Potential blindness from nutritional xerophthalmia in autistic patients.

BACKGROUND: Vitamin A is vital to retinal rod function and epithelial cell differentiation. Although uncommon in the developed world, vitamin A deficiency (VAD) secondary to poor diets or gastrointestinal disease has been reported and can lead to xerophthalmia, which is characterized by night blindness and a spectrum of ocular surface changes. Patients with autism spectrum disorder have been shown to have restrictive diets secondary to sensory issues leading to rejection of foods except for those of certain color or texture. METHODS: We present a case series of 6 pediatric patients with autism who developed varying degrees of xerophthalmia due to VAD, which resulted from restrictive eating. RESULTS: All patients presented with a history of eye irritation that was not relieved by antibiotic or allergy eye drops. Further questioning revealed they had restrictive diets consisting of only or mostly white and tan foods, and serum vitamin A testing confirmed severe VAD. Most stages of xerophthalmia were completely reversed with vitamin A supplementation, but in 2 patients more advanced xerophthalmia resulted in irreversible blindness and ocular damage. CONCLUSIONS: Both pediatricians and pediatric eye care providers must be vigilant for VAD as an etiology of eye irritation, photophobia, or new-onset visual impairment in autistic children. A review of the child's diet must be implemented as a standard part of routine history taken in this vulnerable population. Early identification and vitamin A supplementation can prevent irreversible ocular compromise and vision loss.

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.

Astenopia em docentes universitários durante a pandemia da COVID-19 / Asthenopia in college lecturers during the COVID-19 pandemic

RESUMO Objetivo: Avaliar sintomas astenópicos e fatores sociodemográficos, hábitos comportamentais e clínicos nos docentes universitários durante a pandemia da COVID-19. Métodos: Trata-se de estudo transversal que avaliou a ocorrência de astenopia em 104 docentes. Questionários de sintomatologia visual validados foram adaptados para a coleta de dados. Houve comparação dos docentes quanto à ocorrência ou não de sintomas astenópicos, bem como foi aplicada regressão logística binária, para aferir a associação com variáveis independentes (p<0,05). Resultados: Houve maior aparecimento de sintomas astenópicos durante o período pandêmico, em que o tempo de exposição a telas parece ter sido o fator mais determinante. Além disso, os indivíduos com tempo de tela superior a 5 horas diárias, que faziam uso de telas para o lazer e usavam colírio/lubrificantes apresentaram significativamente maior chance de estar no grupo com sintomas astenópicos. Conclusão: Foi identificada associação significativa entre a ocorrência de sintomas astenópicos e o uso de telas durante o período pandêmico, principalmente nos grupos com maior duração do tempo de tela. O estudo chama atenção para a saúde ocular de docentes universitários em ensino remoto, além de suscitar novos estudos para investigação desse quadro em distintos ambientes escolares.

ABSTRACT Objective: To assess asthenopic symptoms and sociodemographic factors, behavioral and clinical aspects in college lecturers during the COVID-19 pandemic. Methods: This is a cross-sectional study evaluating asthenopia in 104 lecturers. Some validated visual symptom questionnaires were adapted for data collection. Lecturers were compared regarding the occurrence or not of asthenopic symptoms, and binary logistic regression was applied to measure the association with independent variables (p<0.05). Results: Asthenopic symptoms occurred more often during the pandemic, when exposure to screens was a determinant factor. The individuals with screen time longer than five hours a day, who used screens for leisure, and who used eye drops/lubricants were significantly more likely to be in the group with asthenopic symptoms. Conclusion: A significant association was identified in occurrence of asthenopic symptoms and screen use during the pandemic period, especially in groups with longer screen time. The study draws attention to the eye health of college lecturers in distance learning, and the need for further research on this situation in different school environments.

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.

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.

Dry Eye Disease: Prevalence, Assessment, and Management.

Dry eye disease is a chronic condition of the corneal surface marked by persistent symptoms of irritation or burning that can cause inflammatory damage to the cornea and conjunctiva if untreated. Common risk factors for this syndrome include advancing age, female sex, low humidity environments, systemic medications, and autoimmune disorders. Treatments to relieve symptoms include tear replacement, humidification, improved nutrition, and anti-inflammatory ocular agents. Home healthcare nurses can identify signs and symptoms of dry eye syndrome and initiate strategies that range from warm compresses to physician referrals for more aggressive treatment. Consistent management of this condition improves quality of life and minimizes damage to the ocular surface.

