Corneal Dystrophy Adds to the Frustration of a Dry Eye Patient

PURPOSEThis case report highlights how epithelial basement membrane dystrophy (EBMD), coupled with dry eye, can contribute to symptoms of unstable vi-sion and discomfort. This report also reviews corneal dystrophies and offers eye care practitioners (ECPs) clinical pearls for identifying key features. CASE REPORTA 62-year-old Caucasian female presented for a dry eye evaluation due to fluctuating vision and longstanding ocular discomfort, despite ocular lubri-cation. Anterior segment examination revealed Meibomian gland dysfunc-tion (MGD), upper lid margin staining (ULMS) and anterior blepharitis. The patient was unaware of a pre-existing EBMD and this lack of knowl-edge contributed to her frustration concerning her unstable vision, which she had solely attributed to her glasses. Management included warm com-presses for MGD and targeted preservative-free artificial tears for ULMS and EBMD. Photographs were essential for educating the patient with respect to the irregularities of the ocular surface and its effect on vision. This provided a deeper understanding of the multifactorial nature of her symptoms.CONCLUSIONUnstable and/or poor vision is among the main reasons why patients con-sult ECPs and it can be difficult to identify contributory factors. This report highlights that additional chair time may be warranted to educate patients on the multifactorial nature of dry eye and the complexities of corneal dys-trophy.

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Deciphering the Action of Perfluorohexyloctane Eye Drops to Reduce Ocular Discomfort and Pain

Frontiers in Medicine ◽

10.3389/fmed.2021.709712 ◽

2021 ◽

Vol 8 ◽

Author(s):

Miguel Delicado-Miralles ◽

Enrique Velasco ◽

Ariadna Díaz-Tahoces ◽

Juana Gallar ◽

M. Carmen Acosta ◽

...

Keyword(s):

Surface Temperature ◽

Dry Eye ◽

Meibomian Gland ◽

Dry Eye Disease ◽

Eye Disease ◽

Eye Drops ◽

Phenol Red ◽

Corneal Surface ◽

Healthy Humans ◽

Ocular Discomfort

Perfluorohexyloctane (F6H8) eyedrops have been recently introduced in Europe as a product to treat dry eye disease, based on its ability to reduce tear film instability in Meibomian gland dysfunction and evaporative dry eye disease, although its mechanism of action is still unknown. In the present pilot study, we evaluated the effects of the ocular instillation of a single drop of commercial F6H8 eyedrops in 20 healthy humans (9 women/11 men), measuring: (a) Corneal surface temperature (CST) from infrared video images; (b) tear volume using phenol red threads; (c) blinking frequency; and (d) ocular surface sensations (cold, dryness, pricking, foreign body, burning, itching, gritty, eye fatigue, watering eyes, and light-evoked discomfort sensations; scored using 10 cm Visual Analog Scales), before and 5–60 min after F6H8 or saline treatment. CST decreased and tearing and blinking frequency increased significantly after F6H8 but not after saline solution. When applied unilaterally, CST decreased only in the F6H8-treated eye. No sensations were evoked after F6H8 or saline. The corneal surface temperature reduction produced by topical F6H8 does not evoke conscious ocular sensations but is sufficient to increase the activity of corneal cold thermoreceptors, leading to an increased reflex lacrimation and blinking that may relieve dry eye condition thus reducing ocular discomfort and pain.

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Dual corneal involvement by endothelial and epithelial corneal dystrophies in Steinert’s disease: A case of triple dystrophy

European Journal of Ophthalmology ◽

10.1177/1120672119872374 ◽

2019 ◽

pp. 112067211987237

Author(s):

Amparo Gargallo-Benedicto ◽

Vicente Tomás Pérez-Torregrosa ◽

Rodrigo Clemente-Tomás ◽

Antonio Miguel Duch-Samper

Keyword(s):

