scholarly journals INTENSE PULSED LIGHT (IPL) TREATMENT FOR DUPILUMAB INDUCED OCULAR SURFACE DISEASE (DIOSD)

2022 ◽  
Vol 5 (1) ◽  
pp. e1-e11
Author(s):  
Sathi Maiti ◽  
Laura M Periman ◽  
Natasha Balani
Keyword(s):  
Ocular Surface ◽  
Anterior Segment ◽  
Signs And Symptoms ◽  
Intense Pulsed Light ◽  
Ocular Surface Disease ◽  
Topical Steroids ◽  
Pulsed Light ◽  
Traditional Treatment ◽  
Adjunct Therapy ◽  
Effective Adjunct

PurposeTo report a case of dupilumab induced ocular surface disease (DIOSD) managed with intense pulsed light (IPL) as an effective adjunct therapy to topical steroids and topical immunomodulator lifitegrast.MethodsDiscussion of a patient’s case with accompanying anterior segment and meibography photos with diagnosed DIOSD for which adjunct therapy with IPL was an effective treatment after limited relief from and difficulty with adherence to traditional treatment with topical steroids and lifitegrast ophthalmic solutions. ConclusionThis case demonstrates the complexity of management required to treat patients with DIOSD and its chronic nature. IPL as a nonpharmaceutical adjunct therapy to topical steroids and immunomodulators in the treatment of DIOSD showed improved signs and symptoms of DIOSD.

scholarly journals Effects of intense pulsed light treatment on tear cytokines and clinical outcomes in meibomian gland dysfunction

PLoS ONE ◽  
2021 ◽  
Vol 16 (8) ◽  
pp. e0256533
Author(s):  
Qian Li ◽  
Junxiu Liu ◽  
Cheng Liu ◽  
Junfeng Piao ◽  
Wei Yang ◽  
...  
Keyword(s):  
Inflammatory Cytokines ◽  
Ocular Surface ◽  
Signs And Symptoms ◽  
Meibomian Gland ◽  
Intense Pulsed Light ◽  
Tissue Inhibitor Of Metalloproteinase ◽  
Meibomian Gland Dysfunction ◽  
Pulsed Light ◽  
Tnf Α ◽  
Ifn Γ

Meibomian gland dysfunction (MGD) has become a prevalent ocular surface disorder. Its pathogenesis is regarded as a self-perpetuating inflammatory vicious circle. Intense Pulsed Light (IPL) treatment was recently applied to improve the meibomian gland function and reduce symptoms of MGD. However, studies investigating the change of specific inflammatory cytokines during IPL treatment remained sparse. To further figure out how IPL treatment modulates the inflammatory cytokines in tears of MGD, we therefore performed a cross-sectional study and enrolled 32 patients from March 2019 to December 2020. The patients received 3 sessions of IPL treatment (10 to 16 J/cm2) at 4-week interval. The signs and symptoms of MGD were evaluated by ocular surface disease index (OSDI), tear film breakup time (TBUT), and meibomian gland yield secretion score (MGYSS). The clinical evaluators and tear samples were analyzed at baseline and at each IPL treatment session. Concentrations of (chemokine ligand) CXCL1, (C-C motif chemokine) CCL11, (tumor necrosis factor) TNF-α, (interferon) IFN-γ, (interleukin) IL-2, IL-6 and (tissue inhibitor of metalloproteinase) TIMP-1were measured by Quantibody Human Dry Eye Disease Array1. OSDI significantly decreased after IPL treatment compared with baseline. TBUT and MGYSS increased consecutively during treatment. CXCL1, CCL11, TNF-α, IFN-γ, IL-2, IL-6 presented significantly decrease and TIMP-1 showed significantly increase from the pretreatment baseline. The changed concentrations of TNF-α, IFN-γ, IL-2, TIMP-1 correlated with TBUT, the changed values of CXCL1, TNF-α, IFN-γ, CCL11, IL-2, IL-6, TIMP-1 correlated with MGYSS, and the changed concentrations of CXCL1, IFN-γ, CCL11, IL-2, IL-6 correlated with TIMP-1. The data supported IPL treatment could significantly relieve both signs and symptoms of MGD. The therapeutic effect of IPL treatment may originate from regulation of inflammatory cytokines including CXCL1, TNF-α, IFN-γ, CCL11, IL-2, IL-6, and TIMP-1.

