The impact of dry eye disease treatment on patient satisfaction and quality of life: A review.

Several aspects of the quality of life (QoL) and treatment satisfaction of patients with dry eye disease (DED) may be underestimated. Ocular symptoms, which are assessed by validated patient-reported questionnaires and may include stinging, burning, itchiness, grittiness, dryness and discomfort, reduce QoL by affecting daily activities and work productivity. Self-reported symptoms do not always correlate with post-treatment improvements in clinical measures such as tear film break-up time, inflammation and osmolarity. Thus, treatments may improve clinical ocular features without improving symptoms that affect daily life. This review explores 1500 abstracts from congress presentations and peer-reviewed journals for QoL and treatment satisfaction data on the use of active lubricants, osmoprotectants, secretagogues, and immunomodulators present in topical formulations for DED treatment, and validated symptom questionnaires. Patient-reported symptoms of DED are generally improved after treatment with topical formulations for tear replacement, tear stimulation or anti-inflammatory therapy compared with baseline or a control treatment. However, more data are required to compare the performance of active ingredients. It is fundamental to diagnose patients with DED accurately, recognising the major cause behind their dry eyes. Studies are also necessary to identify how patient satisfaction and QoL may be improved through long-term use of topical preparations. We conclude that careful and thorough consideration of patient-reported symptoms should be integrated into DED management to help tailor treatment to patient needs.

Clinical treatment of dry eye using 0.03% tacrolimus eye drops.

PURPOSE: To report the clinical outcome of the treatment of dry eyes using 0.03% tacrolimus eye drops (olive oil + tacrolimus 0.03%) (Ophthalmos, Sao Paulo, Brazil). METHODS: Sixteen eyes of 8 patients with Sjögren syndrome dry eyes (age, 51.13 ± 9.45 years) were enrolled in this study (prospective noncontrolled interventional case series). Patients were instructed to use topical 0.03% tacrolimus eye drops twice a day (every 12 hours) in the lower conjunctival sac. Schirmer I test, break-up time, corneal fluorescein, and rose bengal staining score were performed in all patients 1 day before, and 14, 28, and 90 days after treatment with 0.03% tacrolimus eye drops. RESULTS: The average fluorescein staining and rose bengal staining scores improved statistically significantly after 14 days of treatment and improved even more after 28 and 90 days. The average Schirmer I test did not improve statistically significantly after 28 days of treatment, although we did observe a significant improvement after 90 days of treatment with 0.03% tacrolimus eye drops. The average break-up time did not improve statistically after 14 days of treatment, although we observed a significant improvement after 28 and 90 days of treatment with 0.03% tacrolimus eye drops. CONCLUSIONS: Topical 0.03% tacrolimus eye drops successfully improved tear stability and ocular surface status in patients with dry eyes.

Slit-scanning topography in vernal keratoconjunctivitis.

PURPOSE: To determine slit-scanning topographic (SST) pattern of eyes with vernal keratoconjunctivitis (VKC) and to detect the incidence of keratoconus in this population when compared with a healthy control group. DESIGN: Cross-sectional study. METHODS: A total of 104 patients, 50 eyes with VKC and 54 normal eyes, were included in this study. A comparison was performed between the two groups on the basis of SST data. Distribution curves were established for anterior and posterior elevation peaks, and for the pachymetric index. RESULTS: Anterior and posterior elevation peaks, elevation color patterns, central curvature, thinnest pachymetry, and pachymetric index differed significantly between VKC and control group (P < .05). Distribution curves have also shown abnormal patterns in VKC. Significant correlations were found between elevation peaks and pachymetric index (P < .001), and exponential curves were plotted. A higher frequency of keratoconus was found in the VKC group (P < .01). CONCLUSIONS: Patients with VKC have more abnormal corneal SST patterns than controls. SST abnormal findings may alert us for the risk of keratoconus in this population.

Orbital tuberculosis diagnosed by immunohistochemistry: case reports.

PURPOSE: To describe three cases of orbital tuberculosis, with their clinical characteristics and respective diagnostic procedures, showing the importance of histopathology for the correct diagnosis. PATIENTS AND METHODS: Three patients diagnosed and treated for orbital tuberculosis, in the "Hospital das Clínicas da Faculdade de Medicina da Universidade de Sao Paulo" during the years of 1999 and 2001. RESULTS: All of the patients were female and referred a chronic evolution of swelling of one eyelid associated or not with other symptoms. They had not HIV infection. Two of them had positive epidemiology for tuberculosis. However, the search for systemic evidence of the disease and staining for bacilli (Ziehl-Neelsen method) were negative in all three patients. In all the cases, only the biopsy with immunohistochemical analysis could confirm the diagnosis. COMMENTS: Orbital involvement is a rare ocular manifestation of tuberculosis. Even in a tertiary hospital, few cases, if any, are diagnosed per year. However, the global incidence and prevalence of M. tuberculosis infections is not under control yet, and it has been a serious public health problem. Thus, one must be aware of the possibility of tuberculosis among the orbital diseases.

Orbital tuberculosis diagnosed by immunohistochemistry: case reports

OBJETIVO: Este estudo descreve 3 casos de tuberculose orbitária, com suas características clínicas, procedimentos diagnósticos, mostrando a importância da histopatologia para o diagnóstico correto. PACIENTES E MÉTODOS: Descrição de 3 casos de pacientes com tuberculose orbitária diagnosticada e tratada no Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo entre os anos 1999 e 2001 RESULTADOS: Todos os casos apresentaram-se como massa orbitária de evolução lenta e progressiva em pacientes de sexo feminino, sem doença pulmonar concomitante evidente. Duas tinham epidemiologia positiva para tuberculose. A pesquisa de bacilo álcool ácido resistente (BAAR), pelo método de Ziehl-Neelsen, entretanto, havia sido negativa em todos os casos. O diagnóstico etiológico nos três pacientes foi realizado pela identificação imunohistoquímica de bacilos tuberculínicos intracitoplasmáticos. COMENTARIOS: Baseando-se na elevada prevalência da tuberculose nos países em desenvovimento, associada ao aumento de sua incidência na última década, torna-se necessário considerá-la no diagnóstico diferencial das massas orbitárias em nosso meio.

