Eyelid Diseases

This chapter reviews eyelid malpositions, benign and malignant tumors, infections, and inflammatory diseases of the eyelid. Eyelid lesions can originate in any layer or structure within the eyelid and eyelid adnexa. Benign tumors of the eyelid can often be diagnosed based on their characteristic appearance. A biopsy should be performed if an eyelid lesion is not easily diagnosed based on clinical appearance. Blepharitis and meibomitis are very common disorders. Despite their prevalence, these diseases are often overlooked and misdiagnosed. Meibomian gland dysfunction is a major cause of evaporative dry eye and can occur along with aqueous deficient dry eye. Bacteria, fungi, viruses, and parasites can cause infection of the eyelids in different locations, anterior, posterior, angular, which can have different courses, acute, intermediate, or chronic. This chapter also contains photos with a rare disorder, Urbach-Wiethe disease, demonstrating the lesions of lipoid proteinosis at the lower and upper eyelids.

Imaging the tarsal plate: A Mini-Review

Imaging the tarsal plate and the meibomian glands (MG) grants new opportunities for ophthalmic practitioners who work in the field of the ocular surface and dry eye across the globe. The secretory role of MG plays a fundamental part in protecting the moisture in front of the eye surface by creating an active shield made of meibum (lipid) which prevents tear evaporation and causes dry eye. Evidence from the most popular Dry Eye Workshop reports (2007 and 2016) demonstrate that MG dysfunction is the first cause of evaporative dry eye which is also the most common cause of dry eye and ocular surface discomfort. Fortunately, during the last years, a plethora of new devices for MG observation, diagnosis and follow-up have been made available in the market. These devices range from invasive to minimally invasive, high to low-tech and from being expensive to low-cost. The objective of this mini-review is to condense the latest evidence in MG imaging by providing a narrative overview on the most common technologies plus some other newer aspects which might guide clinicians and researchers in the field of the ocular surface and dry eye.

Meibomian gland dysfunction and primary Sjögren’s syndrome dry eye: a protocol for systematic review and meta-analysis

IntroductionPrimary Sjögren’s syndrome (pSS) is a systemic autoimmune disorder that primarily affects the exocrine glands such as the lacrimal and the salivary glands. Dry eye disease (DED) is one of the most prevalent manifestations of pSS and is usually classified into aqueous-deficient dry eye and evaporative dry eye. Sjögren’s syndrome dry eye (SSDE) is generally described as aqueous-deficient dry eye. However, as the leading pathophysiological mechanism of evaporative dry eye, meibomian gland dysfunction (MGD) also has influence on SSDE, which has been shown in recent studies. We speculate that SSDE is more than just an aqueous-deficient dry eye. While no related systematic review and meta-analysis has been published, the present study is designed to derive a better understanding of the association between MGD and SSDE.Methods and analysisThe Preferred Reporting items for Systematic Reviews and Meta-Analysis for Protocols 2015 statement was used to prepare this protocol. PubMed, Embase, Web of Science, Cochrane Database, China National Knowledge Infrastructure and Wan Fang Database will be searched from their inception to 31 October 2021, with restrictions to publications in English or Chinese. Two reviewers will independently carry out data extraction and quality assessment. The diagnosis of pSS will meet the standard diagnostic criteria, such as American College of Rheumatology/European League against Rheumatism Classification Criteria (ACR/EULAR) or American-European Consensus Group Classification criteria (AECG), and the definition of MGD and DED will differ between studies. The quality of included studies will be judged using the Newcastle-Ottawa Quality Scale. We will carry out this meta-analysis using RevMan V.5.4.1. The incidence of MGD in patients with SSDE will be indicated as OR with 95% CI.Ethics and disseminationEthical approval is not required as this meta-analysis is performed based on published studies and does not involve human participants. The results will be published in a peer-reviewed journal.PROSPERO registration numberCRD42021226017.

