Ocular Symptoms In Patients Research Articles

Two Endogenous Endophthalmitis Cases Accompanying Nephrological Condition in Diabetic Patients

Aims: This report aims to highlight the importance of prompt diagnosis and intervention in cases of endogenous endophthalmitis, with particular focus on its nephrological etiology and associated systemic infections. Presentation of Case: Two cases of endogenous endophthalmitis were observed in patients with nephrological complications. Case 1 involved a 50-year-old man with end-stage renal disease on hemodialysis, who presented with severe visual impairment in the right eye due to Staphylococcus aureus sepsis from a hemodialysis catheter infection. Despite aggressive treatment with intravitreal and systemic antibiotics, the patient’s visual prognosis was poor. Case 2 involved a 65-year-old woman with acute pyelonephritis and undiagnosed diabetes, presenting with unilateral visual loss and ocular inflammation. Systemic and intravitreal antibiotics, alongside corticosteroids, led to a favorable outcome with a final visual acuity of 7/10. Discussion: Diabetic patients with nephrological conditions are particularly susceptible to endogenous endophthalmitis due to compromised immunity and increased risk of systemic infections. Both cases underscore the link between systemic infections, particularly in patients with renal or diabetic conditions, and endogenous endophthalmitis. Prompt recognition of ocular symptoms in patients with systemic infections is critical, as appropriate intervention can preserve visual function. The role of broad-spectrum antibiotics, intravitreal injections, and systemic infection control is emphasized. Conclusion: These cases illustrate the importance of multidisciplinary intervention in managing endogenous endophthalmitis secondary to nephrological infections. While outcomes vary depending on disease severity and patient health, rapid diagnosis and treatment are vital to improving prognosis and preserving vision.

Acute Vision Impairment Caused by Internal Carotid Artery Plaque Hemorrhage Combined With Thrombosis.

Atherosclerosis (As) is an important pathologic basis for ischemic cerebrovascular disease and easily causes stenosis of the origin of the internal carotid artery (ICA). As the main source of intracranial blood supply, the ICA accounts for 70% to 80% of blood flow. This stenosis can cause various ocular symptoms in patients. In the existing literature, it is rare to report cases with only acute vision loss caused by ICA plaque hemorrhage combined with thrombosis. The authors report a case of acute vision impairment caused by ICA plaque hemorrhage. The clinical manifestations, imaging characteristics, differential diagnosis, and treatment methods were discussed based on relevant literature, and the diagnosis and differentiation of the disease were considered to deepen the understanding of the disease.

Application study on the prevention and treatment of spleen aminopeptide oral solution on seasonal allergic rhinitis

