Ocular surface analysis in patients diagnosed with X-linked ichthyosis. / Análisis de superficie ocular en pacientes diagnosticados de ictiosis X.

Seven patients (14 eyes) diagnosed with X-linked ichthyosis were studied using the Schirmer test, biomicroscopy, tonometry, endothelial count, optical coherence tomography, Pentacam®, ocular surface analyser, and confocal microscopy. The mean age was 33.83±20.17 years (range: 7-64 years). The most frequent findings in biomicroscopy were Meibomian glands dysfunction (83.3%) and stromal corneal opacities (33%). The tear break-up time was found shortened in 25% of the eyes. Confocal microscopy (both eyes) revealed activated keratocytes with hyper-reflective particles inside them in the anterior stroma and outside them in the posterior stroma. It is believed that the inclusion of the use of confocal microscopy will help in a better understanding of the corneal pathology associated with ichthyosis X, as well as new characteristics of these patients.

Degeneración nodular de Salzmann en paciente mujer de 20 años de edad: un reporte de caso / Salzmann's nodular degeneration in a 20-year old female patient: case report

La degeneración nodular de Salzmann es un trastorno corneal no inflamatorio, infrecuente, de mayor prevalencia en mujeres mayores de 50 años. Se caracteriza por la presencia de nódulos blanquecinos en la córnea y está asociada a diversas patologías. Reportamos el caso de una paciente de 20 años con historia de astigmatismo, miopía y síndrome de ovario poliquístico. Acudió a consulta por presentar sensación de cuerpo extraño en el ojo izquierdo y negó el haber padecido infección o trauma ocular recientes. Al examen oftalmológico se evidenció disfunción de las glándulas de Meibomio y nódulos opacos en la periferia de ambas córneas. Los hallazgos clínicos y la tomografía de coherencia óptica confirmaron el diagnóstico de degeneración nodular de Salzmann. El tratamiento con ciclosporina tópica demostró ser efectivo en la disminución de la inflamación causada por la disfunción de las glándulas de Meibomio, lo que evitó recurrencias nodulares a corto plazo.

Salzmann's nodular degeneration is an uncommon non-inflammatory corneal disorder, which is more prevalent in women more than 50 years old. It is characterized by the presence of whitish nodules in the cornea and it is associated to certain conditions. We report the case of a 20-year old female patient with past history of astigmatism, myopia, and polycystic ovary syndrome. She presented reporting a foreign body sensation in her left eye and she denied having had recent eye infection or trauma. The ophthalmological examination revealed Meibomian gland dysfunction and opaque nodules in the periphery of both corneas. Clinical findings and an optical coherence tomography (OCT) corroborated the diagnosis of Salzmann's nodular degeneration. Therapy using topical cyclosporin proved to be effective in reducing the inflammation caused by Meibomian gland dysfunction, which prevented nodular recurrence in the short term.

Intense pulsed light therapy: A promising complementary treatment for dry eye disease. / Terapia de luz pulsada intensa regulada: un tratamiento complementario prometedor para la enfermedad de ojo seco.

OBJECTIVE: To propose the Intense Pulsed Light (IPL) therapy as a helpful supplementary treatment in patients with dry eye disease. MATERIAL AND METHODS: Retrospective cross sectional design. Medical records of patients in whom dry eye disease symptoms were not satisfactorily controlled with medical therapy alone and who underwent additional IPL with at least three sessions completed. Data were analyzed before therapy and 3weeks after its completion to asses improvement. Determination of symptoms, through a visual analog scale; tear film stability, through tear Break Up Time (tBUT); measurement of tear secretion, through Schirmer Test; and ocular surface staining with Van Bijsterveld score were evaluated. SPSS software and nonparametric analysis of repeated measures were used. The study was approved by the ethics committee. RESULTS: 50 eyes from 25 subjects were reviewed. There were 9 males (36%) and 16 females (64%), with a median age of 59years (IQR 52-64). The median of the symptoms scale was 8 (IQR 8-9) and 3 (IQR 2-4) before and after the therapy respectively (P<.05). The median of BUT was 4 (IQR 3-5) and 10 (IQR 8-11), Schirmer test was 13 (IQR 12-15) and 15 (IQR 13-20), and Van Bijsterveld score was 3 (RIC 3-4) and 2 (IQR 2-3) before and after the therapy respectively (P<.05, for all measurements). CONCLUSION: IPL treatment has excellent results regarding both: dry eye disease symptoms improvement and in office objective tests such as tBUT, Schirmer test and Van Bijsterveld score; IPL could be considered as an effective adjunct for dry eye disease.

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.

An Eyelid Warming Device for the Management of Meibomian Gland Dysfunction.

