Effects of combined oral doxycycline and topical cyclosporine treatment on ocular signs, symptoms, and tear film parameters in rosacea patients / Efeitos da doxiciclina oral combinada e tratamento tópico com ciclosporina nos sinais e sintomas oculares e em parâmetros do filme lacrimal em pacientes com rosácea ocular

ABSTRACT Purpose: This study reports the effects of combined use of oral doxycycline and topical cyclosporine on ocular signs, symptoms, and tear film parameters in rosacea patients. Methods: Fifty-four right eyes of 54 patients were included in this study. All patients underwent full ophthalmologic examination-including best corrected visual acuity measurement, slit-lamp anterior segment and fundus examination, tear film break-up time, and Schirmer test-before treatment and six months post-treatment. Patients were divided into two treatment groups. The first group was treated with oral doxycycline 100 mg twice daily for the first month and once daily for the following two months. The second group received topical 0.05% cyclosporine emulsion drops twice daily for six months in addition to the oral doxycycline treatment regimen. All patients received preservati ve-free artificial tear drops, warm compress, eyelash cleaning, and topical corticosteroid drops three times daily for one month. Results: A significant improvement in ocular signs and symptoms was recorded for all patients in groups 1 and 2 after treatment. There was not a significant difference in terms of itching, burning, meibomian gland inspissation, corneal neovascularization, and conjunctival hyperemia score changes between groups 1 and 2. The increases in Schirmer test and break-up time scores were significantly higher in group 2 than in group 1. Conclusions: Our results support the finding that topical cyclosporine in addition to the standard regimen improves tear function, as shown by Schirmer test and break-up time scores, in ocular rosacea patients.

RESUMO Objetivo: Este estudo relata os efeitos do uso combinado de doxiciclina oral e ciclosporina tópica sobre sinais e sintomas oculares e sobre parâmetros do filme lacrimal em pacientes com rosácea. Métodos: Cinquenta e quatro olhos direitos de 54 pacientes foram incluídos no estudo. Todos os pacientes foram submetidos a exame oftalmológico completo - incluindo a melhor medida da acuidade visual corrigida, segmento anterior em lâmpada de fenda e exame de fundo de olho, tempo de ruptura do filme lacrimal e teste de Schirmer - antes do tratamento e após seis meses de tratamento. O primeiro grupo foi tratado com doxiciclina oral 100 mg duas vezes ao dia no primeiro mês e uma vez ao dia nos dois meses seguintes. O segundo grupo recebeu gotas tópicas de emulsão de ciclosporina a 0,05% duas vezes ao dia por seis meses, além do tratamento com doxiciclina por via oral. Todos os pacientes receberam gotas de lágrima artificial sem conservantes, compressas mormas, limpeza de cílios e gotas de corticosteróide tópico três vezes ao dia durante um mês. Resultados: Uma melhora significativa nos sinais e sintomas oculares foi registrada para todos os pacientes do grupo 1 e 2 após o tratamento. Não houve diferença significativa em termos de prurido, queimação, inspeção da glândula meibomiana, neovascularização da cór nea e alterações na pontuação da hiperemia conjuntival entre os grupos 1 e 2. O teste de Schirmer e o aumento do tempo de ruptura no grupo 2 foram significativamente maiores do que no grupo 1. Conclusões: Os autores concluíram que os resultados apoiam a descoberta de que a ciclosporina tópica, além do tratamento padrão, melhora a função lacrimal como demonstrado pelo teste de Schirmer e o tempo de ruptura em pacientes com rosácea ocular.