Methods: A total of 392 patients with seasonal allergic rhinitis were selected from the population of the epidemiological investigation project of allergic diseases in Hohhot, Inner Mongolia. The project was led by Department of Allergy, Beijing Shijitan Hospital, Capital Medical University, and assisted by Hohhot First Hospital from April to May 2023. The patients were randomly divided into a spleen aminopeptide group (296 cases) and control group (96 cases) at a ratio of 3∶1, and the enrollment period was from June 1 to 14, 2023. The treatment group was treated with spleen aminopeptide oral solution for 12 weeks starting from 4-6 weeks (±7 days) before the pollen dispersal period, while the control group was treated with a simulated agent of spleen aminopeptide oral solution. Both the treatment group and the control group were treated with oral antihistamines and/or nasal glucocorticoids as needed during the pollen dispersal period. Evaluate the therapeutic effect by comparing the symptom scores, drug scores and quality of life scores of the two groups, and detect the expression levels of cytokines in serum. Symptom scores, quality of life scores, drug scores and laboratory results were compared by independent sample t test/Kruskal-Wallis test and χ2 test/Fisher's exact test. Results: Compared with the control group, spleen aminopeptide treatment for 12 weeks significantly improved symptoms of nasal congestion [M(Q1,Q3):2(1, 2) vs. 2(1, 3), H=6.308, P<0.05], nasal itching [M(Q1,Q3):2(1, 2) vs. 2(1, 3), H=4.966, P<0.05], sneezing [M(Q1,Q3):2(1, 2) vs. 2(1, 3), H=5.245, P<0.05], runny nose [M(Q1,Q3):2(1, 2) vs. 2(1, 3), H=5.41, P<0.05] and tearing [M(Q1,Q3):1(0, 2) vs. 1(0, 3), H=4.664, P<0.05]. At 12 weeks of treatment, the scores of nasal symptoms and ocular symptoms in control group and experimental group were significantly increased compared with baseline (P<0.05). In experimental group, nasal congestion [M(Q1,Q3):1(0, 1) vs. 1(0, 2), H=4.042, P<0.05], eye itching/foreign body sensation/redness symptom scores [M(Q1,Q3):1(0, 2) vs. 1(0, 2), H=5.302, P<0.05] and total scores [M(Q1,Q3):4(-1, 9) vs. 5(0, 12.5), H=3.958, P<0.05] were significantly increased. The antihistamine drug score of the splenic peptide treatment group at 6 weeks were lower than that of the control group (H=4.232, P<0.05). After 12 weeks of treatment, the antihistamine drug score [M(Q1,Q3):10(0, 24) vs. 19(2, 36.5), H=6.67, P<0.05] and the total drug score [M(Q1,Q3):28.5(5, 77.5) vs. 46(6, 155.5), H=3.995, P<0.05] were significantly lower than those of the control group. The serum IL-17A levels of the treatment group were significantly lower than those of the control group after 6 weeks (0.7±1.77 vs. 0.85±1.67,H=10.08, P<0.05) and 12 weeks (0.81±1.63 vs. 0.94±1.73,H=5.196, P<0.05) of splenic aminopeptide treatment. Conclusions: Early treatment with spleen aminopeptide oral solution can significantly improve nasal and ocular symptoms of patients with seasonal allergic rhinitis, reduce the use of drugs during the onset period, and improve the quality of life. It may exert an immunomodulatory effect by reducing the expression level of IL-17A in the serum of patients. Objects: To conduct a study on the prevention and treatment of seasonal allergic rhinitis in Hohhot, Inner Mongolia, evaluate the preventive and therapeutic effects of spleen aminopeptide oral solution on seasonal allergic rhinitis, and explore its related mechanisms.

Uncommon orbital metastasis in ductal breast carcinoma: a rare presentation 12 years after treatment

Abstract Orbital metastasis originating from breast carcinoma, particularly ductal carcinoma, represents a rare clinical entity, with lobular carcinoma usually being more common. Long-term surveillance in breast cancer patients is crucial for early detection of metastasis. Herein, we present a case of a 70-year-old woman with a history of left ductal breast carcinoma, diagnosed and treated 12 years ago. She then developed left eye vision loss, diplopia, enophthalmos, and chemosis in October 2024. Imaging revealed orbital metastasis involving the left superior and lateral rectus extraocular muscles. Biopsy confirmed the diagnosis of orbital metastases arising from ductal breast carcinoma. This case underscores the significance of long-term surveillance in breast cancer patients, as metastasis can manifest years after the initial diagnosis. Despite its rarity, orbital metastasis warrants consideration in the differential diagnosis of ocular symptoms in patients with a history of breast carcinoma. Treatment primarily aims at palliation and preserving visual function, with prognosis typically poor.

