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.

Comparative role of 20% cord blood serum and 20% autologous serum in dry eye associated with Hansen's disease: a tear proteomic study.

BACKGROUND: To compare the role of topically applied serum therapy with preservative-free artificial tear (AT) drops in patients with moderate to severe dry eye in Hansen's disease along with change in tear protein profile. METHODS: 144 consecutive patients were randomly divided into three groups. After a baseline examination of clinical parameters, each of the patients received designated modality of topical therapy six times a day for 6 weeks. Post-treatment documentation of clinical parameters was done at 6 weeks, and then at 12 weeks after discontinuation of topical therapy. Analysis of three tear proteins using gel electrophoresis (sodium dodecyl sulfate polyacrylamide gel electrophoresis) was done at baseline, at the first and second post-treatment visits. RESULTS: In the cord blood serum (CBS) group, except for McMonnies score and staining score, all other clinical parameters showed continued improvement in the first and second post-treatment analyses. In the autologous serum (ALS) group, all the clinical parameters except Schirmer's I showed significant improvement in the first post-treatment analysis .This was sustained at a significant level in the second analysis except for tear film break-up time (TBUT) and conjunctival impression cytology grading. In the AT group, all the parameters improved at a non-significant level except for TBUT in the first analysis. In the next analysis, apart from McMonnies score and TBUT, other clinical parameters did not improve. In the ALS and CBS groups, tear lysozyme, lactoferrin levels improved in both post-treatment measurements (statistically insignificant).Total tear protein continued to increase at statistically significant levels in the first and second post-treatment analyses in the CBS group and at a statistically insignificant level in the ALS group. In the AT group, the three tear proteins continued to decrease in both the analyses. CONCLUSIONS: In moderate to severe dry eye in Hansen's disease, serum therapy in comparison with AT drops, improves clinical parameters and causes betterment in tear protein profile. TRIAL REGISTRATION NUMBER: CTRI/2013/07/003802.

[Prevalence of dry eye in Hansen's disease patients from a colony hospital in Goiânia, Brazil]. / Prevalência de olho seco em portadores de hanseníase de um hospital-colônia em Goiânia.

PURPOSE: To determine the prevalence of dry eye in Hansen's disease patients from the "Hospital de Dermatologia Sanitária de Goiânia". METHODS: The sample of the present study included 70 patients with Hansen's disease, from the "Hospital de Dermatologia Sanitária de Goiânia", and 30 controls, from the "Fundação Banco de Olhos de Goiás", both located in Goiânia-GO, Brazil. Ophthalmologic examination and Schirmer I, break-up time (BUT) and rose Bengal staining tests were carried out for all patients in a single evaluation. For the diagnosis of dry eye the Schirmer I equal or less than 5 mm and rose Bengal grade II or III, in at least one eye were considered. RESULTS: Forty-four (63.0%) patients with Hansen's disease were male and 22 (73.3%) controls were female (p=0.001). The mean age of the patients with Hansen's disease was 61.1+/-12.5 years and in the control group, it was 55.7+/-9.6 years. Fifteen (21.4%) patients with Hansen's disease and four (13.3%) controls presented with dry eye diagnosis (p=0.429). The lepromatous type (74.2%) of Hansen's disease was the most prevalent and dry eye (66.7%) was more frequent in this clinical form of the disease. CONCLUSION: The dry eye disease was more prevalent in patients with Hansen's disease, although the difference was not statistically significant.