scholarly journals Ocular Myasthenia Gravis with Severe Blepharitis and Ocular Surface Disease: A Case Report

2020 ◽  
Vol 11 (2) ◽  
pp. 322-329
Author(s):  
Roee Arnon ◽  
Tal Yahalomi ◽  
Irit Rozen-Knisbacher ◽  
Joseph Pikkel ◽  
Dina Mostovoy
Keyword(s):  
Myasthenia Gravis ◽  
Ocular Surface ◽  
Immunosuppressive Treatment ◽  
Intravenous Immunoglobulins ◽  
Ocular Surface Disease ◽  
Topical Steroids ◽  
Conjunctival Hyperemia ◽  
Tea Tree ◽  
Ocular Myasthenia ◽  
Ocular Myasthenia Gravis

Ocular myasthenia gravis (OMG) is an autoimmune disease of the neuromuscular junction and commonly associated with other immune diseases. We describe a 16-year-old female who presented to our clinic with 1-month complaints of diplopia and strabismus, visual acuity deterioration, and ocular irritation. Her examination showed crossed diplopia and alternating exotropia of 25 prism diopters, severe blepharitis, conjunctival hyperemia, corneal pannus, epithelial irregularities, and subepithelial opacities. Workup included pediatric neurologic examination, laboratory tests, imaging, and electrophysiological tests. Diagnoses of OMG and blepharitis with ocular surface disease were made. Topical treatment included eyelid hygiene, tea tree oil scrubbing, topical steroids, and tacrolimus ointment. Systemic treatment included corticosteroids, pyridostigmine, azathioprine, intravenous immunoglobulins, amitriptyline, and doxycycline. Both diseases were refractory to intensive immunosuppressive treatment and had simultaneous relapses and an intertwined course. Our hypothesis is that a shared immune mechanism may be the cause of both OMG and ocular surface disease in our patient.

scholarly journals Sutureless Amniotic Membranes (ProKera) for Filamentary Keratitis: A Case Series

2019 ◽  
Vol 2 (1) ◽  
pp. e10-e16
Author(s):  
Jennifer S Harthan ◽  
Lindsay A Sicks
Keyword(s):  
Amniotic Membrane ◽  
Ocular Surface ◽  
Management Strategies ◽  
Anterior Segment ◽  
Case Series ◽  
Signs And Symptoms ◽  
Traditional Therapies ◽  
Amniotic Membranes ◽  
Ocular Signs

Purpose To report a case series of refractory filamentary keratitis successfully managed with sutureless amniotic membranes resistant to other management strategies.   Methods Three cases are discussed with anterior segment photography who were diagnosed with filamentary keratitis and successfully managed with sutureless amniotic membranes, after experiencing limited relief with standard treatments.   Conclusions This case series demonstrates the complex management of patients with filamentary keratitis who had failed with traditional therapies and were successfully managed with sutureless amniotic membranes. All three patients demonstrated improvement in both ocular signs and symptoms following amniotic membrane application to the ocular surface. 

scholarly journals Dupilumab-associated ocular surface disease: incidence, management and long-term sequelae

2020 ◽  
Author(s):  
Magdalena Z Popiela ◽  
Ramez Barbara ◽  
Andrew M J Turnbull ◽  
Emma Corden ◽  
Beatrice Suarez Matinez-Falero ◽  
...  
Keyword(s):  
Ocular Surface ◽  
Disease Incidence ◽  
Ocular Inflammation ◽  
University Hospital ◽  
Ocular Surface Disease ◽  
Prior History ◽  
Topical Steroids ◽  
Long Term Effects ◽  
Skin Changes