Uncover the Hidden Veils: Ophthalmoplegia in Breast Cancer

Abstract&#x0D; Introduction : Breast cancer can metastasize to many sites, but the orbit is an infrequent location. Orbital metastases represent 1%–13% of all orbital tumors, and the prognosis is rather poor. We reported a case of orbital metastases of breast cancer that led to findings of other sites involvement.&#x0D; Case Illustration : A 50-year-old female presented with an inward squint and double vision for 9 months before admission. Esotropia, abduction, and elevation deficits in both eyes were observed. The visual acuity of both eyes was 6/6. Orbital MRI revealed an intraconal irregular lesion near the medial rectus muscle, which was hyperintense with contrast and thickened medial rectus muscles of both eyes. She underwent lumpectomy of breast mass two years before admission and no follow-up after surgery. Histopathology showed invasive lobular carcinoma (ILC). We referred her to hematologist- oncologist to have workup on metastases and treatment. Lung and extensive bone metastases were discovered. She was diagnosed with metastatic breast cancer (stage IV) and treated with hormonal therapy and bisphosphonates. On 3-month follow-up, diplopia and gaze limitations persist.&#x0D; Discussion : Diplopia and motility disturbances are the most common symptoms and signs of orbital metastases, including extraocular muscle involvement. The horizontal rectus muscles are more commonly involved. ILC is more frequent histological subtype involving orbital as the orbits are rich in fat and may attract disseminated ILC cells.&#x0D; Conclusion : Ocular symptoms in patients with a history of breast cancer should always be investigated for metastatic disease. A multidisciplinary approach is mandatory to achieve the best therapeutic management and long-term surveillance.

Acute Bilateral Painless Vision Loss in a Pediatric Patient With Infective Endocarditis

Infective endocarditis (IE) is a complex cardiac condition with a myriad of systemic complications, affecting approximately 5% of patients with ocular manifestations. This report details a rare and severe presentation of IE, marked by the acute onset of bilateral vision loss attributed to central retinal arterial occlusion (CRAO) and posterior ischemic optic neuropathy (PION), both critical conditions resulting from vascular impairments associated with IE. CRAO, characterized by the sudden obstruction of blood flow to the retina, leads to rapid vision deterioration, showcasing the critical impact of vascular emboli originating from infective endocardial lesions. On the other hand, PION, a less common vascular disorder, affects the posterior segment of the optic nerve, typically sparing the optic disc from edema but resulting in significant visual impairment. This case emphasizes the importance of recognizing ocular symptoms in patients with IE, as early detection and intervention are vital for managing these rare but devastating complications.

Ocular lesions in patients with ulcerative colitis.

Aim: To analyze the data and evaluate the prevalence of ocular lesions in patients with moderate ulcerative colitis. Materials and Methods: We observed 112 patients aged 18-75 years old with clinically, endoscopically and histologically confirmed moderate ulcerative colitis which lasted at least 6 months. An ophthalmologic exam was performed to determine the presence of ocular symptoms. Results: Of the 112 patients with moderate ulcerative colitis, 21 (18,75%) had the following ocular lesions: episcleritis - 7 patients (6,25%), keratopathy - 5 patients (4,46%), uveitis - 5 patients (4,46%), cataract - 2 (1,78%) and scleritis - 2 (1.78%). Conclusions: Because ocular symptoms in patients with UC are often nonspecific, it may be beneficial to perform ophthalmologic examinations as a routine follow-up component of in such patients.

Ефективність та безпечність інтраназального застосування фіксованої комбінації олопатадину гідрохлориду та мометазону фуроату в терапії пацієнтів з алергічним ринітом

