DOCSLIB.ORG

Ocular Surface Changes in Graves' Ophthalmopathy

Total Page：16

File Type：pdf, Size：1020Kb

Download full-text PDF Read full-text
Ocular Surface Changes in Graves' Ophthalmopathy Dry eye syndrome in Graves’ ophthalmopathy ·Review Article· Ocular surface changes in Graves’ ophthalmopathy Rou Sun1,2, Hui-Fang Zhou1,2, Xian-Qun Fan1,2 1Department of Ophthalmology, Ninth People’s Hospital, outbreak of GO[3-8]. Furthermore, the incidence of GO was Shanghai Jiao Tong University School of Medicine, Shanghai the highest of orbital diseases[9], leading to symptoms such 200011, China as proptosis, eyelid swelling, eyelid retraction, diplopia, 2Shanghai Key Laboratory of Orbital Diseases and Ocular photophobia, excessive tearing, vision loss, strabismus and eye Oncology, Shanghai 200011, China movement disorder[10-11]. Correspondence to: Hui-Fang Zhou and Xian-Qun Fan. GO is devided into active GO and inactive GO according Department of Ophthalmology, Ninth People’s Hospital, to the clinical activity scores (CAS)[12]. The presentation of Shanghai Jiao Tong University School of Medicine, No.639, each symptom mentioned below is considered as one point: Zhizaoju Road, Huangpu District, Shanghai 200011, China. moderate to severe eyelid erythema, moderate to severe eyelid [email protected]; [email protected] swelling, conjunctival redness, chemosis, redness and swelling Received: 2020-05-20 Accepted: 2020-10-19 of lacrimal caruncle, spontaneous orbital pain and orbital pain evoked by gaze. Inactive GO is defined as those scoring Abstract 0-2 and active as scoring of 3-7[13]. Dry eye syndrome (DES) ● Many patients with Graves’ ophthalmopathy (GO) suffer can prevail in any state or stage during the occurrence and from dry eye syndrome (DES), and this is one of the most development of GO. common reasons of eye discomfort in patients with GO. The DES was defined a multifactorial disease associated with tears prevalence of DES in patients with GO is significantly higher and ocular surface by the Tear Film and Ocular Surface Society than normal subjects. The ocular surface changes involving (TFOS) Dry Eye Workshop (DEWS) II. It causes discomfort, changes in tears, cornea, conjunctiva and glands occur in visual impairment as well as tear film instability, leading to GO patients. However, the mechanism of how DES occurs damage of the ocular surface[14]. These symptoms also bother in GO still remains unclear. In this review, the ocular surface GO patients with DES and some of them might even progress changes were illustrated and analyzed the reasons for high to corneal injury and exposed keratitis[15-16]. prevalence of DES in GO patients. For GO patients, proptosis and eyelid retraction might cause ● KEYWORDS: Graves’ ophthalmopathy; dry eye extra ocular exposure, increasing the evaporation of tears. syndrome; ocular surface The autoimmune and inflammatory responses might influence DOI:10.18240/ijo.2021.04.20 the composition of tears, leading to injury of the cornea and conjunctiva. GO also involves lacrimal glands and meibomian Citation: Sun R, Zhou HF, Fan XQ. Ocular surface changes in Graves’ ophthalmopathy. Int J Ophthalmol 2021;14(4):616-621 glands (MG). Therefore, the changes in tears, cornea, conjunctiva and glands in GO patients are considered as risk [17] INTRODUCTION factors for DES . raves’ ophthalmopathy (GO) usually occurs in EPIDEMIOLOGY G patients suffering from Graves disease (GD) with According to TFOS DEWS II, DES is one of the most hyperthyroidism or a history of hyperthyroidism[1]. In common eye diseases, and the prevalence is about 5 to 50 addition, it can also occur in patients with euthyroidism or percent. Based on the worldwide studies, the prevalence hypothyroidism due to autoimmune thyroiditis. The ocular of DES in women is 1.33-1.74 times than that of men. In abnormalities are referred