subjects were exposed to a dry environment using a Controlled Environment Chamber (CEC) where the relative humidity (RH) was 5% and the temperature was 21 °C and screened for ocular symptoms, tear osmolarity, ocular surface temperature (OST) and tear production using ocular Surface Disease Index questionnaire (OSDI), OcuSense TearLab Osmometer, FLIR System ThermaCAM P620 and Schirmer strips/phenol red test respectively. Tear production was calculated by the Tear Function Index test (TFI).ResultsThe mean tear film osmolarity decreased significantly from 296.8 mOsm/l at 40% RH to 291 mOsm/l at 5%. (p = 0.01). Instillation of Emustil resulted in a significant increase in tear osmolarity in the relief method compared with osmolarity seen at 5% RH when no drop was used. The mean PRT value decreased from 26 ± 9 in normal conditions (40% RH) to 22 ± 4 mm in dry conditions (5% RH). Emustil drops did not induce any significant change in tear production in the PRT test. No significant change was found in OST following exposure to 5% RH. OST did not show a statistically significant change with the emulsion when used for relief (p > 0.05). The mean score of ocular discomfort observed was 70 at 5% RH. Still, the instillation of the oil-in-water emulsion (Emustil) resulted in a noticeable decrease in visual discomfort to 37 (p = 0.00) in protection and 59 in relief (p = 0.05). Emustil drops substantially improved tear film parameters under a desiccating environment, however, tear film parameters respond differently to the management modalities. In the protection method, tear film osmolarity was protected against a dry environment, while in the relief mode, tear production was improved.ConclusionCEC allows for a thorough evaluation of tear film parameters and dry eye treatment protocols in labs, providing greater confidence when applying them to patients. In addition, our study showed that Emustil not only provides protection and relief for dry eyes but also helps to maintain ocular homeostasis in desiccating environments. This indicates a promising potential for improving dry eye treatment protocols.

A Study of Prevalence and Risk Factors of Digital Eye Strain among Diabetic and Non-Diabetic Patients

Background: The proliferation of digital devices in modern society has led to a significant increase in the prevalence of Digital Eye Strain (DES), characterized by symptoms such as eye fatigue, dryness, and headaches. This condition poses a particular risk to individuals with systemic conditions, such as diabetes mellitus, which can exacerbate ocular symptoms. Understanding the relationship between DES and diabetes is crucial for developing targeted interventions to alleviate symptoms and improve quality of life. Objective: This study aims to assess the prevalence and risk factors of Digital Eye Strain among diabetic and non-diabetic individuals, examining the impact of digital device usage patterns, ocular surface health, and visual discomfort symptoms in both groups. Methods: A cross-sectional study was conducted at the Eye Department of Jeddah National Hospital, involving 150 diabetic and 150 non-diabetic participants, employing purposive sampling. Participants were evaluated for DES symptoms, digital device usage habits, and clinical signs of ocular surface health, including Tear Break Up Time (TBUT), Fluorescein Stains (FS), and Tear Meniscus Height. Data analysis was performed using SPSS version 25, focusing on statistical differences between the two groups. Results: The mean age of participants was 56 years (SD=10.3) for the diabetic group and 54 years (SD=8) for the non-diabetic group, with a balanced gender distribution across both groups. Diabetic participants demonstrated a significantly lower TBUT (median=5 seconds, IQR=2) compared to non-diabetics (median=7 seconds, IQR=1), P=0.001. DES symptoms, particularly eye fatigue and headaches, were more prevalent among diabetics, with over four hours of computer usage exacerbating symptoms (eye fatigue: 57%, P=0.001; headache: 32.8%, P=0.029). Environmental and behavioral factors, including improper illumination and infrequent breaks, were significantly associated with increased DES symptoms. Conclusion: Digital Eye Strain is more prevalent and severe among diabetic individuals, with significant implications for ocular and general well-being. The findings underscore the need for targeted digital health interventions and ergonomic practices to mitigate DES symptoms, especially among those with diabetes.

Thyroid Eye Disease: Pilot Study Comparison Between Patients in United States-Based and India-Based Practices

PurposeThyroid eye disease (TED) phenotype varies by ethnicity/race and genetic/environmental factors. This study compared demographic and clinical characteristics of TED patients from the US and India. DesignObservational pilot study Methods64 patients with TED ages ≥18 years old with active disease (onset of symptoms ≤18 months or presenting clinical activity score (CAS) ≥4) were recruited between March and October 2021 from clinical practices in the United States (Philadelphia, PA) (n= 30) and India (Hyderabad, India) (n=34). Data collection at baseline and 3 months included clinical measurements, thyroid disease history, and photographs. Ocular symptoms and quality of life data were obtained by phone interview. CAS was calculated using the standard 7-point scale. ResultsThere was no statistically significant difference in age, TED duration, or smoking status between patient groups. Both groups had good vision, a low rate of optic neuropathy, and comparable exophthalmometry. US patients were predominantly female (86.7% (26/30)), with a history of hyperthyroidism (96% 29/30). In comparison, Indian patients were 52.9% (18/34, p=0.004) female; underlying thyroid disease was distributed between hyperthyroidism (52%), hypothyroidism (17.6%) and euthyroid (9.7%). Mean (SD) CAS in the US cohort was double the score in the India cohort (4.2 (1.7) vs 1.65 (1.7), respectively) (P<0.0001). However, patients at both sites experienced subjective symptoms of TED at a similar frequency. ConclusionsObserved differences in TED between US and Indian patients warrant further investigation to elucidate differences in pathogenesis, disease expression, or other factors that may influence TED in diverse populations.