PURPOSE: To determine the effectiveness of the MGDRx EyeBag in managing meibomian gland dysfunction. METHODS: This was a prospective, randomized, controlled, observer-masked, bilateral eye study that enrolled 29 participants. Participants were randomized into either the EyeBag group or the control group. The EyeBag group used the EyeBag 10minutes 2x/day, and the control group remained on their own dry eye treatment regimen (if applicable). All participants were observed at baseline, 2 weeks (2wk) and 4 weeks (4wk). At 4wk, participants in the EyeBag group were asked to stop using the EyeBag. All participants were seen again at 8 weeks (8wk). Primary outcomes were the Ocular Surface Disease Index (OSDI), Current Symptoms Questionnaire (CSQ), meibomian gland score (MG score), and non-invasive tear breakup time (NIBUT). RESULTS: Twenty-five participants completed the study (mean age 38±15 years, 7 male). There was a significant change in OSDI over time for the EyeBag group (mean[lower 95% CI, upper 95% CI], baseline: 39.1[31.1,47.0], 2wk: 26.8[19.7,33.9], 4wk: 26.6[16.5,36.7], 8wk: 27.7[18.4,37.0]; p=0.01), but not in the control group (p=0.22), but no significant difference between groups at all time points (all p>0.27). Symptoms immediately improved after conducting the EyeBag based on at-home CSQ scores (Δ=-5.0 points, p<0.01), but not in the control group. For both groups, there was no significant change (p-value EyeBag,p-value control) in MG score (0.21,0.17) and NIBUT (0.49,0.06) over time. CONCLUSIONS: The EyeBag may relieve symptoms of dry eye, but the effect on meibomian gland function and tear stability when used for only 4 weeks was undetectable.

Relationship between blepharitis and components of the metabolic syndrome. / Relación entre blefaritis y componentes del síndrome metabólico.

OBJECTIVE: To determine the relationship between the components of the metabolic syndrome with the presence of blepharitis. METHODS: The study included 60 patients with a diagnosis of blepharitis and 30 control subjects. Anthropometric measurements and blood pressure were recorded, and peripheral venous blood samples were obtained under fasting conditions to determine the concentration of Glucose, Cholesterol, and Triglycerides. High-density lipoprotein cholesterol (HDL-C) was determined after precipitating lipoproteins containing apoB-100 with phosphotungstic acid/Mg2+. The concentration of low density lipoprotein cholesterol (LDL-C) was calculated using the Friedewald formula modified by DeLong. RESULTS: In the comparative analysis, statistically significant differences were found in the waist circumference (P=.0491), systolic blood pressure (P=.0149), glucose (P=.0045), total cholesterol (P=.0001), HDL-C (P=.0049), LDL-C (P=.0266), and triglycerides (P=.0059); while there was no significant differences in the BMI or the diastolic pressure. CONCLUSIONS: The results support the hypothesis that the metabolic syndrome could be considered a risk factor for the development of blepharitis, and its timely detection is essential to avoid future complications.

Infrared meibography and molecular assessment of p63 gene mutations in a Mexican patient with EEC syndrome. / Meibografía infrarroja y evaluación molecular de la mutación del gen p63 en un paciente mexicano con síndrome EEC.

OBJECTIVE: To report the finding of infrared meibography in a Mexican patient with EEC syndrome (Ectrodactyly-ectodermal dysplasia-cleft syndrome) confirmed by molecular analysis of the p63 gene. CLINICAL CASE: A 31 year-old male patient was seen due to a history of progressive visual loss in both eyes associated with long-term photophobia. The patient was born with cleft lip and palate, ectrodactyly of right hand, and afterwards, displayed nail dysplasia, anodontia and alopecia, with which ectodermal dysplasia was diagnosed. The ophthalmological findings were limited to the adnexa and the ocular surface. In vivo infrared meibography showed total absence of Meibomian glands in the lower eyelids and severe deficiency in the upper eyelids. In addition, it was shown that the patient was a heterozygous carrier of a missense mutation R304W (C → T) in exon 8 of the p63 gene. DISCUSSION: The R304W mutation in the p63 gene region is definitely related to characteristics such as the absence of Meibomian glands.

Immediate effect of a tear enhancer and meibomian gland expression on the corneal surface and whole eye higher order aberrations.

PURPOSE: To investigate changes in higher order ocular aberrations (HOA) induced by the administration of 0.15% sodium hyaluronate tear enhancer (TE) and meibomian gland expression (ME) on the tear film of normal subjects. METHODS: HOA values were obtained from the corneal surface (CS) and whole eye (WE), using a corneal topographer and Shack-Hartmann aberrometer, from both eyes of 50 subjects (25 females, mean age±sd 32.5±11.0 years, and 25 males, 33.88±11.2 years) for two pupil sizes (3 and 6mm) in a dark environment. One drop of Blink Contacts™ (Abbott Medical Optics) was instilled into the right eye and HOA measurements repeated after 30s. After 1h, the meibomian glands of the left lower eyelid were gently squeezed and HOA measurements repeated after 30s. RESULTS: There was no significant difference for CS and WE root mean square (RMS) HOAs between right and left eyes before (both pupil sizes) and after TE use or ME (3mm pupil). For 6mm pupil, TE use significantly reduced the WE RMS HOA (p<0.05, mean±sd) for Z40 (0.297±0.136 to 0.053±0.069), and Z55 (0.221±0.372 to 0.098±0.121) while ME significantly increased CS RMS HOA (p<0.05, mean±sd) for Z3-3 (0.799±1.178 to 1.302±1.991) and Z44 (0.594±1.184 to 0.988±1.463). In general, the change in HOA was significantly correlated with the initial value before TE use or ME (p<0.05). CONCLUSION: There were no detectable differences between right and left eyes. For the 6mm pupil, the tear enhancer tended to improve optical performance of the WE and meibomian gland expression tended to reduce the optical performance at the CS.