to GO, and its pathogenesisis still addition, age seems to be associated with positive symptoms remains unknown. The orbital tissue has cross-reactivity of DES. The studies showed that the total prevalence of DES antigens with thyroid. They express the stimulating receptors is about 14.4-24.4 percent in Asia, 14.5 percent in America, targeting thyroid-stimulating hormone receptor (TSHR), and 18.4 percent in Spain, 20 percent in United Kingdom and 39.2 cause inflammatory reaction in the orbit[2]. Other antibodies percent in France. Many studies indicated that the prevalence that are targeted insulin-like growth factor-I receptor (IGF-1R) and changes slightly in people under 49 (about 15-25) percent, interleukin (IL)-17 might also play important roles in the which increases with age (about 25-45 percent)[18]. 616 Int J Ophthalmol, Vol. 14, No. 4, Apr.18, 2021 www.ijo.cn Tel: 8629-82245172 8629-82210956 Email: [email protected] The annual incidence of GO in women is about 16 cases per Other cytokines, in spite of no direct evidence in proving their 100 000 people and 3 cases per 100 000 in men[17]. Middle- relation with CAS, such as IL-17, IL-2, IL-10, tumor necrosis aged women are the main victims of GO. However, there is factor-α (TNF-α), interferon-γ (INF-γ), IL-7, IL-15, IL-17, no clear data with regard to prevalence in patients of different IL-12p70, IL-21 and RANTES showed higher expression in ages and genders with GO suffering from DES. Some studies GO patients[29-31]. have estimated that 65 to 85 percent of GO patients suffer from The spectrum of proteins has altered in the tears of GO patients. DES[19-20]. For middle-aged women, the prevalence of DES is In the study conducted by Matheis et al[32], some proteins undoubtedly higher in GO patients than normal subjects (<20 were downregulated when compared with normal subjects percent). by antibody microarray: proline-rich protein 1 (PROL1, OCULAR SURFACE CHANGES P<0.05), proline-rich protein 4 (PRP4, P<0.05), calgranulin A Objective Changes (S10A8, P=0.004) and transcription activator BRG1 (SMCA4, Tears P=0.002), while some were upregulated: Midasin and POTE- Tear breakup time and Schirmer’s test The changes in ankyrin-domain family-member I (P<0.05). Aass et al[33] tears play a significant role in the occurrence of DES in GO have reported a significant increase of lysozyme C (LYZ), patients. There are two basic indexes to estimate the condition lacritin (LACRT) and zinc-alpha-2 glycoprotein 1 (AZGP1) of tears: the tear breakup time (BUT) and the Schirmer’s I test by enzyme-linked immunosorbent assay (ELISA). Song (SIt). BUT is a test that assesses the stability of the tear film, et al[31] have reported overexpression of CD40, CD40 ligand, while SIt levels are the amount of basic secretion of tears. glucocorticoid-induced tumor necrosis factor receptor (GITR), Wei et al[15] have reported that the BUT (8.40±2.80s) and SIt IL-12p70, IL-1β, IL-2, IL-21, IL-6, macrophage inflammatory (8.53±3.54 mm) in a GO group showed statistically significant protein-3α (MIP-3α) and TRANCE in the tears of GO using differences from that of the control group (13.47±3.62s, high-throughput microarray technology. In addition, the P=0.002; 14.87±7.12 mm, P=0.009). This illustrated damage downregulation of granulocyte-macrophage colony stimulating to both quality as well as quantity of tears in GO. Many other factor (GM-CSF), IL-1 sRI, and IL-13 was also reported. reports have shown similar conclusions[21-23]. Furthermore, Choi et al[34] have reported increased levels of The tear film osmolarity The past studies have suggested oxidative stress markers, 8-hydroxy-2’-deoxyquanosine that the osmolarity of the tear film is often higher in GO (8-OHdG; r=0.676, P<0.001) and malondialdehyde (MDA; patients[17,24]. For example, Iskeleli et al’s[25] work mentioned r=0.506, P=0.002) in