Ocular surface damage and tear lactoferrin in dry eye syndrome

Because falls are common among the elderly and are associated with high morbidity and mortality, community surveillance has been recommended. The purpose of this study was to characterize the impact of falls among the elderly on emergency medical transport services (EMS) and to explore the potential for community surveillance of falls through the use of computerized EMS data. Computerized EMS data and United States census data for 1990 for persons aged > or = 65 in Forsyth County, NC, were used to produce EMS transport rates for falls and to make comparisons by age, gender, race, and residence (nursing home vs community). A fall was reported as the cause for EMS summons in 15.1% (613 of 4,058) of cases. Transport rates in 1990 for falls were 7.8 per 1,000, 25.4 per 1,000, and 58.5 per 1,000 for the age groups of 65 to 74 years, 75 to 84 years, and 85 years and older. Rates were higher for females than for males (17.1 per 1,000 v 8.1 per 1,000) and higher for whites than for African-Americans (14.3 per 1,000 v 10.3 per 1,000). Rates for nursing home residents were four times that of community residents (70.6 per 1,000 v 16.0 per 1,000). Over 50% of nursing home fallers were transported between midnight and 0400 compared with 25% of community dwellers. EMS summons for older adults reporting a fall accounts for a significant portion (15%) of all transports in this county. Computerized EMS data demonstrated patterns of falls among the elderly that are consistent with known demographic factors. The potential for using computerized EMS data as a practical means of community surveillance should be further explored.     

Argon laser punctal therapy versus thermal cautery for the treatment of aqueous deficiency dry eye syndrome

1. Pregnant Wistar rats were treated orally with a single dose of 100 microg 3,3',4,4'-tetrachlorobiphenyl (PCB 77)/kg b.w. or 10 microg 3,3',4,4',5 pentachlorobiphenyl (PCB 126)/kg b.w. on day 15 of pregnancy. The control rats received peanut oil at the same day. Developmental landmarks were assessed in all offspring rats and reproductive effects of PCB 77 and PCB 126 on male offspring were studied on postnatal day 65 (at puberty) and on postnatal day 140 (at adulthood). 2. The ano-genital distance as well as the ratio ano-genital distance to body length was reduced in male pups of the PCB 126 group and the age at vaginal opening was significantly delayed in the female pups. 3. Testis, brain weights and daily sperm production were permanently increased and seminal vesicle weights were decreased in male offspring of the PCB 77 group. In male rats of PCB 126 group, the brain weights were permanently increased and ventral prostate weights permanently reduced. In both PCB groups, however, serum testosterone concentration was reduced only at adulthood. Additionally, the male rats of the PCB 126 group showed alterations in sexual behavior. In these rats the number of mounts with intromissions was significantly increased. 4. The results of this study show that PCB 126 elicits some TCDD-like reproductive effects after in utero exposure, while the reproductive effects of in utero exposure to PCB 77 on male offspring may be attributed to the neonatal hypothyroidism induced by the substance during early fetal development. Further studies using multiple doses and providing thyroid hormone data will be necessary to support this hypothesis.     

Diagnostic methods and treatment modalities of dry eye conditions

One may view dry eye conditions as a group of diseases in which the ocular surface is adversely affected. Tear film instability invariably leads to some degree of cellular surface damage over the cornea and conjunctiva. In turn, ocular epitheliopathy may adversely affect tear film stability. The clinical presentation of the disease may not yield a clue as to its etiology. In recent years considerable progress was made both in the diagnosis and the treatment of the disease and promising studies are planned or are underway. The diagnostic techniques can be divided into four groups. The first is concerned with the clinical presentation. The second is concerned with the bulk properties of the aqueous tears including dynamic characteristics, composition, and colligative properties. The third is tear-film related and includes the film break-up time, evaporation rate, and lipid abnormality. The fourth is concerned with the ocular surface and includes vital staining, impression cytology, and surface microscopy. The most promising attempts are being made in the second group by attempting to elucidate the role of enzyme and enzyme activator activity and inhibitor contents as well as the tear protein profiles and correlating them with the specific disease states. The treatment modalities belong to three major groups aside from surgical intervention; the supplementation, preservation, and the stimulation of tears. The modern version of tear supplementation is expected to include the topical use of efficacious aqueous formulations that typically contain film stabilizing polymers, nutrients, and/or--in the future--biochemically active ingredients such as enzyme activators and inhibitors.     