Comparative of meibomian gland morphology in patients with evaporative dry eye disease versus non-dry eye disease

Many recent studies have showed that morphological changes are one of the key signs of meibomian gland disease (MGD). These changes can be seen even before symptom onset, potentially underestimating the prevalence of MGD; however, until now, there is no conclusive information about the impact of meibomian gland (MG) morphology in tear film physiology and disease. This study aimed to investigate the prevalence of anatomical and morphological MG alterations between patients with evaporative dry eye disease (DED) and healthy controls. Retrospective chart review of seventy-five patients with evaporative DED and healthy individuals who had dry eye assessments included Ocular Surface Disease Index questionnaire, meibum quality, meibum expressibility, lid margin abnormality, ocular staining, non-invasive tear film break-up time, and meibography. We did not find significant differences in MG alterations in the upper lid between healthy and DED subjects. Patients with evaporative DED presented MG alterations in the lower lid more frequently than healthy subjects (54.8 vs. 30.3%; p = 0.03). The presence of shortened glands was the only MG alteration that was more prevalent in the lower lid in dry-eye patients than in healthy subjects (p < 0.05). Subjects with evaporative DED presented more alterations in the lower lid than healthy subjects.

Focused ultrasound stimulation on meibomian glands for the treatment of evaporative dry eye

Current treatments for meibomian gland dysfunction have several limitations, creating a necessity for other advanced treatment options. The purpose of this study is to determine the effectiveness of focused ultrasound stimulation for the treatment of dry eye disease caused by meibomian gland dysfunction. An in vivo study of nine Dutch Belted rabbits was conducted with focused ultrasound stimulation of the meibomian glands. A customized line-focused ultrasonic transducer was designed for treatment. Fluorescein imaging, Schirmer’s test, and Lipiview II ocular interferometer were used to quantify outcomes from three aspects: safety, tear production, and lipid layer thickness. Both tear secretion and lipid layer thickness improved following ultrasound treatment. Five to 10 min after the ultrasound treatment, the mean values of lipid layer thickness increased from 55.33 ± 11.15 nm to 95.67 ± 22.77 nm ( p < 0.05), while the mean values measured with the Schirmer’s test increased from 2.0 ± 2.3 to 7.2 ± 4.3 ( p < 0.05). Positive effects lasted more than three weeks. Adverse events such as redness, swelling, and mild burn, occurred in two rabbits in preliminary experiments when the eyelids sustained a temperature higher than 42°C. No serious adverse events were found. The results suggest that ultrasound stimulation of meibomian glands can improve both tear production and lipid secretion. Ultimately, ultrasound stimulation has the potential to be an option for the treatment of evaporative dry eye disease caused by meibomian gland dysfunction.

Dry eye, its clinical subtypes and associated factors in healthy pregnancy: A cross-sectional study

The study determined the frequency of dry eye, its clinical subtypes and risk factors among pregnant women. This study was a hospital-based cross-sectional study of pregnant women visiting the antenatal clinic of the University of Cape Coast hospital. Clinical dry eye tests were performed along with the administration of a symptom questionnaire. Frequencies, chi-square analysis and logistic regression analyses were conducted to determine the frequency of dry eye disease, its clinical subtypes and associated factors. The prevalence of dry eye disease among the cohort of pregnant women was 82/201 (40.8% 95% confidence interval 34.3%-47.3%). Among the 82 pregnant women with dry eye disease, the frequencies of the clinical subtypes of dry eye were: evaporative dry eye [15/82(18.3%; 95% CI, 12.2%–25.2%)], aqueous deficient dry eye [10/82(12.2.%; 95% CI, 7.3%–18.3)], mixed dry eye [6/82(7.3%; 95% CI, 3.7%–11.0%)], and unclassified dry eye [51/82(62.2%; 95% CI, 52.4%–72.0%)]. Binary logistic regression analysis showed that the following factors were not significantly associated with dry eye: age, BMI, lipid profile, prolactin level, testosterone level, ocular protection index and blink rate. Only gestational age was significantly associated with dry eye disease in pregnancy. In conclusion, the current study showed that dry eye disease occurs frequently in pregnant women ranging from the first to the third trimester and it is associated with increasing gestational age. The evaporative dry eye was more common compared to the aqueous deficient dry eye, but most dry eye could not be classified.