Basement Membrane ◽

Myotonic Dystrophy ◽

Anterior Segment ◽

Corneal Dystrophy ◽

Specular Microscopy ◽

Myotonic Dystrophy Type 1 ◽

Myotonic Dystrophy Type ◽

Epithelial Basement Membrane ◽

Epithelial Basement

Introduction: A case of dual corneal involvement due to Fuchs endothelial corneal dystrophy and epithelial basement membrane corneal dystrophy in a patient with Steinert’s myotonic dystrophy type 1 is described, and a literature review on the triple association is made. Case description: A 52-year-old male diagnosed with myotonic dystrophy type 1 presented due to progressive bilateral vision loss during the past year. A full ophthalmological evaluation was made, with biomicroscopy, funduscopy, anterior segment optical coherence tomography, and endothelial cell count using specular microscopy. Exploration revealed bilateral superior palpebral ptosis, visual acuity 0.5 in the right eye and 0.3 in the left eye, and with an intraocular pressure of 11 and 10 mmHg, respectively. Biomicroscopy revealed map-dot-fingerprint lesions characteristic of epithelial basement membrane corneal dystrophy in both eyes, as well as abundant endothelial guttae due to Fuchs endothelial corneal dystrophy (stage II) and bilateral nuclear and posterior subcapsular cataracts. Specular microscopy in turn showed cell loss and a destructured endothelial map. Finally, anterior segment optical coherence tomography revealed the accumulation of epithelial basement membrane and hyperreflective endothelial excrescences corresponding to guttae. Conclusion: The association of Fuchs endothelial corneal dystrophy with myotonic dystrophy has been described and explained by a common genetic basis in the expansion of a CTG trinucleotide repeat, though this is the first reported case of the triple association of Fuchs endothelial corneal dystrophy, epithelial basement membrane corneal dystrophy, and myotonic dystrophy type 1. New mutations or still unknown genetic alterations could possibly explain the triple association reported in our case.

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Corneal Dystrophies

10.4018/978-1-7998-6937-5.ch008 ◽

2022 ◽

pp. 322-340

Keyword(s):

Late Onset ◽

Corneal Thickness ◽

Corneal Dystrophy ◽

International Committee ◽

Level Of Evidence ◽

Corneal Dystrophies ◽

Tgfbi Gene ◽

Epithelial Basement Membrane ◽

Posterior Polymorphous Corneal Dystrophy

Corneal dystrophies have classically referred to inherited, bilateral disease without systemic findings, although there are several exceptions to this definition. Hereditary pattern is not present in most patients with epithelial basement membrane dystrophy (EBMD). Unilateral corneal changes may be found in some patients with posterior polymorphous corneal dystrophy (PPCD). TGFBI gene mutation (p.His572del) is associated with a unilateral, late-onset variant of lattice corneal dystrophy. Among all dystrophies, macular corneal dystrophy and posterior amorphous corneal dystrophy are associated with decreased corneal thickness. The International Committee for Classification of Corneal Dystrophies (IC3D) was created in 2005 to revise the corneal dystrophy nomenclature and create a current and accurate corneal dystrophy classification system. Evidential categories were created in the IC3D classification for reflecting the natural evolution of a corneal dystrophy and indicate the level of evidence supporting the existence of a given dystrophy.

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Anterior Corneal Dystrophy of American Dutch Belted Rabbits: Biomicroscopic and Histopathologic Findings

Veterinary Pathology ◽

10.1177/030098588702400106 ◽

1987 ◽

Vol 24 (1) ◽

pp. 28-33 ◽

Cited By ~ 28

Author(s):

C. P. Moore ◽

R. Dubielzig ◽

S. M. Glaza

Keyword(s):

Basement Membrane ◽

Corneal Stroma ◽

Corneal Dystrophy ◽

Surface Epithelium ◽

Slit Lamp ◽

Corneal Dystrophies ◽

Epithelial Basement Membrane ◽

Corneal Opacities ◽

Histopathologic Findings ◽

Epithelial Basement

Spontaneously occurring anterior corneal opacities were present in related, juvenile American Dutch belted rabbits. Slit lamp biomicroscopy revealed focal opacities of epithelium, basement membrane, and subepithelial corneal stroma. Lesions were characterized histologically by thin and disorganized surface epithelium, thickened and intensely staining epithelial basement membrane, fimbriated and irregular basement membrane-stromal juncture, and disorganized subepithelial stroma. Biomicroscopic and histopathologic features of anterior corneal dystrophy of American Dutch belted rabbits appear similar to those of human anterior corneal dystrophies.