GO patients, especially active GO, and that the tear film osmolarity that is measured by an auto- are determined by ELISA. Also, CAS showed significant osmometer (OM-6030 AUTO STAT; Daiichi, Kyoto, Japan) correlation with the concentrations of these. in GO patients (340.38±18.74 mOsm) is significantly different Cornea from that of healthy subjects (290.80±13.58 mOsm/L, Staining Because of extra ocular exposure and abnormal state P=0.0001). The increased tear film osmolarity might be of tears in GO, patients might undergo corneal epithelial injury caused by proptosis and higher palpebral fissure. However, a and even exposed to keratitis. recent study conducted by Kashkouli et al[26] have provided Corneal fluorescein staining assesses the area and density of an inconsistent conclusion that even though 16.2% eyes of damage. It is often graded from 1-4 in every quadrant and the moderate-severe GO patients showed abnormal osmolarity, higher the total score is, the more severe the injury caused. the mean osmolarity measured by TearLab device was Li et al[35] have reported that almost 1/3 of GO patients suffer 295.9 mOsm/L, which might be due to the differences in the from epithelial injury and the results demonstrated statistical detection methods. differences between active GO and inactive GO. Similar Composition of tears For autoimmune and inflammatory conclusion has been drawn by many other studies[23,26,36-37]. reactions that take place in the orbit of GO patients, many In vivo confocal microscopy In vivo confocal microscopy is studies have tested the amount of proteins and cytokines in the a device that is used to scan and collect images of each layer tears and found several differences in active GO, inactive GO of cornea and conjunctiva. After examining the density and and healthy controls. morphology of Langerhans cells (LCs) of the cornea in 40 GO The studies conducted by Kishazi et al[27] and Ujhelyi et al[28] patients and 20 normal controls (NC), Wu et al[21] have found have revealed that some cytokines in tears such as IL-1β, IL-6, that both active and inactive GO patients have significantly IL-8, IL-13 are higher in GO patients than healthy subjects.
Load more

Recommended publications
  • Scleral Faqs
    www.scleralcenter.com SCLERAL FAQS CONTACT US: Office: 501 E. Palm Valley Blvd. WHY ARE SCLERAL LENSES SO Round Rock, TX 78664 COMFORTABLE? Website: www.scleralcenter.com Scleral lenses vault over the cornea and rest on Phone: 512.248.2424 the white portion of the eye (sclera), which is less sensitive. They fit under the eyelid, resulting in comfort & stability. JAVIER R. ZAMORA, OD Dr. Zamora is the co-founder of Advanced Eye Care & Surgery and has been fitting specialty contact lenses since 1998. He is a graduate of the University of Texas at Austin and the University of Houston College of Optometry. FIRM LENSES LARGER LENSES Sharp Vision Comfort & Stability DEBBIE A. ZAMORA, OD Dr. Zamora is the co- founder of Advanced Eye WHY DO SCLERAL LENSES OFFER Care & Surgery and has SUPERIOR VISION? been fitting specialty contact lenses since They are manufactured in Gas Permeable (GP) 2001. She is a graduate HOW material which provides a smooth optical surface of Tulane University and the University of Houston and excellent vision even if your cornea has an College of Optometry. SCLERAL LENSES irregular shape. Scleral lenses treat astigmatism and are available with bifocal options. CAN HELP YOU DEBRA A. WARE, OD WHAT IS THE ‘LIQUID BANDAGE’ Dr. Ware has been fitting EFFECT? specialty contact lenses since 1998. She is Scleral lenses provide extra moisture for healthy a graduate of Baylor eyes, as well as for patients with severe dry eyes. University and the The space between your eye and the back of the University of Houston scleral lens acts as a fluid reservoir that provides College of Optometry.