Effect of Mingmu nourishing cream on asthenopia

Purpose: To assess the therapeutic efficacy and safety of Mingmu nourishing cream in asthenopia. &#x0D; Methods: This study retrospectively analyzed data from 124 patients who were treated for asthenopia in the Affiliated Hospital of Shanxi University of Traditional Chinese Medicine, China from January 2015 to January 2018. Patients were divided into control group (n = 63; received conventional eye drops) and study group (n = 61; received Mingmu nourishing cream in addition to control group treatment). The ocular symptom scores and tear secretion test (Schirmer's I test (SIT)) were compared between the two groups before and after treatment. Furthermore, the clinical efficacy of Mingmu nourishing cream in the treatment of asthenopia was evaluated. &#x0D; Results: The differences in SIT, conjunctival congestion classification and ocular symptoms between the two groups after treatment were statistically significant (p &lt; 0.05). Moreover, the rate of total therapeutic efficacy in the study group was 86.9 % (53/61), which was significantly higher than the control group (p &lt; 0.05). &#x0D; Conclusion: Mingmu nourishing cream significantly improves symptoms and exhibits favourable tolerability profile. Multi-center large sample study is needed for further verifications of the findings of this study.

Diamond Bur Microblepharoexfoliation Combined with Intense Pulse Light and Meibomian Gland Expression for Evaporative Dry Eye: A Short-term Controlled Clinical Trial.

To assess the efficacy and safety of the combination of microblepharoexfoliation (MBE), intense pulse light (IPL) and meibomian gland expression (MGX) for treatment of meibomian gland dysfunction (MGD). This was a prospective, parallel-control trial conducted from April 2022 to January 2023. Participants were assigned to receive either three sessions of MBE-IPL-MGX treatment and home-based therapy (treatment group) or home-based therapy alone (control group). Outcome measures were assessed at baseline and after 2-month follow-up. Seventy eyes of 70 patients were enrolled. MBE-IPL-MGX treatment achieved better improvements than home-based therapy in ocular surface disease index (OSDI) and symptom assessment in dry eye (SANDE) scores, noninvasive tear film break-up time (NIBUT), lipid layer grade (LLG), loss area meibomian gland (LAMG) and meibomian gland yielding secretion score (MGYSS). The mean differences between the two groups were as follows: OSDI (- 11.23 ± 4.68 points, P < 0.001), SANDE (- 24.63 ± 13.41 points, P < 0.001), NIBUT (1.3 ± 1.57s, P = 0.033), LLG (0.4 ± 0.04 points, P = 0.003), LAMG (- 2.85 ± 1.69%, P = 0.023) and MGYSS (7.5 ± 2.32 points, P < 0.001). In addition, the increment (Δ) of MGYSS after MBE-IPL-MGX treatment was significantly higher in MGD grades 2 and 3 (all P < 0.001). MBE-IPL-MGX treatment is an effective and well-tolerated procedure that improves dry eye symptoms and signs as well as meibomian gland secretions in patients with MGD. In addition, this treatment is recommended for MGD grades 2 and 3.

COVID-19 and Its Ophthalmic Manifestations: A Literature Review.

Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is a novel coronavirus discovered in late 2019 in Wuhan, Hubei Province, China. The virus has now developed into a full-scale global pandemic affecting hundreds of millions of people to date. A majority of cases present with nonspecific acute upper respiratory symptoms. A wide range of systemic symptoms has been reported, with some patients presenting with nonspecific extrapulmonary symptoms. Recently, there has been an increased association of COVID-19-positive patients presenting with ocular symptoms. As an increasing number of patients present with ophthalmic manifestations, recognizing these visual symptoms is of utmost importance. Some patients may present with ocular symptoms as the first indication of COVID-19 infection; quickly isolating and starting treatment can aid in stopping the spread of this novel coronavirus. This review will describe the current epidemiology and pathophysiology of SARS-CoV-2, emphasizing the ophthalmic manifestations and their clinical course progression. Further, we will be reporting on the growing number of rare ocular manifestations that have occurred in some COVID-19-positive patients, along with the route of transmission, specific manifestations, and the treatment methods for both these pulmonary and extrapulmonary symptoms, specifically the ocular manifestations.