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Meesmann Corneal Dystrophy Associated With Epithelial Basement Membrane and Posterior Polymorphous Corneal Dystrophies

Cornea ◽

10.1097/ico.0b013e31815c18fa ◽

2008 ◽

Vol 27 (3) ◽

pp. 374-377 ◽

Cited By ~ 5

Author(s):

Federico A Cremona ◽

Faris R Ghosheh ◽

Peter R Laibson ◽

Christopher J Rapuano ◽

Elisabeth J Cohen

Keyword(s):

Basement Membrane ◽

Corneal Dystrophy ◽

Corneal Dystrophies ◽

Epithelial Basement Membrane ◽

Epithelial Basement

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Tear Film Instability and Meibomian Gland Dysfunction Correlate with the Pterygium Size and Thickness Pre- and Postexcision in Patients with Pterygium

Journal of Ophthalmology ◽

10.1155/2019/5935239 ◽

2019 ◽

Vol 2019 ◽

pp. 1-9 ◽

Cited By ~ 1

Author(s):

Ning Li ◽

Tao Wang ◽

Ruixue Wang ◽

Xuanchu Duan

Keyword(s):

Dry Eye ◽

Anterior Segment ◽

Tear Film ◽

Multivariate Regression Analysis ◽

Meibomian Gland ◽

Meibomian Gland Dysfunction ◽

Clinical Implementation ◽

Lipid Layer ◽

Ocular Surface Disease Index ◽

Pterygium Excision

Purpose. This study aimed to evaluate the effects of excision on dry eye and meibomian gland dysfunction (MGD) in individuals with pterygium, before and after surgery. It also aimed to investigate how these effects correlate with the size and thickness of the pterygium. Subjects and Methods. 63 eyes from 63 patients with primary nasal pterygium and 45 eyes from 45 healthy volunteers without ocular pathologies were enrolled in this study. 63 eyes from 63 patients underwent pterygium surgery. ImageJ software was used to calculate the pterygium size based on images of the anterior segments. Anterior segment spectral domain optical coherence tomography (SD-OCT) was performed preoperatively to measure the thickness of the pterygium 1 mm anterior to the nasal scleral spur. The ocular surface disease index (OSDI), Schirmer I Test (SIT), and MGD grade were used to evaluate the eyes, and the eyes were imaged using the noninvasive keratograph average tear film breakup time (NIBUTav), tear meniscus height (TMH), meiboscore, and lipid layer grading tools of the Oculus® Keratograph 5M, preoperatively and at 1, 3, and 6 months postoperatively. Results. The OSDI, NIBUTav, lid margin abnormality, meiboscore, and lipid layer grading values differed significantly in the pterygium patients in comparison with the controls (p<0.01 for all scores). However, the SIT and TMH values were unchanged between the two groups (all p>0.05). Multivariate regression analysis demonstrated that the NIBUTav, meiboscore, and lipid layer grading score was significantly correlated with the pterygium parameters, such as size and thickness. The postoperative OSDI, NIBUTav, lid margin abnormality, and lipid layer grading values improved significantly (p<0.05 for all scores). The SIT, TMH, and meiboscore results did not differ significantly between the pre- and postoperative values (p>0.05). Among the conventional and automated indexes, at 1 month postoperatively, SIT and TMH were significantly correlated with the pterygium parameters, but no correlation was observed at 3 and 6 months postoperatively. The OSDI, NIBUTav, meiboscore, and lipid layer grading values at 1, 3, and 6 months postoperatively were significantly correlated with the pterygium parameters. Conclusion. Abnormal tear film and meibomian gland (MG) function improved following pterygium excision in the patients with primary pterygium, which was associated with uncomfortable ocular symptoms. Pterygium parameters, such as size and thickness, correlated with the dry eye and MGD indexes in patients pre- and postoperatively, potentially offering a novel strategy for clinical implementation of pterygium excision surgery.