Assessment of non-invasive tear break-up time and tear meniscus height after instillation of three different formulations of anesthetic eye drops by Oculus Keratograph 5M / Avaliação do tempo de ruptura lacrimal não invasivo e da altura do menisco lacrimal após a instilação de três diferentes formulações de colírio anestésico por Oculus Keratograph 5M

Abstract Purpose: To assess the non-invasive tear break-up time (NITBUT) and tear meniscus height (TMH) after instilling the three different types of anesthetic eye drops by Oculus Keratograph 5M. Methods: In this prospective study, 85 healthy subjects (85 eyes) were randomly divided into three groups. The groups were randomly received lidocaine hydrochloride 2%, proparacaine hydrochloride 0.5%, and tetracaine hydrochloride 0.5%. The qualitative and quantitative parameters of tear film were assessed using NITBUT and TMH, respectively. In all groups, the quantity of tear film using TMH was measured in the right eye of subjects, while the quality of tear film using NITBUT was assessed in the left eye. The analysis of variance (ANOVA) was used to compare the difference between before and after the intervention. A P-value < 0.05 was considered significant. Results: Differences for TMH and NITBUT between before and after applying lidocaine hydrochloride 2% were not statistically significant (P > 0.05). The mean values of NITBUT and TMH after the instillation of proparacaine hydrochloride 0.5% showed a significant decrease than before the intervention (P < 0.05). Also, after the use of tetracaine hydrochloride 0.5%, the mean value of NITBUT was significantly increased (P < 0.05), but the mean value of TMH was significantly decreased than before the intervention (P < 0.05). Conclusion: Our study showed that lidocaine hydrochloride 2% as an anesthetic eye drops can be an appropriate choice for eye examinations due to a lack of significant effect on the quantity and quality of tear film.

Resumo Objetivo: Avaliar o tempo de ruptura lacrimal não invasivo (NITBUT) e a altura do menisco lacrimal (TMH) após instilar os três tipos diferentes de colírio anestésico pelo Oculus Keratograph 5M. Métodos: Neste estudo prospectivo, 85 indivíduos saudáveis (85 olhos) foram divididos aleatoriamente em três grupos. Os grupos receberam aleatoriamente cloridrato de lidocaína a 2%, cloridrato de proparacaína a 0.5% e cloridrato de tetracaína a 0.5%. Os parâmetros qualitativos e quantitativos do filme lacrimal foram avaliados utilizando NITBUT e TMH, respectivamente. Em todos os grupos, a quantidade de filme lacrimal utilizando TMH foi medida no olho direito dos sujeitos, enquanto a qualidade do filme lacrimal usando NITBUT foi avaliada no olho esquerdo. A análise de variância (ANOVA) foi utilizada para comparar a diferença entre antes e depois da intervenção. Um valor de P < 0.05 foi considerado significativo. Resultados: Diferenças para TMH e NITBUT entre antes e depois da aplicação de cloridrato de lidocaína a 2% não foram estatisticamente significantes (P > 0.05). Os valores médios de NITBUT e TMH após a instilação de cloridrato de proparacaína a 0.5% mostraram uma diminuição significativa do que antes da intervenção (P < 0.05). Além disso, após o uso de cloridrato de tetracaína a 0.5%, o valor médio de NITBUT foi significativamente aumentado (P < 0.05), mas o valor médio de TMH foi significativamente menor do que antes da intervenção (P < 0.05). Conclusão: Nosso estudo mostrou que o cloridrato de lidocaína a 2% como colírio anestésico pode ser uma escolha apropriada para exames oftalmológicos devido à falta de efeito significativo sobre a quantidade e a qualidade do filme lacrimal.

Tear film and ocular surface alterations in chronic users of antiglaucoma medications

PURPOSE: Tear film can be altered by chronic medications that may disrupt the equilibrium responsible for the functioning of the lacrimal gland and ocular surface. The purpose of this study was to determine if antiglaucomatous chronic treatment induced alterations in the tear film and ocular surface. METHODS: After informed consent, 21 patients using antiglaucomatous eye drops for more than 8 months and 20 age- and sex-matched volunteers without eye and systemic medications (control group) were enrolled. The data of ocular discomfort, fluorescein and lisamine green staining, tear film break-up time and Schirmer test were collected and compared by Student's t test. The impression cytology data were graded and compared by chi-square test. RESULTS: Patients chronically using antiglaucomatous medications presented with significant higher fluorescein staining (p=0.003), lisamine green staining (p=0.02) and lower TFBUT (p=0.001). The other comparedparameters, including impression cytology were similar between the treated and control group (p>0.05). CONCLUSIONS: The present study shows that the tear film and the ocular surface are altered in patients under antiglaucomatous medications. In common, all medications were preserved with benzalkonium chloride. Efforts to minimize the adverse effects of chronic use of antiglaucomatous drugs must be addressed.