Síndrome de Fatiga ocular y su relación con el medio laboral / Ocular Fatigue Syndrome and its relation to the work environment

INTRODUCCIÓN: Los problemas visuales ocasionados por el uso de ordenadores son actualmente una de las afecciones más comunes entre los trabajadores. Este trabajo resume la evidencia científica sobre el Síndrome de Fatiga Ocular (SFO) y su relación con el medio laboral, los factores de riesgo, la población especialmente sensible y los aspectos preventivos. MÉTODOS: Se realizó una revisión sistemática de la literatura científica publicada entre 2005 y 2015, en varias bases de datos, utilizando ecuaciones de búsqueda con términos MeSH. Se filtraron las referencias en base a los objetivos obteniendo una colección final de 19 artículos. El nivel de evidencia se determinó según criterios SIGN. RESULTADOS: Se identificaron factores de riesgo comunes para desarrollar SFO; como son el género femenino con un nivel de evidencia 3 y 2-, presencia de defectos refractivos (nivel de evidencia 3) y el número de horas de exposición a pantallas (nivel de evidencia 3 y 2+). CONCLUSIÓN: La mayoría de autores coinciden en un creciente aumento del SFO. mientras que otros mencionan una posible disminución debido a la optimización de equipos de trabajo. Es frecuente la sobreestimación de síntomas debido al uso masivo de dispositivos electrónicos fuera del ambiente laboral. Aunque existen resultados dispares, se evidencia una asociación significativa entre el tiempo de exposición y aparición de síntomas, así como una relación con el género femenino y el uso de lentes de contacto. Como medida principal de prevención se menciona la mejora del ambiente de trabajo

INTRODUCTION: Visual problems caused by computer use are nowadays one of the most common conditions among workers. This paper summarizes the scientific evidence on Eye Fatigue Syndrome (EFS) and its relationship to work environment, risk factors, especially sensitive population and preventive aspects. METHODS: A systematic review of the scientific literature published between 2005 and 2015 was carried out in several databases using search equations with MeSH terms. The references filtered based on the objectives obtained a final collection of 19 articles. The evidence level was determined according to SIGN criteria. RESULTS: Common risk factors for developing EFS were identified, such as female genre with a level of evidence 3 and 2- (according to SIGN criteria), presence of refractive defects (level of evidence 3) and number of hours staring at a screen (level of evidence 3 and 2+). CONCLUSION: Most authors agree on a growing increase in EFS. Meanwhile others mention a possible decrease due to the optimization of working teams. The overestimation of symptoms is frequent due to the massive use of electronic devices outside the workplace. Significant association between exposure time and onset of symptoms, as well as relation to female genre and use of contact lenses is evident, although disparate results were observed. The improvement of the work environment is mentioned as the main preventive measure

Relation of accommodative microfluctuation with dry eye symptoms in short tear break-up time dry eye.

PURPOSE: To investigate accommodative microfluctuations (AMFs) and visual function in short tear break-up time (BUT)-type dry eye (DE) and non-DE subjects. METHODS: This prospective comparative study included 48 volunteers with DE symptoms (mean age 34.8 ± 5.5 years, age range 25-42 years) and 73 without DE symptoms (mean age 30.6 ± 4.7 years, age range 25-42 years). The eyes were divided into two groups: (1) DE group with DE symptoms and BUT ≤ 5 s and (2) non-DE group without DE symptoms and BUT > 5 s. We excluded eyes with Schirmer score ≤ 5 mm and positive keratoconjunctival epithelial damage. Tear evaluation, AMF, and functional visual acuity (VA) examinations were performed. AMF parameters included total high-frequency component (HFC), HFC with low accommodation for the task of staring into the distance (HFC1), and HFC with high accommodation for deskwork (HFC2). Functional VA parameters included starting VA, functional VA, visual maintenance ratio, and blink frequency. RESULTS: A total of 33 and 34 eyes were categorized in the DE and non-DE groups, respectively. Mean blink frequency and HFC1 values were significantly higher in the DE group than they were in the non-DE group. CONCLUSIONS: DEs with symptoms showed abnormal AMF and visual function, which may be associated with DE symptoms.