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Effect of 0.15% Preservative-free Sodium Hyaluronate on Dry Eye Disease after Femtosecond Laser-assisted Cataract Surgery

Journal of the Korean Ophthalmological Society ◽

10.3341/jkos.2021.62.7.922 ◽

2021 ◽

Vol 62 (7) ◽

pp. 922-930

Author(s):

Tae Hwan Kim ◽

Byunghoon Chung ◽

Kang Yoon Kim ◽

Ikhyun Jun ◽

Kyoung Yul Seo ◽

...

Keyword(s):

Treatment Group ◽

Dry Eye ◽

Sodium Hyaluronate ◽

Tear Film ◽

Meibomian Gland ◽

Dry Eye Disease ◽

Eye Disease ◽

Control Group ◽

Lipid Layer ◽

Preservative Free

Purpose: The efficacy of using preservative-free 0.15% sodium hyaluronate eyedrops for dry eye disease after femtosecond laser- assisted cataract surgery (FLACS) was evaluated. Methods: This prospective randomized study was conducted on patients with dry eye who were scheduled for FLACS among those with Tear Film & Ocular Surface Society Dry Eye Workshop II Dry Eye Levels 1 and 2. In total, 37 eyes scheduled for FLACS were randomized to the treatment group (n = 19) or control group (n = 18). Corneal and conjunctival fluorescein staining (CFS), tear breakup time (TBUT), Schirmer I test (SIT) value, ocular surface disease index (OSDI), meibomian gland evaluation result, and lipid layer thickness were evaluated for all patients, preoperatively and at 1 and 3 months postoperatively. Results: In the treatment group, the OSDI and CFS scores were significantly lower at 3 months postoperatively than at baseline, but the TBUT and SIT values were significantly increased. In the control group, TBUT was significantly shorter at 3 months postoperatively than at baseline, SIT values were significantly decreased at 1 and 3 months postoperatively compared with the baseline, and meibum quality was significantly aggravated at 1 month postoperatively compared with the baseline. In the treatment group, OSDI improved significantly from baseline at 1 and 3 months. TBUT increased significantly in the treatment group at postoperative 3 months. Meibomian gland quality showed clinically better results in the treatment group than in the control group at postoperative 3 months. There were no significant differences in corneal and CFS, lipid layer thickness, and other dry eye disease parameters between the treatment and control groups. Conclusions: Preservative-free 0.15% sodium hyaluronate eyedrops were effective for improving dry eye symptoms and tear film stability after FLACS.

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Can We Optimise the Medical Therapy of Glaucoma?

European Ophthalmic Review ◽

10.17925/eor.2012.06.05.275 ◽

2012 ◽

Vol 06 (05) ◽

pp. 275

Author(s):

James Gilbart ◽

Christophe Baudouin ◽

Carl Erb ◽

Lutz Pillunat ◽

◽

...

Keyword(s):

Dry Eye ◽

Benzalkonium Chloride ◽

Adverse Reactions ◽

Meibomian Gland ◽

Diurnal Variations ◽

Dry Eye Syndrome ◽

Eye Drops ◽

Antiglaucoma Medication ◽

Ocular Symptoms ◽

Preservative Free

The use of glaucoma medications containing the preservative benzalkonium chloride (BAK) is associated with a number of ocular symptoms including ocular surface disease and dry eye syndrome. These are debilitating conditions and current strategies of therapeutic escalation compound the problem. The effects are greater in sensitive patients and rises as the number of eye drops used increases. Preservative-free antiglaucoma medications are available and should be considered in patients with primary dry eye syndrome, ocular allergy, meibomian gland dysfunction, contact lens wearing, corneal and conjunctival adverse reactions to antiglaucoma medication and pre-operative to trabeculectomy. The importance of elevated diurnal variations in intraocular pressure (IOP) in glaucoma patients was also considered.

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