OBJETIVO: O filme lacrimal pode ser alterado por medicações crônicas, que podem comprometer o equilíbrio responsável pela função da glândula lacrimal e da superfície ocular. O objetivo desse estudo foi determinar se o tratamento crônico com drogas antiglaucomatosas induz alterações no filme lacrimal e superfície ocular. MÉTODOS: Após o consentimento informado, 21 pacientes usando drogas antiglaucomatosas por mais de 8 meses e 20 voluntários com similar distribuição etária e por sexo, não usuários de medicação ocular ou sistêmica (grupo controle) foram incluídos. Os dados do desconforto ocular, coloração com fluoresceína e lissamina verde, tempo de ruptura do filme lacrimal e teste de Schirmer foram colhidos e analisados pelo teste t de Student. A citologia de impressão foi avaliada e comparada pelo teste de qui-quadrado. RESULTADOS: Pacientes usando cronicamente medicação antiglaucomatosa apresentaram ignificativamente maior coloração por fluoresceína (p=0,003), lissamina verde (p=0,02) e menor TRFL (p=0,001). Os outros parâmetros comparados, incluindo a citologia de impressão foram similares entre o grupo tratado e controle (p>0,05). CONCLUSÕES: Esse estudo demonstra que o filme lacrimal e a superfície ocular estão alterados em usuários de medicação antiglaucomatosa. Essas medicações apresentam em comum o cloreto de benzalcônio como conservante. Esforços para minimizar efeitos adversos do uso crônico de drogas antiglaucomatosas devem ser considerados.

[Iohexol effects on tear biochemical profiles in normal large animal model]

Dacryocystography or visualization of nasolacrimal duct has been widely used in the assessment of the nasal lacrimal system. The water-soluble agent iohexol is currently widely used in nervous and vascular lesion in diagnostic radiology and also employed in dacryocystography. This study was performed to determine the effects of iohexol on tear parameters in normal donkey as a large animal model. We examined 10 normal donkeys mean age approximately 4.5 years. The donkeys received iohexol once a day. All donkeys were housed out doors throughout the study. Different tear parameters [total protein, lysozyme, sodium, and potassium and protein electrophoresis of tear] were measured at 0, 2 hours and 2 weeks after dacryocystography with iohexol. The results showed that mean and standard deviation of total protein of tear were 5.88 +/- 2.15 mg/ml before dacryocystography and after 2 hours was 4.10 +/- 0.96 and after two weeks was 7.36 +/- 3.68. Mean and standard deviation of lysozyme was 858.39 +/- 170.88 units in Mg of protein of tear and after two hours was 1013.19 +/- 178.67 and after two week was 702.54 +/- 360.50. Mean +/- SD of sodium of tear before dacryocystography was 3084.90 +/- 725.44 micro/ml and after two hours and two weeks were 3508.40 +/- 1372.52 and 8026.20 +/- 2953.88 respectively. Mean +/- SD of Potassium of tear before dacryocystography was 863.37 +/- 52.55 micro/ml and after two hours and two weeks were 753.84 +/- 46.81 and 1564.20 +/- 276 +/- 41 respectively. Results of SDS-PAGE of donkeys tear confirmed that nine protein bands with molecular weights between 10 kDa and 15 kDa are present. No differences found in protein electrophoresis pattern before and after iohexol administration. No significant changes were present in measured factors at different times. In conclusion iohexol is a safe and suitable contrast media for dacryocystography

Short Term Effects of Topical Cyclosporine and Viscoelastic on the Ocular Surfaces in Patients with Dry Eye