Efficacy and safety of 0.3% carbomer gel compared to placebo in patients with moderate-to-severe dry eye syndrome

PURPOSE: Carbomer gel is a water-soluble polymeric resin that has been reported to maintain the tear film in contact with the eye for an extended period. The efficacy and safety of this new artificial tear were assessed. METHODS: A multicenter, single-masked, randomized, placebo-controlled study was carried out on 123 patients with moderate-to-severe dry eyes. The placebo was a mannitol solution with benzalkonium chloride 0.008% as preservative. Patients were observed over an 8-week period, and subjective and objective changes analyzed, compared to a baseline of no therapy, after 1 to 7 days washout period from previous medication. RESULTS: All primary subjective symptoms decreased significantly in the carbomer gel-treated group compared to the placebo group (i.e., dryness, discomfort, and foreign body sensation). The carbomer gel also significantly improved the rose bengal staining score relative to placebo. When data for the primary subjective efficacy variables were stratified for disease severity, there was a statistically significant improvement from baseline by day 10 for severely affected patients and from day 42 for patients with moderate disease. Secondary subjective symptoms that improved significantly in the tear gel group compared to placebo were photophobia, erythema, tear breakup time, blurry-filmy, dry-sandy sensation, and physician impression. However, no significant improvements in the secondary subjective symptoms of tearing, itching, scaling, conjuctival discharge, palpebral conjunctival redness, bulbar conjuctival redness, conjunctival luster, relief of discomfort, ease of use, and overall acceptability were found in either group over the baseline score. In addition, neither carbomer gel nor placebo improved the baseline fluorescein staining score or the Schirmer test score. Two patients suffered local allergic reactions to the carbomer gel or its preservative, which settled on withdrawal of the medication. CONCLUSIONS: Carbomer gel was more efficacious than was placebo in improving a number of subjective and objective symptoms of moderate-to-severe dry eye syndrome. The results of this study indicate that carbomer gel was a safe as was the placebo.     

Moisture aid during sleep for the treatment of dry eye: wet gauze eye mask

While various techniques have been proposed for the treatment of dry eye, there have been no studies published evaluating the efficacy of the following wet gauze eye mask (WGEM) treatment of dry eye. One or two gauze mask(s) (9 x 12 cm) wetted with tap water and wrung were placed over both eyes during sleep. The treatment was performed on 30 patients with dry eye. Of these, 22 performed the treatment actively. In 14 (63.6%) out of the 22 patients, dry-eye symptoms were eliminated by the WGEM all day or until the evening. Of these 14, 7 were freed from eye drop treatment by the WGEM procedure. The WGEM treatment is safe, effective, simple and economical, and can be performed by the patients themselves. Moisture aid by the WGEM and/or a humidifier should be performed before resorting to punctal-plug insertion which may induce canalicular obstruction.     

Sjogren''s syndrome and the "dry syndrome" in combination with lung diseases

Because of the reported success of primary closure of Skeletal Muscle abscess we conducted a retrospective study of breast abscess treated over a period of 24 months. There were essentially two groups: In one group the abscess cavities were initially packed with gauze and then dressed daily. In the second group, the abscess cavities were primarily closed and a negative suction drain instituted for about five to seven days. The second group had shorter healing period, better scar formation and reduction of cost in terms of labour and material. But a recurrence could occur within two to three days especially if the drain is removed prematurely.     

Tear hyperosmolarity in renal dialysis patients asymptomatic for dry eye

Plasma levels of IGF-I, IGFBP-I and IGFBP-3 were measured before and during treatment with tamoxifen up to 19+ months in 34 post-menopausal patients with advanced breast cancer. In 28 patients, pro-IGF-IIE (IGF-IIE) levels were determined and IGFBP-3 was evaluated by immunoblot in 27 patients. Tamoxifen suppressed plasma levels of IGF-I by a mean value of 25.5%-37.7% at different times. This effect was fully developed after 1-2 months of treatment. IGF-IIE was decreased by a mean value of 7.7-23.2% at different time intervals during treatment with tamoxifen, but this effect was significant after long-term treatment (19 months +) only. Plasma IGFBP-I increased by a mean value varying between 48.6% and 190.1%. Tamoxifen had no significant effect on total IGFBP-3 levels. However, patients responding to treatment had a 28% reduction in fragmentation of IGFBP-3, while patients with progressive disease had a 36% increase in fragmentation. The difference between responders and non-responders was highly significant. These findings confirm and extend previous observations regarding the effects of treatment with tamoxifen on IGF-I and IGFBP-I. The finding that patients responding to tamoxifen achieve a reduction in the ratio of fragmented to intact IGFBP-3, while patients progressing on therapy experience an increase in the IGFBP-3 fragmentation ratio, suggest that the tumor burden influences IGFBP-3 protease activity in breast- cancer patients.     