Eficacia del sondaje intraductal en la disfunción de las glándulas de Meibomio / Efficacy of intraductal probing in Meibonian gland dysfunction

Objetivo: determinar la efectividad del sondaje intraductal en el tratamiento de la disfunción de las glándulas de Meibomio. Métodos: se realizó un estudio descriptivo, longitudinal, prospectivo, en el Instituto Cubano de Oftalmología Ramón Pando Ferrer, en el período de marzo del año 2014 al mismo mes del año 2015 en 50 ojos (25 pacientes) con diagnóstico de disfunción de las glándulas de Meibomio, a los que se les realizó el sondaje intraductal. Resultados: el tiempo de ruptura de la película lagrimal preoperatorio mínimo fue de 1 segundo y el máximo de 9; al mes y a los seis meses el tiempo de ruptura de la película lagrimal mínimo era de 9 segundos y el máximo de 13. En el preoperatorio los 50 ojos tuvieron tiempo de ruptura de la película lagrimal ˂ 10 segundos; en cambio, al mes y a los seis meses el 50 por ciento tenían tiempo de ruptura de la película lagrimal de ≥ 10 segundos. El índice de enfermedad de la superficie ocular preoperatorio fue 87,80 ± 9,48; a la semana 64,00 ± 10,20; al mes 35,30 ± 9,55 y a los seis meses 36,10 ± 10,37, con diferencia significativa con respecto al preoperatorio ( p= 0,000); no entre el posoperatorio de uno y seis meses (p= 0,6135). Los lubricantes fueron necesarios en todos antes y después del procedimiento; pero al mes y a los seis meses todos los usaban con menor frecuencia. No hubo complicaciones; 5 ojos (10 por ciento) necesitaron un segundo tratamiento y el tiempo promedio fue de 4,4 meses. Conclusiones: el sondaje intraductal de las glándulas de Meibomio es un procedimiento único, seguro, con baja necesidad de retratamiento, que reduce la necesidad del uso de lubricantes, por lo que es un tratamiento efectivo en la disfunción de estas(AU)

Objective: to determine the effectiveness of intraductal probing in treatment of Meibonian gland dysfunction. Methods: a prospective, longitudinal and descriptive study was conducted in 50 eyes (25 patients), who had been diagnosed as Meibonian gland dysfunction and performed the intraductal probing at Ramon Pando Ferrer Cuban Institute of Ophthalmology in the period March 2014 to March 2015. Results: the minimal length of time of rupture of the lachrymal film before surgery was one second and the maximum 9 seconds; after one month and six months the minimal value was 9 seconds and the maximum value was 13. In the preoperative period, 50 eyes showed length of time of rupture of the lachrymal film below 10 seconds; however, one month and six months later, 50 percent of patients had length of time of rupture of the lachrymal film equal or over 10 seconds. The preoperative index of disease of the ocular surface was 87.80 ± 9.48; after one week was 64.00 ± 10.20; after one month 35.30 ± 9.55 and after six months 36.10 ± 10.37, with significant difference in the preoperative (p= 0.000); but it was non-significant between the postoperative term at one month and at six months (p= 0.6135). Oils were necessary in all the eyes before and after the surgical procedure; however, one month and six months later, all the patients used them less frequently. There were no complications, five eyes (10 percent) required a second treatment and the average time elapsed was 4.4 months(AU) Conclusions: the intraductal Meibonian gland probing is a safe, single procedure with almost no requirement for retreatment, which reduces the need for the use of oils and is and effective therapy for Meibonian gland dysfunction.