Subjective and Objective Measures of Dryness Symptoms in Primary Sjögren's Syndrome: Capturing the Discrepancy.

OBJECTIVE: To develop a novel method for capturing the discrepancy between objective tests and subjective dryness symptoms (a sensitivity scale) and to explore predictors of dryness sensitivity. METHODS: Archive data from the UK Primary Sjögren's Syndrome Registry (n = 688) were used. Patients were classified on a scale from -5 (stoical) to +5 (sensitive) depending on the degree of discrepancy between their objective and subjective symptoms classes. Sensitivity scores were correlated with demographic variables, disease-related factors, and symptoms of pain, fatigue, anxiety, and depression. RESULTS: Patients were on average relatively stoical for both types of dryness symptoms (mean ± SD ocular dryness -0.42 ± 2.2 and -1.24 ± 1.6 oral dryness). Twenty-seven percent of patients were classified as sensitive to ocular dryness and 9% to oral dryness. Hierarchical regression analyses identified the strongest predictor of ocular dryness sensitivity to be self-reported pain and that of oral dryness sensitivity to be self-reported fatigue. CONCLUSION: Ocular and oral dryness sensitivity can be classified on a continuous scale. The 2 symptom types are predicted by different variables. A large number of factors remain to be explored that may impact symptom sensitivity in primary Sjögren's syndrome, and the proposed method could be used to identify relatively sensitive and stoical patients for future studies.

Prevalencia de síntomas de enfermedad de la superficie ocular en pacientes que acuden a consulta oftalmológica.

OBJECTIVE: To determine the prevalence of symptoms of ocular surface disease (OSDI) surface disease and its relationship with associated risk factors in patients of ophthalmic practices using OSDI questionnaire. METHOD: A cross-sectional survey was conducted Between September and December 2014 to assess the prevalence and risk factors for OSDI. RESULTS: The OSDI average value was 40.46 ± 23.62 points, with 86.4% of patients (1967) having a OSDI score higher than 12 points. Women had OSDI symptoms more frequently than men (odds ratio: 1.17; 95% confidence interval: 1.08-1.28) and higher OSDI score (42.12 ± 24.03 vs. 38.01 ± 22.81 points). Patients without disease were younger than the patients with severe disease (45.30 ± 18.32 vs. 50.62 ± 18.86). CONCLUSIONS: Ophthalmological patients have a prevalence of 80.4% of OSDI. Female and older age was associated with ocular surface disease.

Vitamin A deficiency and xerophthalmia in children of a developed country.

AIM: We aim (i) to characterise the clinical features of vitamin A deficiency (VAD) in a small cohort of Australian children; (ii) to determine the effects of VAD; and (iii) to quantify the prevalence of ophthalmic review in this group. METHODS: Data collected from the charts incorporated patient demographics, laboratory results, past medical history, ophthalmic symptoms and dietary history. Outcome measures were (i) occurrence of VAD in our study population; (ii) presence of associated systemic effects and ocular manifestations in those diagnosed with VAD; and (iii) determination of whether children with VAD had an ophthalmology review. RESULTS: Fifty-two of the 146 children had VAD; their average age was 8.4 years (range 11 days to 18 years old). In this Australian cohort, the most common pre-existing medical conditions in those children whose vitamin A status was investigated were cystic fibrosis, gastro-oesophageal reflux disease, micronutrient deficiency and short gut syndrome. The most common medical conditions affecting children with measured VAD in this cohort include autism, coeliac disease and cystic fibrosis. A significant association was found between VAD and anaemia and serum iron levels. Of the 146 children, 28 had ophthalmology review, of whom 13 had VAD. The most common reason for ophthalmology review was retinopathy of prematurity; there was only one referral for review for xerophthalmia. There was one case of xerophthalmia referred due to microbial keratitis. CONCLUSION: Vitamin A deficiency and xerophthalmia do exist in children of developed country. The potential for xerophthalmia should be considered, and there should be a consideration of an ophthalmology review.

