RESUMO
PURPOSE: To demonstrate that intense pulsed light therapy (IPL) of the upper and lower eyelids with meibomian gland expression (MGX) is effective in improving dry eye disease due to meibomian gland dysfunction (MGD). METHODS: Patients with ocular discomfort (Ocular Surface Disease Index -OSDI- above 13) and signs of MGD were recruited. All patients underwent OSDI, visual acuity (VA), intraocular pressure, Schirmer test, meibography, non-invasive tear breakup time (NITBUT), slit-lamp examination (corneal and conjunctival staining, hyperemia, gland expressibility, and meibum quality), tear osmolarity and lipid layer thickness. IPL was performed with Optima IPL (Lumenis Ltd.) following a standardized protocol on upper and lower eyelids of both eyes, with inferior eyelid MGX. Patients received four sessions separated by two weeks each. Four weeks after, examinations were repeated. RESULTS: 160 patients (320 eyes) were included, of which 108 (67.5%) were women and mean age was 59.2 ± 15.08 (range 20-89). After four sessions, VA, OSDI, tear osmolarity, lipid layer thickness, NITBUT, hyperemia, corneal and conjunctival staining, gland expressibility, meibum quality, inferior eyelid Meiboscore and Schirmer test improved (all, p < 0.027). Changes in OSDI, initial and average NITBUT increased with dry eye disease severity (according to OSDI). Increased pre-treatment OSDI, hyperemia, corneal and conjunctival staining and Schirmer test were associated with an improvement in OSDI (all, p < 0.040). No adverse events were noted. CONCLUSIONS: The combination of IPL on upper and lower eyelids with MGX is safe and effective for the treatment of MGD. Patients with severe dry eye disease present greater improvements.
RESUMO
Debido a la gran importancia de la visión en el medio aeronáutico, la legislación vigente es bastante restrictiva en cuanto a los requisitos establecidos en el apartado de oftalmología de los reconocimientos médicos que se exigen al personal con responsabilidad de vuelo, tanto inicialmente a su ingreso, como pare revalidar su aptitud con periodicidad. El desarrollo de nuevas técnicas en la corrección quirúrgica de los errores de refracción, supone la necesidad de actualizar dicho marco legal, que de continuo queda obsoleto. Se realiza una revisión bibliográfica sobre la cirugía refractiva y las condiciones especiales del medio aeronáutico, principalmente las ocasionadas por la hipoxia y la altitud, poniendo de manifiesto que éstas pueden producir ligeras desviaciones de la refracción hacia la miopía o hipermetropía, dependiendo de la técnica quirúrgica empleada (AU)
Due to the fact that the vision in aeronautical environment is very important, the current legislation is quite restrictive for initial and periodical medical test for the flight personnel, as far as the requirements in the ophthalmologic area are concerned (initial and periodical tests). The development of new techniques on the surgical correction of refraction errors means the review of the current legislation and its continuous update. The bibliography about refractive surgery and its special conditions in the aeronautical environment, mainly those produced by hypoxia, is reviewed. Depending on which surgical technique you use, slight refraction changes towards myopia and hyperopia can be produced by hypoxia (AU)