Eficacia del sondaje intraductal en la disfunción de las glándulas de Meibomio / Efficacy of intraductal probing in Meibonian gland dysfunction

Objetivo: determinar la efectividad del sondaje intraductal en el tratamiento de la disfunción de las glándulas de Meibomio. Métodos: se realizó un estudio descriptivo, longitudinal, prospectivo, en el Instituto Cubano de Oftalmología Ramón Pando Ferrer, en el período de marzo del año 2014 al mismo mes del año 2015 en 50 ojos (25 pacientes) con diagnóstico de disfunción de las glándulas de Meibomio, a los que se les realizó el sondaje intraductal. Resultados: el tiempo de ruptura de la película lagrimal preoperatorio mínimo fue de 1 segundo y el máximo de 9; al mes y a los seis meses el tiempo de ruptura de la película lagrimal mínimo era de 9 segundos y el máximo de 13. En el preoperatorio los 50 ojos tuvieron tiempo de ruptura de la película lagrimal ˂ 10 segundos; en cambio, al mes y a los seis meses el 50 por ciento tenían tiempo de ruptura de la película lagrimal de ≥ 10 segundos. El índice de enfermedad de la superficie ocular preoperatorio fue 87,80 ± 9,48; a la semana 64,00 ± 10,20; al mes 35,30 ± 9,55 y a los seis meses 36,10 ± 10,37, con diferencia significativa con respecto al preoperatorio ( p= 0,000); no entre el posoperatorio de uno y seis meses (p= 0,6135). Los lubricantes fueron necesarios en todos antes y después del procedimiento; pero al mes y a los seis meses todos los usaban con menor frecuencia. No hubo complicaciones; 5 ojos (10 por ciento) necesitaron un segundo tratamiento y el tiempo promedio fue de 4,4 meses. Conclusiones: el sondaje intraductal de las glándulas de Meibomio es un procedimiento único, seguro, con baja necesidad de retratamiento, que reduce la necesidad del uso de lubricantes, por lo que es un tratamiento efectivo en la disfunción de estas(AU)

Objective: to determine the effectiveness of intraductal probing in treatment of Meibonian gland dysfunction. Methods: a prospective, longitudinal and descriptive study was conducted in 50 eyes (25 patients), who had been diagnosed as Meibonian gland dysfunction and performed the intraductal probing at Ramon Pando Ferrer Cuban Institute of Ophthalmology in the period March 2014 to March 2015. Results: the minimal length of time of rupture of the lachrymal film before surgery was one second and the maximum 9 seconds; after one month and six months the minimal value was 9 seconds and the maximum value was 13. In the preoperative period, 50 eyes showed length of time of rupture of the lachrymal film below 10 seconds; however, one month and six months later, 50 percent of patients had length of time of rupture of the lachrymal film equal or over 10 seconds. The preoperative index of disease of the ocular surface was 87.80 ± 9.48; after one week was 64.00 ± 10.20; after one month 35.30 ± 9.55 and after six months 36.10 ± 10.37, with significant difference in the preoperative (p= 0.000); but it was non-significant between the postoperative term at one month and at six months (p= 0.6135). Oils were necessary in all the eyes before and after the surgical procedure; however, one month and six months later, all the patients used them less frequently. There were no complications, five eyes (10 percent) required a second treatment and the average time elapsed was 4.4 months(AU) Conclusions: the intraductal Meibonian gland probing is a safe, single procedure with almost no requirement for retreatment, which reduces the need for the use of oils and is and effective therapy for Meibonian gland dysfunction.

Effect of pulsed laser light in patients with dry eye syndrome. / Efecto del láser de luz pulsada en pacientes con síndrome de ojo seco.

OBJECTIVES: The objective of this study was to determine the clinical benefits of pulsed light therapy for the treatment of Dry Eye Syndrome (DES) due to the decrease in aqueous tear production (aqueous deficient DES) and/or excessive tear evaporation (evaporative DES) due to Meibomian Gland Dysfunction (MGD). METHODS: A study was conducted on 72 eyes corresponding to 36 patients with DES. Out of these 72 eyes, 60 underwent refractive surgery (48 with femtosecond laser, 6 were operated with a mechanical microkeratome, and 6 with refractive photo-keratectomy[RPK], 6 treated with phacoemulsification, and 6 with no previous surgical treatment. Pulsed laser light (Intense Pulsed Light Regulated [IRPL®]) was use to stimulate the secretion of the Meibomian glands during 4 sessions, one every 15 days. RESULTS: Patients with aqueous deficient DES did not show any improvement. Eyes with no previous surgery and those treated with phacoemulsification and PRK had a favourable outcome. On the other hand, less conclusive results were observed in the eyes treated with excimer laser. CONCLUSIONS: This treatment could be very helpful to treat evaporative DES produced by MGD. On the other hand, it is not helpful for those cases related to an isolated damage in the aqueous phase, or the mucin phase.

