Epiteliopatía en limpiaparabrisas en pacientes con blefaroespasmo o espasmo hemifacial / Lid wiper epitheliopathy in patients with blepharospasm and/or hemifacial spasm

Objetivo Evaluar la presencia de epiteliopatía en limpiaparabrisas en pacientes con blefaroespasmo o espasmo hemifacial antes del tratamiento habitual con toxina botulínica y 4 semanas después. Métodos Estudio prospectivo compuesto por 31 ojos de 20 pacientes con diagnóstico neurológico de espasmo hemifacial (9 ojos de 9 pacientes) y blefaroespasmo esencial (22 ojos de 11 pacientes). Se evaluaron antes y 4 semanas después de la infiltración con toxina botulínica diversos parámetros de superficie ocular con el cuestionario OSDI, test de Schirmer, tiempo de rotura lagrimal y tinciones de fluoresceína y verde de lisamina valoradas con el test de Oxford y el grado de afectación del limpiaparabrisas palpebral. Resultados El 100% de los pacientes presentaron afectación del limpiaparabrisas palpebral antes (30% grado leve y 70% moderado) y después del tratamiento con toxina (100% grado leve). El 75% de los pacientes presentaron un OSDI normal-leve antes del tratamiento; después del tratamiento fue del 80%. El tiempo de rotura lagrimal fue de 7,2±0,2 s antes y de 7,5±0,7 s después del tratamiento. El test de Schirmer fue de 11,4±5,5 y 12,5±5,5mm antes y después del tratamiento. El test de Oxford resultó patológico inicialmente en el 69,3% de los pacientes; tras 4 semanas solo fue patológico en el 54%. Conclusión La epiteliopatía en limpiaparabrisas está presente en el 100% de los pacientes con blefaroespasmo o espasmo hemifacial. El principal mecanismo fisiopatológico que la desencadena en estos pacientes es el aumento en el coeficiente de fricción, ya que el volumen y la estabilidad lagrimal son normales (AU)

Objective To evaluate the presence of wiper epitheliopathy in patients with blepharospasm and/or hemifacial spasm before and 4 weeks after routine treatment with botulinum toxin. Methods Prospective study comprising 31 eyes of 20 patients with neurological diagnosis of hemifacial spasm (9 eyes of 9 patients) and essential blepharospasm (22 eyes of 11 patients). Various ocular surface parameters were assessed before and 4 weeks after infiltration with botulinum toxin using the OSDI questionnaire, Schirmer's test, tear break-up time, fluorescein and lissamine green staining assessed with the Oxford test and the degree of involvement of the palpebral wiper. Results 100% of the patients had palpebral wiper involvement before (30% mild and 70% moderate) and after toxin treatment (100% mild). 75% of patients had mild-normal OSDI before treatment, after treatment it was 80%. The tear break-up time was 7.2±0.2 sg before and 7.5±0.7 sg after treatment. Schirmer's test was 11.4±5.5 and 12.5±5.5mm before and after treatment. The Oxford test was initially pathological in 69.3% of patients, after 4 weeks it was pathological in only 54%. Conclusion Wiper epitheliopathy is present in 100% of patients with blepharospasm and/or hemifacial spasm. The main pathophysiological mechanism that triggers it in these patients is the increase in the coefficient of friction, as tear volume and stability are norma (AU)

Lid wiper epitheliopathy in patients with blepharospasm and/or hemifacial spasm.

OBJECTIVE: To evaluate the presence of wiper epitheliopathy in patients with blepharospasm and/or hemifacial spasm before and 4 weeks after routine treatment with botulinum toxin. METHODS: Prospective study comprising 31 eyes of 20 patients with neurological diagnosis of hemifacial spasm (9 eyes of 9 patients) and essential blepharospasm (22 eyes of 11 patients). Various ocular surface parameters were assessed before and 4 weeks after infiltration with botulinum toxin using the OSDI questionnaire, Schirmer's test, tear break-up time (BUT), fluorescein and lissamine green staining assessed with the Oxford test and the degree of involvement of the palpebral wiper. RESULTS: 100% of the patients had palpebral wiper involvement before (30% mild and 70% moderate) and after toxin treatment (100% mild). 75% of patients had mild-normal OSDI before treatment, after treatment it was 80%. The BUT was 7.2 ±â€¯0.2 sg before and 7.5 ±â€¯0.7 sg after treatment. Schirmer's test was 11.4 ±â€¯5.5 and 12.5 ±â€¯5.5 mm before and after treatment. The Oxford test was initially pathological in 69.3% of patients, after 4 weeks it was pathological in only 54%. CONCLUSION: Wiper epitheliopathy is present in 100% of patients with blepharospasm and/or hemifacial spasm. The main pathophysiological mechanism that triggers it in these patients is the increase in the coefficient of friction, as tear volume and stability are normal.

