Adaptación cultural, lingüística y validación del cuestionario Dry Eye Questionnaire 5 en una población chilena / Adaptation culturally and linguistically to the Chilean population and validation the Dry Eye Questionnaire 5

Antecedentes y objetivo Existen distintos métodos de evaluación de la enfermedad de ojo seco (EOS), entre ellos cuestionarios que analizan distintos aspectos de su sintomatología, los que son importantes para su mejor comprensión y manejo terapéutico. El Dry Eye Questionnaire 5 (DEQ-5) es único en su tipo, pues además de su simplicidad, mide sintomatología en cuatro dimensiones. El objetivo de este estudio fue adaptar cultural, lingüísticamente y validar, este cuestionario para una población chilena. Materiales y métodos Para la adaptación, se realizó la traducción y retrotraducción de la versión original, su análisis lingüístico, una prueba piloto y el examen de expertos, que incorporó una especialista en lingüística. Para la validación se realizó el análisis psicométrico de fiabilidad y validez de constructo. La muestra en la que se validó quedó constituida por 205 personas con EOS. Resultados De los encuestados, 141 (69%) fueron mujeres, la media de edad fue de 48 años ± 16,7 y la mediana del puntaje total DEQ-5 fue de 13 puntos (R.I 8-15 puntos). La versión adaptada resultó con un alfa de Cronbach de 0,8085, puntaje que la clasificó como buena. Discusión El cuestionario DEQ-5 adaptado y validado resultó un buen instrumento para ser usado en poblaciones con características similares a las del estudio. Además, el análisis factorial enriqueció la comprensión de la manera en que las personas con EOS relacionan sus síntomas y qué preguntas se corresponden más entre ellas, representando de mejor manera los aspectos evaluados de la sintomatología de esta enfermedad (AU)

Background and objective There are different methods for evaluating dry eye disease (DID), including questionnaires that analyze different aspects of its symptoms, which are important for its better understanding and therapeutic management. The Dry Eye Questionnaire 5 (DEQ-5), is unique in its kind, because in addition to its simplicity, it measures symptoms in four dimensions. The aim of this study is to adapt culturally and linguistically and validate this instrument to the Chilean population. Material and methods For the adaptation, the translation and retro-translation of the original version was carried out, its linguistic analysis, the pilot test and the expert panel review (which included a linguistics specialist) were used. For the validation, a psychometric analysis of reliability and validity of the construct was incorporated. The sample in which it was validated was constituted by 205 people with dry eye disease. Results One hundred and forty-one (69%) of the respondents were women, the mean of age was 48 years ± 16.7, and the median of the total score DEQ-5 was 13 points (R.I 8–15 points). The adapted version resulted in a Cronbach alpha of 0.8085, scoring that classified it as good. Discussion The questionnaire DEQ-5, which was adapted and validated, was a good instrument to be used in populations with similar characteristics of those in the study. More so, the factor analysis enriched comprehension of the way in which people with dry eye disease relate their symptoms and which questions relate more between them, representing in a better way the aspects evaluated of the symptomatology of this disease (AU)

Light Perception Vision and Xerophthalmia in an 11-Year-Old Boy.

The authors present a case of a child who had severe dietary restriction with consumption of french fries only. He presented to the ophthalmology clinic with light perception vision in both eyes, and was found to have dry, leathery conjunctivae with Bitot's spots and hazy corneas with diffuse punctate epithelial erosions. Electroretinography testing showed an absent rod response and a decreased cone response. Laboratory testing results were positive for vitamin A deficiency. After prompt initiation of treatment, he had improvement in his vision and anterior segment findings. This case serves as a reminder that vitamin A deficiency can present in high-income countries, and that ophthalmologists may play a key role in diagnosing the condition, initiating treatment, and sending patients to the appropriate subspecialists for further evaluation and management of the underlying condition. For patients with vitamin A deficiency, ophthalmologists can play an essential role in preventing permanent vision loss and the systemic consequences of deficiency such as infection or death. [J Pediatric Opthalmology & Strabismus. 2022;59(3):e35-e38.].

Recognizing vitamin A deficiency: special considerations in low-prevalence areas.

