Nonlinear effects of humidex on risk of outpatient visit for allergic conjunctivitis among children and adolescents in Shanghai, China: A time series analysis.

Background: Various epidemiological studies have focused on the adverse health outcomes of meteorological factors. However, there has been little research on the impact of humidex on allergic conjunctivitis, especially in child and adolescent populations. We aimed to explore the impact of humidex, a comprehensive index of relative humidity and temperature, on child and adolescent allergic conjunctivitis admissions. Methods: Outpatient visit data for allergic conjunctivitis, meteorological factors and air pollutants in Shanghai for the 2017-2022 period were retrieved. For the purpose of analysing the nonlinear connection and lag impact between humidex and admissions for paediatric and adolescent allergic conjunctivitis, the distributed lag nonlinear model (DLNM) was fitted. Results: A total of 147 090 cases were included in our cohort. We found a significantly nonlinear effect on humidex and allergic conjunctivitis. In the single-day lag pattern, the relative risks (RR) of allergic conjunctivitis were significant at lag 0 (RR = 1.08, 95% confidence interval (CI) = 1.05-1.11) to lag 2 (RR = 1.01, 95% CI = 1.00-1.01), lag 5 (RR = 1.01, 95% CI = 1.00-1.01) to lag 9 (RR = 1.01, 95% CI = 1.00-1.01), and lag 14 (RR = 1.02, 95% CI: 1.01-1.03). In the cumulative-lag day pattern, the RR of allergic conjunctivitis were significant at lag 0-0 (RR = 1.08, 95% CI = 1.05-1.11) to lag 0-14 (RR = 1.21, 95% CI = 1.13-1.28). We found that boys, children aged 7-17 years, and children in the warm season were more vulnerable to humidex. In addition, the highest attributable fraction (AF) and attributable number (AN) of humidex are at lag 0-14 (AF = 0.17, AN = 25 026). Conclusions: Humidex exposure markedly increased the risk of allergic conjunctivitis, especially in highly high humidex. Appropriate public health management is needed for disease management and early intervention.

Relations between nonmotor manifestations and motor disorders in patients with benign essential blepharospasm.

PURPOSE: To evaluate the relations between nonmotor manifestations (dry eye, mood disorders, and sleep disturbance) and motor disorders in patients with benign essential blepharospasm (BEB), and to determine whether relieving motor disorders by botulinum neurotoxin can improve the nonmotor manifestations. METHODS: In this prospective case series study, 123 BEB patients were enrolled for evaluations. Among them, 28 patients underwent botulinum neurotoxin therapy and attended another two postoperative visits at 1 month and 3 months. Motor severity was measured with Jankovic Rating Scale (JRS) and Blepharospasm Disability Index (BSDI). We assessed dry eye using OSDI questionnaire, Schirmer test, tear break-up time (TBUT), tear meniscus height, lipid layer thickness (LLT) and corneal fluorescence staining. Zung's Self-rating Anxiety and Depression Scale (SAS, SDS) and Pittsburgh Sleep Quality Index (PSQI) were for mood status and sleep quality evaluations. RESULTS: Patients with dry eye or mood disorders had higher JRS scores (5.78 ± 1.13, 5.97 ± 1.30) than those without (5.12 ± 1.40, 5.50 ± 1.16; P = 0.039, 0.019, respectively). BSDI values of patients with sleep disturbance (14.61 ± 4.71) was higher than those without (11.89 ± 5.44, P = 0.006). Correlations were found between JRS, BSDI and SAS, SDS, PSQI, OSDI, TBUT. Botulinum neurotoxin effectively relieved JRS, BSDI and improved PSQI, OSDI, TBUT, LLT (8.11 ± 5.81, 21.77 ± 15.76, 5.04 ± 2.15 s, 79.61 ± 24.11 nm) at the 1-month visit compared to baseline (9.75 ± 5.60, 33.58 ± 13.27, 4.14 ± 2.21 s, 62.33 ± 22.01 nm; P = 0.006, < 0.001, = 0.027, < 0.001, respectively). CONCLUSIONS: The BEB patients with dry eye, mood disorders, or sleep disturbance had more severe motor disorders. Motor severity was associated with the severity of the nonmotor manifestations. Relieving motor disorders by botulinum neurotoxin was effective in improving dry eye and sleep disturbance.

Administration of serotonin and norepinephrine reuptake inhibitors tends to have less ocular surface damage in a chronic stress-induced rat model of depression than selective serotonin reuptake inhibitors.

