Corneal ulceration in a LASIK patient due to vitamin a deficiency after bariatric surgery.

PURPOSE: To review the case of a 41-year-old woman who underwent bariatric surgery in 2000. She subsequently underwent laser in situ keratomileusis (LASIK) surgery in 2008 and complained of dry eye since the LASIK surgery. In November 2010, she was diagnosed with a corneal melt and was treated with aggressive lubrication, followed by eventual amniotic membrane placement and a tarsorrhaphy. She then presented for consultation at the Bascom Palmer Eye Institute when she developed a corneal infiltrate. She was diagnosed with fungal keratitis with corneal xerosis. At that time, vitamin A levels were measured and were less than 2 µ/dL. The patient admitted noncompliance with nutritional supplements. METHODS: Case report. RESULTS: The patient was treated with aggressive lubrication and natamycin. Vitamin supplements were restarted, and the patient experienced dramatic improvement in symptoms with resolution of the infection. A central corneal scar with corneal thinning remains. The patient underwent a penetrating keratoplasty for visual rehabilitation. CONCLUSIONS: Patient education with emphasis on compliance with nutritional supplements is essential after bariatric surgery. Consider vitamin A deficiency in the differential diagnosis of dry eye after LASIK surgery.

Síndrome de Sjögren / Sjögren’s syndrome

El síndrome de Sjögren es una enfermedad sistémica autoinmunitaria que se caracteriza por queratoconjuntivitis seca, xerostomía y un amplio espectro de signos y síntomas que se traduce en una enfermedad muy heterogénea. La forma leve con afección de mucosas es la más frecuente, pero existen patrones más severos y activos, que se manifiestan por afección extraglandular, con peor pronóstico. El espectro clínico incluye afección de mucosas, fenómeno de Raynaud, parotidomegalia o artritis, pero puede agravarse por afección neurológica, pulmonar o renal. El tratamiento inicial incluye el tratamiento tópico con lágrimas artificiales, pomadas nocturnas, hasta fármacos sialogogos para la afección glandular importante, mientras que la afección sistémica grave precisa de tratamiento immunosupresor. Recientemente han aportado datos relevantes sobre la utilización de fármacos biológicos en el tratamiento de casos severos y pertinaces (AU)

Sjögren’s syndrome is a systemic autoimmune disease that is characterized by the presence of keratoconjunctivitis sicca, xerostomy and a large spectrum of signs and symptoms that translate into a very heterogeneous disease. The mild form that affects mucosal tissues is the most frequent, but there are more severe and active patterns, manifested by the presence of extraglandular affection with a worse prognosis. The clinical spectrum includes anything from mucosal alterations, Raynaud’s phenomenon, parotid enlargement or arthritis, but can be aggravated by the presence of neurological, lung or renal affection. Initial therapy includes topical treatment with artificial tears, nocturnal cream and drugs that stimulate secretion for important glandular affection, while severe systemic affection merits immunosuppressant therapy. There has been recent evidence that biologic therapy is useful for the treatment of severe and resistant cases (AU)

[Effect of acupuncture in keratoconjunctivitis sicca]. / Akupunktureffekt bei Keratoconjunctivitis sicca.

BACKGROUND: Conjunctivitis sicca is a chronic disease of the ocular surface. The substitution of tear deficiency with artificial tears is not satisfying in many patients. In a series of patients successfully treated with acupuncture we observed very different effects on each patient. In this study we evaluate the correlation between the effect of acupuncture and the etiology of the dry eyes treated. PATIENTS AND METHODS: 102 patients (87 women, 15 men) with dry-eye syndrome have been needed 10 sessions, once per week, for 30 minutes. We recorded causal factors according to the traditional chinese medicine (TCM): external and internal factors. External factors were: toxic, allergic, drug-induced, ocular surface inflammation and infection, contact lens and generally external irritations. Internal factors were disorders of hormones, immune system, psychic, and vitamin-A deficiency. Ophthalmologic observation included the slit-lamp examination, Schirmers test II, break-up time of tear film (BUT) and a drop-frequency protocol--before and 1 week after acupuncture treatment. RESULTS: There was a statistically significant difference (p < 0.001) in Schirmers test, BUT and drop frequency between before and after acupuncture. There was no significant difference between internal and external factors, but the effect on external induced sicca was better. The best effect of acupuncture was found in external factors after inflammation and in patients with imbalance of the autonomic nervous system, the least effects in Sjögren Syndrome. The effect was better in younger then in patients over 50 years. CONCLUSION: The study demonstrate, according DeLa Fuye that the best effect of acupuncture is seen on functionally disorders.

Ocular findings in cystic fibrosis patients receiving vitamin A supplementation.

BACKGROUND: Vitamin A deficiency with eye symptoms has been reported in patients with cystic fibrosis who received the recommended daily intake of vitamin A. METHODS: We measured serum retinol, dark adaptation, contrast sensitivity, and dry eye status in 35 adult cystic fibrosis patients to ascertain whether they had ocular signs or symptoms. RESULTS: Median serum retinol concentration was 1.95 mumol/l, range 1.08-4.01 mumol/l, with no values indicating vitamin A deficiency. Retinal light sensitivity was normal. Nineteen patients had reduced contrast sensitivity. Conjunctival imprints all showed plenty of goblet cells, but were characteristic of dry eye in 42% of patients (n = 14). Decreased tear film stability was found in 49% (n = 17), tear production was low in 31% (n = 11), and 23% (n = 8) showed an increased amount of dying epithelial cells. Nine patients (26%) had keratoconjunctivitis sicca according to the Copenhagen criteria. CONCLUSION: Our patients had no biochemical or clinical signs of vitamin A deficiency. We speculate that the high incidence of dry eye could be a primary manifestation of cystic fibrosis.