PURPOSE OF REVIEW: Although vitamin A deficiency (VAD) is rare in well resourced countries, there is a growing trend of VAD in at-risk pediatric populations. Early diagnosis is critically important to prevent its associated morbidity and mortality. This review highlights key lessons for evaluation, diagnosis, and management of children with xerophthalmia in the United States. It synthesizes the latest findings from the literature on the pathophysiology, epidemiology, risk factors, evaluation, and management of VAD in low-prevalence areas. RECENT FINDINGS: Vitamin A is crucial for maintaining the functional integrity of the eye, immune system, skin, and mucous membranes. Despite the scarcity of VAD in developed countries, there are increasing reports of VAD in at-risk children, including those with autism spectrum disorder and gastrointestinal conditions. There is a broad range of manifestations of VAD, posing a diagnostic challenge. Familiarity with the variable presentations of VAD and having a high index of suspicion in at-risk populations can aid in its early diagnosis. Systemic vitamin A supplementation and a multidisciplinary approach are important components of the management of VAD. SUMMARY: Even in well resourced countries, VAD should remain on the differential in patients with risk factors who present with relevant signs and symptoms. Early diagnosis and appropriate involvement of a multidisciplinary care team can help prevent morbidity and mortality associated with VAD.

[Xerophthalmia in a 7-year-old autistic child]. / Xeroftalmi ­ tidig diagnos kan hindra irreversibla ögonskador.

Vitamin A deficiency and xerophthalmia is a rare finding in developed countries. We report a severe case of xerophthalmia in a 7-year-old autistic child with restricted diet. Both eyes had Bitot's spots and ulceration. The right cornea had a perforation at admission. After treatment with high doses of vitamin A the right cornea epithelialized with formation of the anterior chamber and the left eye healed completely. This case adds to the increasing number of reports on cases of xerophthalmia particularly in autistic children and highlights the importance of considering vitamin A deficiency in patients with risk of malnutrition also in developed countries.

The clinical effects of sodium hyaluronate, polyethylene glycol, and dextran-70 eye drops in relieving dry eye after phacoemulsification.

ABSTRACT: To compare the clinical efficacy of sodium hyaluronate eye drops, polyethylene glycol eye drops, and compound dextran eye drops in the treatment of dry eye after phacoemulsification of cataract.A total of 99 patients with dry eye after cataract phacoemulsification combined with intraocular lens implantation were treated in our hospital. Patients were divided into group A (sodium hyaluronate eye drops), group B (polyethylene glycol eye drops), and group C (dextran-70 eye drops). The clinical effect, tear film breakup time, basic tear secretion, corneal staining score, dry eye symptom score, and the incidence of ocular irritation were assessed.On the 3rd, 15th, 30th, and 60th day after operation, the tear film breakup time, corneal staining score, Schirmer I test, and dry eye symptom score in group A and group B were better than those in group C (P < .05). In addition, there were no significant differences in tear breakdown time, corneal staining score, Schirmer I test, and dry eye symptom score between group A and group B (P > .05). At 3 days to 60 days after operation, the incidence of dry eye in group A (12.12%) and group B (18.18%) was lower than that in group C (39.39%), and the incidence of dry eye in group A was significantly lower than that in group B (P < .05).The effect of sodium hyaluronate eye drops elicited a greater beneficial impact as compared to polyethylene glycol eye drops and dextran-70 eye drops.

Servicio profesional farmacéutico de indicación farmacéutica en sequedad ocular utilizando el programa 'I-VALOR' / Minor ailment service for dry eye syndromes: I-VALOR programme