Mejoría clínica después del sondaje intraductal en la disfunción de las glándulas de Meibomio / Clinical improvement after use of intraductal probing in the Meibomian gland dysfunction

Objetivo: comparar síntomas del paciente (sensibilidad a la luz, sensación de arenilla, irritación o dolor ocular, visión borrosa y mala visión) antes y después del sondaje intraductal. Métodos: se realizó un estudio descriptivo, longitudinal y prospectivo en el Instituto Cubano de Oftalmología Ramón Pando Ferrer, en el período comprendido de marzo del año 2014 a marzo de 2015, en 50 ojos (25 pacientes) con el diagnóstico de disfunción de las glándulas de Meibomio, a los que se les realizó el sondaje intraductal. Resultados: la edad promedio fue de 47,12 ± 11,49 años, con ligero predominio del sexo femenino (64 por ciento). Los pacientes presentaron, la última semana previa al tratamiento, sensibilidad a la luz; sensación de arenilla; irritación o dolor ocular, visión borrosa y mala visión desde la mitad del tiempo hasta todo el tiempo. A la semana después de sondaje no hubo respuestas de todo el tiempo, excepto en la visión borrosa y la mala visión. Al mes y a los 6 meses los resultados fueron similares con respuestas de en ningún momento hasta la mitad del tiempo en la sensibilidad a la luz, sensación de arenilla e irritación ocular. En cuanto a la visión borrosa y la mala visión, la respuesta más frecuente fue algunas veces. Conclusión: el sondaje intraductal ofrece mejoría de los síntomas del paciente con disfunción de las glándulas de Meibomio desde la primera semana posterior al tratamiento; se hace más manifiesta después del mes, y se mantiene durante los seis meses posteriores a este(AU)

Objective: to compare the symptoms experience by the patient (light sensitivity, eye irritation or pain, blurred vision and low vision) before and after use of the intraductal probing. Methods: a prospective, longitudinal and descriptive study conducted in 50 eyes (25 patients) diagnosed with Meibomian gland dysfunction and treated with intraductal probing at Ramon Pando Ferrer Cuban Institute of Ophthalmology from March 2014 to March 2015. Results: average age was 47.12 ± 11.49 years and females were slightly predominant (64 por ciento). One week before treatment, the patients presented with light sensitivity, feeling of having some gravel in the eyes, reddened eyes or ocular pain, blurred vision and low vision which were affecting them part of time or all the time. One week after probing, there were no answers all the time except for blurred vision and low vision. One month, and six months later, the results were similar with answers ranging from at no time to part of time regarding light sensitivity, feeling of some gravel in the eyes and red eye. As to blurred vision and low vision, the most common answer was sometimes. Conclusions: intraductal probing improves the symptoms of the patient who face melbonian gland dysfunction since the first week after treatment; it turned to be more evident after the first month and remained for the next six months(AU)

Mejoría clínica después del sondaje intraductal en la disfunción de las glándulas de Meibomio / Clinical improvement after use of intraductal probing in the Meibomian gland dysfunction

Objetivo: comparar síntomas del paciente (sensibilidad a la luz, sensación de arenilla, irritación o dolor ocular, visión borrosa y mala visión) antes y después del sondaje intraductal. Métodos: se realizó un estudio descriptivo, longitudinal y prospectivo en el Instituto Cubano de Oftalmología Ramón Pando Ferrer, en el período comprendido de marzo del año 2014 a marzo de 2015, en 50 ojos (25 pacientes) con el diagnóstico de disfunción de las glándulas de Meibomio, a los que se les realizó el sondaje intraductal. Resultados: la edad promedio fue de 47,12 ± 11,49 años, con ligero predominio del sexo femenino (64 por ciento). Los pacientes presentaron, la última semana previa al tratamiento, sensibilidad a la luz; sensación de arenilla; irritación o dolor ocular, visión borrosa y mala visión desde la mitad del tiempo hasta todo el tiempo. A la semana después de sondaje no hubo respuestas de todo el tiempo, excepto en la visión borrosa y la mala visión. Al mes y a los 6 meses los resultados fueron similares con respuestas de en ningún momento hasta la mitad del tiempo en la sensibilidad a la luz, sensación de arenilla e irritación ocular. En cuanto a la visión borrosa y la mala visión, la respuesta más frecuente fue algunas veces. Conclusión: el sondaje intraductal ofrece mejoría de los síntomas del paciente con disfunción de las glándulas de Meibomio desde la primera semana posterior al tratamiento; se hace más manifiesta después del mes, y se mantiene durante los seis meses posteriores a este(AU)

Objective: to compare the symptoms experience by the patient (light sensitivity, eye irritation or pain, blurred vision and low vision) before and after use of the intraductal probing. Methods: a prospective, longitudinal and descriptive study conducted in 50 eyes (25 patients) diagnosed with Meibomian gland dysfunction and treated with intraductal probing at Ramon Pando Ferrer Cuban Institute of Ophthalmology from March 2014 to March 2015. Results: average age was 47.12 ± 11.49 years and females were slightly predominant (64 por ciento). One week before treatment, the patients presented with light sensitivity, feeling of having some gravel in the eyes, reddened eyes or ocular pain, blurred vision and low vision which were affecting them part of time or all the time. One week after probing, there were no answers all the time except for blurred vision and low vision. One month, and six months later, the results were similar with answers ranging from at no time to part of time regarding light sensitivity, feeling of some gravel in the eyes and red eye. As to blurred vision and low vision, the most common answer was sometimes. Conclusions: intraductal probing improves the symptoms of the patient who face melbonian gland dysfunction since the first week after treatment; it turned to be more evident after the first month and remained for the next six months(AU)