Estudio observacional del ojo seco en una farmacia comunitaria / Observational study of dry eye in community pharmacy

Introducción: El síndrome de ojo seco (SOS) afecta a cinco millones de personas en España y a sesenta millones en todo el mundo, acarreando importantes costes y afectando a actividades diversas. Puede ser de tipo acuodeficiente o evaporativo y el diagnóstico se lleva a cabo según la percepción del paciente, seguida de pruebas objetivas. No tiene curación y el tratamiento va siempre enfocado a paliar los síntomas. Objetivos: Conocer la prevalencia del SOS en A Gudiña (Ourense). Además, se determinó en qué grado la falta de adherencia afecta al tratamiento con lágrimas artificiales (LA); así como la asociación entre el SOS y ciertas variables analizadas. Material y métodos: Durante los siete meses de duración del estudio, se seleccionó una muestra final de 51 pacientes de SOS. Los datos se recogieron cumplimentando una hoja de registro diseñada ad hoc. Resultados: La prevalencia de SOS en A Gudiña es relativamente baja (4,3%). La media de edad es de 66 años, afectando mayoritariamente a mujeres. Se detectó una falta de adherencia al tratamiento con LA. Todas las variables analizadas mostraron asociación con la enfermedad. Conclusiones: La prevalencia de síndrome de ojo seco en A Gudiña es ligeramente menor que la encontrada en la literatura. La exclusión de las LA del seguro médico es la causa principal de la falta de adherencia a los tratamientos. De los antecedentes patológicos valorados en este estudio, la cirugía ocular es el que más afecta en el desarrollo del SOS (AU)

Introduction: Dry Eye Disease (DED) is a multifactorial symdrom. It affects five million people in Spain and sixty million persons around the world, carrying significant costs and affecting different activities. DED can be aqueous-deficient or evaporative and diagnosis is performed according to the patient’s symptoms, followed by objective tests. It is a chronic disease; therefore, treatment is always focused on alleviating symptoms. Objectives: The main purpose of this study was to set DED prevalence in A Gudiña (a municipality in the province of Ourense). Additionally, it was determined to what extent it is affected by the lack of adherence to the treatment with artificial tears (AT) and the association between DED and certain variables analyzed. Materials and methods: During the seven months of the study, a final sample of 51 DED patients was selected. Data were collected by completing a registration form designed ad hoc. Results: DED prevalence in A Gudiña is relatively low (4.25%). The average age being 66, it was proved to affect mostly women. A lack of adherence to the treatment with AT was reported. All variables analyzed showed association with the disease. Conclusions: DED prevalence in A Gudiña is lower than that found in the literature. The exclusion of AT from health insurance is the main cause of low adherence to treatment. From the set of the medical variables analyzed, eye surgery is the main source of DED development (AU)

Common symptoms of nepalese soft contact lens wearers: a pilot study / Síntomas comunes en los usuarios nepalís de lentes de contacto blandas: un estudio piloto

Aim: To determine the common symptoms in current soft contact lens (CL) wearers and their association with other factors among Nepalese population. Methods: All the current CL wearers who started to wear soft CL in Nepal Eye Hospital between July 2007 and June 2012 were invited for the participation. Frequency of the ten most common symptoms, divided into never, occasionally, frequently and consistent were recorded. Association between degree of symptoms with other factors, e.g. age, gender, profession, cigarette smoking, ethnicity, level of education and duration and wearing modality of CL wear were analyzed. Results: Out of 129 subjects participated in this study, 67% were female; the mean age of the subjects was 23.9 ± 4.3 years. Ninety seven percent of them had at least one symptom occasionally or frequently or consistently. Discomfort was found in 88.4% of the total subjects. Other common symptoms were foreign body sensation in 73.6%, redness in 65.9%, reduced wearing time in 63.6% and dryness in 62.8%. Symptoms were found occasionally in the majority of subjects. Degree of symptoms was not associated with age, gender, profession, education status, ethnicity of subjects and duration or modality of lens wear (p > 0.05) but was positively associated with passive cigarette smoking (p < 0.001). Conclusion: Almost all of the Nepalese soft CL wearers had some types of symptoms at least occasionally. Discomfort was the most common symptom. Degree of symptoms was associated with the passive smoking but not with other factors like age, sex, profession and duration of lens wear (AU)