    [Show full text]
  • Dry Eye in Patient with Clinical History of Chronic Blepharitis and Chalaziosis Edited by Dr
    year 10 num b e r 2 4 e y e d o c t o r m a r ch- a p r i l 2018 CLINICAL CASES OF LUCIO BURATTO Dry eye in patient with clinical history of chronic blepharitis and chalaziosis edited by Dr. Maria Luisa Verbelli, Dr.Alessia Bottoni Observation and 1 anamnesis Arrives at our observation at CIOS, Italian Center for Dry Eye at CAMO, a 56-year-old patient with blepharitis, redness, ocular burning and abundant mucous secretion present in both eyes. Furthermore, an enlarged lymph node is seen in the right laterocervical site. At ocular anamnesis the patient reports chronic blepharitis from the juvenile age, multiple chalazion in both eyes, an operation for right Fig. 1 Handpiece for the application of the pulsed light of the Eye-Light instrument upper eyelid chalaziosis in 2006 (4 upper eyelid chalazion , 3 in the lower); negative anamnesis for these pathologies in the family. The patient is shortsighted since adolescence, has not had any other eye operations and has no ocular allergies. The general anamnesis does not report major systemic diseases or medication intake. On objective examination of the anterior segment we find bilaterally: reduced lacrimal meniscus, posterior blepharitis, obstruction of all the Meibomian glands of the upper and lower eyelids, conjunctival hyperemia with dry spots, transparent cornea, transparent crystalline. The no contact tonometry is 15 mmHg in RE, 16 mmHg in LE. The OCT of the macula does not show changes in both eyes. The BUT is 4.9 seconds in RE, and 15.6 seconds in LE.
    [Show full text]
  • Scleral Lenses and Eye Health
    Scleral Lenses and Eye Health Anatomy and Function of the Human Eye How Scleral Lenses Interact with the Ocular Surface Just as the skin protects the human body, the ocular surface protects the human Scleral lenses are large-diameter lenses designed to vault the cornea and rest on the conjunctival tissue sitting on eye. The ocular surface is made up of the cornea, the conjunctiva, the tear film, top of the sclera. The space between the back surface of the lens and the cornea acts as a fluid reservoir. Scleral and the glands that produce tears, oils, and mucus in the tear film. lenses can range in size from 13mm to 19mm, although larger diameter lenses may be designed for patients with more severe eye conditions. Due to their size, scleral lenses consist SCLERA: The sclera is the white outer wall of the eye. It is SCLERAL LENS made of collagen fibers that are arranged for strength rather of at least two zones: than transmission of light. OPTIC ZONE The optic zone vaults over the cornea CORNEA: The cornea is the front center portion of the outer Cross section of FLUID RESERVOIR wall of the eye. It is made of collagen fibers that are arranged in the eye shows The haptic zone rests on the conjunctiva such a way so that the cornea is clear. The cornea bends light the cornea, overlying the sclera as it enters the eye so that the light is focused on the retina. conjunctiva, and sclera as CORNEA The cornea has a protective surface layer called the epithelium.
