Ocular Rosacea (Subtype 4)
Frank C. Powell, Jonathan Wilkin in Rosacea: Diagnosis and Management, 2008
Most of the patients who present to the clinician with ocular rosacea have relatively mild disorders and can be treated with simple measures (Table 2). For those patients who complain of dryness of the eyes without evidence of inflammation, artificial tears are the preferred treatment. Cold winds exacerbate symptoms and wearing glasses or sunglasses can offer protection. When there is inflammation of the lashes or lid margins warm soaks or compresses, or commercially available eye scrubs help to settle the symptoms by removing the debris around the lashes and stimulating meibomian gland secretion. Eyelash and eyelid margin lavage can be carried out twice daily using a warm saline solution in an egg cup with a drop of baby shampoo added. A cotton-tipped applicator dipped in this solution can be used to brush the eyelids from the base to the ends (the upper lid with the eye closed and the lower lid with the lid pulled down). Manual expression of the meibomian glands daily to release the thickened yellowish secretions may be required in some patients and this will be facilitated by the prior lavage and removal of the material plugging the follicular orifices. If there are collaret’s of keratin about the base of the lashes a cream applied to these over night helps to soften the keratin and facilitate its removal in the morning.
Familial Dysautonomia
David Robertson, Italo Biaggioni in Disorders of the Autonomic Nervous System, 2019
The corneal hypesthesia and alacrima predispose the cornea to neurotropic corneal ulcerations due to undetected trauma and excessive dryness. Corneal complications have been decreasing with regular use of artificial tear solutions containing methylcellulose and maintenance of normal body hydration. Artificial tears are instilled three to six times daily, depending on the child’s own baseline eye moisture, environmental conditions and whether or not the child is febrile or dehydrated. Moisture chamber spectacle attachments help to maintain eye moisture and protect the eye from wind and foreign bodies. Tarsorraphy has been reserved for unresponsive and chronic situations. Soft contact lenses are also beneficial in promoting corneal healing. Corneal transplants have had limited success.
The diagnostic evaluation and management of hyperthyroidism due to Graves’ disease, toxic nodules, and toxic multinodular goiter
David S. Cooper, Jennifer A. Sipos in Medical Management of Thyroid Disease, 2018
Since the cause of Graves’ ophthalmopathy is unknown, treatment is directed at treating symptoms. In most patients, the problem is self-limited, often resolving as the hyperthyroidism is treated. Although most experts feel that it is best for the patient to be euthyroid, there is no consistent relationship between a patient’s thyroid function and progression or regression of eye disease. There is good evidence that smoking exacerbates Graves’ ophthalmopathy (172), and it is suggested that smoking cessation has a beneficial effect (173). The mechanism by which smoking affects Graves’ ophthalmopathy is unknown. There is solid evidence that radioactive iodine therapy can exacerbate Graves’ eye disease when it is moderately severe at baseline (130, 131), likely due to the increase in TRAb levels after treatment (39). When the condition is mild, symptoms such as irritation, tearing, and photophobia are easily treated with artificial tears and lubricating eye ointments. In more severe cases, high doses of glucocorticoids usually will result in prompt improvement in local symptoms and ocular motility. Data from randomized clinical trials have shown that intravenous pulse therapy with methylprednisolone is more effective and safer than high-dose oral therapy (174, 175). One commonly used regimen is methylprednisolone 500 mg IV weekly for 6 weeks followed by 250 mg IV for 6 weeks, which resulted in a 77% response rate and minimal toxicity (176). Unfortunately, as the glucocorticoid is tapered, the ophthalmopathy often flares up, so that other measures are sometimes needed.
Comparison of matrix metallopeptidase-9 expression following cyclosporine and diquafosol treatment in dry eye
Published in Annals of Medicine, 2023
Ha Rim So, Jiwon Baek, Ji Young Lee, Hyun Seung Kim, Man Soo Kim, Eun Chul Kim
Topical 0.05% cyclosporin A, 3.0% diquafosol tetrasodium, artificial tears are the most commonly used medications in dry eye treatment. The mechanism of action on dry eye is different among the three drugs. Cyclosporin A is known to reduce surface inflammation in dry eye by inhibiting T-cell activation and downregulating the production of inflammatory cytokines [16,17]. Conversely, diquafosol tetrasodium is a purinergic P2Y2 receptor agonist that stimulates water and mucin secretion from conjunctival epithelial cells and goblet cells [18,19]. Artificial tears are eyedrops used to lubricate dry eyes and help maintain moisture on the outer surface of eyes. The purpose of this study was to compare the expression of MMP-9 in dry eyes treated with either cyclosporin or diquafosol and their association with other dry eye markers.
Lacrimal Gland Insufficiency in Aqueous Deficiency Dry Eye Disease: Recent Advances in Pathogenesis, Diagnosis, and Treatment
Published in Seminars in Ophthalmology, 2022
These have been the first line of management in patients with ADDE, regardless of the disease severity. They are known to improve the ocular surface lubrication, tear retention, tear osmolarity and TBUT and reduce the ocular surface staining. However, there are various types of artificial tears available which differ in its constituents.73,74 Preservatives such as benzalkonium chloride should be avoided as it causes stinging sensation and ocular surface toxicity with long-term use. The pH of the human tear is between 6.9 and 7.5. Any compound having a higher pH causes burning sensation upon instillation. These factors further worsen the pre-existing symptoms of a patient with DED. Current recommendations are that a preservative-free compound having a lower pH should be preferred. Due to the varied compositions, the drops need to be individualized in every patient.
Corneal Collagen Cross-Linking Complications
Published in Seminars in Ophthalmology, 2018
Charisma B. Evangelista, Kathryn M. Hatch
Postoperative pain is a common complaint with cross-linking. The surgeon should prepare patients for postoperative pain associated with the procedure. In a prospective study by Ghanem et al.,11 pain after epi-off CXL was worse on the day of surgery and postoperative day 1 (mean 2.8 and 2.1, respectively, on a scale of 0 to 5 with 5 being worst pain) and improved on subsequent days (mean 0.12 on postoperative day 5). Subjects were given standard postoperative topical drops to include 0.4% ketorolac as well as oral nonsteroidal anti-inflammatory drug (NSAID) daily and paracetamol with codeine as needed for severe pain. They reported 43% of patients had 4 or 5 pain level on the first day, which dropped to 24% on the following day.11 Similar to post-phototherapeutic keratectomy, placement of a bandage contact lens in conjunction with systemic pain medications and cold compresses are currently some of the tools employed to reduce postoperative pain. Preservative-free refrigerated artificial tears may also mitigate symptoms.
Related Knowledge Centers
- Antibody
- Antimicrobial Peptides
- Conjunctivitis
- Enzyme
- Mucus
- Lipid
- Eye Drop
- Dry Eye Syndrome
- Tears
- Electrolyte