PURPOSE: To compare the short term effects of topical 0.05% cyclosporine (CsA) and a mixture of 0.08% chondroitin sulfate and 0.06% sodium hyaluronate (CS-HA) on dry eye ocular surfaces. METHODS: 36 patients with moderate to severe dry eye (5 mm/5 min or less with Schirmer's test or tear break up time (BUT) less than 6 seconds), were treated with topical application of CS-HA on one eye and CsA on the other 4 times a day for 6-8 weeks. BUT, Schirmer's test without anesthesia, and conjunctival impression cytology (CIC; goblet cell density, nucleus to cytoplasmic ratio, and epithelial cell morphology) were evaluated and compared between eyes before and after treatment (repeated measurement of ANOVA). RESULTS: After treatment, BUT and tear wettings were significantly prolonged in each group. Topical CsA treated eyes had greater increase in BUT (p=0.026); there was no significant difference in tear wetting (p=0.132). While the 3 parameters of CIC improved in both groups, goblet cell density was significantly higher in eyes treated with CsA (p=0.033). CONCLUSIONS: While both CS-HA and 0.05% CsA eyedrops improve ocular surfaces, topical CsA may have a better effect on enhancing tear film stability and goblet cell density.

Comparação entre o uso tópico do fumarato de cetotifeno 0.025 por cento e do cloridrato de olopatadina 0.1 por cento no tratamento da ceratoconjuntivite primaveril / Comparative study between 0.025 percent ketotifen fumarate and 0.1 percent olopatadine hydrochloride in the treatment of vernal keratoconjunctivitis

OBJETIVO: O objetivo desse estudo foi comparar as soluções oftálmicas de fumarato de cetotifeno 0,025 por cento e de cloridrato de olopatadina 0,1 por cento em pacientes portadores de ceratoconjuntivite primaveril. MÉTODOS: Avaliação realizada em um único centro, simples-cega, comparando-se paralelamente cetotifeno e olopatadina. As medicações foram avaliadas em 4 momentos (dias 1, 7, 14 e 21) por meio de tabelas de graduações padronizadas. A freqüência de eventos adversos foi a principal variável de segurança. RESULTADOS: Na avaliação da evolução do prurido ocular, ardor, lacrimejamento, hiperemia conjuntival, secreção e fotofobia observou-se que o uso tópico do cetotifeno proporcionou melhora significante deste sintoma em relação a olopatadina (p>0,05). Observou-se que a partir do 7° dia de tratamento os pacientes em uso da olopatadina tinham menos ardor, em relação aos que fizeram uso do cetotifeno, mas após o 21° dia essa relação inverteu. Na comparação da sensação de corpo estranho, papilas e pontos de Horner-Trantas evidenciou-se equivalência sem significância estatística. CONCLUSÃO: Concluímos que ambas são drogas equivalentes e atuaram de forma eficaz e segura na remissão dos sintomas relacionados à conjuntivite alérgica primaveril. Houve diferença a favor do cetotifeno (p<0,05) na melhora do prurido, lacrimejamento, hiperemia conjuntival, presença de secreção e fotofobia.

PURPOSE: To compare the topical use of 0.025 percent ketotifen fumarate and 0.1 percent olopatadine hydrochloride in the treatment of patients with vernal keratoconjunctivitis. METHODS: A study performed in one center, simple masked, parallel-group compared ketotifen and olopatadine. These patients were evaluated on four visits during the treatment (days 1, 7, 14 and 21), defined by ratings scores. Adverse events were the main variable of safety rating. RESULTS: On evaluating ocular itching, burning, tearing, conjunctival hyperemia, mucous discharge and photophobia, the ketotifen group showed a significant improvement of total signs and symptoms (p<0.05). Between the baseline and the 2nd visit, treatment with olopatadine resulted in decreased burning, but after the 4th visit, ketotifen was slightly better. Sand sensation, papillae and Horner-Trantas dots were not significantly different in both groups. CONCLUSION: Both drugs were efficient and safe relieving the main symptoms and signs of vernal keratoconjunctivitis. Between the same timepoints, there was a significant difference in favor of ketotifen-treated patients (p<0.05), showing improvement of itching, tearing, conjunctival hyperemia, mucous discharge and photophobia.