Objetivo: Determinar los síntomas comunes en los usuarios actuales de lentes de contacto blandas (LC), así como su asociación a otros factores, entre la población nepalí. Métodos: Se solicitó la participación de los usuarios actuales de LC, que habían comenzado a utilizar dichas lentes en el Hospital Ocular de Nepal entre julio de 2007 y junio de 2012. Se registró la frecuencia de los diez síntomas más comunes, divididos entre: nunca, ocasionalmente, frecuentemente y consistentemente. También se analizó la asociación entre el grado de los síntomas y otros factores tales como edad, sexo, profesión, consumo de cigarrillos, etnia, nivel de educación, duración y modalidad de uso de LC. Resultados: De los 129 sujetos participantes en este estudio, el 67% eran mujeres; la edad media de los sujetos fue de 23,9 ± 4,3 años. El noventa y siete por ciento de ellos tenía al menos un síntoma de manera ocasional, frecuente, o consistente. El 88,4% de los sujetos reflejó malestar. Otros síntomas comunes fueron la sensación de cuerpo extraño en el 73,6% de los casos, el enrojecimiento en el 65,9%, la reducción del tiempo de uso en el 63,6%, y la sequedad en el 62,8%. Los síntomas fueron ocasionales en la mayoría de los sujetos. El grado de los síntomas no estuvo asociado a la edad, sexo, profesión, situación educativa, casta de los sujetos y duración o modalidad de uso de las lentes (p > 0,05), aunque se asoció de modo positivo a la exposición pasiva al humo del trabaco (p < 0,001). Conclusión: Casi todos los usuarios nepalís de LC blandas reflejaron algún tipo de síntoma, al menos ocasionalmente. El malestar fue el síntoma más común. El grado de los síntomas se asoció a la exposición pasiva al humo de tabaco, pero no a otros factores tales como edad, sexo, profesión y duración del uso de las lentes (AU)

The relationship between dry eye and migraine.

Presently, migraine and dry eye are both thought to have an inflammatory pathogenesis. We aimed to investigate dry eye findings and any relationship with headache characteristics in migraine patients with and without aura. In total, 58 migraineurs and 41 age- and gender-matched controls were enrolled in this prospective clinical study. The migraine diagnosis was made according to the International Classification of Headache Disorders II diagnostic criteria. All patients underwent a complete ophthalmologic examination including tear meniscus measurements, meibography, tear breakup time, Schirmer test and the Ocular Surface Disease Index questionnaire. The presence of dry eye was higher in migraineurs as compared to the control group, but this did not reach statistical significance (p = 0.282). Among the headache characteristics, the presence of aura was significantly higher, and disease and attack durations were significantly longer in migraineurs with dry eye than in those without dry eye (p = 0.009, p = 0.010, and p = 0.003, respectively). In multiple logistic regression model, attack duration was found to be independently associated with the presence of dry eye in migraine patients (OR; 95 % CI; p = 0.029). The results show that dry eye may present in migraine patients with greater presence of auras and longer disease and attack durations.

Psychological distress, job dissatisfaction, and somatic symptoms in office workers in 6 non-problem buildings in the Midwest.

BACKGROUND: Researchers examined office worker characteristics and reports of non-specific somatic symptoms in 6 non-problem buildings in the Midwestern United States. METHODS: We assessed office workers for demographic characteristics and somatic symptoms that occurred in the workplace. Sampling was conducted over a 1-week period in each building over 4 seasons. Our team administered the Medical Outcome Survey questionnaire, the Brief Symptom Inventory, and the Job Content Questionnaire to individuals at each site, comparing office workers reporting no symptoms to those reporting ≥4 symptoms. RESULTS: Self-reported nonspecific somatic symptoms were frequent in office workers in non-problem buildings. High symptom levels were associated with younger age, female sex, psychological distress, impaired quality of life, and poor job satisfaction. CONCLUSIONS: The findings suggest that office workers frequently report somatic symptoms they believe are related to the workplace even in buildings considered non-problematic. People with high symptom levels perceived as related to the workplace are psychologically distressed, have impaired quality of life, and feel dissatisfied and powerless in the workplace.