Depressed patients who medicate with selective serotonin reuptake inhibitors (SSRIs) often report ocular dryness. Epidemiological studies have found that serotonin and norepinephrine reuptake inhibitors (SNRIs) are not risk factors for dry eye in depressed patients. However, the effect of SNRIs on the ocular surface is unknown. A depression rat model was induced by chronic unpredictable mild stress (CUMS), and SNRIs or SSRIs were administered to the rats for 3 or 6 weeks. The levels of norepinephrine (NE) and serotonin in tear fluid were tested by ELISA. The corneal fluorescence and lissamine green staining were used to evaluate ocular surface damage. NE and/or serotonin were administered to human corneal epithelial cells in vitro. RNA sequencing (RNA-seq) analysis was performed to investigate the mRNA expression profiles. Tear NE levels were higher in the SNRIs group, and ocular surface inflammation and apoptosis were significantly reduced compared to the SSRIs group. RNA-Seq indicated that NE significantly activate MAPK signaling pathway. NE can inhibit serotonin-induced activation of the NF-κB signaling pathway through α-1 adrenergic receptors and promotes the proliferation of corneal epithelial cells through activation of the MAPK signaling pathway. SNRIs administration have less ocular surface damage than SSRIs. NE protects human corneal epithelial cells from damage, and reduce inflammation on the ocular surface via activating the MAPK signaling pathway. SNRIs might be used as an appropriate treatment for depression-related DED.

The effect of short-term air pollutants exposure on outpatient admission for blepharitis in Shanghai, China: a hospital-based study.

Blepharitis is a very common ophthalmologic disease, and few studies have examined if air pollutants contribute to the risk of blepharitis. We investigated the presence of any potential correlation between exposure to air pollution and outpatient admission for blepharitis in Shanghai, China. Data on daily outpatient admission for blepharitis were collected from January 2017 to July 2022. Air pollution and meteorological data were acquired from the Shanghai Environmental Protection Agency. Using the distributed lag non-linear model (DLNM) we investigated the relationship between air pollutants and blepharitis. Seasonal stratified analysis was carried out. In total, 10,681 blepharitis patients were recruited. In the single-pollutant model, a 10 µg/m3 increase in particulate matter with < 2.5 µm PM2.5 and 10 µm PM10 along with sulfur dioxide (SO2) and 100 µg/m3 increase in carbon monoxide (CO) was significantly associated with outpatient visits for blepharitis. In the multi-pollutant model, a 10 µg/m3 increase in ozone (O3) and nitrogen dioxide (NO2) and a 100 µg/m3 increase in carbon monoxide (CO) was significantly associated with outpatient visits for blepharitis. Moreover, there was an obvious relationship between blepharitis and PM2.5 and O3 in the summers and blepharitis and PM10, NO2, and SO2 during the winters. Exposure to short-term air pollution increases the risk of blepharitis outpatient visits in Shanghai, China.

Serum Metabolomics of Benign Essential Blepharospasm Using Liquid Chromatography and Orbitrap Mass Spectrometry.

Background: Benign essential blepharospasm (BEB) is a form of focal dystonia that causes excessive involuntary spasms of the eyelids. Currently, the pathogenesis of BEB remains unclear. This study is aimed at investigating the serum metabolites profiles in patients with BEB and healthy control and to identify the mechanism and biomarkers of this disease. Methods: 30 patients with BEB and 33 healthy controls were recruited for this study. We conducted the quantitative and nontargeted metabolomics analysis of the serum samples from 63 subjects by using liquid chromatography and Orbitrap mass spectrometry (LC-Orbitrap MS). Multivariate statistical analysis was performed to detect and identify different metabolites between the two groups. The Kyoto Encyclopedia of Genes and Genomes (KEGG) and receiver operating characteristic (ROC) curve analysis of the altered metabolites were performed. Results: A total of 134 metabolites were found and identified. The metabolites belonged to several metabolic pathways including phenylalanine metabolism, phenylalanine, tyrosine and tryptophan biosynthesis, arginine biosynthesis, linoleic acid metabolism, tryptophan metabolism, aminoacyl-tRNA biosynthesis, sphingolipid metabolism, glycosphingolipid biosynthesis, leucine and isoleucine biosynthesis, and vitamin B6 metabolism. Eight metabolites were identified as the potential biomarkers. Conclusions: These results demonstrated that serum metabolic profiling of BEB patients was significantly different from healthy controls based on LC-Orbitrap MS. Besides, metabolomics might provide useful information for a better understanding of BEB.

Anatomic characteristics of primary acquired nasolacrimal duct obstruction: a comparative computed tomography study.