Prevalência de olho seco em portadores de hanseníase de um hospital-colônia em Goiânia / Prevalence of dry eye in Hansen's disease patients from a colony hospital in Goiânia, Brazil

OBJETIVO: Determinar a prevalência de olho seco em hansenianos do Hospital de Dermatologia Sanitária de Goiânia. MÉTODOS: A amostra do presente estudo incluiu 70 hansenianos, do Hospital de Dermatologia Sanitária de Goiânia, e 30 controles, da Fundação Banco de Olhos de Goiás, ambos localizados em Goiânia-GO. Foram realizados exame oftalmológico e testes de Schirmer I, "break-up time" (BUT) e rosa bengala em todos estes indivíduos em uma única avaliação. Para o diagnóstico de olho seco foi considerado o teste de Schirmer I menor ou igual a 5 mm e o rosa bengala grau II ou III, em pelo menos um olho. RESULTADOS: Quarenta e quatro (63,0 por cento) hansenianos eram do sexo masculino e 22 (73,3 por cento) controles, do sexo feminino (p=0,001). A idade média dos hansenianos foi de 61,1±12,5 anos e no grupo controle, 55,7±9,6 anos. Quinze (21,4 por cento) hansenianos e quatro (13,3 por cento) controles apresentaram diagnóstico de olho seco (p=0,429). A forma virchowiana (HV) (74,2 por cento) da hanseníase foi a mais prevalente e o olho seco (66,7 por cento) foi mais freqüente nesta forma clínica da doença. CONCLUSAO: A prevalência de olho seco foi maior no grupo de hansenianos, apesar de não ter havido diferença significativa.

Elevated free tear lactoferrin levels in leprosy are associated with Type 2 reactions.

PURPOSE: To determine the association of demographics, leprosy and ocular characteristics with altered levels of lactoferrin in the tears of normal subjects and leprosy patients, and to detect the presence of antibodies to lactoferrin in these tear samples. METHOD: We collected light-stimulated tears from 298 leprosy patients and an equal number of normal subjects using the glass capillary method. Free lactoferrin levels were estimated using ELISA and the presence of antibodies to lactoferrin was detected using the immuno-blotting method. Significant associations were looked for between tear lactoferrin levels and demographic characteristics, leprosy characteristics such as type of disease, duration of disease, reactions, deformity and bacterial load, and ocular complications, using chi-square and regression analysis. RESULTS: Tear lactoferrin levels with a mean (SD) of 2.55 (2.83)mg/ml in the control group were significantly different (P<0.000) from leprosy patients with a smean (SD) of 5.66 (7.21)mg/ml. Age showed an inverse correlation with tear lactoferrin levels in controls. Increased bacterial load, grade 2 leg deformity and Type 2 reactions were significantly associated (P<0.05) with increased tear lactoferrin levels. Type 2 reactions remained significantly associated (P=0.01) on multiple regression analysis. Tear lactoferrin levels were not associated with gender, serum lactoferrin levels, Type 1 reactions, face patches, treatment status, orbicularis oculi weakness, lagophthalmos, ectropion, entropion, corneal opacity, cataract and iridocyclitis. CONCLUSION: Age is inversely related to tear lactoferrin levels in normal subjects. Free lactoferrin levels in tears are significantly higher in leprosy patients compared with normal controls. Type 2 reactions in leprosy are significantly associated with elevated tear lactoferrin levels.

Pathogenesis of dry eye in leprosy and tear functions.

Seventy-five leprosy patients and an equal number of age- and sex-matched controls were examined for tear functions, using Schirmer's test and tear break up time (BUT). There was no statistically significant difference in the Schirmer's test, but the tear BUT showed a statistically significant lower value of < 10 seconds in multibacillary patients compared to paucibacillary patients. Leprosy patients with lagophthalmos and decreased corneal sensation showed a lower value of tear BUT which was also statistically significant. This study shows that even though the quantity of tears is not affected, proper and prolonged wetting of the cornea is deficient in many leprosy patients.

Factors influencing corneal involvement in leprosy.