    [Show full text]
  • Frequency and Risk Factors of Symptomatic Dry Eye Disease at Tertiary Care Eye Hospital, Karachi
    Biostatistics and Biometrics Open Access Journal ISSN: 2573-2633 Research Article Biostat Biometrics Open Acc J Faisal’s Issue - January 2018 Copyright © All rights are reserved by Muhammad Faisal Fahim DOI: 10.19080/BBOAJ.2018.04.555639 Frequency and Risk Factors of Symptomatic Dry Eye Disease at Tertiary Care Eye Hospital, Karachi Shaheerah Gul1, Adil Salim Jafri1, Muhammad Faisal Fahim2* 1Department of Ophthalmology, Al-Ibrahim Eye Hospital, Pakistan 2Department of Research & Development, Al-Ibrahim Eye Hospital, Pakistan Submission: November 27, 2017; Published: January 19, 2018 *Corresponding author: Muhammad Faisal Fahim, M.Sc (Statistics), Statistician, Research & Development Department, Al-Ibrahim Eye Hospital, Isra postgraduate Institute of Ophthalmology, Karachi, Pakistan, Tel: ; Email: Abstract Objective: To determine frequency and risk factors of symptomatic dry eye disease at tertiary care eye hospital, Karachi. Material & Methods: This was a descriptive cross sectional study carried out at Al-Ibrahim Eye Hospital, Isra postgraduate Institute of Oph- thalmology, Karachi from March to October 2016. Non-Probability purposive sampling technique was used for data collection. Inclusion criteria give consent. Symptoms of dry eye were assessed using Tear breakup test (TBUT) test. SPSS version 20.0 was used to analyze data. were patients aged ≥ 21 years and on the basis of dry eye symptoms. Exclusion criteria were other systemic eye disease and those who did not Results: A total of 100 patients 65 female and 35 male were diagnosed with dry eye syndrome. The age group of 21-30 years having the high- est frequency of 34 patients, whereas after the 50 years of age the frequency of patients decreases to 21.
    [Show full text]
  • Blepharitis Last Revised in October 2015
    Menu Sign in (https://accounts.nice.org.uk/signin) Search... Blepharitis Last revised in October 2015 Changes Back to top Last revised in October 2015 October 2015 — reviewed. A literature search was conducted in October 2015 to identify evidence­ based guidelines, UK policy, systematic reviews, and key randomized controlled trials published since the last revision of the topic. No changes to clinical recommendations have been made. Previous changes Back to top September 2012 — reviewed. A literature search was conducted in September 2012 to identify evidence­based guidelines, UK policy, systematic reviews, and key RCTs published since the last revision of the topic. No changes to clinical recommendations have been made. April 2011 — minor update. Change to recommendation regarding need for additional contraception during or after a course of tetracycline ­ additional contraception is no longer required when using antibiotics that are not enzyme inducers with combined hormonal methods for durations of 3 weeks or less [FSRH, 2011 (/blepharitis#!references/­315093)]. Issued in June 2011. March 2011 — topic structure revised to ensure consistency across CKS topics — no changes to clinical recommendations have been made. September 2010 — minor update. Hydromoor® (hypromellose 0.3% preservative­free single dose eye drops) have been included. Issued in September 2010. March 2010 — minor update. Lubri­Tears® eye ointment has been discontinued. Prescription removed. Issued in March 2010. December 2007 to May 2008 — converted from CKS guidance to CKS topic structure. The evidence­ base has been reviewed in detail, and recommendations are more clearly justified and transparently linked to the supporting evidence. The clinical scenario structure has been reviewed.
    [Show full text]
  • 29 Yo White Female
    5/21/2014 29 yo white female CC: Decreased VA OD X few days Women of Vision Present Are We PMHx: 5 months pregnant at Risk for Vision Morbidity MODERATOR BVA: 20/30 OD 20/20 OS Pupils: (-) APD Louise Sclafani O.D. Louise A. Sclafani, OD, FAAO CF: FTFC OD/OS Co-instructors: Jill Autry, OD, Melissa Associate Professor Barnett, OD, Susan Cotter, OD, Diana University of Chicago Hospital Shechtman, OD GOALS It’s a BOY… • Our panel will take on this challenge and discuss this population as it relates to the following conditions optic neuritisOCT Women at Risk: Retinal Issues Fetus maculopathy??? evaluation, AMDnutritional controversy, psychosocial issuesmanagement options with strabismus, ocular concerns for common Diana Shechtman, OD systemic pharmaceuticals, safety issues with [[email protected]] ophthalmic drugs, and the hormonal influence Associate Professor of Optometry at on ocular surface disease NOVA Southeastern University College of Optometry Courtesy of Dr. M Rafieetary CASE PRESENTATION SUMMARY So why would’t ICSC (idiopathic central serous chorioretinopathy) WE (female gender) be stressed out? Serous macular detachment due to RBR breakdown • As ODs we need to place a higher priority on those individuals at increased risk for vision- threatening ocular disease. It has been estimated that the female gender represents 23 of all visually compromised individuals due to inherent risk factors and lack of access to healthcare. Diana Shechtman OD FAAO 1 5/21/2014 Hyperpermeability at RPE site is associated with choroidal Which of the following drugs in Not associated CSR in women circulation disruption/vascular congenstion with ICSC? Quillen et al.