Primary conjunctival amyloidosis and allergic conjunctivitis. / Amiloidosis conjuntival primaria y conjuntivitis alérgica.

Primary conjunctival amyloidosis is a rare disease of unknown origin, secondary to the deposit of amyloid material within the conjunctiva itself, producing a tumour. In the case presented, the concurrence of allergic conjunctivitis and chronic eye scratching could be triggers of the excessive production of immunoglobulins. The deposit of insoluble immunoglobulin light chains located within the conjunctiva itself causes this conjunctival mass.

High resolution anterior segment optical coherence tomography for differential diagnosis between corneo-conjunctival intraepithelial neoplasia and pterygium. / Tomografía de coherencia óptica de segmento anterior de alta resolución como método de diagnóstico diferencial entre neoplasia intraepitelial córneo-conjuntival y pterygium.

OBJECTIVE: To assess if anterior segment optical coherence tomography (AS-OCT) is a noninvasive diagnostic method suitable to differentiate benign corneo-conjunctival lesions (pterygium) from premalignant lesions (corneo-conjunctival intraepithelial neoplasia, CIN). MATERIAL AND METHODS: An observational, analytical and cross-sectional study was conducted in 22 eyes with conjunctival lesions clinically suspicious for pterygium and CIN during two years. Morphological differences between both lesions were studied with AS-OCT; epithelial thicknesses (EE) and extension length on corneal surface (GIC) were compared between both groups. A surgical excision of the lesion was performed for histopathological diagnosis. RESULTS: Mean age of patients with pterygium (n=18) was 52.67±15 y.o and 74±12 y.o in subjects with CIN (n=4) (p<0.021). In pterygia, AS-OCT showed typical features (normal, thinning or slightly thickened EE; 77.4±26µm), in addition to an increase in wedge-shaped subepithelial tissue. Patients with CIN had a mean thickened EE (262.5±124µm) and strongly hyperreflective, with abrupt transition between normal and pathological epithelium. Analysis of EE between subjects with pterygium and CIN revealed statistically significant differences (p<0.002). ROC curve revealed a 100% sensitivity and specificity of OCT-SA in differentiation between CIN and pterygium, using 141µm as cutoff point of EE. CONCLUSION: AS-OCT is a useful tool for the differentiation between pterygium and CIN able to provide typical morphological characteristics. An EE greater than 141µm in AS-OCT suggests a sensitivity and specificity of 100% for the diagnosis of CIN.

Morphology of the Meibomian gland evaluated using meibography in patients with hypohidrotic ectodermal dysplasia. / Morfología de las glándulas de Meibomio valorada por meibografía en pacientes con displasia ectodérmica hipohidrótica.

INTRODUCTION: Hypohidrotic ectodermal dysplasia (HED) is a rare disease that results from the abnormal development of the ectodermal germ layer in early embryogenesis. In these patients, hypoplasia of Meibomian glands is one of the most frequent ophthalmological manifestations. The main aim of this study is to evaluate the usefulness of meibography for the morphology of Meibomian glands in a group of patients with HED, and to compare it with a control group. METHODS: A total of 14 eyes of 7 patients diagnosed with HED were included, and 32 eyes of 16 patients were included as a control group. The meibographic study was carried out using CA-800 Corneal Analyser (Topcon®). Grading of images was assessed by a meibomian gland atrophy score: grade 0, no alterations; grade 1, ≤25% gland atrophy; grade 2, 25% to 50% gland atrophy; grade 3, 51% to 75% gland atrophy; and grade 4 >75% gland atrophy. Both groups were compared using the Mann-Whitney U non-parametric test. RESULTS: All patients with HED showed some degree of gland atrophy, with 57% showing severe atrophy (>75% of gland atrophy), 35.8% with a grade 3, and 7.2% grade 2. The mean grade of glandular atrophy in HED was 3 (1-4). In the control group, 62.5% had no involvement (grade 0), with 28.1% showing grade 1 and 9.4% grade 2 gland atrophy. The mean glandular atrophy grade within the control group was 0 (0-2). There were statistically significant differences between both groups. CONCLUSIONS: Meibography is a simple diagnostic tool that allows to differentiate between patients without disease and those with HED.

Primary lymphocytic lymphoma of lacrimal gland. / Linfoma linfocítico primario de glándula lagrimal.