Corneal involvement in leprosy is known to be influenced by factors such as lagophthalmos, ectropion, and corneal anesthesia. In the present study conducted on 400 eyes of leprosy patients, observations were made on tear film abnormalities, and their relation to the above-mentioned factors was analyzed. The abnormality of tear film breakup time (BKUT) was found to be clinically more significant (47.2%) than a Schirmer's test alone (24.5%), and this finding was of greater significance in the lepromatous form of leprosy. An abnormal BKUT reflects a decreased mucin secretion by the conjunctival goblet cells. Tear film abnormalities in association with lagophthalmos, corneal anesthesia, concomitant ocular diseases, and environmental factors such as high relative humidity have been identified as factors contributing to corneal involvement in leprosy in India. It is not surprising that with so many mechanisms of corneal involvement the clinical manifestations are diverse, and all forms of pathological changes may contribute to corneal morbidity.

Evaluation of precorneal tear film in leprosy.

The present study analyses the precorneal teat film using schirmer's test and tear film breakup time (BKUT) in 400 eyes of patients with various types of leprosy. An abnormal tear film BKUT (47.2%) was observed to be much more informative in the present series than the study of schirmer's test alone (25.4%). In patients with lagophthalmos an abnormal tear film BKUT (70%) was higher as compared to an abnormal schirmer's test (40%); while in cases of lagophthalmos with ectropion an abnormal schirmer's test was seen less frequently (26.8%) than in cases of lagophthalmos without ectropion (58.3%). This implied an increase in the aqueous content of the tear film in cases of lagophthalmos with ectropion on the basis of an associated chronic conjunctivitis. Lagophthalmos and ectropion have been identified as additional factors contributing to corneal morbidity. There was a statistically significant difference in the tear film abnormality in different types of leprosy, the maximal difference being in the lepromatous variety.

Tear lysozyme in lepromatous leprosy.

Lysozyme concentrations have been estimated in 47 patients with lepromatous leprosy and in 50 healthy people by a single radial immunodiffusion technique using monospecific antiserum against human lysozyme. In healthy people the mean tear lysozyme concentration was 1.34 mg/ml. In leprosy patients the mean tear lysozyme concentration was 1.0 mg/ml. Anterior uveitis per se did not appear to alter the lysozyme concentration in tears.

Ocular findings in Bell's palsy.

Thirty-three patients with Bell's palsy underwent ophthalmic examination, including Schirmer testing, corneal sensitivity measurement, and electromyography. Sixteen patients returned for follow-up after one year. Sixty-one percent of the patients initially showed punctate fluorescein staining of the inferior cornea. Electromyographic studies demonstrate a high correlation between orbicularis function and the presence of corneal epithelial staining. Our results demonstrate a high frequency of minor corneal involvement in the acute phase of Bell's palsy. Healing of the epithelial defects follows improvement in orbicularis function.

Syndrome of crocodile tears caused by lepra bacilli.

A case of the syndrome of crocodile tears as a result of tuberculoid type of leprosy is reported to lend support that the syndrome may be caused by this disease after a long period of its onset.

Syndrome of crocodile tears caused by lepra bacilli

A case of the syndrome of crocodile tears as a result of tuberculoid type of leprosy is reported to lend support that the syndrome may be caused by this disease after a long period of its onset.

Ocular immunoglobulins in lepromatous leprosy.

Immunoglobulin levels in the ocular fluids have been estimated in normal subjects and lepromatous leprosy patients. In the normal tear, IgA is the major immunoglobulin while IgG is the only immunoglobulin detected in the aqueous humor. The immunoglobulin profiles in the tear and the aqueous humor in normal subjects are different. The mean IgA level in the tears of the lepromatous leprosy group is significantly lower than in the control patients. IgA and IgG levels are raised in the aqueous humor of some leprosy cases who had suffered from uveitis in the past and also in all cases with active endogenous uveitis. Therefore, in lepromatous leprosy the pattern of immunoglobulin alteration in the tear and the aqueous humor is not parallel.

Management of the eye in facial paralysis

Ocular complications in patients with facial paralysis may be minimal or they may be severe enough to seriously handicap a patient. This discussion is concerned primarily with solutions to eye problems resulting from facial paralysis.