Characteristics of tear meniscus using a spectral domain optical coherence tomography in medically controlled glaucoma.

Purpose: To compare the tear meniscus height (TMH) and tear meniscus depth (TMD) between medically controlled glaucoma subjects and age-matched controls. Methods: This prospective, cross-sectional, observational study included 50 patients with medically controlled glaucoma and 50 age-matched controls. Glaucoma subjects using topical medications for the duration of more than 1 year were included. The age-matched controls were participants with no history of glaucoma, dry eye, or any other diseases affecting the ocular surface. All the participants underwent TMH and TMD scan using spectral domain-optical coherence tomography (SD-OCT), which was followed by ocular surface disease index (OSDI) questionnaire administration. Results: The mean ages of glaucoma subjects and age-matched controls were 40 ± 22 and 39 ± 21 years, respectively (P > 0.05). Of them, 40% (n = 22) were on single drug therapy or monotherapy and 60% (n = 28) were on multidrug therapy. TMH and TMD of glaucoma subjects and age-matched controls were 101.27 ± 31.86 versus 230.63 ± 49.82 µm and 70.60 ± 27.41 versus 167.37 ± 57.06 µm, respectively. Subjects on multidrug therapy showed a statistically significant reduction in TMH and TMD when compared to age-matched controls. Conclusion: Preservative containing topical glaucoma medications affects the ocular surface, including the tear film. The prolonged duration and multiple combination of this drug usage serve as potential factors for causing reduction in the tear meniscus levels leading to drug-induced dryness.

Ocular manifestation in treated multibacillary Hansen's disease.

PURPOSE: To report the prevalence of ocular morbidity in patients with treated multibacillary Hansen's disease (HD) using modern ophthalmic diagnostic techniques in a rural community endemic for HD. DESIGN: Cross-sectional, observation study. PARTICIPANTS: All patients with multibacillary HD who had completed their multidrug therapy and who resided in 4 defined geographical areas in Vellore, Tamil Nadu, India. METHODS: All participants underwent a complete eye examination that included slit-lamp examination, esthesiometry, gonioscopy, applanation tonometry, and dilated fundus examination, including a stereobiomicroscopic examination of the fundus at an ophthalmic center set up for that purpose. Glaucoma suspects underwent automated perimetry using a Humphrey Field Analyzer (Humphrey Instruments, San Leandro, CA). MAIN OUTCOME MEASURES: The prevalence of various ocular disease parameters were reported as mean value with 95% confidence interval. The difference of disease prevalence between various leprosy groups was compared using an unpaired t test. The association between eye symptoms and potentially sight-threatening complications was analyzed using the chi-square test. RESULTS: Three hundred eighty-six of the 446 patients with multibacillary HD residing in the defined areas were evaluated. Four patients (1.04%; 95% confidence interval [CI], 0.0%-2.0%) were bilaterally blind; 33 (8.55%; 95% CI, 5.8%-11.3%) had unilateral blindness. Mean intraocular pressure was 12 mmHg (standard deviation, 4.1 mmHg), and prevalence of glaucoma was 3.6% (95% CI, 1.8%-5.5%). Potentially sight-threatening (PST) pathologic features (corneal anesthesia, lagophthalmos, uveitis, scleritis, and advanced glaucoma) were present in 10.4% (95% CI, 7.4%-13.4%) of patients. Significant cataracts occurred 3 times more frequently in those with polar lepromatous leprosy. The odds ratio for PST pathology in the presence of patient-reported symptoms (pain, redness, inability to close eye, burning, and irritation) was 2.9 (95% CI, 1.34-6.26). CONCLUSIONS: Patients who have completed treatment for multibacillary HD continue to have significant ocular morbidity. A history of specific eye symptoms can be the basis for referral by field staff.

Leading causes of blindness worldwide.

The main causes of blindness and visual disabilities, as described in documents published by the World Health Organization (WHO), are discussed.

Blindness in Africa: present situation and future needs.

AIM: To review the prevalence and causes of blindness in sub-Saharan Africa, the existing services and limitations, and the Vision 2020 goals for the future. METHODS: Methodologically sound population based surveys published in the past 20 years are reviewed and results for prevalence and causes of blindness are tabulated. The current resources and needs according to recent publications and international working groups are described. CONCLUSIONS: Blindness prevalence rates vary widely but the evidence suggests that approximately 1% of Africans are blind. The major cause is cataract; trachoma and glaucoma are also important causes of blindness. The bulk of blindness in the region is preventable or curable. Efforts should focus on eye problems which are universally present and for which there are cost effective remedies, such as cataract and refractive problems and on those problems which occur focally and can be prevented by primary healthcare measures, such as trachoma, onchocerciasis, and vitamin A deficiency. Major development of staffing levels, infrastructure, and community programmes will be necessary to achieve Vision 2020 goals.