Abstract. One of the options for pharmacotherapy of allergic rhinitis (AR) with values of visual analogue assessment of symptoms ≥ 5 is the use of intranasal H1-histamine blocker in combination with intranasal cocorticosteroid. One of the new combinations that qualitatively corresponds to this composition is the combination of olopatadine hydrochloride and mometasone furoate. The aim of the study was to study the effectiveness and safety of symptomatic therapy by the fixed combination of olopatadine hydrochloride and mometasone furoate in the form of a nasal spray in the treatment of AR. Materials and methods. 45 patients were examined, of which 37 patients completed treatment (8 patients dropped out of the study due to poor compliance). All of them made up the main group of the study (age — 29.3 (16.6; 42.0) years, men — 13 (35.0 %), women — 24 (65.0 %). The design of the study was randomized prospective with interventional model in the form of monoprescription. The diagnosis of AR was established in accordance with the ARIA guidelines. To control nasal symptoms before and during treatment, a generally accepted scoring system was used — the TNSS scale (Total nasal symptom score), eye symptoms — the TOSS scale (Total ocular symptom score) The Rhinoconjunctivitis Quality of Life mini Questionnaire (RQLQ) was used to assess the quality of life of AR patients. The results. In the course of treatment, a statistically significant improvement in nasal symptoms (TNSS) was noted — a decrease in severity from 10.11 (8.71; 11.51) points to 1.31 (1.00; 1.63) points on the 28-th day of treatment (p &lt; 0.05). A similar statistically significant improvement was observed in the severity of ocular symptoms (TOSS) — a decrease in severity from 3.31 (1.81, 4.81) points to 0.36 (0.30, 0.42) points on the 28-th day of treatment (p &lt; 0.05). A statistically significant improvement in the quality of life according to the RQLQ during treatment was noted — the score decreased from 3.04 (2.72; 3.37) points at the initial visit to 1.83 (1.61; 2.05) points on the 7-th day. 1.02 (0.86, 1.18) points on day 14, 0.63 (0.51, 0.75) points on day 21 and 0.45 (0.41, 0.49) points on day 28 treatment (p &lt; 0.05). Conclusion. A fixed combination of mometasone furoate and olopatadine hydrochloride was effective in relieving nasal and ocular symptoms in patients with moderate/severe AR, reducing the TONSS score from 13.42 (10.81; 16.03) to 1.67 (1.14; 2.20) points and in improving the quality of life, reducing the degree of discomfort from 3.04 (2.72; 3.37) points to 0.45 (0.41; 0.49) points. For 4 weeks of use, no side effects from the use of the drug were registered, which indicates good tolerability.

Safety and Efficacy of Human Amniotic Epithelial Stem Cells Eye Dropin Ocular Chronic Graft-Versus-Host Disease

Background Approximately 50% of patients with allogeneic hematopoietic stem cell transplantation (allo-HSCT) suffer from ocular chronic GVHD (ocGVHD), which causes severe dryness and visual impairment. However, current clinical treatments for ocGVHD, such as artificial tears, immunosuppression therapy, and punctual occlusion, typically offer only limited benefits. Amniotic membrane transplantation (AMT) can significantly alleviate ocular symptoms in patients with ocGVHD, but it is an invasive procedure that is not appropriate for all patients with ocGVHD. Therefore, we designed a clinical trial to demonstrate the safety and efficacy of eye drops containing human amniotic epithelial stem cells (hAESC) in ocGVHD. M ethods Register Number: ChiCTR2200057857. The enrolled eyes received 1*10 6 cells/mL of hAESC eye drops four times daily for one to three treatment cycles (A cycle was defined as two weeks of continuous administration and two weeks without hAESC eye drops). The primary outcome measure is safety following treatment with hAESC eye drops. In addition, other clinical indices, such as the ocular surface disease index (OSDI), NIH score(eye), Schirmer's test, corneal fluorescein staining (CFS) score, fluorescein tear breakup time (FTBUT), and in vivo confocal microscopy (IVCM) were essential parameters. Results ： 19 of the 25 patients included in the study completed at least one round of treatment. The average length of follow-up was 9.4 months. There were no adverse events associated with hAESC. After one round of treatment(n=19), there was a significant decrease in OSDI score (P=0.0003) and eye NIH score (P0.0001), an increase in Schirmer basal secretion score (P=0.0237), and a significant improvement in CFS score (P0.0001), corneal subbasal nerve density(P=0.006), and corneal epithelial cell density(P=0.0349). It also produced statistically significant improvements in FTUBT after two rounds of treatment (n=14) (P= 0.024). After three rounds of treatment (n=11), we observed additional improvements in the OSDI (P=0.0001) and CFS (P0.001) scores. Conclusion ： The findings of this study indicated that hAESC eye drops are safe and effective at alleviating symptoms and signs in patients with ocGVHD, making them a promising therapeutic option for the treatment of ocGVHD.