Complicaciones de la Blefaritis. Presentación de caso / Complications of Blepharitis. Case presentation

Introducción: la Blefaritis se define como inflamación bilateral crónica de los bordes palpebrales. Produce alteraciones de bordes palpebrales, glándulas de Meibomio, córnea, conjuntiva y película lagrimal, dando lugar a complicaciones. Tiene especial importancia debido a su elevada incidencia y al daño que produce sobre la superficie ocular. Objetivo: evidenciar manifestaciones clínicas y complicaciones oftalmológicas en paciente con Blefaritis mixta. Presentación del caso: paciente masculino de 82 años, raza negra con antecedentes patológicos personales de salud, acude por aumento de volumen del párpado inferior de ojo izquierdo desde hace 2 años acompañado de secreción y lagrimeo, sin tratamiento previo. El examen oftalmológico evidencia párpado inferior invertido, pestañas que contactan con la conjuntiva. Bordes palpebrales inflamados, con costras y telangiectasias, dilatación de los orificios de las glándulas de Meibomio. Lesiones tumorales en número de 3 que varían entre 2 y 4 mm, duras e indoloras en tarso inferior. Inyección conjuntival moderada y secreción espumosa. Prueba de Shirmer I 9 mm y tiempo de ruptura de película lagrimal 5 segundos. Se diagnosticó Blefaritis mixta complicada con múltiples chalazión, entropión y queratoconjuntivitis seca. Se indicó, previo consentimiento del paciente, tratamiento con tetraciclina, prednisolona, lágrimas artificiales y tratamiento quirúrgico de múltiples chalazión, y se logró la desaparición del entropión. Se realizó el diagnóstico diferencial con carcinoma de glándulas sebáceas, penfigoide cicatrizal y síndrome de Stevens-Johnson. Conclusiones: la Blefaritis es causa importante de morbilidad ocular debido a los cambios que ocasiona sobre la anatomía de los párpados y película lagrimal con el consecuente daño a la superficie ocular(AU)

Introduction: the Blepharitis is defined like a chronic inflammation of the eyelids borders. It produces alterations of eyelids borders, Meibomio glands, and cornea, conjunctive and lachrymal film, giving place to complications. It has special importance due to their high incidence. Objective: evidencing clinical manifestations and ophthalmologic complications in patient with mixed Blepharitis. Case Presentation: a male patient of 82 years, black race with antecedents of health consults because an increase of volume of the lower left lid of eye for 2 years accompanied by secretion and shed tears, without previously treatment. The ophthalmologic exam evidences reversed lower lid, lashes that contact with the conjunctive. We observed a palpable border with a blush eyelid and scabs, telangiectasias, dilation of the holes of Meibomio glands, tumor injuries in number of 3 with a size between 2 and 4 mm, hard and painless lower plate, moderate conjunctival injection, and scarce foamy secretion. The Schirmers test I 9 mm and plate break down up to 5 seconds. It was diagnosed complicated mixed Blepharitis with multiple chalazion, entropion and dry keratoconjunctivitis. Previous informed consent treatment was indicated withtetracycline, prednisolone, artificial tears and surgical treatment of multiple chalazion, being achieved the disappearance of the entropion. It was carried out the differential diagnosis with carcinoma of sebaceous glands, cicatricial pemphigus and Stevens-Johnson´s syndrome. Conclusions: the Blepharitis is an important cause of ocular morbidity due to the changes produced on the anatomy of the lids and lachrymal film with the consequent damage to the ocular surface(AU)

Atomic force microscopy and Langmuir-Blodgett monolayer technique to assess contact lens deposits and human meibum extracts.

PURPOSE: The purpose of this exploratory study was to investigate the differences in meibomian gland secretions, contact lens (CL) lipid extracts, and CL surface topography between participants with and without meibomian gland dysfunction (MGD). METHODS: Meibum study: Meibum was collected from all participants and studied via Langmuir-Blodgett (LB) deposition with subsequent Atomic Force Microscopy (AFM) visualization and surface roughness analysis. CL Study: Participants with and without MGD wore both etafilcon A and balafilcon A CLs in two different phases. CL lipid deposits were extracted and analyzed using pressure-area isotherms with the LB trough and CL surface topographies and roughness values were visualized using AFM. RESULTS: Meibum study: Non-MGD participant meibum samples showed larger, circular aggregates with lower surface roughness, whereas meibum samples from participants with MGD showed more lipid aggregates, greater size variability and higher surface roughness. CL Study: Worn CLs from participants with MGD had a few large tear film deposits with lower surface roughness, whereas non-MGD participant-worn lenses had many small lens deposits with higher surface roughness. Balafilcon A pore depths were shallower in MGD participant worn lenses when compared to non-MGD participant lenses. Isotherms of CL lipid extracts from MGD and non-MGD participants showed a seamless rise in surface pressure as area decreased; however, extracts from the two different lens materials produced different isotherms. CONCLUSIONS: MGD and non-MGD participant-worn CL deposition were found to differ in type, amount, and pattern of lens deposits. Lipids from MGD participants deposited irregularly whereas lipids from non-MGD participants showed more uniformity.

