Prevalence and risk factors for dry eye disease: the Sao Paulo dry eye study / Prevalência e fatores de risco para doença do olho seco: o estudo de olho seco - São Paulo

ABSTRACT Purpose: To estimate the prevalence and risk factors of dry eye disease symptoms and clinical diagnoses in Sao Paulo city, state of Sao Paulo, Brazil. Methods: A total of 582 participants over 18 years old, living in the east zone of Sao Paulo city responded to a short questionnaire. Dry eye disease was on that is defined by the presence of severe symptoms or previous clinical diagnosis of dry eye disease by an ophthalmologist. The association between dry eye disease and possible risk factors was assessed. Results: Overall dry eye disease severe symptoms and/or clinical diagnoses prevalence was calculated as 24.4% for both sexes. Women presented a higher frequency of severe symptoms of dry eye disease (16.07%) than men (8.48%; p=0.0244), as well as the composite of severe symptoms or diagnosed dry eye disease, presented by 26.86% of women and 18.18% of men (p=0.0366). In women, ages between 55 to 75 years old were associated with dry eye disease severe symptoms (OR=3.11; 95%CI 1.56-6.23, p=0.001) and diagnosed dry eye disease (OR=2.02; 95% CI 1.04-3.93, p=0.037). Hypertension was significantly associated with dry eye disease symptoms (OR=1.98; 95% CI 1.14-3.43, p=0.015) and diagnoses (OR=3.54; 95% CI 1.92-6.53, p=0.0001) in women. Eye drops use was associated with severe symptoms of dry eye disease and diagnosed dry eye disease in both women and men (p≤0.01). Conclusions: Dry eye disease prevalence in Sao Paulo city is higher in women than in men. Age and hypertension were stronger risk factors of dry eye disease for women, while eye drops use was a significant indicator of dry eye disease for both sexes.

RESUMO Objetivo Estimar a prevalência e os fatores de risco para os sintomas e o diagnóstico clínico da doença do olho seco na cidade de São Paulo, estado de São Paulo, Brasil. Métodos: Quinhentos e oitenta e dois participantes acima de 18 anos, residentes na zona leste da cidade de São Paulo responderam a um questionário de três perguntas sobre olho seco. A doença do olho seco foi definida pela presença de sintomas severos ou diagnóstico clínico prévio de doença do olho seco por um oftalmologista. A associação entre doença do olho seco e possíveis fatores de risco foi avaliada. Resultados: A prevalência de sintomas graves da doença do olho seco e/ou diagnóstico clínico foi calculada em 24,4% para ambos os sexos. O sexo feminino apresentou uma frequência maior de sintomas severos da doença do olho seco (16,07%) que o sexo masculino (8,48%; p=0,0244), assim como a associação de sintomas severos ou diagnóstico de doença do olho seco, foi de 26,86% no sexo feminino e 18,18% no sexo masculino (p=0,0366). No sexo feminino, a faixa etária entre 55 e 75 anos de idade foi associada com sintomas severos da DOS (odds ratios (OR) = 3,11; IC 95% 1,56-6,23; p=0,001) e com doença do olho seco diagnosticada (OR=2,02; IC 95% 1,04-3,93; p=0,037). Hipertensão foi associado com sintomas da doença do olho seco (OR=1,98; IC 95% 1,14-3,43; p=0,015) e diagnóstico da doença do olho seco (OR=3,54; IC 95% 1,92-6,53; p=0,001) no sexo feminino. Uso de colírios foi associado a sintomas severos e diagnóstico da doença do olho seco em ambos os sexos (p≤0,01). Conclusão: A prevalência da doença do olho seco na cidade de São Paulo é mais frequente no sexo feminino que no masculino. Idade e hipertensão foram fatores de risco maiores para doença do olho seco no sexo feminino, enquanto uso de colírios foi um indicador de doença do olho seco para ambos os sexos.

Prevalence and risk factors for dry eye disease: the Sao Paulo dry eye study.

PURPOSE: To estimate the prevalence and risk factors of dry eye disease symptoms and clinical diagnoses in Sao Paulo city, state of Sao Paulo, Brazil. METHODS: A total of 582 participants over 18 years old, living in the east zone of Sao Paulo city responded to a short questionnaire. Dry eye disease was on that is defined by the presence of severe symptoms or previous clinical diagnosis of dry eye disease by an ophthalmologist. The association between dry eye disease and possible risk factors was assessed. RESULTS: Overall dry eye disease severe symptoms and/or clinical diagnoses prevalence was calculated as 24.4% for both sexes. Women presented a higher frequency of severe symptoms of dry eye disease (16.07%) than men (8.48%; p=0.0244), as well as the composite of severe symptoms or diagnosed dry eye disease, presented by 26.86% of women and 18.18% of men (p=0.0366). In women, ages between 55 to 75 years old were associated with dry eye disease severe symptoms (OR=3.11; 95%CI 1.56-6.23, p=0.001) and diagnosed dry eye disease (OR=2.02; 95% CI 1.04-3.93, p=0.037). Hypertension was significantly associated with dry eye disease symptoms (OR=1.98; 95% CI 1.14-3.43, p=0.015) and diagnoses (OR=3.54; 95% CI 1.92-6.53, p=0.0001) in women. Eye drops use was associated with severe symptoms of dry eye disease and diagnosed dry eye disease in both women and men (p≤0.01). CONCLUSIONS: Dry eye disease prevalence in Sao Paulo city is higher in women than in men. Age and hypertension were stronger risk factors of dry eye disease for women, while eye drops use was a significant indicator of dry eye disease for both sexes.

Clinical Aspects of Stevens-Johnson Syndrome and Toxic Epidermal Necrolysis With Severe Ocular Complications in Brazil.

Stevens-Johnson syndrome (SJS) and toxic epidermal necrolysis (TEN) are acute and potentially fatal inflammatory vesiculobullous reactions that affect the skin and mucous membranes, and which are most often triggered by particular medications and infections. In Brazil, the drugs most frequently associated with TEN and SJS include cold medicine such as dipyrone and NSAIDs, followed by carbamazepine, phenobarbital, penicillin, and allopurinol. Genetic variations have been found to increase the risk of SJS/TEN in response to triggering factors such as medications. The most closely associated genes found in Brazilian cold-medicine-related SJS/TEN patients with severe ocular complications are HLA-A*66:01 in those of mixed African and European ancestry and HLA-B*44:03 and HLA-C*12:03 in those of solely European ancestry. Our classification system for grading ocular surface complication severity in SJS/TEN patients revealed the most severe complications to be limbal stem cell deficiency and dry eye. Changes to the conjunctival flora have also been observed in SJS/TEN patients. Our group identified bacterial colonization in 95% of the eyes (55.5% of which were gram-positive cocci, 25.5% of which were gram-negative bacilli, and 19% of which were gram-positive bacilli). Several new treatment options in the acute and chronic ocular management of the SJS/TEN patients have been described. This article highlights some Brazilian institutions' contributions to ocular surface care in both the acute phase (including the use of amniotic membrane transplantation) and the chronic phase (such as eyelid margin and fornix reconstruction, minor salivary gland transplantation, amniotic membrane and limbal transplantation, scleral contact lenses, anti-angiogenic eyedrops for corneal neovascularization, ex-vivo cultivated limbal epithelium transplantation, conjunctival-limbal autografting, oral mucosa transplantation, and keratoprosthesis).