Prevalence of ocular symptoms in patients suffering from allergic rhinitis in an Indian suburb: A cross-sectional study

Allergic rhinitis (AR) also presents with multiple ocular symptoms such as itching, lacrimation, and bloodshot eyes which has an impact on patients’ life in areas of sleep, learning ability and job. Evaluation of prevalence of ocular symptoms in patients with allergic rhinitis. A cross-sectional, observational study was conducted in a health centre in India's suburban area. Between August 2022 and July 2023, 140 patients with AR were recruited in a systematic manner. During registration, medical history and information about concomitant disease, such as allergic diseases, medication, AR duration, and the presence of ocular symptoms, was gathered through interviews and physical tests. A total of 140 patients were included in the study who fulfilled the eligibility criteria. The average age was 27.3 years (+13.6 years), with men accounting for 63.7% (n=89). Comorbidities were seen in ten (7.14%) of the patients. Eye irritation, lacrimation, red eyes, and swollen eyelids were reported in 71 (50.70%), 37 (26.40%), 24 (17.14%), and 8 (5.71%) individuals, respectively (). Symptoms of eye irritation, lacrimation, red eyes and swollen eyelids were reported in 71 (50.70%), 37 (26.40%), 24 (17.14%), and 8 (5.71%) individuals, respectively. The ocular symptoms in patients with AR might have a major impact on their quality of life.

Likelihood of spontaneous closure of cavernous sinus dural arteriovenous fistulas based on clinical and radiological findings.

Cavernous sinus dural arteriovenous fistula (CSDAVF) is a rare condition that radiologists would encounter in their careers. We aim to describe the clinical and radiological characteristics of this condition, and to provide a management workflow. In our retrospective study, we studied 27 patients with CSDAVF from January 2007 to August 2020. Patients with direct cavernous sinus AVFs and patients with incomplete date were excluded. Clinical and radiological data were collected and analyzed. Fourteen patients were conservatively treated with spontaneous resolution while 13 patients had endovascular intervention performed. In the intervention group, seven patients had intra-cranial reflux seen on radiological imaging and six patients had clinical deterioration, hence requiring intervention. Clinically, among our patients, 21 had proptosis, 20 had conjunctiva hyperaemia, 18 had extraocular movement limitation, 13 had raised intraocular pressure, 11 had chemosis, ten had ocular pain, nine had ocular bruit, eight had headache and six had worsening visual acuity. Radiologically, a concurrence was seen between superior ophthalmic vein thrombosis and spontaneous resolution of the CSDAVF, as compared to those who underwent intervention. A paradoxical increase of ocular symptoms was seen despite a decrease of flow or stagnation of contrast in radiological imaging of CSDAVF. In our study, 52% of CSDAVF closed spontaneously. As deterioration of ocular symptoms in patients with CSDAVF might also reflect spontaneous progressive occlusion, it warrants dynamic vascular imaging to check the status of venous outflow. Patients with CSDAVF with corticovenous reflux or deterioration of visual acuity need more urgent (endovascular) treatment.

Traditional Chinese Medicine's Luffa Formula Reduces Nasal and Ocular Symptoms in Patients with Environmental and Food Allergies

Environmental allergy (EA) often coexists with other inflammatory conditions such as food allergy. It has been previously shown that the Luffa Formula in Traditional Chinese Medicine (TCM) reduces symptoms of allergic rhinoconjunctivitis in a murine model. We conducted a retrospective study on the Luffa Formula’s effect in reducing EA symptoms among people with comorbid environmental and food allergies, and conducted an in vitro study on IgE production and mast cell activation.

