[Ocular surface and outdoor air pollution: A systematic review]. / Surface oculaire et pollution environnementale extérieure : revue systématisée de la littérature.

INTRODUCTION: Air pollution has steadily increased for several decades, with widely studied effects on human health, including increased mortality, incidence of stroke, respiratory and allergic disease. However, the effects of pollution on the ocular surface, in direct contact with the outside world, have been less precisely studied. MATERIALS AND METHODS: We conducted a literature review of articles on the subject published from 1966 to October 2020. Among the 661 articles identified, 33 were retained. Ocular surface disease associated with pollution included non-specific conjunctivitis, dry eye disease, blepharitis, and allergic conjunctivitis. The studied pollutants were particulate matter less than 2.5µm and 10µm (PM2.5, PM10), ozone (O3), nitrogen dioxide (NO2), carbon monoxide (CO) and sulfur dioxide (SO2). Certain air quality parameters such as temperature and relative humidity were also studied. RESULTS: Among the markers of air pollution possibly associated with ophthalmic disease, NO2 and SO2 appear to be the most frequent and highly correlated. High temperatures and low humidity levels also appear to be aggravating factors for the ocular surface. However, due to the heterogeneity of the studies, the results must be interpreted with caution. Indeed, the methodology and the results of the various studies are sometimes contradictory. The inclusion of patients, the analysis of environmental data, and the correlation between these two elements indeed raise numerous methodological questions. CONCLUSION: Air pollution control would appear essential, as well as the development of new studies based on reliable methods of studying the environmental and its clinical effects.

[Management of ocular toxoplasmosis in France: Results of a modified Delphi study]. / Prise en charge de la toxoplasmose oculaire en France : résultats d'une étude Delphi modifiée.

OBJECTIVE: To evaluate diagnostic and therapeutic practices and then establish a consensus on the management of ocular toxoplasmosis in France through a Delphi study. MATERIALS AND METHODS: Twenty-three French experts in ocular toxoplasmosis were invited to respond to a modified Delphi study conducted online, in the form of two questionnaires, in an attempt to establish a consensus on the diagnosis and management of this pathology. The threshold for identical responses to reach consensus was set at 70 %. RESULTS: The responses of 19 experts out of the 23 selected were obtained on the first questionnaire and 16 experts on the second. The main elements agreed upon by the experts were to treat patients with a decrease in visual acuity or an infectious focus within the posterior pole, to treat peripheral lesions only in the presence of significant inflammation, the prescription of first-line treatment with pyrimethamine-azithromycin, the use of corticosteroid therapy after a period of 24 to 48hours, the prophylaxis of frequent recurrences (more than 2 episodes per year) with trimethoprim-sulfamethoxazole as well as the implementation of prophylactic treatment of recurrences in immunocompromised patients. On the other hand, no consensus emerged with regard to the examinations to be carried out for the etiological diagnosis (anterior chamber paracentesis, fluorescein angiography, serology, etc.), second-line treatment (in the case of failure of first-line treatment), or treatment of peripheral foci. CONCLUSION: This study lays the foundations for possible randomized scientific studies to be conducted to clarify the management of ocular toxoplasmosis, on the one hand to confirm consensual clinical practices and on the other hand to guide practices for which no formal consensus has been demonstrated.

[Digital eye strain. Functional symptoms and binocular balance analysis in intensive digital users]. / Stress oculaire induit par les écrans. Analyses des symptômes fonctionnels et de l'équilibre binoculaire chez des utilisateurs intensifs.