    [Show full text]
  • Ocular Complications of Obstructive Sleep Apnea
    Journal of Clinical Medicine Review Ocular Complications of Obstructive Sleep Apnea Pei-Kang Liu 1,2,3,4 , Tzu-Yu Chiu 1,2 , Nan-Kai Wang 4 , Sarah R. Levi 4 and Ming-Ju Tsai 5,6,7,8,* 1 Department of Ophthalmology, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung 807, Taiwan; [email protected] (P.-K.L.); [email protected] (T.-Y.C.) 2 School of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung 807, Taiwan 3 Institute of Biomedical Sciences, National Sun Yat-sen University, Kaohsiung 804, Taiwan 4 Department of Ophthalmology, Edward S. Harkness Eye Institute, Columbia University, New York, NY 10032, USA; [email protected] (N.-K.W.); [email protected] (S.R.L.) 5 Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung 807, Taiwan 6 Sleep Disorders Center, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung 807, Taiwan 7 Department of Respiratory Care, College of Medicine, Kaohsiung Medical University, Kaohsiung 807, Taiwan 8 Graduate Institute of Clinical Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung 807, Taiwan * Correspondence: [email protected]; Tel.: +886-7-3121101 (ext. 5601) Abstract: Obstructive sleep apnea (OSA), the most common form of sleep-disordered breathing, is characterized by repetitive episodes of paused breathing during sleep, which in turn induces transient nocturnal hypoxia and hypercapnia. The high prevalence of OSA and its associated health consequences place a heavy burden on the healthcare system. In particular, the consequent episodic oxygenic desaturation/reoxygenation series and arousals from sleep in patients with OSA have the potential to trigger oxidative stress, elevated systemic inflammatory responses, and autonomic Citation: Liu, P.-K.; Chiu, T.-Y.; dysfunction with sympathetic activation.
    [Show full text]
  • Changes in Tear Biomarker Levels in Keratoconus After Corneal Collagen Crosslinking
    Molecular Vision 2019; 25:12-21 <http://www.molvis.org/molvis/v25/12> © 2019 Molecular Vision Received 7 April 2018 | Accepted 18 January 2019 | Published 20 January 2019 Changes in tear biomarker levels in keratoconus after corneal collagen crosslinking Jose Ignacio Recalde,1 Juan Antonio Duran,1,2 Iñaki Rodriguez-Agirretxe,1,3 Javier Soria,4 Miguel Angel Sanchez-Tena,5 Xandra Pereiro,6 Tatiana Suarez,4 Arantxa Acera4 1Instituto Clínico-Quirúrgico de Oftalmología, Bilbao, Bizkaia, Spain; 2Department of Ophthalmology, University of the Basque Country, Experimental Ophtalmo-Biology Group UPV/EHU, Leioa, Bizkaia, Spain; 3Hospital Universitario Donostia, San Sebastian, Gipuzkoa,Spain; 4Bioftalmik Applied Research, Bizkaia Science and Technology Park, Derio, Bizkaia, Spain; 5Universidad Europea de Madrid, Madrid, Spain; 6Department of Cell Biology and Histology, University of the Basque Country, Experimental Ophtalmo-Biology Group UPV/EHU, Leioa, Bizkaia, Spain Purpose: The purpose of this work was to analyze the expressions of matrix metalloproteinase 9 (MMP-9), calcyclin (S100A6), and cystatin S (CST4) in the tears of keratoconus (KC) patients. The correlations between the expressions of these proteins and the values of various ocular surface parameters were examined after accelerated corneal crosslinking (A-CXL) with pulsed ultraviolet light. Methods: This prospective, observational study enrolled patients with different grades of KC, scheduled to undergo the A-CXL procedure, as well as healthy subjects. Tear samples were analyzed by employing customized antibody microar- ray assays for MMP-9, S100A6, and CST4 proteins. The keratometry readings at the maximum keratometry (Kmax) and the simulated keratometry (SimK) values were obtained for examining the postoperative evolution of corneal topography.