CASE REPORT: We report a case of primary small-cell lymphocytic lacrimal gland lymphoma in a male diagnosed with primary antiphospholipid syndrome. These rare lymphomas are usually presented in the clinic as disseminations secondary to chronic lymphocytic leukaemia, and the primary site is rare in the orbit. DISCUSSION: Non-Hodgkin lymphomas are a heterogeneous group of tumours. Although treatment in the IE stage is usually radiotherapy, due to its association with antiphospholipid syndrome, systemic treatment with rituximab was administered.

[Anophthalmia as an isolated congenital defect]. / Anoftalmía como defecto congénito aislado.

CASE REPORT: We present the case of a newborn male whose only anomaly was an anophthalmia in his left eye. Complementary explorations were carried out to discard associated systemic pathologies. DISCUSSION: Anophthalmia/microphthalmia is the most frequent congenital eye malformation in the newborn. Its prevalence in Spain for the past twenty years was 21.34/100,000 newborn. The most usual presentation is as part of syndromes, appearing only exceptionally in an isolated way. It is important for the ophthalmologist to be aware of this pathology since the early treatment, because the corresponding orbital prosthesis may help to avoid, at least in part, dysmorphogenesis and derived aesthetic problems.

Anoftalmía como defecto congénito aislado / Anophthalmia as an isolated congenital defect

Caso clínico: Presentamos el caso de un varón recién nacido cuya única anomalía fue una anoftalmía en ojo izquierdo. Se le realizaron exploraciones complementarias para descartar patologías sistémicas asociadas que resultaron normales. Discusión: La anoftalmía/microftalmía es el defecto congénito ocular más frecuente en el recién nacido. Su prevalencia en España en los últimos 20 años es de 21,34/100.000 recién nacidos. Este defecto se presenta habitualmente en la clínica formando parte de síndromes, siendo muy rara su presentación de forma aislada. Es importante para el oftalmólogo conocer esta patología puesto que el tratamiento precoz con implantes orbitarios ayuda a evitar en parte la dismorfogénesis y trata de paliar los problemas estéticos subsecuentes (AU)

Desarrollo de un nuevo índice topográfico de regularidad corneal / Development of a new topographic index of corneal regularity

Objetivo: Desarrollar un nuevo índice topográfico que cuantifique microirregularidades en la superficie corneal. Métodos: Se incluyen 155 ojos de 128 pacientes con una edad media de 29,2 años, a los cuales se les realiza una topografía corneal (TC). Se diferencian tres grupos en función de la regularidad corneal: grupo I formado por 50 ojos de pacientes con córneas regulares, grupo II 45 ojos córneas con macroirregularidad, y grupo III 60 ojos córneas con microirregularidad. A partir de los valores de los radios de curvatura aportados por el mapa de datos numéricos de la TC, se elabora un algoritmo que expresa las diferencias en poder dióptrico entre puntos muy próximos. Se realizó una estadística descriptiva en cada grupo y para la comparación entre grupos se utilizó la comparación múltiple de medias de Scheffé. Resultados: El índice de irregularidad medio en el grupo I fue 7.Conclusiones: El nuevo índice de irregularidad es capaz de cuantificar microirregularidades en la superficie corneal. Este índice es tanto mayor de cero cuanto mayores sean las microirregularidades de la córnea (AU)

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Alteraciones topográficas y paquimétricas inducidas por el uso de lentes de contacto de porte prolongado / Topographic and pachymetric alterations caused by contact lenses for prolonged use

Objetivo: Evaluar las alteraciones paquimétricas y topográficas inducidas por el uso de lentes de contacto blandas y Dk/t >100, tras 3 semanas de porte continuado. Métodos: Se incluyeron 24 ojos de 12 pacientes con edades comprendidas entre 19 y 32 años, a los cuales se les adaptó la nueva lente de contacto Focus® Night & Day. Se analizaron distintos parámetros topográficos poder corneal central, radios corneales a los 3, 5, 7 mm, queratometría simulada y paquimetría antes de la adaptación y al 1.er y 21 día de la misma. En el análisis estadístico utilizamos el test de Wilcoxon para muestras apareadas y el análisis vectorial para valorar la esfera, cilindro y eje del astigmatismo inducido por el porte de la lente. Resultados: La refracción media de los sujetos fue de 3,28 D. El poder corneal central medio inicial fue de 42,5 D. No se encontraron diferencias significativas en poder corneal y radios tras 21 días de uso de la lente. La paquimetría media inicial fue de 541,46 µm y de 557,64 µm tras 24 h de porte. Se encontraron diferencias significativas en los datos paquimétricos tras el uso de la lente. Conclusiones: No se producen alteraciones topográficas significativas tras el porte continuado de las lentes de contacto (21 días). El aumento del espesor corneal tras el porte de la lente fue en todos los casos <5 por ciento (AU)

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