Conceptos actuales en la disfunción de las glándulas de Meibomio / Current concepts about the meibomian gland dysfunction

Los científicos han estado interesados en el estudio de las secreciones de las glándulas de Meibomio desde hace muchos años. Enfermedades asociadas, como los cánceres y la blefaritis posterior, se han observado en la literatura médica, desde la primera parte del siglo XX. Sin embargo, el término disfunción de las glándulas de Meibomio fue introducida por Korb y Henríquez en 1980. No existía una definición establecida publicada en la literatura hasta que más de 50 expertos internacionales participaron en un taller, que tuvo lugar durante un período de dos años, donde se llegó a definir como una anormalidad crónica y difusa de estas glándulas, comúnmente caracterizada por la obstrucción del conducto terminal y cambios cualitativos/cuantitativos en la secreción de esta. Esto puede resultar en la alteración de la película lagrimal, síntomas de irritación ocular, inflamación clínicamente aparente y enfermedad de la superficie ocular. Es en el mismo Taller Internacional, donde se decide clasificar de acuerdo con los cambios anatómicos, fisiopatológicos, o la gravedad de la enfermedad, donde la forma obstructiva fue la más generalizada. Constituye una afección frecuente con disminución de la calidad de vida y perjuicios potencialmente graves para el bienestar humano(AU)

Scientists have been interested in the study of secretions from meibomian glands for many years. Related illnesses as cancer and posterior blepharitis have been found in the medical literature since the first half of the 20th century. However, the term meibomian gland dysfunction was introduced by Korb and Henríquez in 1980. There was not a set definition published in the literature until over 50 international experts participated in a workshop held for 2 years. It was there where this disorder was finally defined as a chronic diffuse anomaly occurred in these glands, which is generally characterized by obstructed terminal duct and qualitative/ quantitative changes in the gland secretion. This may cause altered lachrymal film, ocular irritation symptoms, clinically apparent inflammation and ocular surface disease. In the same international workshop, it was decided to classify meibomian gland dysfunction according to the anatomical, physiopathological changes or to the severity of the disease, being the obstructive type the most generalized form. This is a frequent illness that reduces the quality of life and causes potentially serious damages for the human wellbeing(AU)

Sonda permeabilizadora en el tratamiento de la disfunción obstructiva de las glándulas de Meibomio / Permeabilizing probing for the treatment of obstructive meibonian gland dysfunction

El ojo seco constituye una de las principales afecciones de la superficie ocular por la que acuden las personas a la consulta de Oftalmología. El 70 por ciento de los pacientes con este diagnóstico presentan algún signo relacionado con la enfermedad de las glándulas de Meibomio y su control con los tratamientos habituales continúa siendo un problema. Las compresas calientes y los lavados con champú infantil darán alivio temporal, pero por lo general son abandonados por los pacientes. Otro enfoque es la expresión de las glándulas de Meibomio, la cual es molesta y por lo general necesita realizarse mßs de una vez; de ahí que el sondeo quirúrgico de esta sea una alternativa a utilizar. El sondaje mediante las sondas de Maskin introducidas desde el 2009 constituye una nueva modalidad terapÚutica, la cual, de acuerdo con el conocimiento de los autores, no había sido introducida previamente en el país. La no disponibilidad de sondas con este fin en Cuba fue la motivación para diseñarla con el objetivo de permeabilizar los conductos excretores en la disfunción obstructiva de las glándulas de Meibomio (O- MGD), y así implementar esta técnica. Este dispositivo se construyó con medios propios en el taller de prototipos del laboratorio, de acuerdo con las características anatómicas del sistema glandular. Actualmente se usa de manera regular por doctores con resultados alentadores, como en los casos que se presentan(AU)

Dry eye is one of the main eye surface diseases that make people go to the ophthalmological service. Seventy percent of patients with such diagnosis present with some type of symptoms related to the meibonian gland disease and its control with the regular treatments remains a problem. Hot pads and washing using shampoo for children give temporary relief, but are generally the patients do not comply with them for a long period of time. Another approach is the meibonian gland expression, which is uncomfortable and the treatment should be repeated more than once. Hence, the surgical probing seems to be a good alternative. Probing with Maskin probes introduced in 2009 is a new therapeutic variant which, according to the authors, had not been practiced in Cuba before. The lack of this type of probes in Cuba was the main incentive for their design in order to create permeabilization of the excretory ducts in the obstructive meibonian gland dysfunction, and to implement this technique. The devise was built with the resources of the lab prototype shop, taking the anatomical characteristics of the glandular system into consideration. The probes are presently used on a regular basis by ophthalmologists with encouraging results as in the reported cases(AU)