Dysfunctional peroxisomal lipid metabolisms and their ocular manifestations.

Retina is rich in lipids and dyslipidemia causes retinal dysfunction and eye diseases. In retina, lipids are not only important membrane component in cells and organelles but also fuel substrates for energy production. However, our current knowledge of lipid processing in the retina are very limited. Peroxisomes play a critical role in lipid homeostasis and genetic disorders with peroxisomal dysfunction have different types of ocular complications. In this review, we focus on the role of peroxisomes in lipid metabolism, including degradation and detoxification of very-long-chain fatty acids, branched-chain fatty acids, dicarboxylic acids, reactive oxygen/nitrogen species, glyoxylate, and amino acids, as well as biosynthesis of docosahexaenoic acid, plasmalogen and bile acids. We also discuss the potential contributions of peroxisomal pathways to eye health and summarize the reported cases of ocular symptoms in patients with peroxisomal disorders, corresponding to each disrupted peroxisomal pathway. We also review the cross-talk between peroxisomes and other organelles such as lysosomes, endoplasmic reticulum and mitochondria.

Combination therapy of allergic rhinitis: efficacy, safety and impact on quality of life

Currently, allergic rhinitis is one of the most common allergic diseases, and its significance is often underestimated by both doctors and patients, resulting in increased severity, decreased physical, professional, and social activity, sleep disturbance, and the impairment of the quality of life.&#x0D; Despite modern drug availability, the control level over allergic rhinitis symptoms in routine clinical practice remains low. Patients who do not receive a quick result from using intranasal glucocorticosteroids, which have anti-inflammatory and pathogenetic properties, prefer fast-acting decongestants instead, which can lead to chronization and adverse events. The use of intranasal glucocorticosteroids and antihistamines combination, which have additive effects on the key pathogenesis stages of allergic inflammation, allows for rapid treatment of the most severe rhinitis symptoms and can improve adherence to therapy.&#x0D; This review presents the results of clinical studies and key characteristics of the new nasal spray of the olopatadine and mometasone fixed combination, confirming the high efficacy and good safety profile of olopatadine + mometasone. The administration of olopatadine and mometasone fixed combination provides rapid relief from nasal and ocular symptoms in patients with allergic rhinitis, ultimately leading to an improvement in the quality of life.

Ocular Manifestations of Loeys–Dietz Syndrome

Loeys–Dietz syndrome (LDS) is caused by connective tissue mutations; the resulting defective connective tissue in organs such as the eye may be related to ocular symptoms in patients with LDS. The aim of this study was to review different ocular manifestations in LDS. A literature review of articles published within the past 5 years was performed using Web of Science™ and PubMed to search for ‘Loeys–Dietz’ with the terms ‘ocular’ and ‘ophthalmology.’ Additional search terms were generated from the initial literature assessment, and 32 articles were ultimately reviewed. Reported ocular symptoms in LDS included hypertelorism, ocular misalignment, refractive errors, and more. For LDS, the most reported findings were hypertelorism (n=111), astigmatism (n=25), down slanting palpebral fissures (n=20), myopia (n=9), and strabismus (n=8). However, more research on ocular symptoms in LDS is needed.

Management of Patients with Thyroid-Associated Ophthalmopathy: Role of Spectral Domain Optical Coherence Tomography