Análise morfométrica da fenda palpebral de pacientes com oftalmopatia distireóidea antes e após aplicação de toxina botulínica tipo A / Morphometric analysis of the palpebral fissure in patients with thyroid-related disfunction before and after application of botulinum toxin / Morphometric analysis of the palpebral fissure in patients with thyroid-related disfunction before and after application of botulinum toxin

INTRODUÇÃO: A toxina botulínica tem sido usada como opção terapêutica para retração palpebral em pacientes com oftalmopatia distireóidea. Os objetivos deste trabalho foram apresentar dados morfométricos da fenda palpebral, avaliar o efeito da medicação sobre a função do músculo elevador da pálpebra superior e em relação à exposição ocular. MÉTODOS: Foram incluídos 7 pacientes com retração palpebral. A propedêutica foi realizada com o registro de imagens através de câmera filmadora digital. Foram utilizados programas para edição dos vídeos e para análise da fenda palpebral. Também foi realizada a medida da função do tendão do músculo elevador da pálpebra superior e a propedêutica do filme lacrimal. RESULTADOS: Os dados morfométricos mostraram uma diminuição da fenda palpebral e da distância entre a margem da pálpebra superior e o reflexo luminoso no centro da córnea, a função do músculo elevador da pálpebra superior apresentou uma diminuição de seu valor e a propedêutica do filme lacrimal evidenciou uma maior estabilidade do filme lacrimal após o uso da medicação. DISCUSSÃO: A toxina pode ser uma opção de tratamento para pacientes com retração palpebral, amenizando o problema estético e os sinais de exposição corneana.

INTRODUCTION: Botulinum toxin is an alternative treatment for retraction of ocular thyroid related dysfunction. The aim of this study was to evaluate the effects of this medication on upper lid position, levator palpebrae superioris muscle function and corneal exposure. METHODS: Seven patients were enrolled into the study. The palpebral fissure images were acquired by a digital camera and transferred to a computer video edition program in order to be processed and analyzed. The levator palpebrae superioris muscle function and lacrimal film tests were also studied. RESULTS: The distance between upper eyelid superior margin and light reflection on the center of the cornea had a significantly reduction in its measurements after toxin injection. The muscle function was diminished and there were improvement in corneal exposure after treatment. DISCUSSION: Botulinum toxin injection could be an alternative treatment for upper eyelid retraction; it may relieve symptoms and improve eye appearance.

Avaliação do filme lacrimal de pacientes com distonia facial durante tratamento com toxina botulínica tipo A / Lacrimal film evaluation of patients with facial dystonia during botulinum toxin type A treatment

OBJETIVO: Determinar o efeito da toxina botulínica no filme lacrimal em pacientes com distonia facial. MÉTODOS: Foram incluídos 24 pacientes portadores de blefaroespasmo essencial e espasmo hemifacial que receberam aplicação de toxina botulínica tipo A que foram submetidos à propedêutica do filme lacrimal previamente à aplicação e após, com 7 e 30 dias. RESULTADOS: Houve diminuição das queixas de olho seco trinta dias após a aplicação, entretanto, o tempo de ruptura do filme lacrimal e o teste de Schirmer não demonstraram variação significativa entre os períodos pré-tratamento e 1 mês da aplicação. Em relação ao teste de coloração com rosa bengala, todos os olhos que coraram no pré-tratamento, melhoraram na última avaliação. CONCLUSÃO: A injeção de toxina botulínica pode aliviar as queixas de olho seco nos pacientes com distonia facial pela provável ação de inibição do orbicular na sua função de bomba lacrimal.