Meibomian gland dysfunction determines the severity of the dry eye conditions in visual display terminal workers.

OBJECTIVE: To explore meibomian gland dysfunction (MGD) may determine the severity of dry eye conditions in visual display terminal (VDT) workers. METHODOLOGY: Prospective, case-control study carried out in China.106 eyes of 53 patients (VDT work time >4 hour per day) were recruited as the Long time VDT group; 80 eyes of 40 control subjects (VDT work time ≤ 4 hour per day) served as the Short time VDT group. A questionnaire of Ocular Surface Disease Index (OSDI) and multiple tests were performed. Three dry eye tests: tear film breakup time (BUT), corneal fluorescein staining, Schirmer I test; and three MGD parameters: lid margin abnormality score, meibum expression assessment (meibum score), and meibomian gland dropout degree (meiboscore) using Keratograph 5 M. PRINCIPAL FINDINGS: OSDI and corneal fluorescein score were significantly higher while BUT was dramatically shorter in the long time VDT group than the short time VDT group. However, the average of Schirmer tear volumes was in normal ranges in both groups. Interestingly, the three MGD parameters were significantly higher in the long time VDT group than the short time one (P<0.0001). When 52 eyes with Schirmer <10 mm and 54 eyes with Schirmer ≥ 10 mm were separated from the long time VDT workers, no significant differences were found between the two subgroups in OSDI, fluorescein staining and BUT, as well as the three MGD parameters. All three MGD parameters were positively correlated with VDT working time (P<0.0001) and fluorescein scores (P<0.0001), inversely correlated with BUT (P<0.05), but not correlated with Schirmer tear volumes in the VDT workers. CONCLUSIONS: Our findings suggest that a malfunction of meibomian glands is associated with dry eye patients in long term VDT workers with higher OSDI scores whereas some of those patients presenting a normal tear volume.

Síndrome del ojo seco. Factores de riesgo laboral, valoración y prevención / Dry eye syndrome. Occupational risk factors, valuation and prevention

El síndrome de ojo seco en ámbito laboral se asocia a nuevas formas de trabajo, con uso creciente de pantallas y dispositivos electrónicos y condiciones medioambientales surgidas en los modernos diseños de oficinas, despachos y otros entornos. Influyen igualmente exposiciones laborales a radiaciones ionizantes, productos químicos o polvo ambiental, con incremento de sequedad ocular. El estudio de los aspectos fisiopatológicos y las causas laborales del ojo seco deben ser una tarea coordinada entre salud laboral, salud pública y responsables del Sistema Nacional de Salud, encaminada a actuaciones preventivas primarias y secundarias más eficaces y un correcto diagnóstico, control y seguimiento de la enfermedad. Un mayor conocimiento de los riesgos laborales y actuaciones consensuadas y coordinadas entre médicos del trabajo, prevencionistas, médicos de atención primaria y especialidades implicadas, como oftalmología, permitirá obtener resultados, tanto más eficaces cuanto más precoces, y optimizar los recursos disponibles (AU)

Dry eye syndrome in the workplace is associated with new ways of working, with increasing use of screens and electronic devices and environmental conditions encountered in modern office designs and other environments. Also affect occupational exposure to ionizing radiation, chemicals or atmospheric dust with increased ocular dryness. The study of pathophysiological aspects and laboral causality of the dry eye, must be to develop joint task in Occupational Health, Public Health in coordination with and responsible for the national health system, which would involve primary and secondary preventive measures more effective and proper diagnosis, control and monitoring of the disease, A better knowledge of occupational hazards and actions agreed and coordinated between occupational physicians, preventers, primary care physicians and specialist physicians, such as ophthalmology, will get results much more effective when earlier and optimize available resources (AU)

Prevalence and determinants of xerophthalmia in rural children of Uttarpradesh, India.