Clinical Study on Ocular Manifestations in Patients with Psoriasis, in Chennai, India

BACKGROUND We wanted to determine the prevalence of ocular manifestations assess the frequency and distribution of potential sight threatening complications in patients with psoriasis. METHODS This is a non interventional, observational hospital based study conducted at a tertiary health care centre which included 105 patients with psoriasis. A background history was taken regarding the duration of psoriasis and treatment taken. The prevalence of ocular manifestations were assessed by detailed ocular examination which involved the best corrected visual acuity using Snellen’s chart, examination of the anterior chamber using slit lamp, examination of the fundus, intraocular pressure measurement, dry eye evaluation including Schirmer’s test, tear film break up time test, and Rose Bengal stain test. RESULTS In total 105 patients with psoriasis were enrolled in this study. Among the 105 patients whose 210 eyes were examined, 77 % had psoriasis vulgaris, 14 % had scalp psoriasis, and 9 % had palmoplantar psoriasis. Among the 105 patients, 38 patients had symptomatic ocular manifestations. Out of the 38 % patients with symptomatic ocular manifestations, we found that 28 %, 25 %, 17 %, 2 % of the patients manifested with evaporative dry eye, blepharoconjunctivitis, redness and episcleritis respectively. CONCLUSIONS In our study, ocular manifestations were even seen among the asymptomatic patients. Hence a multi-disciplinary approach including effective screening and early detection of ocular manifestations followed by prompt treatment is essential to reduce the morbidity in patients with psoriasis. KEY WORDS Psoriasis, Dry Eye, Uveitis

Correlation of Chronic Smoking with Meibomian Gland Dysfunction – A Study at Wardha, Maharashtra, India

BACKGROUND Meibomian gland dysfunction (MGD) is one of the causes of evaporative dry eye disease. It is the terminal duct obstruction of the Meibomian gland and is associated with glandular secretion changes. These changes lead to decreased amount of lipids secretion which accounts for instability of tear film leading to evaporative dry eye disease. Chronic smoking also causes irritative, burning eyes along with unstable tear film. We wanted to study the corelation of chronic smoking with Meibomian gland dysfunction. METHODS This is a hospital based observational cross-sectional study that enrolled a total of 100 subjects having Meibomian gland disease (MGD), out of whom 61 were smokers and 39 were non-smokers. All enrolled subjects underwent tear film breakup time (TBUT), Schirmer I test (SIT) and slit-lamp microscope examination of lid margin abnormalities, Meibomian gland expression as well as meibum. RESULTS Our study found that the patients with Meibomian gland dysfunction with the history of chronic smoking had a remarkably decreased value of tear film break up time (TBUT), Schirmer’s 1 Test which explains the dry eye symptoms as compared to MGD patients without smoking. No significant differences were seen in lid margin irregularity and meibum secretion. Meibomitis is found in 29 smokers with MGD and 5 non-smokers with MGD which is not significant. CONCLUSIONS Chronic smoking is associated with MGD. KEY WORDS Cigarette Smoking, Meibomian Gland Dysfunction, Tear Film Tests

EVALUATION OF THE PREVALENCE AND RISK FACTORS OF DRY EYE IN YOUNG POPULATION

Purpose:To analyse prevalence and risk factor of dry eye among young population. Methods: It was a prospective, interventional study conducted at Anugrah Narayan Medical College, Gaya, Bihar, during year 2020 to 2021. The total 500 patients (1000 eyes) were screened. Out of which 30 patients (60 eyes) with bilateral presentation were included. Patients less than 18 years of age visiting the outpatient department of the Ophthalmology, ANMMCH. Results: The 60 eyes of 30 children were included in this study, out of which 10 (33.33%) were female and 20 (66.67%) were male. We have divided the children in four age group, in which 4 (13.33%) children were in 1-4 years' age group, 10 (16.66%) were in 5-8 years' age group ,15 (50.04%) children were in age group 9-12and 6 (20.00%) were in 13-16 years' age group. The prevalence of the dry eye was 6% (60 out of 1000 eyes) in our study. The prevalence of dry eyes was highest in age group of the 9-12 years (50.04%), while lowest in age group of 1-4. Conclusion: The evaporative dry eye due to MGD & CVS is common in pediatric age group, while the aqueous deciency dry eye is not so. The use of mobiles, tablets, computers leads to increase the rate of dry eye in children, which also affect the outdoor activity, study of child & child over all development.