AIM: To demonstrate the changes in optic nerve head (ONH), retinal nerve fiber layer (RNFL) and macula in patients with thyroid-associated ophthalmopathy (TAO) by spectral domain optical coherence tomography (SD-OCT). &#x0D; METHODS: We included forty-one eyes of 41 patients with a diagnosis of TAO and forty-eight eyes of 48 age- and sex-matched healthy subjects (control group) from June 2016 to July 2018. The ONH parameters, RNFL and macular thicknesses in the nine macular quadrants according to ETDRS were measured with SD-OCT. Proptosis level was determined by Hertel exophthalmometer. Clinical activity score (CAS) according to the European Group of Graves' Orbitopathy (EUGOGO) guidelines was determined in all patients. &#x0D; RESULTS: Superior, inferior and average RNFL thicknesses were significantly lower in the TAO group compared to the control group (p &lt; 0.05). Optic disc area was significantly larger in the TAO group. Outer quadrant macular thicknesses and average macular thickness were significantly lower in the TAO group (p &lt; 0.05). CAS had a weak correlation with RNFL thickness and average macular thickness. &#x0D; CONCLUSION: Alterations in RNFL thicknesses and macular thicknesses according to ETDRS template can be detected before the development of ocular symptoms in patients with TAO. OCT is a convenient, non-invasive tool for the evaluation and follow-up of macular structural changes. Patients can be diagnosed at an early stage prior to the development of functional damage. However, the low number of studies investigating this subject and the conflicting findings of existing studies necessitate further studies.

Monoclonal gammopathy of ocular significance (MGOS) – a short survey of corneal manifestations and treatment outcomes

Monoclonal gammopathy of ocular significance (MGOS) is a rare subset of monoclonal gammopathy of clinical significance occurring secondary to plasma cell disorders and causing ocular manifestations. We identified 23 patients with paraproteinemic keratopathy (PPK) in the setting of monoclonal gammopathy of unknown significance (MGUS, 10), smoldering multiple myeloma (SMM, 3) or multiple myeloma (MM, 10). Many of these patients with PPK (11/23) presented decreased vision. All patients with MM and 40% of those with other diagnoses such as SMM and MGUS received systemic therapy with or without autologous stem cell transplantation. Four eyes of four patients were treated by penetrating keratoplasty. In most cases, neither ocular nor hematologic treatment afforded a durable improvement in the visual acuity (recurrence after a median of 11 months), despite initial responses. Further studies will be required to determine the optimal strategy to treat and prevent the relapse of ocular symptoms in patients with PPK.

Monoclonal Gammopathy of Ocular Significance (MGOS) - a Series of Corneal Manifestations and Treatment Outcomes

IntroductionMonoclonal gammopathy of ocular significance (MGOS) is a rare subset of monoclonal gammopathy of clinical significance (MGCS) occurring secondary to plasma cell dyscrasia resulting in ocular manifestations. Given the rarity of these conditions, optimal management strategies are not defined; the approach is dependent upon the underlying cause of the monoclonal gammopathy and whether or not the patient's vision is affected. We report our review of 23 cases with MGOS, more specifically on paraproteinemic keratopathy (PPK) the most common form, to obtain a better understanding of the patient characteristics, diagnosis and treatments.MethodsWe report an international retrospective series of patients with MGOS. Data was collected on patients with MGOS:there were no other inclusion criteria besides monoclonal gammopathy with an ophthalmologic manifestation; however, this report focuses only on patients with PPK. Efficacy outcomes were the hematologic and the ocular responses in patients with PPK. Hematologic responses were reported according to the IMWG response criteria. The ophthalmologic response to treatment was assessed by each contributing physician and reported as either complete, partial or no sight recovery.ResultsWe identified 23 patients with PPK in the setting of monoclonal gammopathy of unknown significance (MGUS), smoldering multiple myeloma (SMM), or multiple myeloma (MM) diagnosed between 2006 and 2019 in 7 countries. Table 1 summarizes the patients' characteristics. The ocular diagnosis was typically made at the same time or after the hematologic diagnosis. Eleven of 23 patients presented decreased vision. Four were treated by penetrating keratoplasty with or without systemic therapy, including chemotherapy with new generation anti-MM agents with or without autologous stem cell transplantation (ASCT). All patients with MM and 40% of those with other diagnoses such as SMM or MGUS received systemic therapy. In most cases, neither ocular nor hematologic treatment, even when ASCT was performed, afforded a durable improvement in the visual acuity despite initial responses. MGOS typically relapsed within one year of the initial response (Table 2).ConclusionTo date, this is the largest retrospective study focusing on MGOS patients with monoclonal immunoglobulin deposits accumulating in the cornea and resulting in visual impairment. Further studies will be required to determine the optimal strategy to treat and prevent the relapse of ocular symptoms in patients with PPK and specifically to address the timing of keratoplasty and systemic chemotherapy and the role of maintenance therapy. Patients with corneal manifestation of unknown origin should undergo a hematologic check-up and patients with paraproteinemia should have a periodic ocular health assessment. [Display omitted] DisclosuresGarderet: Takeda: Consultancy; Sanofi: Consultancy; Amgen: Consultancy; Janssen: Consultancy; Celgene: Consultancy. Munder: Janssen: Consultancy, Honoraria; BMS: Consultancy, Honoraria; Abbvie: Consultancy; Takeda: Consultancy, Honoraria; Amgen: Honoraria; Sanofi: Consultancy; GSK: Consultancy; Incyte: Research Funding. Gozzetti: AbbVie: Honoraria; Janssen: Honoraria. Rosinol: Janssen, Celgene, Amgen and Takeda: Honoraria. Jurczyszyn: Janssen-Cilag, Amgen: Honoraria, Speakers Bureau.