Compliance with and typical usage of artificial tears in dry eye conditions

BACKGROUND: Although the literature on dry eye is extensive, little has been written about the typical use of tear supplements among the clinical population. METHODS: This study consisted of chart reviews and telephone surveys. Self-reported use of tear supplements was evaluated. RESULTS: At the time of the survey, 63% of those recommended to use artificial tear solutions (114 of 229) continued to do so. The discontinuation rate was higher for ointments, with 53% (47 of 89) having stopped using a recommended ointment. The majority of those continuing to use drops will use one or two drops per day (30 gtts/30 days, +/- 89). In addition to the extreme amount of variability in the number of artificial tears used by any individual, a great deal of day-to-day variability is seen within any individual. CONCLUSIONS: Patients appear to titrate dosage to symptoms on any given day. Given this, there may be little reason to prescribe a specific dosage regimen for the majority of persons using tears. Researchers who are looking at the effectiveness of tear supplements need to take into account the individual variability of use in tear supplements. When prescribing artificial tears, patient education regarding purpose for treatment, specific agent, and dosage used may improve relatively low compliance rates.     

Cat eye syndrome with hypogonadotropic hypogonadism

Epidemiological studies on the relation between selenium and human cancer have yielded strongly conflicting results. Prompted by the observation of a positive association between selenium intake and site-specific cancers, including melanoma, in a large cohort of nurses, we studied the 11-year melanoma incidence in an Italian cohort that consumed unusually high levels of inorganic selenium in tap water from 1975 to 1985. The setting was Reggio Emilia, an Italian municipality that provided a natural experiment relating to intake of high levels of inorganic selenium. We identified 2,065 individuals with high selenium exposure, who contributed a total of 20,179 person-years of follow-up, and we compared their experience with the 1,384,386 person-years of follow-up in the remaining population of Reggio Emilia. We included all cases of pathologically confirmed malignant melanoma, including intraocular melanoma, identified from the Reggio Emilia Hospital, the Bologna regional registry of hospital discharges, and the Milan National Cancer Institute. Eight cases of malignant melanoma occurred in the exposed cohort during the follow-up. Melanoma incidence was 3.9 times greater in the exposed than in the unexposed cohort (95% exact confidence limits, 1.8-7.4).     

Glaucoma and vasospasm

AIMS/BACKGROUND: To study the vasoactivity of glaucoma patients with four previously described and distinct disc appearances potentially representative of primary open angle glaucoma subgroups. METHODS: Patients with pure examples of four glaucomatous optic disc types--focal ischaemic, myopic glaucomatous, senile sclerotic, and those with generalised cup enlargement, were selected. A detailed ophthalmic, systemic, drug, and smoking history was taken from the patients who, in addition, underwent assessment of peripheral vasospasm with a laser Doppler flowmeter. Differences between the groups were evaluated using an analysis of variance, Student's t test, Pearson's chi 2 test, Fisher's exact test together with Spearman's and Pearson's correlation tests. RESULTS: 38 patients with focal ischaemic, 37 with myopic glaucomatous, 24 with senile sclerotic, and 24 with discs characterised by generalised cup enlargement met the selection criteria. The group of patients with focal ischaemic discs contained more women (66% versus 32%-50% in the other three groups; p = 0.01) and had a higher prevalence of vasospasm (63% versus 25%-49%; p = 0.01), migraine (32% versus 8%-19%; p = 0.02), and cold extremities (66% versus 17%-30%; p = 0.00003). The group of patients with senile sclerotic discs had a higher prevalence of systemic cardiovascular disease (58% versus 21%-30% in the other three groups; p = 0.01) and thyroid disease (21% cf 0%-8%; p = 0.01) and although their mean age was greater (76 years cf 55-65 years; p < 0.00001) the findings were independent of age. Smoking was unrelated to optic disc type. CONCLUSION: Vasospasm, previously associated with normal tension glaucoma, and generalised cardiovascular disease both appear to be specific risk factors for the development of particular subgroups of glaucoma and may be independent of absolute intraocular pressure levels exerting effects in patients with both "normal" or "raised" intraocular pressure. The simple assessment as to whether a glaucoma patient suffers from colder extremities than average appeared to be better at distinguishing the focal ischaemic type of glaucoma than the more complex determination of vasospasm using the laser Doppler flowmeter.     