INTRODUCTION: In almost 50 % of cases, acute or chronic screen exposure is accompanied by symptoms of dry eye or binocular imbalance, known as digital eye strain. This phenomenon is described relatively little in the literature. The goal of this study is to determinate the effects of screen exposure on subjective comfort and binocular balance. PATIENTS AND METHODS: This is a cross-sectional, prospective, monocentric pilot study conducted from August to October 2019. The first part of the study focused on disturbances induced by short-term screen exposure (comparison between morning and evening examinations) between a control group (less than 5hours a day) and an exposed group (more than 5hours a day). The second part investigates the consequences of chronic exposure (screen exposure greater than 5hours a day, 5 days a week for one year) excluding pre-presbyopic and presbyopic patients (over 35 years of age). The study parameters consisted of an ocular discomfort questionnaire and binocular function tests (refraction, phoria, near point of accommodation and convergence, fusional vergence (FV), and binocular amplitude facility (BAF)). RESULTS: Short exposure : 52 participants were included. No significant difference was found between the control group (n=24, mean exposure=2.6 hr) and the exposed group (n=28, mean exposure=6.1 hr) for any of the objective parameters. The ocular discomfort score was highest in the exposed group for the following parameters: near (p=0.04) and intermediate (p=0.02) blurred vision and light sensitivity (p=0.04). Chronic exposure: 35 participants were included. The exposed group (n=12, mean exposure=6.7 hr) showed a decrease in FV (p=0.045) and BAF (p=0.038) compared to the control group (n=23, mean exposure=2.1 hr). DISCUSSION: Binocular balance is disturbed by intensive and chronic use of screens. Special attention must therefore be paid to these patients.

[Digital eye strain. Symptoms, prevalence, pathophysiology, and management]. / Perturbations oculaires secondaires à l'utilisation de supports numériques. Symptômes, prévalence, physiopathologie et prise en charge.

The digital revolution, which has been underway since the 1980's, is disrupting our daily routines with an exponential increase in the use of screens, which has not been without consequence to our visual system. Digital eye strain (DES), or computer vision syndrome (CVS), includes all the visual symptoms secondary to the use of digital devices. DES is present in at least 50% of regular users of digital media and is defined by blurred vision, difficulty focusing, ocular irritation or burning, dry eye, visual fatigue, headaches and increased sensitivity to light. Exposure time, age, female gender, and work environment are the main factors increasing its prevalence. Its pathophysiology, still poorly understood, is felt to be multifactorial and includes disturbances in the accommodative-convergence balance and changes in the ocular surface. Regarding accommodation and convergence, the studies are mostly old and their results heterogeneous. Conversely, many studies have shown an increase in the prevalence of dry eye in screen users. Although the retinal toxicity of blue light has been proven in in vitro models, the low level of evidence in the available studies does not allow it to be clearly correlated with the symptoms of DES. The objective of this review is to condense the knowledge available in the literature on the symptoms, prevalence, pathophysiology and management of DES.

[Vision screening for children: Recommended practices from AFSOP]. / Le dépistage visuel chez l'enfant : les recommandations de l'Association Francophone de Strabologie et d'Ophtalmologie Pédiatrique (AFSOP).

In light of the international literature, a workgroup of experts from the AFSOP met in February 2019 to formulate updated recommendations for visual screening in children. An ophthalmologic examination during the first month of life is recommended for children at risk of developing infantile organic amblyopia. An ophthalmologic examination including cycloplegic refraction between 12 and 15 months of age is recommended for children at risk of developing functional amblyopia. At any age, a prompt ophthalmologic examination is recommended for a child suspected of functional or organic ocular pathology. In children without risk factors or warning signs, a systematic orthoptic screening examination is recommended during the third year of life, including a monocular visual acuity test, a cover-test and a refraction by photoscreener. The child is referred to the ophthalmologist only in the case of an abnormal screening result, according to the following criteria: visual acuity <5/10, or >1 difference between eyes, abnormal cover test, photodetection refraction values <-3D or>+2.5D for the sphere,>1.5D for astigmatism and>1D for anisometropia. Finally, we review normal childhood refractive errors as a function of age as well as the correct use of photo screening devices.

[Interest of environmental exposure chambers in the evaluation of allergic conjunctivitis]. / Intérêt des chambres d'exposition environnementale dans l'évaluation des conjonctivites allergiques.

Allergic conjunctivitis affects 15 to 20% of the general population. It is currently evaluated by the Conjunctival Provocation Test (CPT), which is considered as the gold standard. In the investigation of allergic rhinitis and asthma, environmental exposure chambers (EEC) are increasingly utilised. For allergic conjunctivitis, EEC might be a valid alternative to the CPT. However, evaluation of the allergen response in individual provocation tests or in EECs is still in discussion due to the multiplicity of symptom scores. Indeed, there are many scores used to evaluate allergic conjunctivitis. The main criteria used were described by Abelson in 1990 and include redness, itching, tearing, and swelling. In clinical studies, the specifically ocular score most used is the Total Ocular Symptom Score (TOSS). Few treatments have been evaluated by EEC, including cold compresses, epinastine and N-acetyl aspartyl glutamic acid. Moreover, early data shows good correlation between ocular symptoms induced in an EEC and those assessed during natural exposure. EEC might be a valid alternative to CPT and correlate with natural seasonal allergen exposure. Finally, EEC might be useful in other fields as well, such as in the study of dry eye disease.