Electrically Induced Blink for the Prevention of Ocular Symptoms and Blurred Vision in Patients With Acute Facial Nerve Palsy.

Objectives: Facial nerve palsy causes blurred vision and ocular discomfort due to deficits in blinking and eye closure. The objective of this study was to determine whether eye-blinks could be elicited by electrical stimulation and whether electrically induced blink would have an effect on the visual acuity and ocular symptoms in patients with acute facial nerve palsy. Methods: The zygomatic branch of the facial nerve of fifteen participants with acute facial nerve palsy was electrically stimulated in order to elicit a blink. In successful cases, the participant proceeded with a two-hour TV watching session in which an electrically induced blink was delivered every 5seconds. The control condition consisted of an otherwise similar TV watching session without electrically induced blinking. Subjective ocular symptoms were evaluated with a Dry Eye Questionnaire and visual acuity was assessed with a Logarithm of the Minimum Angle of Resolution (LogMAR) chart before and after both sessions. Results: The stimulation produced a blink in 8 participants (53%). The visual acuity in the affected eye decreased during the control session, whereas no significant change occurred during the stimulation session. The ocular symptoms were significantly reduced during the stimulation session. Conclusions: Electrically elicited blink is a promising method for reducing the eye symptoms in individuals with acute facial nerve palsy.

SARS-CoV-2 in Conjunctiva and Tears and Ocular Symptoms of Patients with COVID-19.

This study investigates the presence of SARS-CoV-2 in conjunctival secretions and tears and evaluates ocular symptoms in a group of patients with COVID-19. We included 56 hospitalized patients with COVID-19 in this cross-sectional cohort study. Conjunctival secretions and tears were collected using flocked swabs and Schirmer strips for SARS-CoV-2 reverse-transcriptase polymerase chain reaction (RT-PCR). Assessment of ocular surface manifestations included an OSDI (Ocular Surface Disease Index) questionnaire. Patients had been admitted to hospital for an average of 2.4 days (range 0–7) and had shown general symptoms for an average of 7.1 days (range 1–20) prior to ocular testing. Four (7.1%) of 56 conjunctival swabs and four (4%) of 112 Schirmer strips were positive for SARS-CoV-2. The mean E-gene cycle threshold values (Ct values) were 31.2 (SD 5.0) in conjunctival swabs and 32.9 (SD 2.7) in left eye Schirmer strips. Overall, 17 (30%) patients presented ocular symptoms. No association was found between positive ocular samples and ocular symptoms. This study shows that SARS-CoV-2 can be detected on the conjunctiva and tears of patients with COVID-19. Contact with the ocular surface may transmit the virus and preventive measures should be taken in this direction.