INTRODUCCIÓN: la labor del farmacéutico comunitario en el Servicio de Indicación Farmacéutica (SIF) es muy importante como primera línea de asistencia a la población, aunque no está suficientemente documentada. OBJETIVOS: evaluar la intervención del farmacéutico comunitario en el SIF ante una consulta sobre enfermedad de ojo seco (EOS) con el uso de protocolos. MATERIAL Y MÉTODOS: estudio descriptivo, observacional realizado dentro del programa I-VALOR (enero-junio 2015). Los participantes fueron farmacéuticos voluntarios y pacientes que solicitaron algún remedio para aliviar la EOS. Se utilizó el protocolo del SIF del Foro de Atención Farmacéutica en Farmacia Comunitaria, un consenso para EOS realizado entre sociedades científicas, una hoja de derivación, un informe para el paciente y una hoja de recomendaciones. RESULTADOS: participaron 6.350 pacientes. 62,7 % consultas fueron realizadas por mujeres (24,3 % 46-65 años). El 60 % de los pacientes no presentaba ningún criterio de derivación. Se detectaron 3.887 criterios de derivación en 2.537 pacientes. Se decidió no derivar al 15,4 %, y del resto, 87,3 % aceptó la derivación. La dispensación de algún tratamiento tuvo lugar en el 80 % de los pacientes: 3.157 con tratamiento farmacológico (89,2 % un único medicamento) y 2.403 con tratamiento no farmacológico. El 35 % recibió consejos higiénico-dietéticos y consejo farmacéutico. Se detectaron 25 reacciones adversas a medicamentos (0,4 %). El 70,5 % de todas las consultas realizadas fueron resueltas sin necesidad de derivar al médico. CONCLUSIONES: el programa I-VALOR para EOS ha permitido evaluar la intervención protocolizada del farmacéutico en EOS mediante el registro de las actuaciones farmacéuticas para demostrar la labor desarrollada desde la farmacia comunitaria

BACKGROUND: Minor ailment service offered in community pharmacist is a key element in patient care. Thought in Spain the service is not properly documented. AIMS: The main objective was to evaluate community pharmacists' interventions through an agreed minor ailment service for dry eye syndromes (DES). METHOD: Descriptive study undertaken alongside I-VALOR programme (January-June 2015). Participants were pharmacists from SEFAC who voluntarily decided to do, and patients were those who consulted about DES in community pharmacy. Pharmacists used the Pharmaceutical Care Forum guideline for the Minor Ailment Service and an agreed consensus between pharmaceutical and medical societies. A patient's form and a referral's form were designed. RESULTS: There were 6,350 patients involved. 62.7% consultations were made by women 24.3% of 46-65 years old). No referral criteria were detected in 60% of patients. The pharmacist detected 3,887 referral criteria in 2,537 patients. Pharmacists decided not to refer 15.4% of those patients. 87.3% of the patients referred accepted the referral. Treatments were dispensed in 80% of patients: 3,157 pharmacological treatment (89.2% a single medication) and 2,403 non-pharmacological treatment (medical device, food supplement or eye cleaning product). 35% received hygienic-dietary advice and pharmaceutical advice. Twenty-five adverse drug reactions were detected (0.4%). 70.5% of all consultations made were managed with no referral to a general practitioner (GP). CONCLUSIONS: I-VALOR programme allowed to evaluate an agreed intervention for DES in community pharmacy through the record of MAS to demonstrate CP contribution to manage minor ailments

Economic impact of dry eye disease in Spain: A multicentre retrospective insurance claims database analysis.

PURPOSE: To analyse the occurrence and cost of dry eye disease in Spain in the recent years. METHODS: A cross-sectional analysis based on anonymised data from an insurance claims database that includes data from 1997 to 2015 from public and private hospitals and healthcare centres; 36,081 patients were eligible for the study after duplicate elimination. Five ICD9 codes associated with dry eye were used for patient selection, including vitamin A deficiency with xerophthalmic scars of cornea, xerophthalmia due to vitamin A deficiency, keratoconjunctivitis sicca not specified as Sjögren's, dry eye syndrome and keratoconjunctivitis sicca Sjögren's disease. RESULTS: Over 88% of the patients were female, and the mean age was 66 years. Patients with keratoconjunctivitis sicca Sjögren's disease represented more than 89% of all patients and had the highest percentage of women. Both the annual number of patients and the number of admissions have increased exponentially since 1997 raising from 1079 to 3097 and from 1344 to 5938, respectively. The in-hospital length of stay was 9.6 (standard deviation = 11.6) days where more than 65% of the admissions were due to emergencies. Total costs were found to increase from €4.9 to €30.3 million during the study period; in parallel, there was an increase in the mean annual cost per patient, which was on average €7379. CONCLUSION: Disease incidence is likely to increase due to the influence of modern-day workplace, and it is important to take into account the high economic burden and the large decrease in quality of life in regards to Spanish society and health policies.