AbstractObjectiveTo determine the incidence of ocular surface disease in patients with atopic dermatitis (AD) treated with dupilumab at a tertiary, university hospital. To describe the features of dupilumab-associated ocular surface disease, establish the need for treatment and report any long-term effects on the ocular surface.MethodsA retrospective analysis of consecutive patients treated with dupilumab for AD between January 2017 and August 2019 was undertaken. Data was collected on demographics, incidence and type of ocular disease features, natural history and treatment.Results50% (14/28) patients developed ocular symptoms with a mean time of onset of 6.75 (+/- 6.1) weeks from starting dupilumab. 69% of these (9/13) were diagnosed with conjunctivitis - associated with cicatrisation in two patients and periorbital skin changes in four. Of these nine, four had prior history of atopic keratoconjunctivitis. All were treated with topical steroids; two required additional ciclosporin drops. 67% (6/9) patients developed chronic ocular inflammation requiring maintenance drops at a mean of 16 (+/- 6.9) months of follow up. All patients had improvement in their AD severity; only one patient discontinued dupilumab due to ocular side effects.ConclusionThe rate of dupilumab-associated ocular surface disease was 32%. Periorbital skin changes and conjunctival cicatrisation were noted in association with conjunctivitis. Ocular surface disease improved on topical steroids and ciclosporin but 67% of patients needed on-going treatment. Patients should be referred to an ophthalmologist prior to starting dupilumab as a large proportion develops chronic ocular inflammation.

scholarly journals Evaluation of signs and symptoms of ocular surface disease after intravitreal injection

2019 ◽  
Vol 97 (8) ◽  
Author(s):  
Thomas H. Dohlman ◽  
Buntitar Lertsuwanroj ◽  
Donald J. D'Amico ◽  
Jessica B. Ciralsky ◽  
Szilárd Kiss
Keyword(s):  
Intravitreal Injection ◽  
Ocular Surface ◽  
Signs And Symptoms ◽  
Ocular Surface Disease

scholarly journals Intense Pulsed Light Therapy with Optimal Pulse Technology as an Adjunct Therapy for Moderate to Severe Blepharitis-Associated Keratoconjunctivitis

2019 ◽  
Vol 2019 ◽  
pp. 1-10 ◽  
Author(s):  
Fang Ruan ◽  
Yunxiao Zang ◽  
Ruti Sella ◽  
Hongshuang Lu ◽  
Shang Li ◽  
...  
Keyword(s):  
Treatment Group ◽  
Outcome Measures ◽  
Meibomian Gland ◽  
Intense Pulsed Light ◽  
Pulsed Light ◽  
Ocular Surface Disease Index ◽  
Open Label ◽  
Eyelid Margin ◽  
Adjunct Therapy ◽  
Pulse Technology

Purpose. To evaluate the intense pulsed light (IPL) therapy with optimal pulse technology (OPT, M22™, Lumenis, USA) as an adjunct therapy for the prevention of recurrences in moderate to severe blepharokeratoconjunctivitis (BKC). Methods. This open-label nonrandomized clinical trial evaluated 33 patients diagnosed with BKC. Twenty-one patients received four bilateral OPT therapy sessions with Meibomian gland expression (MGX) (treatment group), and 11 patients received MGX alone (controls). This trial was initiated after a four-week pharmacotherapy for BKC in both groups and was scheduled at four-week intervals. Efficacy outcome measures included meibum quality, Meibomian gland (MG) secretion function, eyelid margin signs, corneal fluorescein staining (CFS) score, noninvasive keratography breakup time (NIKBUT), ocular surface disease index (OSDI) score, Schirmer I test (SIT), classification of tear film lipid layer (TFLL), and Meibomian gland dropout (MGDR). Safety outcome measures included visual acuity, intraocular pressure, eye structure damage, and facial skin appearance at each visit. Results. Quality of meibum, MG expressibility, eyelid margin signs, and OSDI score showed a statistically significant greater improvement in the treatment group after one to three treatment sessions, compared to controls (p<0.05). While these improved in both groups in comparison to baseline, the NIKBUT and upper and lower eyelid MGDRs significantly improved only in the treatment group (p<0.05). No adverse events occurred in both groups. No BKC recurrences were noted in the treatment group. Conclusions. IPL is a safe and effective adjuvant treatment for BKC and possibly more effective in reducing eyelid margin inflammation and prevents recurrences than MGX alone. This trial is registered with ChiCTR-ONN-17013864.

