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1.
Eye Contact Lens ; 35(4): 203-8, 2009 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-19516145

RESUMO

PURPOSE: To determine the differential features of tear physiology and meibomian gland function in blepharitics for ascertaining the diagnostic potential of a number of clinical tests. METHODS: Two groups of subjects, 15 with clinically diagnosed blepharitis (11 women and 5 men mol/L; age 60.9 +/- 12.5; range 41-79) and 15 age- and sex-matched controls (11 women and 5 men mol/L; age 60.7 +/- 12.6; range 40-78), were included in the study. Tear physiology was assessed by evaporimetry and interferometry and the meibomian glands by expression and meibography. RESULTS: Tear evaporation rate was significantly higher (P<0.001) in blepharitics (46.3 +/- 22.9 g/m/hr) than that in normals (18.0 +/- 10.7 g/m/hr). The lipid pattern was found to be significantly less stable (P=0.001) in the blepharitic group compared with that in the normal group. By meibography, meibomian gland dropout was scored and found to be significantly greater (P=0.001) in blepharitics in both the upper eyelids (blepharitis 1.0 +/- 0.8; normal 0.1 +/- 0.3) and lower eyelids (blepharitis 2.1 +/- 8.3; normal 1.0 +/- 0.8). The dropout score was the same or greater for the lower lids than for the upper lids, in all cases. A significant difference (P=0.000) in meibomian gland expression was found between blepharitics and normals; meibum was significantly thicker and more opaque in blepharitics in both the upper (blepharitis 2.2 +/- 0.7; normal 1.0 +/- 0.2) and lower (blepharitis 2.6 +/- 0.7; normal 1.3 +/- 0.4) eyelids. CONCLUSIONS: There are significant differences in tear physiology and meibomian gland function in patients with blepharitis when compared with those without. All the tests employed would be useful as single tests in the diagnosis of blepharitis, with meibomian gland dropout of the lower eyelid offering the greatest effectiveness as a single measure.


Assuntos
Blefarite/fisiopatologia , Glândulas Tarsais/fisiopatologia , Lágrimas/metabolismo , Adulto , Idoso , Blefarite/diagnóstico , Técnicas de Diagnóstico Oftalmológico/normas , Pálpebras/patologia , Feminino , Tecnologia de Fibra Óptica , Humanos , Interferometria , Metabolismo dos Lipídeos , Masculino , Glândulas Tarsais/patologia , Pessoa de Meia-Idade , Perda Insensível de Água
2.
Cornea ; 26(2): 175-81, 2007 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-17251808

RESUMO

PURPOSE: To determine the effect of an oil-in-water emulsion eye drop compared with a conventional dry eye supplement (hypromellose) on tear physiology in dry eye. METHODS: A randomized parallel, longitudinal, and investigator-masked study of the efficacy of 1.25% castor oil emulsion and 0.32% hypromellose solution was carried out. A total of 53 patients with mild to moderate dry eye (27 in emulsion group and 26 in hypromellose group) were recruited for the study. Patients were enrolled if they reported at least 2 symptoms on a McMonnies Dry Eye Questionnaire together with 1 of the following screening tests: noninvasive tear breakup time (5-10 seconds) and Schirmer test without anesthesia (2-5 mm in 5 minutes). Patients were instructed to use the test solutions 3 times a day for 30 days. Tear production, evaporation, lipid layer structure, and osmolality were measured before and 30 days after use of the drops. RESULTS: A statistically significant decrease was seen after 1 month in tear evaporation rates with both emulsion (7.25 +/- 5.43 g/m2/h) and hypromellose (2.02 +/- 4.75 g/m2/h). However, the decrease with emulsion was significantly greater than with hypromellose (P < 0.001). Lipid layer structure improved from day 1 to day 30 of the study with the emulsion but not with the hypermellose. No significant changes were seen in tear production and osmolality with either of the drops. CONCLUSIONS: The oil-water emulsion was more effective in reducing tear evaporation than hypromellose after repeated application over a 1-month period. This finding signifies the potential of the emulsion in the management of evaporative dry eye.