    [Show full text]
  • Blepharitis and Eyelid Hygiene
    Blepharitis and Eyelid Hygiene You have been informed by your doctor or specialist that you have Blepharitis. Answers to some of the most commonly asked questions are given below. What is Blepharitis? Blepharitis is an inflammatory condition that affects the edges (margins) of the eyelids, and usually causes itching and irritation. It usually affects both eyes and it can occur at any age. Although Blepharitis maybe uncomfortable, it is not a sight threatening condition. What are the symptoms? Blepharitis may cause one or more of the following: Itchiness around the eyes. Persistent irritation or ‘burning’ sensation. Redness and swelling of the eyelid edges. Tiny flakes on the eyelashes. Crusting of the eyelids, especially in the morning. Eyelid cysts / styes. Sensation of ‘grit’ in the eye. Redness of the eye. Symptoms may come and go. It is common to have flare ups or long periods with no symptoms. Scaly Scabs Normal eyelid Eyelid swollen and reddened Bacterial Infection _________________________________________________________________ What are the causes? Blepharitis may be due to a combination of one or more of the following: 0262/05/Sept 2018 - Blepharitis and Eyelid Hygiene Page 1 of 6 A disorder of the Meibomian (oil) Glands at the edge of the eyelid: Normal tears of the eye are made up of three layers - an oily (lipid) layer, a watery (Aqueous) layer and a sticky (mucous) layer. There are Meibomian glands inside the eyelids with openings onto the edges of the eyelids (lid margins) which naturally produce oil. This oil stops the watery element of the tear film from drying out. At times the Meibomian glands become blocked; this leads to the tear film breaking down and ‘evaporative’ dry eyes.
    [Show full text]
  • The Definition and Classification of Dry Eye Disease
    DEWS Definition and Classification The Definition and Classification of Dry Eye Disease: Report of the Definition and Classification Subcommittee of the International Dry E y e W ork Shop (2 0 0 7 ) ABSTRACT The aim of the DEWS Definition and Classifica- I. INTRODUCTION tion Subcommittee was to provide a contemporary definition he Definition and Classification Subcommittee of dry eye disease, supported within a comprehensive clas- reviewed previous definitions and classification sification framework. A new definition of dry eye was devel- T schemes for dry eye, as well as the current clinical oped to reflect current understanding of the disease, and the and basic science literature that has increased and clarified committee recommended a three-part classification system. knowledge of the factors that characteriz e and contribute to The first part is etiopathogenic and illustrates the multiple dry eye. Based on its findings, the Subcommittee presents causes of dry eye. The second is mechanistic and shows how herein an updated definition of dry eye and classifications each cause of dry eye may act through a common pathway. based on etiology, mechanisms, and severity of disease. It is stressed that any form of dry eye can interact with and exacerbate other forms of dry eye, as part of a vicious circle. II. GOALS OF THE DEFINITION AND Finally, a scheme is presented, based on the severity of the CLASSIFICATION SUBCOMMITTEE dry eye disease, which is expected to provide a rational basis The goals of the DEWS Definition and Classification for therapy. These guidelines are not intended to override the Subcommittee were to develop a contemporary definition of clinical assessment and judgment of an expert clinician in dry eye disease and to develop a three-part classification of individual cases, but they should prove helpful in the conduct dry eye, based on etiology, mechanisms, and disease stage.