Management of the dry eye with parotid duct transplantation: a summary on 40 cases

PURPOSE: As today the effect of parotid duct transplantation is clinically regarded as uncertainty, and there is still absent of effective managenent of the dry eye, this paper tries to clarify its value, and see if it can be used clinically. METHODS: Forty dry eyes were operated with a follow up of 3 weeks to more than 6 years in the past 42 years. The pre- and postoperative changes of tear flow and vision, and the cause of dry eye, operative method, length of parotid duct and complications of bilateral operation were briefly summarized. RESULTS: Of these 40 operated eyes postoperatively, 82.5% had tearing, but no tearing occurred in 27.5%. Finally: vision increased in 72.5% with out any decrease. There was no difference in the results whether the procedure done extraorally or intraorally. The parotid duct being shorter was only seen in 7.5%, which were satisfactorily managed by tube making with oral mucosa. Four cases operated binocularly and silmutaneously, only 1 occurred aveolar abscess with complaining dry mouth, but cured 1 week later. After operation, profusive tearing occurred in 25 dry eyes caused by trachoma during eating and 96% usually, but tearing stopped finally in 3 eyes (2, due to infection). Four dry eyes with ocular pemphigoid failed. Among 9 dry eyes resulted from Stevens-Johnson syndrome, 6 had little tearing postoperatively, 2 of which attained a nearly normal results. One of the two dry eyes resulted from alkali eye burn failed and the other, occurred tearing but only followed-up for 1 month, the result was uncertain. CONCLUSION: As the technique of the parotid duct transplantation is simple and easy with no much complications, and for treating the dry eye, there is up to now still absent of effective management, therefore, the parotid duct transplantation should be considered to be indicated in dry eyes esp, caused by Stevens-Johnson syndrome. Though its success rate is lower than that of traucomatous ones, the satisfactory result of nearly normal postoperative tearing may be got. In ocular pemphigoid, however, it is contraindicated.     

The "dry eye" phenomenon and ovarian function. Study of 700 women pre- and postmenopausal

One kind of extragenital effects of estrogens are those on the eye-a topic that should interest gynecologists and ophthalmologists alike. The frequency of ovarian function being relevant to the complaint "dry eye" was the subject of a study among more than 700 women. 1.4 out of 11 particular symptoms related to the "dry eye" showed a lower incidence among postmenopausal women receiving oral estrogen-therapy than among those postmenopausal patients without estrogen substitution. Examples for this are epiphora in 16% respectively 32% and visual disturbance in 27% respectively 3% of patients. 2. The more time had passed since the entrance to menopause the more some symptoms increased without estrogen substitution respectively decreased under estrogen-therapy, e.g. visual flicker more than 10 years after menopause: 35% versus 10%. 3. The symptoms of the "dry eye" are most often medicable by estrogen substitution below the age of 60 years. 4. Postmenopausal women aged under 60 years and not receiving estrogen substitution complained of "severe eye problems" in 32% those with estrogen-therapy in only 11% of cases. 5. During child-bearing period the symptoms of the "dry eye" are also relevant to gynaecological practice. Seven of the 11 particular symptoms showed higher incidence among patients taking ovulation inhibitors than among those having spontaneous menstrual cycles. Visual flicker in 42% respectively 24% of patients may serve as an example. This study demonstrates that functional disorders of tear film with symptoms of keratoconjunctivitis sicca are "relatively often" related to ovarian steroids- and therefore to gynecological practice.     

Effect of retinol palmitate as a treatment for dry eye: a cytological evaluation

OBJECTIVE: To investigate a method of detecting adhesion molecule (CD44) contents in ovarian tumors and its clinical significance. METHODS: In 106 patients with ovarian tumors (50 benign and 56 malignant), the adhesion molecule (CD44) contents in peripheral blood lymphocytes (PBL) and in neoplastic tissues were analysed (quantitatively by using flow cytometric-immunological method). RESULT: (1) The CD44 contents in the PBL of the patients with malignant tumor were obviously higher than those of patients with benign tumors (P<0.05) and than those of the control (P < 0.01); (2) Within the group of patients with malignant tumors, the CD44 contents in the neoplastic tissues were higher than those in the PBL (0.01 < P < 0.05); There was no significant difference in CD44 contents among the different histopathological types, whether benign or malignant; (4) The CD44 contents in the PBL decreased gradually after surgery. CONCLUSION: To analyse the CD44 contents in PBL and neoplastic tissues by flow cytometry may be an important method or parameter to differentiate benign ovarian tumors from malignant tumors and to discover recurrence of metastasis of malignant tumors in early stage.