An investigation of low power convex lenses (adds) for eyestrain in the digital age (CLEDA) / Investigación sobre las lentes convexas de baja potencia (adiciones) para la fatiga en la era digital (CLEDA)

INTRODUCTION: Digital eye strain (DES; computer vision syndrome) is a common cause of symptoms when viewing digital devices. Low-powered convex lenses (adds) have been recommended for the condition and "accommodative support" designs developed on this premise. The present research reports the extent to which dry eye is present in this population and the effect of convex lenses on symptoms and visual performance. METHODS: The CVS-Q instrument was used to select pre-presbyopic adults with the symptoms of DES. Participants received a full eye examination including an assessment of dry eye with a modified SANDE questionnaire and using DEWS I criteria. The immediate effect of low-powered convex lenses (low adds: +0.50D, +0.75D, +1.25D) was investigated using subjective preference and a double-masked comparison with plano lenses with the Wilkins Rate of Reading Test (WRRT). Throughout this testing, participants wore their full distance refractive correction, based on non-cycloplegic retinoscopy and subjective refraction. RESULTS: The signs and symptoms of dry eye were frequently present. Most participants reported a subjective preference for low adds, with +0.75D the most commonly preferred lens. Low adds (+0.50D and +0.75D; but not +1.25D) were associated with significantly improved performance at the WRRT. One quarter of participants read more than 10% faster with these additional convex lenses. CONCLUSIONS: The study population was aged 20-40y and mostly worked on desktop computers. It is possible that +1.25D add may be more advantageous for people who are older or work more at closer viewing distances. Many symptomatic users of digital devices report a preference for low adds and use of these lenses is often associated with an improvement in reading performance

INTRODUCCIÓN: La fatiga digital (DES; síndrome visual informático) es una causa común de síntomas, a causa de la visualización de dispositivos digitales. Se han recomendado lentes convexas de baja potencia para esta situación, así como diseños de "apoyo acomodativo" desarrollados sobre la base de este principio. Los informes de investigación actuales reportan el alcance de la presencia de ojo seco en esta población, así como el efecto de las lentes convexas en los síntomas y el desempeño visual. MÉTODOS: Se utilizó el instrumento CVS-Q para seleccionar adultos pre-presbiópicos con síntomas de DES. Se realizó un examen visual completo a los participantes, incluyendo valoración de ojo seco con un cuestionario SANDE modificado, y utilizando los criterios DEWS I. Se investigó el efecto inmediato de las lentes convexas de baja potencia (adiciones bajas: +0,50D, +0,75D, +1,25D) utilizando la preferencia subjetiva y una comparación doble ciego con lentes planas mediante la prueba Wilkins Rate of Reading Test (WRRT). A lo largo de esta prueba, los participantes utilizaban su corrección refractiva de distancia completa, basada en retinoscopia no ciclopéjica y refracción subjetiva. RESULTADOS: Los signos y síntomas del ojo seco estuvieron frecuentemente presentes. Muchos participantes reportaron una preferencia subjetiva de bajas adiciones, siendo las lentes de +0,75D las más comúnmente preferidas. Las bajas adiciones (+0,50D y +0,75D, pero no +1,25D) se asociaron a un desempeño significativamente mejorado en la prueba WRRT. Un 25% de los participantes leyeron un 10% más rápido con estas lentes convexas adicionales. CONCLUSIONES: La edad de la población de estudio fue de 20 a 40 años, trabajando la mayoría de dichos sujetos en ordenadores de mesa. Es posible que la adición de +1,25D sea más ventajosa para personas de mayor edad, o que trabajen más con distancias de visualización más próxima. Muchos usuarios de dispositivos digitales sintomáticos reportan una preferencia por bajas adiciones, asociándose a menudo el uso de estas lentes a una mejora del desempeño lector

Common inflammatory and infectious conditions of the eyelid.