Assuntos
Óleo de Rícino/administração & dosagem , Síndromes do Olho Seco/tratamento farmacológico , Metilcelulose/análogos & derivados , Lágrimas/fisiologia , Água/administração & dosagem , Adulto , Óleo de Rícino/uso terapêutico , Síndromes do Olho Seco/diagnóstico , Síndromes do Olho Seco/metabolismo , Emulsões , Feminino , Seguimentos , Humanos , Derivados da Hipromelose , Interferometria , Masculino , Metilcelulose/administração & dosagem , Metilcelulose/uso terapêutico , Soluções Oftálmicas , Concentração Osmolar , Cooperação do Paciente , Índice de Gravidade de Doença , Inquéritos e Questionários , Lágrimas/efeitos dos fármacos , Resultado do Tratamento
3.
Cornea ; 31(1): 1-5, 2012 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-21968605

RESUMO

PURPOSE: To compare the efficacies of sodium hyaluronate, hydroxypropyl methylcellulose (HPMC), and a new oil-in-water emulsion (Emustil unidose; SIFI) in the management of lipid-deficient dry eye. METHODS: Seventy-five subjects with dry eye were randomly divided into 3 groups. Each was allocated sodium hyaluronate, HPMC, or emulsion eyedrops to be used four times daily for 90 days. Parameters were measured at baseline, 30 days, and 90 days. A compliance visit was performed at days 7 and 60. RESULTS: Significant reduction (P < 0.05) in evaporation and improvement in symptoms in all groups were found. No statistically significant increase in tear turnover rate (TTR) was found with any solution. A significant difference in tear stability and noninvasive tear break-up time (NITBUT) was found in the emulsion and sodium hyaluronate groups but not in the HPMC group (P > 0.05). There was a significant decrease in osmolarity and corneal staining in the emulsion group (P < 0.001) but not in the sodium hyaluronate or HPMC group (P > 0.05). CONCLUSIONS: A significant reduction in evaporation and improvement in symptoms in all therapy groups were found from baseline to 90 days. However, no significant effect was seen on TTR for any group. The emulsion drops were shown to perform best, improving tear stability, and decreasing osmolarity and corneal staining. These results are consistent with improvements in the lipid layer of the tear film as a result of prolonged use of emulsion drops.


Assuntos
Síndromes do Olho Seco/tratamento farmacológico , Ácido Hialurônico/uso terapêutico , Metilcelulose/análogos & derivados , Soluções Oftálmicas/uso terapêutico , Lágrimas/fisiologia , Adulto , Síndromes do Olho Seco/metabolismo , Emulsões/uso terapêutico , Feminino , Humanos , Derivados da Hipromelose , Interferometria , Masculino , Metilcelulose/uso terapêutico , Pessoa de Meia-Idade , Lágrimas/efeitos dos fármacos
4.
Cornea ; 29(9): 1036-41, 2010 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-20577088

RESUMO

PURPOSE: Tear hyperosmolarity is diagnostic of dry eye disease (DED), yet difficulty in measurement has limited its utility; development of new instruments could facilitate its clinical application. This study compares the new OcuSense TearLab osmometer (OcuSense, Inc, San Diego, CA), based on electrical impedance "lab-on-a-chip" nanoliter technology, with the freezing point depression Clifton Osmometer (Clifton Technical Physics, Hartford, NY). METHODS: Thirty-six subjects were recruited: 15 DED (9 women, 6 men age: 41 +/- 16 years) and 21 controls (12 women, 9 men age: 35 +/- 12 years); criteria for DED were noninvasive tear breakup time <10 seconds, Schirmer I test <5 mm, and positive symptoms. Samples were collected from the inferior tear meniscus for testing with both osmometers. RESULTS: Osmolarity values measured with OcuSense TearLab were 308 +/- 6 and 321 +/- 16 mOsm/L for controls and dry eye, respectively, and those measured with Clifton were 310 +/- 7 and 323 +/- 14 mOsm/L for controls and dry eye, respectively; these values were significantly different. Significant correlation was found between OcuSense and Clifton measurements (r = 0.904; P = 0.006). Bland-Altman analysis revealed agreement between techniques; the majority of points fell within the 95% confidence limits, and actual values differed by less than 1%. A cutoff value of >316 mOsm/L, derived from the distribution of osmolarity values, was used to diagnose DED with an effectiveness of 73% sensitivity, 90% specificity, and 85% positive predictive value for the OcuSense and 73% sensitivity, 71% specificity, and 65% positive predictive value for the Clifton in the study samples. CONCLUSIONS: Tear film osmolarity measured with the OcuSense TearLab system correlates well with the Clifton Osmometer. The new instrument has the potential to provide clinicians with a readily available clinically applicable measure, which could become the gold standard in DED.