[Clinical and epidemiological features in Neuromyelitis Optica Spectrum Disorder]. / Comparaison clinico-épidémiologique des pathologies du spectre des neuromyélites optiques.

INTRODUCTION: Neuromyelitis optica spectrum disorder (NMO-SD) has been recognized for the past decade. Biomarkers such as anti-Aquaporin 4 antibodies (AQP4) and anti-Myelin Oligodendrocyte Glycoprotein (MOG) have been able to classify NMO-SD into several groups. METHODS: A retrospective study was performed in the Strasbourg University Medical Center among patients with AQP4+, MOG+ and double-seronegative NMO to compare their clinical, epidemiological and paraclinical features. RESULTS: Thirty-two patients with NMO were included. The AQP4+ NMO patients had a median of age of 45 years, with associated myelitis in 62.5% of cases and other autoantibodies in 37.5% of cases. The mean number of relapses by clinical history was 3. The mean initial visual acuity during an exacerbation was 0.3 LogMAR, and the visual acuity after an exacerbation was 0.1 LogMAR. MOG+NMO patients had a median age of 23 years, with severely impaired initial visual acuity (0.6 LogMAR) but better recovery (0 LogMAR); optic disc edema was present in 80% of cases; the mean number of relapses on clinical history was 1. AQP4-/MOG- NMO's were more common in women (70%) and were bilateral in 40% of cases. CONCLUSION: The diagnostic characteristics of NMO-SD are becoming increasingly differentiated, with a positive impact on functional prognosis and long-term progression. Other biomarkers have yet to be identified to improve the diagnosis and treatment of these disorders.

[Vision screening in children: Review of the literature]. / Dépistage visuel de l'enfant : revue de la littérature.

In children, refractive errors and amblyopia are the two most common causes of avoidable visual impairment. Screening for these is essential, especially since there is a so-called "sensitive" period during which the maturation of the visual pathways is not complete. The child's visual prognosis will therefore depend on his or her age, the duration of the visual deprivation and the timing of management. Visual screening is part of a public health approach, but there are significant regional disparities regarding its organization and the means used. We conducted a review of the literature in order to establish an inventory of available resources and improve practices.

[Clinical and epidemiological profile of pediatric uveitis, course of inflammatory uveitis treated with anti-TNF alpha]. / Profil clinique et épidémiologique des uvéites pédiatriques, évolution des uvéites inflammatoires sous anti-TNF alpha.

INTRODUCTION: Uveitis is the leading cause of acquired childhood blindness with a prevalence of 30 cases per 100,000 inhabitants. There are multiple causes ; nevertheless, there is no standardized etiological assessment. The goal of our study is to define an epidemiological and clinical profile of uveitis diagnosed in a university hospital and their course when treated with anti-tumor necrosis factor (TNF) α. PATIENTS AND METHODS: All cases of uveitis under 18 years old, from 1994 to 2016, were included. Post-traumatic, post-surgical, pseudo-uveitis and retinopathy of prematurity were excluded. Demographic data, patient history, initial ophthalmological status, etiologic assessment data and treatments already underway were collected. RESULTS: Ninety cases of pediatric uveitis were included, among which were 16.7 % infectious uveitis, 38.9 % inflammatory uveitis and 44.4 % idiopathic uveitis. Etiologic investigations were considered incomplete in 45 % of idiopathic uveitis cases. Treatment with anti-TNFα was selected for 15.5 % of patients. In total, 33 % of patients treated with etanercept required other anti-TNFα drugs due to a lack of control of inflammation. Infliximab and adalimumab successfully managed to control inflammation in 28.6 % of cases each. DISCUSSION: Diagnostic criteria based adult systemic disease are sometimes inappropriate for children. The advent of anti-TNFα appears to improve the visual prognosis of inflammatory uveitis resistant to conventional immunosuppressant therapy, but we still need to perfect protocols for their use. CONCLUSION: There are neither standardized etiological assessment nor clear diagnostic and therapeutic protocols for children. TNFα inhibitors are more effective in controlling inflammation in severe pediatric uveitis.