Patients with infection or inflammation of the eyelid will often first present to their primary care physicians with symptoms such as redness, swelling, tearing, itchiness, or a foreign body sensation. There are a variety of conditions that affect the eyelid which can cause such symptoms, and the exam and history can help a provider differentiate some of the more common conditions. This article will provide a comprehensive review of the background, diagnosis and management of dry eye disease, chalazion, hordeolum (stye), and preseptal cellulitis.

Long-term results of the treatment of primary hyperhidrosis with oxybutynin: follow-up of 1,658 cases.

BACKGROUND: Hyperhidrosis (HH) is characterized by exaggerated sweating in a specific region due to hyperfunction of the sweat glands. In the late 2000s, we started treating patients with an anticholinergic, oxybutynin, that was not being used until then. OBJECTIVES: To present, after 12 years of utilizing this medication in our service, the substantial experience obtained with the use of oxybutynin as an initial treatment of HH in a large series of 1,658 patients. METHODS: We analyzed 1,658 patients treated with oxybutynin for HH from May 2006 to June 2018. The patients were divided into four groups according to the main site of HH: the plantar group, the axillary group, the facial group, and the palmar group. To measure the degree of satisfaction, a quality of life (QoL) questionnaire was used. RESULTS: Pre-treatment QoL was poor or very poor in more than 94% of the cases, and the palmar group had the worst quality of life. After treatment, we observed an improvement in the quality of life in 77% of patients. More than 70% of the patients in all groups present moderate or optimal subjective clinical improvement in sweating after treatment. The group with the best result was the facial group. Intense dry mouth was reported in 24.9% of all patients in all groups. CONCLUSIONS: This study included a large number of patients followed for a long period and demonstrated the good effectiveness of treatment with oxybutynin for hyperhidrosis in the main sites of sweating.

Application of classification criteria of Sjogren syndrome in patients with sicca symptoms: Real-world experience at a medical center.

BACKGROUND: Patients who have symptoms of sicca, such as dry eyes and mouth, may have Sjögren's syndrome (SS). However, the conservative culture makes patients hesitate to undergo an invasive biopsy, which contributes to the difficulty of confirming a diagnosis. We aimed to identify the characteristics of patients with sicca symptoms to develop a better predictive value for each item included in the three different diagnostic criteria for SS and clarify the best diagnostic tools for the local population. METHODS: This is a single-center retrospective case-control study from January 2016 to December 2017. Patients who underwent sialoscintigraphy because of clinical symptoms of xerostomia and xerophthalmia at one medical center were reviewed via the patients' electronic medical records. RESULTS: Of 515 patients enrolled, the severity of results for sialoscintigraphy and Schirmer's test was correlated with a diagnosis of SS and generated receiver operator characteristic curve. The area under curve (AUC) was 0.603 for positive Schirmer's test, 0.687 for positive anti-Ro/La results, 0.893 for a positive salivary gland biopsy. The AUC was 0.626 and 0.602 for Schirmer's test which is redefined as <10 mm/5 minutes in either eye and according to 2016 the American College of Rheumatology/ European League Against Rheumatism criteria, respectively. CONCLUSION: Our results indicate the cut-off point for defining a positive test result in the Schirmer's test is worth modified to <10 mm/5 minutes in either eye.

Chronic eyelid edema and xerophthalmia secondary to periorbital hyaluronic acid filler injection.

BACKGROUND: Hyaluronic acid (HA) is a popular, nonsurgical, temporary technique that is commonly used in the periocular region to restore volume in areas that have undergone volume loss, as well as adjusting the height and contour of the eyebrow. AIMS: Due to the location of glands, nerves, and vasculature, the facial anatomy should be well understood to avoid injections into areas that may result in complications. PATIENT/METHODS: A 54-year-old woman presented for a cosmetic consultation to address "puffy eyelids". She states she had HA filler injected along the orbital ridge inferior to the eyebrow and medially at the glabellar crease two years prior. Two months after her injection, she began to notice upper eyelid edema, xerophthalmia, and dryness of her nasal mucous membranes. Extensive evaluation and imaging were done by physicians of different specialties with a negative workup. RESULTS: A total of 60 units of hyaluronidase were injected into the areas of previous filler placement over a three-week period. This resulted in complete resolution of the patient's presenting symptoms. CONCLUSION: Familiarity with potential adverse events is arguably the most important aspect of treating patients with HA filler. The anatomy of the orbit and lacrimal system are important to keep in mind when evaluating symptoms related to possible long-term complications of retained filler injections. Reporting this case should raise awareness about this potential adverse event and further explain the delicate anatomy of the periorbital area.