    [Show full text]
  • Ocular Side Effects of Novel Anti-Cancer Biological Therapies
    www.nature.com/scientificreports OPEN Ocular side efects of novel anti‑cancer biological therapies Vicktoria Vishnevskia‑Dai1*, Lihi Rozner1, Raanan Berger2,3, Ziv Jaron1, Sivan Elyashiv1, Gal Markel2,3 & Ofra Zloto1 To examine the ocular side efects of selected biological anti‑cancer therapies and the ocular and systemic prognosis of patients receiving them. We retrospectively reviewed all medical records of patients who received biological anti‑cancer treatment from 1/2012 to 12/2017 and who were treated at our ocular oncology service. The following data was retrieved: primary malignancy, metastasis, type of biological therapy, ocular side efects, ophthalmic treatment, non‑ocular side efects, and ocular and systemic disease prognoses. Twenty‑two patients received biological therapies and reported ocular side efects. Eighteen patients (81.8%) had bilateral ocular side efects, including uveitis (40.9%), dry eye (22.7%), and central serous retinopathy (22.7%). One patient (4.5%) had central retinal artery occlusion (CRAO), and one patient (4.5%) had branch retinal vein occlusion (BRVO). At the end of follow‑up, 6 patients (27.27%) had resolution of the ocular disease, 13 patients (59.09%) had stable ocular disease, and 3 patients (13.64%) had progression of the ocular disease. Visual acuity improved signifcantly at the end of follow‑up compared to initial values. Eighteen patients (81.8%) were alive at study closure. Biological therapies can cause a wide range of ocular side efects ranging from dry eye symptoms to severe pathologies that may cause ocular morbidity and vision loss, such as uveitis, CRAO and BRVO. All patients receiving biological treatments should be screened by ophthalmologists before treatment, re‑screened every 4–6 months during treatment, and again at the end of treatment.
    [Show full text]
  • Obstructed Tear Duct Causes Epiphora and Precocious Eyelid Opening Due
    bioRxiv preprint doi: https://doi.org/10.1101/2020.04.17.046383; this version posted April 17, 2020. The copyright holder for this preprint (which was not certified by peer review) is the author/funder, who has granted bioRxiv a license to display the preprint in perpetuity. It is made available under aCC-BY 4.0 International license. Obstructed tear duct causes epiphora and precocious eyelid opening due to disruption of Prickle 1-mediated Wnt/PCP signaling Dianlei Guo1*, Jiali Ru1*, Jiaying Fan2*, Rong Ju1, Kangxin Jin1, Hong Ouyang1, Lai Wei1, Yizhi Liu1, Chunqiao Liu1$ 1, State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou 510060, China 2, Guangzhou Woman & Children’s Medical Center *Equal contribution $Correspondence should be addressed to Dr. Chunqiao Liu: Email: [email protected] bioRxiv preprint doi: https://doi.org/10.1101/2020.04.17.046383; this version posted April 17, 2020. The copyright holder for this preprint (which was not certified by peer review) is the author/funder, who has granted bioRxiv a license to display the preprint in perpetuity. It is made available under aCC-BY 4.0 International license. Abstract The tear drainage apparatus evolved in terrestrial animals serving as conduits for tear flow. Obstruction of tear drainage causes a range of ocular surface disorders. Hitherto, genetics of tear duct development and obstruction has been scarcely explored. Here we report that a severe Prickle 1 hypomorph mouse line exhibited epiphora. This phenotype was due to blockage of the tear drainage by the incompletely formed nasolacrimal duct (NLD) and lacrimal canaliculi (CL).
    [Show full text]