The Effect of Low-Dose Doxycycline Therapy in Chronic Meibomian Gland Dysfunction

PURPOSE: The aim was to investigate the effect of low dose doxycycline (20 mg) therapy in patients with chronic meibomian gland dysfunction that were refractory to conventional therapy. METHODS: The randomized prospective study enrolled 150 patients (300 eyes) who have chronic meibomian gland dysfunction and who didn't respond to lid hygiene and topical therapy for more than 2 months. All topical therapy was stopped for at least 2 weeks prior to beginning the study. After conducting the tear break up time test (TBUT) and Schirmer test, the authors randomly divided the patients into three groups a high dose group (doxycycline, 200 mg, twice a day), a low dose group (doxycycline, 20 mg, twice a day) and a control group (placebo). After one month, the author repeated the TBUT and Schirmer tests, and analyzed the degree of symptomatic improvement. RESULTS: Compared to the control group, both the high and low dose group showed statistically significant differences after treatment in TBUT, Schirmer test, the number of symptoms reported and the degree of improvement of subjective symptoms. However, there was no statistically significant difference between the high and low dose group after treatment in TBUT (9.42+/-2.87 sec, 9.54+/-1.58 sec, p=0.726), Schirmer test (19.98+/-4.05 mm, 19.65+/-5.02 mm, p=0.624), the number of symptoms reported (1.45+/-0.62, 1.53+/-0.52, p=0.304), as well as the degree of improvement of subjective symptoms (p=0.288). The high dose group (18 patients, 39.13%) reported side effects more frequently than did the low dose group (8 patients, 17.39%) (P=0.002). CONCLUSIONS: Low dose doxycycline (20 mg twice a day) therapy was effective in patients with chronic meibomian gland dysfunction that were refractory to conventional therapy.

General anesthesia reduces basal tear production

To measure the effect of general anaesthesia on basal tear production in order to determine the need for the prophylactic use of ophthalmic preparations. Design and Setting: 150 patients [300 eyes] undergoing general anaesthesia for more than 90 minutes for non-ophthalmic surgical procedures were divided randomly into 3 groups [C, T and O]. Eyes in group C were left as such, in group T hypoallergen tape was applied and in group O chloromycetin applicap ointment was used. In all the eyes basal tear production was assessed by Schirmer 1 and 2 tests both pre and postoperatively. All the patients were subjected to conventional general anaesthesia technique. General anaesthesia reduced basal tear production irrespective of the method of eye protection used [P < 0.0001]. It is suggested that prophylactic eye care during general anaesthesia should include both replacement of tears and prevention of mechanical exposure of the cornea

Factores del postoperatorio de pterigium que llevan al abandono del tratamiento antes de terminarlo en los pacientes ambulatorios del Hospital San Ignacio / Pterigium postoperative factors which convey to abandom of the treatment before ending by the ambulatory patients from Hospital San Ignacio

Se revisaron las historias clinicas de 35 pacientes operados de pterigium durante los 4 primeros meses de 1987., que habian interrumpido o modificado el tratamiento postoperatorio prescrito por el cirujano, para identificar los motivos que los llevaron a esta determinacion, teniendo en cuenta que todos tenian algun grado de escolaridad y el 71.4 por ciento reconocia la importancia del cuidado postoperatorio. En el presente estudio se encontro que el 65.7 por ciento no reconocia la utilidad del vendaje ocular, el 5.6 por ciento no daba importancia a la aplicacion de calor humedo local y el 17.1 por ciento no utilizo los colirios prescritos durante el tiempo indicado. El 91 por ciento manifesto que el vendaje le habia molestado en terminos de sensacion de presion sobre el ojo incrementando la sensacion de cuerpo extrano producida por la sutura. El 82.7 por ciento sintio ardor despues de aplicarse el colirio. Las medidas mas utilizadas por los pacientes para reducir la incomodidad fueron: aflojar o retirar el vendaje (58 por ciento ) y reducir la frecuencia de la administracion de la droga. Se evaluaron tambien las modificaciones de pH de las lagrimas, en respuesta a la aplicacion de Maxitrol, Blefamide, y Flumex encontrandose que el primero produce mayores cambios, seguido del Blefamide y del Flumex