Case Report: Vitamin A Deficiency and Nyctalopia in a Patient with Chronic Pancreatitis.

SIGNIFICANCE: Vitamin A deficiency is a known concern in developing countries, but it is often overlooked in developed regions. A history of conditions causing alimentary malabsorption should be considered when patients present with complaints of nyctalopia. PURPOSE: A case of vitamin A deficiency with nyctalopia in a patient with chronic pancreatitis including pertinent diagnostic testing, treatment, and management is presented. The intent is to draw attention to the condition as a differential diagnosis for nyctalopia due to increased prevalence of conditions causing malabsorption. CASE REPORT: A patient with a history of chronic pancreatitis and pancreatic tumor presented with symptoms of nyctalopia and xerophthalmia. Given his systemic history, testing was ordered to determine serum vitamin A levels and retinal function. After results had confirmed depleted vitamin A levels and diminished retinal function, treatment with both oral and intramuscular vitamin A supplementation was initiated to normalize vitamin A levels and improve retinal photoreceptor function. Subjective improvement in symptoms was reported shortly after beginning supplementation, and ultimately, vitamin A levels and retinal function showed improvement after intramuscular treatment. CONCLUSIONS: Detailed case history and a careful review of systems along with serum vitamin A testing and, if available, electroretinography to assess retinal function can help to make a definitive diagnosis. With appropriate comanagement with the patient's primary care physician, it is possible for those with nyctalopia to begin vitamin A supplementation and regain retinal function.

Aplicación de toxina botulínica en el músculo de Horner para el tratamiento de ojo seco / Application of botulinum toxin in Horner's muscle for the treatment of dry eye

OBJETIVO/MÉTODOS: Describir el uso de toxina botulínica tipo A para aumentar la retención lagrimal en pacientes con ojo seco mediante el reporte de 2 casos. RESULTADOS: Pacientes con ojo seco moderado a severo, a quienes se les inyectaron 5 UI de toxina botulínica tipo A en el músculo de Horner. Se describen los resultados al mes y 3 meses. Se evaluó la percepción subjetiva del paciente en cuanto a la mejoría, además, del Ocular Surface Disease Index, la queratitis punteada superficial, el tiempo de rotura de la lágrima y el menisco lagrimal, los cuales también fueron tenidos en cuenta. Se evidenció una importante mejoría de la percepción subjetiva del paciente, el Ocular Surface Disease Index, la queratitis punteada superficial, el tiempo de rotura de la lágrima y el menisco lagrimal al mes de la aplicación, manteniéndose aún con buenos resultados al tercer mes. No se presentaron eventos adversos. DISCUSIÓN: El uso de toxina botulínica tipo A puede ser considerado una alternativa para aumentar la retención de la lágrima en pacientes con ojo seco moderado a severo con una buena respuesta durante el primer mes, manteniendo una respuesta aceptable incluso al tercer mes. Dado el efecto temporal del medicamento, podría precisar retratamientos

OBJECTIVE/METHODS: The aim of this study is to describe the use of botulinum toxin to increase tear retention in patients with dry eye, using the description of 2 cases. RESULTS: Patients with moderate to severe dry eye that were given an injection of type A botulinum toxin in the Horner's muscle. The results at one month and 3 months are reported. An assessment was made of the subjective perception of the patient as regards any improvement, as well as taking into account, the Ocular Surface Disease Index, superficial punctate keratitis, and the time of the tear rupture and tear meniscus. A significant improvement was observed in the subjective perception of the patient, the Ocular Surface Disease Index, superficial punctate keratitis, and the time of the tear rupture and tear meniscus at one month after treatment, and the good results still being maintained at the third month. There were no adverse events. DISCUSSION: The use of type A botulinum toxin can be considered as an alternative to increase tear retention in moderate to severe dry eye, with a good response during the first month, with an acceptable response still being maintained at the third month. Given the temporary effect of the drug, further treatments would be required

Epidermal Fatty Acid-Binding Protein: A Novel Marker in the Diagnosis of Dry Eye Disease in Sjögren Syndrome.