Assuntos
Técnicas de Diagnóstico Oftalmológico/instrumentação , Síndromes do Olho Seco/diagnóstico , Lágrimas/química , Adulto , Impedância Elétrica , Reações Falso-Positivas , Feminino , Humanos , Masculino , Concentração Osmolar , Valor Preditivo dos Testes , Reprodutibilidade dos Testes , Sensibilidade e Especificidade , Temperatura de Transição , Pressão de Vapor
5.
Cornea ; 29(7): 745-50, 2010 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-20489593

RESUMO

PURPOSE: To determine the utility of the tear function index (Liverpool modification TFI) in assessing tear turnover rate (TTR), evaluate association of tear clearance rate (TCR) and TFI with measurements of TTR by fluorophotometry, and determine effectivity of these test measures in dry eye (DE) diagnosis. METHODS: Forty-one subjects with DE and 15 control subjects participated. Tests included symptoms, fluorophotometry (by automated scanning fluorophotometry), and TCR and TFI from a prepared Liverpool modification TFI strip. RESULTS: Significant differences between subjects with DE and control subjects were found for all tests. Although wetting length values gave highest sensitivity (SS) and specificity (SP) (71% and 73%, respectively), this resulted from a high degree of selection bias because the Schirmer test was one of the inclusion criteria for patients entering the study. Therefore, the best tear production test was found to be TTR (SS 71% and SP 60%). The TTR test is not readily available in clinical settings; therefore, associations between the TTR test and other tests were determined. Significant correlations were found between TTR and wetting length/TCR/TFI, indicating these latter clinical tests useful as surrogates. The strongest correlations, TTR/TCR at 0.69 (P = 0.000) and TTR/TFI at 0.65 (P = 0.000), indicate TCR/TFI with the Liverpool test can be used as an alternative to TTR by fluorophotometry. The diagnostic effectiveness between these tests was compared, with both TCR and TFI found to have equal effectivity of 78% SS and 40% SP (TCR) and 83% SS and 40% SP (TFI). CONCLUSIONS: TCR measured by the commercially available Liverpool modification TFI strip is an acceptable alternative to TTR by fluorophotometry as a measure of tear production. It is effective as a single test for the discrimination of those with DE from those without the condition.


Assuntos
Síndromes do Olho Seco/diagnóstico , Fluorofotometria , Lágrimas/fisiologia , Adulto , Síndromes do Olho Seco/fisiopatologia , Feminino , Humanos , Aparelho Lacrimal/fisiopatologia , Masculino , Sensibilidade e Especificidade , Inquéritos e Questionários , Lágrimas/metabolismo
6.
Optom Vis Sci ; 85(8): 732-9, 2008 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-18677237

RESUMO

PURPOSE: To determine the effect of two artificial tears of different viscosities in the relief of environmental dry eye induced with a novel tear stress test (TST). METHODS: A novel TST was developed and validated. The following four test conditions were evaluated in 12 healthy normal subjects in a cross-over and subject masked study; unprotected (no test solution used), relief (test solution instilled just after application of TST), immediate protection (test solution instilled just before application of TST), and chronic protection (1 week prophylactic use of the solution). The test solutions were Cellumed, with high viscosity, and Refresh Contacts, with low viscosity. Low contrast visual acuity, symptoms with analogue scales (symptom scoring), non-invasive tear break-up time, and tear evaporation were measured before (prestress) and 2 min after (poststress) application of TST. Two weeks of washout period was allowed after first test solution. RESULTS: In unprotected test condition, there was no significant difference between pre- and poststress visual acuity (p = 0.102), tear evaporation (p = 0.530), and non-invasive tear break-up time (p = 0.878), however, poststress total symptom score was significantly higher than prestress (p = 0.002). No significant differences were seen between pre- and post-total symptom score at relief (p = 0.241 for Cellumed and 0.114 for Refresh Contacts) and immediate protection (p = 0.890 for Cellumed and 0.136 for Refresh Contacts) for both test solutions, whereas postsymptoms total score was significantly higher than prestress at chronic protection (p = 0.003 for both). No significant differences were seen in the effect of the two solutions in all test conditions. CONCLUSIONS: There is an increase in dry eye symptomatology after ocular stress. The use of artificial tears just before or after ocular stress is helpful in relieving resultant symptoms in normals.


Assuntos
Técnicas de Diagnóstico Oftalmológico , Síndromes do Olho Seco/tratamento farmacológico , Soluções Oftálmicas/administração & dosagem , Adulto , Câmaras de Exposição Atmosférica , Piscadela/fisiologia , Terminais de Computador , Sensibilidades de Contraste/fisiologia , Estudos Cross-Over , Método Duplo-Cego , Síndromes do Olho Seco/fisiopatologia , Feminino , Humanos , Masculino , Modelos Biológicos , Projetos Piloto , Lágrimas/química , Lágrimas/fisiologia , Resultado do Tratamento , Viscosidade , Acuidade Visual/fisiologia
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