Conjunctival hyperemia associated with bimatoprost use: a histopathologic study.

PURPOSE: To evaluate histopathologic signs of conjunctival inflammation in patients with conjunctival hyperemia induced by bimatoprost treatment. DESIGN: Prospective interventional study. METHODS: The study included 15 eyes of 15 patients scheduled for cataract surgery. Patients in the treatment group (n = 9) exhibited trace to moderate conjunctival hyperemia when treated with bimatoprost 0.03% every day for 15 to 30 days before surgery. The control group (n = 6) included untreated patients with no ocular disease other than cataract. Conjunctival biopsies were obtained for histologic evaluation with light microscopy. RESULTS: Vascular congestion was observed in biopsies from 7 patients (78%) in the bimatoprost group and 5 patients (83%) in the control group. Signs of inflammation were found in biopsies from 2 patients (22%) in the bimatoprost group and 2 patients (33%) in the control group. CONCLUSIONS: Histopathologic signs of inflammation were no more frequent in conjunctival specimens from bimatoprost-treated patients with trace to moderate hyperemia than in those from untreated control subjects.

Vasculitis of the lacrimal sac wall in Wegener granulomatosis.

A 35-year-old woman with a 4-year history of generalized Wegener granulomatosis (WG) had clinically controlled disease. She was evaluated for a 6-month history of right lacrimal sac mass. On examination, a right chronic dacryocystitis and mucocele were observed. A right external dacryocystorhinostomy was performed. The surgical biopsy specimen from the lacrimal sac showed leukocytoclastic vasculitis with more aggressive damage to the small vessels in the deeper mucosa and focal microhemorrhages. The patient was free of symptoms 1 year after surgery. We believe this is the first report of generalized WG presenting features of an active vasculitis of the lacrimal sac wall on surgical biopsy specimen. We conclude that the lacrimal drainage system can be affected directly by focal WG vasculitis, suggesting that nasolacrimal duct obstruction is not always due to contiguous paranasal disease.

Eyelid merkel cell carcinoma: report of three cases.

PURPOSE: To present three cases of Merkel cell carcinoma, a primary cutaneous neuroendocrine tumor that arises from Merkel cells, and to describe their clinical features, diagnosis, and management. METHODS: Case series. RESULTS: In only one case, the disease was clinically recognized. In the others, the diagnosis was confirmed by histology, and chalazion was initially suspected in one of them. Surgery was performed in all patients, and there was no evidence of metastatic disease. CONCLUSIONS: The rarity of eyelid Merkel cell carcinoma and the fact that it can simulate benign entities frequently lead to difficulties in diagnosis and a delay in the establishment of suitable therapy.

Uso da membrana amniótica para reconstrução da superfície ocular após exérese de melanoma conjuntival / Amniotic membrane transplantation for ocular surface reconstruction after surgical excision of conjunctival malignant melanoma

Objetivo: Relatar o uso da membrana amniótica para a reconstrução da superfície ocular após uma ressecção cirúrgica ampla da conjuntiva para o tratamento de uma caso dee melanoma da conjuntiva. Local: Clínica Oftalmológica do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (FMUSP). Método: Relato de um caso de melanoma da conjuntiva tratado com exérese da lesão com amplas margens de segurança, empregando-se membrana amniótica na correção da área exposta. Resultado: Após o exérese cirúrgica do melanoma da conjuntiva com ampla margem de segurança, o defeito conjuntival resultante foi corrigido utilizando-se um transplante de membrana amniótica. Obteve-se excelente resultado estérico pós-operatório e mesmo após um período de dois anos não foram identificados sinais de recorrência local. Conclusão: Demonstrou-se que a utilização da membrana amniótica para a reconstrução da superfície ocular após uma ressecção ampla da conjuntiva para o trtatamento do melanoma conjuntival é segura, promovendo a epitelização e inibindo a fibrose local. As vantagens da nova técnica incluem o excelente resultado estérico pós-operatório, a ausência de morbidade do local doador e a possibilidade dee monitorização da recorrência local, já que o tecido utilizado possui grande transparência.

Efeitos do uso do colirio de mitomicina C na superficie ocular de coelhos / Effects of use of mitomycin C on ocular surface in rabbits eyes

Proposito: Investigar os efeitos do uso topico de mitomicina C (MMC), na contagem de celulas caliciformes e no tipo de infiltrado celular inflamatorio, na conjuntiva ocular de coelhos. Metodos: coelhos de raca California receberam duas gotas de MMC (0,2mg/ml) quatro vezes por dia (n=15) ou agua destilada (n=5) por 14 dias. Exames biomicroscopicos foram realizados durante 25 dias. Especimens de conjuntiva para exame histopatologico foram obtidos apos a suspensao do uso de MMC nos dias 1 (n=5), 36 (n=5) e 86 (n=5) e foram processados para microscopia de luz corados com HE e PAS. A contagem de celulas caliciformes PAS-positiva foi realizada em campos de 400 aumentos em cada amostra. Resultados: Hiperemia conjuntival foi observada no quarto dia de instilacao de MMC e persistiu por 7 dias apos a suspensao da droga.