Conceptos actuales en la disfunción de las glándulas de meibomio / Current concepts about the meibomian gland dysfunction

Los científicos han estado interesados en el estudio de las secreciones de las glándulas de Meibomio desde hace muchos años. Enfermedades asociadas, como los cánceres y la blefaritis posterior, se han observado en la literatura médica, desde la primera parte del siglo XX. Sin embargo, el término "disfunción de las glándulas de Meibomio" fue introducida por Korb y Henríquez en 1980. No existía una definición establecida publicada en la literatura hasta que más de 50 expertos internacionales participaron en un taller, que tuvo lugar durante un período de dos años, donde se llegó a definir como una anormalidad crónica y difusa de estas glándulas, comúnmente caracterizada por la obstrucción del conducto terminal y cambios cualitativos/cuantitativos en la secreción de esta. Esto puede resultar en la alteración de la película lagrimal, síntomas de irritación ocular, inflamación clínicamente aparente y enfermedad de la superficie ocular. Es en el mismo Taller Internacional, donde se decide clasificar de acuerdo con los cambios anatómicos, fisiopatológicos, o la gravedad de la enfermedad, donde la forma obstructiva fue la más generalizada. Constituye una afección frecuente con disminución de la calidad de vida y perjuicios potencialmente graves para el bienestar humano.

Scientists have been interested in the study of secretions from meibomian glands for many years. Related illnesses as cancer and posterior blepharitis have been found in the medical literature since the first half of the 20th century. However, the term «meibomian gland dysfunction¼ was introduced by Korb and Henríquez in 1980. There was not a set definition published in the literature until over 50 international experts participated in a workshop held for 2 years. It was there where this disorder was finally defined as a chronic diffuse anomaly occurred in these glands, which is generally characterized by obstructed terminal duct and qualitative/quantitative changes in the gland secretion. This may cause altered lachrymal film, ocular irritation symptoms, clinically apparent inflammation and ocular surface disease. In the same international workshop, it was decided to classify meibomian gland dysfunction according to the anatomical, physiopathological changes or to the severity of the disease, being the obstructive type the most generalized form. This is a frequent illness that reduces the quality of life and causes potentially serious damages for the human wellbeing.

Sonda permeabilizadora en el tratamiento de la disfunción obstructiva de las glándulas de meibomio / Permeabilizing probing for the treatment of obstructive meibonian gland dysfunction

El ojo seco constituye una de las principales afecciones de la superficie ocular por la que acuden las personas a la consulta de Oftalmología. El 70 % de los pacientes con este diagnóstico presentan algún signo relacionado con la enfermedad de las glándulas de Meibomio y su control con los tratamientos habituales continúa siendo un problema. Las compresas calientes y los lavados con champú infantil darán alivio temporal, pero por lo general son abandonados por los pacientes. Otro enfoque es la expresión de las glándulas de Meibomio, la cual es molesta y por lo general necesita realizarse más de una vez; de ahí que el sondeo quirúrgico de esta sea una alternativa a utilizar. El sondaje mediante las sondas de Maskin introducidas desde el 2009 constituye una nueva modalidad terapéutica, la cual, de acuerdo con el conocimiento de los autores, no había sido introducida previamente en el país. La no disponibilidad de sondas con este fin en Cuba fue la motivación para diseñarla con el objetivo de permeabilizar los conductos excretores en la disfunción obstructiva de las glándulas de Meibomio (O- MGD), y así implementar esta técnica. Este dispositivo se construyó con medios propios en el taller de prototipos del laboratorio, de acuerdo con las características anatómicas del sistema glandular. Actualmente se usa de manera regular por doctores con resultados alentadores, como en los casos que se presentan.

Dry eye is one of the main eye surface diseases that make people go to the ophthalmological service. Seventy percent of patients with such diagnosis present with some type of symptoms related to the meibonian gland disease and its control with the regular treatments remains a problem. Hot pads and washing using shampoo for children give temporary relief, but are generally the patients do not comply with them for a long period of time. Another approach is the meibonian gland expression, which is uncomfortable and the treatment should be repeated more than once. Hence, the surgical probing seems to be a good alternative. Probing with Maskin probes introduced in 2009 is a new therapeutic variant which, according to the authors, had not been practiced in Cuba before. The lack of this type of probes in Cuba was the main incentive for their design in order to create permeabilization of the excretory ducts in the obstructive meibonian gland dysfunction, and to implement this technique. The devise was built with the resources of the lab prototype shop, taking the anatomical characteristics of the glandular system into consideration. The probes are presently used on a regular basis by ophthalmologists with encouraging results as in the reported cases.