INTRODUCTION: Vitamin A deficiency (VAD) is recognized as a major cause of blindness among children in India. OBJECTIVE: To find out the prevalence of VAD in rural children of Uttar Pradesh, India. MATERIALS AND METHODS: This cross-sectional study was undertaken amongst children (0-15 years) in a rural area of Bareilly (Uttar Pradesh) where the study population was selected by simple random sampling out of villages under a Primary Health Centre. Out of 844 children, 802 participated in the study. The WHO classification of xerophthalmia was used. RESULTS: Overall, the prevalence of xerophthalmia was 5.4 %. The prevalence of Bitot's spots was 0.9 % in children under six years of age and 3.3 % in children above six years. The prevalence of xerophthalmia was significantly more in older children. Overall, the prevalence of anemia was found to be 11.8 % in the study population. A significantly high prevalence of xerophthalmia (OR= 5.7; 95 % CI = 2.8 - 11.5) was observed in children suffering from anemia. CONCLUSION: The presence of a milder manifestation of xerophthalmia and a 0.9 % prevalence of Bitot's spot in children under six years of age in the present study shows a declining trend of VAD although it is still a public health problem. The higher prevalence in children above six years of age shows that apart from strengthening of Vitamin A prophylaxis programs, health education is needed for dietary diversification to include vegetables and fruits in the diet for long-term sustainability in improving the vitamin A status of children of all age groups.

Vitamin A deficiency control measures: importance of vitamin A supplementation as a public health policy in the Indian context.

Recently prominent nutrition scientists across the world have opposed continuation of vitamin A supplementation (VAS) programmes and recommended gradual phasing out VAS for pre-school children. A few eminent nutrition scientists in India have echoed this view, arguing that vitamin deficiency (VAD) is no longer a public health problem in India. We review the evidence, highlighting the high rates of VAD among pre-school children in India, (clinical, subclinical, and dietary deficiency) and argue that in India VAD remains an immensely important public health problem and it is crucial to strengthen and continue the existing VAS programme in India, and in other developing countries until such time as their children's dietary consumption of vitamin A is improved adequately and blood vitamin A levels reach optimal levels.

The frequency of sicca symptoms and Sjögren's syndrome in patients with systemic sclerosis.

OBJECTIVE: The objectives are to detect the frequency of sicca symptoms and Sjögren's syndrome (SS) in patients with systemic sclerosis (SSc) based on the diagnostic criteria of the American-European Consensus Group (AECG) and to evaluate demographic, clinical and serologic characteristics. PATIENTS AND METHOD: One hundred and eighteen SSc patients referred to our hospital were included in this study. All SSc patients were questioned with respect to sicca symptoms. Levels of rheumatoid factor (RF), anti-nuclear antibodies (ANA), anti-Ro and anti-La antibodies were measured; non-stimulated saliva amounts were recorded and Schirmer test and break-up time were applied to all patients. Minor salivary gland biopsy samples were obtained from those patients giving ≥ 3 positive answers to sicca symptom questions, patients with positive xerostomia/xerophthalmia test results, and patients with at least one antibody being positive. Patients presenting with grade 3 and/or grade 4 sialoadenitis based on Chisholm criteria were considered pathological. RESULTS: Sicca symptoms were present in 84 of 118 patients with SSc (71.2%). Minor salivary gland biopsy samples were obtained from 74 patients. Grade 3 and/or grade 4 sialoadenitis was detected in 40 (33.9%) patients and they were diagnosed with SS. Compared to patients diagnosed with SSc alone, systemic sclerosis patients diagnosed with SS had lower pulmonary hypertension and less diffuse lung involvement. Statistically significant difference was detected in terms of sclerodactylia and telangiectasia between SSc-SS and SSc patient groups (P = 0.045 and P = 0.011, respectively). Serological assessments revealed that in the SSc-SS group, 13 patients were anti-Ro antibody positive, six were anti-La antibody positive and 37 were anti-topoisomerase 1 antibody positive. RF, ANA and anti-centromere antibody levels were higher in the SSc-SS group. CONCLUSION: In the present study, highly frequent sicca symptoms and Sjögren's syndrome based on AECG criteria were noted in patients with systemic sclerosis. The SSc-SS patient group had less severe clinical course and lung involvement.