PURPOSE: Sjögren syndrome (SS) is a chronic inflammatory autoimmune disease of the lacrimal and salivary glands. This study compared the concentrations of epidermal fatty-acid binding protein (E-FABP) in the saliva, serum, and tears of SS patients with dry eye and dry mouth, with those of healthy adults to investigate the usefulness of E-FABP as a diagnostic marker for SS. DESIGN: Prospective, observational case series. PARTICIPANTS: The subjects were 11 new patients with untreated Sjogren syndrome and 12 healthy control individuals. METHODS: The diagnosis of SS was in accordance with the Ministry of Health, Labour and Welfare (Japan) Diagnostic Criteria (1999). Saliva, serum, and tear specimens were collected during internal medicine, dental, and ophthalmological examinations. The ophthalmological tests included the Dry Eye-related Quality of life Score (DEQS), tear break-up time (BUT), vital staining with fluorescein (FS) and lissamine green (LG), and the Schirmer test-1. The E-FABP concentration in the tears, saliva, and serum was measured by enzyme-linked immunosorbent assay (ELISA). MAIN OUTCOME MEASURE: The E-FABP concentrations were compared between patients and controls. RESULTS: There were significant differences between the patient and healthy control groups in all ophthalmological test results. There were no significant differences between the groups in the E-FABP concentrations in the saliva (p = 0.1513) or the serum (p = 0.4799), but the E-FABP concentration in the tears significantly differed between groups. The E-FABP concentration in tears tended to be significantly lower in patients with SS (mean, 323.5 ± 325.6 pg/mL) than healthy control subjects (mean, 4076 pg/mL; p = 0.0136). The E-FABP concentration in tears significantly correlated with the results of dry eye parameters. CONCLUSION: The E-FABP concentration in tears appears to be related to ocular surface epithelial damage and tear stability and may be a promising novel biomarker in the diagnosis of SS.

Enfermedad orbitaria relacionada con Ig-G4 / IgG4-related orbital disease

CASO CLÍNICO: Presentamos el caso de una mujer de 64 años con tumefacción palpebral, dacrioadenitis bilateral y exoftalmos, e historia de rinitis crónica y asma bronquial. Se evidenció aumento de IgG4 sérica y se realizó biopsia incisional de glándulas lagrimales que demostró fibrosis e infiltrado linfoplasmocitario con células productoras de IgG4. Discusión: El compromiso orbitario en enfermedad relacionada con IgG4 es frecuente. La dacrioadenitis bilateral es la manifestación más común. La histopatología es esencial para el diagnóstico de la enfermedad y excluir malignidad

CASE REPORT: The case is presented of a 64-year-old woman with bilateral palpebral swelling and dacryoadenitis, exophthalmos, and a history of chronic rhinitis and asthma. An increase in serum IgG4 was observed, and an incisional biopsy of lacrimal glands was performed, which showed fibrosis and a lymphoplasmacytic infiltrate with IgG4 producing cells. DISCUSSION: Orbital involvement in IgG4-related disease is frequent. Bilateral dacryoadenitis is the most common manifestation. Histopathology is essential for the diagnosis and to exclude malignancy

Discrepancy between subjective symptoms, objective measures and disease activity indexes: the lesson of primary Sjögren's syndrome.

Mucosal dryness is a key clinical feature in primary Sjögren's syndrome (pSS) and its assessment relies on both objective measurement of residual secretion and subjective symptoms reported by patients. However, while the objective assessment and grading of glandular dysfunction can be easily performed, the spectrum of clinical symptoms encompassed by the terms 'dry eye' and 'dry mouth' is wide and heterogeneous. Therefore, patient reported outcomes (PROs) for dryness in pSS poorly correlate with the amount of glandular secretion. In addition, subjective dryness is not correlated with the severity of systemic disease and severely affects the patient quality of life even in presence of active extraglandular manifestations. The purpose of this review article is to provide an overview of glandular dysfunction in pSS as well as the impact of discrepancy between objective assessment, subjective symptom and extraglandular disease activity on disease management.