Lepromatous uveitis diagnosed by iris biopsy.

Ocular leprosy is rarely seen in developed countries. We report the long-term follow-up of a patient with bilateral uveitis, glaucoma, and keratitis. Skin, iris and aqueous humor biopsies disclosed abundant Wade-Fite-positive organisms consistent with Mycobacterium leprae. Leprosy must be considered in the differential diagnosis of keratitis and uveitis.

Ocular involvement in tuberculoid leprosy--a case report.

Leprosy is rarely diagnosed in our part of the world. In our 26-year-old patient, borderline lepromatous leprosy was first diagnosed in 1992 and was treated with Rifoldin, Lemprene and Dapson according to the standard WHO scheme of treatment. Ophthalmic examination showed minor epithelial lesions of the cornea in both eyes, a reduced corneal reflex in the left eye and a scleral leproma nasally and close to the limbus, also in the left eye. In 1995, the patient was examined again and was treated as above for lepromata of the left eyebrow nasally and of both lower legs. Ophthalmic examination revealed conjunctival irritation, anterior uveitis with leprosy pearls on the pupillary margin and secondary glaucoma. The glaucoma was treated with hypotonics, the uveitis was treated with topical cortisone. The intra-ocular pressure normalised and the uveitis improved. Of the two main types of leprosy, lepromatous leprosy and tuberculoid leprosy, our patient had the second, milder form.

Cataract surgery in a leprosy population in Liberia.

In Liberia, 43 eyes of 30 patients with ocular leprosy underwent cataract extraction; 33 eyes had extracapsular cataract extraction (ECCE) and 10 eyes had intracapsular cataract extraction (ICCE). ICCE was performed in eyes with poor visualization of the anterior chamber. In 95% of the eyes, the postoperative vision improved by 2 Snellen lines or more, but functional visual acuity (better than 20/200) was achieved in only 65% (82% post-ECCE and 10% post-ICCE). Fewer postoperative complications were observed after ECCE. These findings may have been related to less ocular involvement by leprosy preoperatively. ECCE should be attempted when the visualization of the anterior chamber is fair.

Glaucoma in Hansen's disease.

Glaucoma is considered to be an uncommon complication of Hansen's disease (leprosy). This study determined the prevalence and characteristics of glaucoma in a large institutionalised leprosy population. All 193 patients currently residing at the Gillis W Long Hansen's Disease Center received a complete ophthalmic examination and review of their records. All had been previously treated with dapsone and/or clofazimine. Based on the strict definition of a recorded intraocular pressure greater than or equal to 22 mm Hg and characteristic optic nerve pathology, 19 patients (10%) were found to have glaucoma. Glaucoma secondary to uveitis was noted in 11 of these patients. These findings suggest that the chronic inflammatory process of Hansen's disease, even when treated, may be followed by secondary glaucoma. We recommend that all patients with Hansen's disease receive regular periodic examinations, including slit-lamp biomicroscopy to detect low-grade iridocyclitis and measurement of intraocular pressure.

Salud ocular comunitaria: en busqueda de soluciones; primera parte / Ocular community health: in search of solutions; first part

Enfermedades como la catarata, tracoma, glaucoma, oncocercosis, xeroftalmia, degeneracion macular, retinopatia diabetica y lepra son las principales causas de ceguera en el mundo. El 93% de los ciegos estan distribuidos en Asia, Africa y Latinoamerica como resultante de las desfavorables condiciones socio-economicas, ambientales, culturales y el limitado acceso da la atencion oftalmologica de sus habitantes. De acuerdo con las estadisticas presentadas en Colombia es prioridad desarrollar un programa nacional de salud ocular, que ademas de realizar acciones para la prevencion de la ceguera, incluya la atencion adecuada de otros problemas visuales como los defectos refractivos y de patologias oculares que, a pesar de no ser causa de limitacion visual permanente, necesitan tratamiento medico o quirurgico. A nivel departamental, la Fundacion Oftalmologica de Santander -FOS, con el apoyo de organismos internacionales, avanza en la planeacion de actividades de investigacion basica y en el desarrollo de programas de prevencion y tratamiento para las poblaciones mas necesitadas

Ophthalmic disease in Western Samoa.

Since the last report on eye disease in Western Samoa in 1959 by Dr. Elliott, the population has increased from 97,000 to 158,000. The country now has a full-time ophthalmologist but could benefit from a larger eye care service. The distribution of disease is very similar to that found in 1959, with pterygium, cataract and injuries comprising the most frequent eye problems. Acute angle-closure glaucoma is much more common than open-angle glaucoma and is associated with a plateau iris configuration.