Background: Studies of local anatomic characteristics of primary acquired nasolacrimal duct obstruction (PANDO) are important for understanding the etiology of PANDO and guiding surgical treatment. The purpose of this study was to review computed tomography (CT) scans to identify the anatomic differences in the obstructed and unobstructed sides of PANDO patients as well as in control patients in a Chinese population. Methods: In this retrospective comparative observational study, the CT scans of 126 PANDO patients were reviewed. A total of 76 patients who underwent CT examinations for eyeball atrophy or an intraocular foreign body but had a healthy lacrimal drainage system and orbit structure were enrolled as controls. The nasolacrimal canal (NLC) widths, lacrimal sac fossa structures, and nasal abnormalities in the obstructed and unobstructed sides in patients and both sides in controls were evaluated. Results: Both obstructed and unobstructed sides in PANDO patients showed significant differences to the sides of controls in NLC width (obstructed: 3.91±0.90 mm, unobstructed: 3.86±0.83 mm, control: 4.31±0.95 mm; obstructed and control: P<0.01, unobstructed and control: P<0.01, respectively), ethmoid sinusitis (26%, 28%, 16%; P=0.03 and P=0.03, respectively), osteomeatal complex opacification (18%, 14%, 7%; P<0.01 and P=0.04, respectively), and agger nasi cell opacification (22%, 20%, 9%; P<0.01 and P<0.01, respectively). However, although no significant differences (all P>0.05) were found between the obstructed and unobstructed sides of unilateral PANDO patients in these characteristics, there were correlations (r=0.714, 0.209, 0.376, and 0.112; P<0.01, P=0.03, P<0.01, P=0.24, respectively). We also found expanded lacrimal sac fossa width (6.45±1.01 mm) and decreased frontal process proportion (45.9%±15.4%) only in the obstructed sides of PANDO patients compared to the lacrimal sac fossa width in controls (6.08±1.16 mm, P<0.01) and the frontal process proportion in controls (49.9%±15.4%, P=0.03). There was no difference in the positional relationship of the uncinate process (UP) with the lacrimal fossa between patients and controls. Conclusions: A narrow NLC and nasal inflammation are associated with PANDO, while an expanded lacrimal sac fossa and a decreased frontal process proportion could be pathological changes. The healthy sides of unilateral PANDO patients might have a high risk of developing an obstruction. We also found an increased probability of the UP overlapping the lower lacrimal sac fossa in an Asian population compared to the published European data.

Treatment of Dry Eye With Intracanalicular Injection of Hydroxybutyl Chitosan: A Prospective Randomized Clinical Trial.

Background: Punctal/intracanalicular plugs on the market nowadays are all designed before clinical use in treating dry eye disease (DED). To provide an individualized lacrimal drainage system occlusion method and reduce the complications, we developed a "liquid plug" strategy by intracanalicular injection of hydroxybutyl chitosan (HBC) solution, a thermosensitive, phase-changing biomaterial. This study evaluated the efficacy and safety of the HBC plug in treating dry eye disease by comparing it with the VisiPlug absorbable intracanalicular plug. Methods: A monocenter, randomized, controlled clinical trial was performed. Fifty patients with DED were randomized 1:1 to undergo either the HBC injection treatment or the VisiPlug treatment. Ocular Surface Disease Index (OSDI) questionnaire, tear break-up time (TBUT), corneal fluorescence staining (CFS), tear meniscus height (TMH), and phenol red thread test were evaluated at Day 0 (baseline, before treatment) and Weeks 1, 4, and 12. Results: The two groups had a balanced baseline of age, gender, and DED-related characteristics. Both occlusion methods could relieve the symptoms and signs of DED. Significant improvement was found in OSDI, phenol red thread test, and tear meniscus height (P < 0.05 compared to baseline) but not in corneal fluorescence staining and tear break-up time (P > 0.05). There is no statistically significant difference between HBC injection and VisiPlug at Weeks 1 and 4 (P > 0.05). However, at week 12, the HBC injection was not as effective as the VisiPlug in maintaining phenol red thread test (HBC: 5.35 ± 3.22 mm, VisiPlug: 8.59 ± 4.35 mm, P = 0.009) and tear meniscus height (HBC: 206.9 ± 47.95 µm, VisiPlug: 242.59 ± 60.30 µm, P = 0.041). The numbers of ocular adverse events were relatively low in both groups. Conclusions: The HBC injection showed similar efficacy and safety compared to VisiPlug. The intracanalicular injection of HBC solution proves to be a promising, individualizing method to treat DED. Clinical Trial Registration: This study is registered with the Chinese Clinical Trial Registry (https://www.chictr.org.cn/enindex.aspx), Identifier: ChiCTR1800016603.