[Whiplash and oculomotor disorders: The pet peeve of the experts ]. / Coup de lapin (whiplash) et déséquilibres oculomoteurs : la bête noire des experts .

Whiplash is a lay term combining all the complications of a cervical sprain or distortion associated with an extension. It may lead to cervical or back pain, but patients may also complain about functional visual impairment. These visual complaints: fixation disparity, heterophoria or convergence insufficiency, are frequently neglected and difficult to quantitate and treat. Establishing the relationship between the indirect cervical trauma and the visual signs may be challenging for the medical-legal expert and must include consideration of the previous oculomotor status of the patient.

[Surgery for convergent strabismus in childhood: why and when?]. / Pourquoi et quand opérer un strabisme convergent chez l'enfant ?

The authors explain the reasons for and the timing of surgery for convergent strabismus, or esotropia, in children as a function of the particular type of strabismus. The goal of surgery is to correct the cross-eyed deviation by choosing the most opportune time so as to obtain the best binocular result with the minimum number of surgeries. The authors take a position in the debate over age at time of surgery for childhood esotropia, which is still controversial. Their arguments are based on recent neurophysiological and clinical data.

[Role of systematic ophthalmological screening for congenital toxoplasmosis: epidemiological study of an Alsatian cohort from 1990 to 2011]. / Intérêt du dépistage ophtalmologique systématique de la toxoplasmose congénitale: étude d'une cohorte alsacienne entre 1990 et 2011.

INTRODUCTION: Ophthalmologic complications of congenital toxoplasmosis, such as retino-choroiditis, are particularly feared. Any child with confirmed congenital toxoplasmosis is systematically treated and followed regularly with multiple fundus examinations. The goal of our study is to describe the management and monitoring of a cohort of patients with congenital toxoplasmosis in Alsace, and the impact of this disease in terms of parental anxiety using a standardized questionnaire. MATERIALS AND METHODS: Our study recorded 35 children with congenital toxoplasmosis, born between 1990 and 2011 in Alsace. All patients were followed by an ophthalmologist. A standardized questionnaire concerning the experience of pregnancy and post-natal follow-up was administered to the parents. RESULTS: At birth, retinochoroiditis was detected in 2 of the 35 children, and only one child developed chorioretinitis detected during follow-up monitoring (follow-up ranged from 1 to 22 years). Brain abnormalities were noted in 3 children at birth; none of them have presented with chorioretinitis to this day. An average score of 15 out of 23 was found by our standardized questionnaire, reflecting significant anxiety due to congenital toxoplasmosis. DISCUSSION: Parental anxiety due to congenital toxoplasmosis is obvious, as demonstrated by our standardized questionnaire. Follow-up, directed by comprehensive pediatric examination at birth, including fundus examination, and good information on functional signs of ocular toxoplasmosis may improve screening, so as to avoid impact on visual function.

[Scintigraphic study of the lymphatic drainage of the anterior chamber of the mouse eye and its pathophysiological implications]. / Étude scintigraphique du drainage lymphatique de la chambre antérieure de l'œil de la souris et ses implications physiopathologiques.

For many years, the intraocular lymphatic system and particularly the drainage of the aqueous humor by this system have been considered non-existant. Our study is the first to demonstrate, in a dynamic in vivo fashion, the existence of lymphatic drainage in the mouse eye. This has become possible with lymphoscintigraphy with nano-molecules of rhenium sulphide, marked by technetium-99m and injected into the anterior chamber of the mouse eye. Readings were taken using an experimental gamma camera specially built for the small animal. The hypothesis of a "uveolymphatic" drainage pathway within the ciliary body, contributing to aqueous outflow, has recently been highlighted by new improvements in microbiology (discovery of lymphatic endothelial-specific markers) and imaging. This new pathway may lead to many prospects: the development of techniques for visualization and quantification of this in vivo lymphatic flow may help to increase our understanding of the physiopathology and perhaps treatment of chronic glaucoma as well as neoplastic conditions.