Short-term changes in ocular surface signs and symptoms after phacoemulsification

2020 ◽  
Vol 30 (6) ◽  
pp. 1301-1307 ◽  
Author(s):  
María García Zamora ◽  
Eugenia Francés Caballero ◽  
Miguel J Maldonado
Keyword(s):  
Dry Eye ◽  
Ocular Surface ◽  
Signs And Symptoms ◽  
Disease Index ◽  
Ocular Surface Disease ◽  
Schirmer Test ◽  
Short Term ◽  
Ocular Surface Disease Index ◽  
Fluorescein Staining ◽  
Superficial Punctate Keratopathy

Purpose: The aim of this study is to evaluate the incidence, natural course, and distribution pattern of superficial punctate keratopathy and describe the changes in signs and symptoms of dry eye after cataract surgery. Setting: The setting of this study is University Hospital Rio Hortega and Instituto Universitario de Oftalmobiología Aplicada, Valladolid, Spain. Design: This is a prospective interventional study. Materials and Methods: In total, 55 eyes of 55 different patients with no history of dry eye underwent standard phacoemulsification through a 2.75-mm-wide corneal incision. We measured tear break-up time, Schirmer test I, and tear meniscus height, and recorded the Ocular Surface Disease Index score, fluorescein staining patterns, and photo documentation of the ocular surface before and 1 day, 1 week, and 1 month postoperatively. Patients were divided into two groups (with and without superficial punctate keratopathy development, 1 day postoperatively). Results: Patients (mean age: 75.75 ± 7.27 years) showed an incidence of 76.3% of superficial punctate keratopathy at 24 h. Location predominated in the center of the cornea until a week (32.7%) and then began to prevail in the inferior quadrant (21.8%) at 1 month. All dry eye tests were significantly worse after surgery. Ocular Surface Disease Index increased from 10.98 ± 5.05 to 15.87 ± 6.57 at 24 h ( p < .001), to 12.80 ± 5.77 at 7 days ( p < .001), and to 11.09 ± 4.63 at 1 month ( p = .90). Fluorescein staining patterns got worse 24 h postoperatively with a score of 2.12 using the National Eye Institute/Industry–recommended guidelines staining grid. Average break-up time values were significantly lower at 1 day (6.61 ± 2.68),1 week (6.98 ± 2.79), and 1 month (7.05 ± 2.86) postoperatively than preoperatively (8.78 ± 2.97) ( p < .001). The mean postoperative first month Schirmer test I value (8.32 ± 3.58) was significantly lower than preoperative value (9.05 ± 3.63) ( p < .001). Conclusion: Phacoemulsification tends to induce short-term transitory ocular surface impairment manifesting as both signs and symptoms. Superficial punctate keratopathy distribution has a characteristic pattern evolution according to the postoperative time. Those patients with altered preoperative values are more likely to develop ocular surface disease and for longer time.

Prevalence of signs and symptoms of ocular surface disease in individuals treated and not treated with glaucoma medication

2012 ◽  
Vol 40 (7) ◽  
pp. 675-681 ◽  
Author(s):  
Sudipta Ghosh ◽  
Fleur O'Hare ◽  
Ecosse Lamoureux ◽  
Rasik B Vajpayee ◽  
Jonathan G Crowston
Keyword(s):  
Ocular Surface ◽  
Signs And Symptoms ◽  
Ocular Surface Disease ◽  
Glaucoma Medication

scholarly journals Ocular Surface Disease Signs and Symptoms of Glaucoma Patients and Their Relation to Glaucoma Medication in Finland

2021 ◽  
Author(s):  
Minna Parkkari ◽  
Petri Purola ◽  
Hannu Uusitalo
Keyword(s):  
Dry Eye ◽  
Ocular Surface ◽  
Open Angle Glaucoma ◽  
Signs And Symptoms ◽  
Ocular Surface Disease ◽  
Pigmentary Glaucoma ◽  
Eye Drops ◽  
Glaucoma Medication ◽  
Cross Sectional ◽  
Active Compounds

Abstract Purpose: To evaluate the prevalence of ocular surface disease (OSD) signs and symptoms of glaucoma patients in relation to topical glaucoma treatment and to compare them to non-glaucomatous population. Methods: A multicenter, cross-sectional study consisting of private ophthalmology clinic visits in southern Finland. Glaucoma patients had a diagnosis of primary open-angle glaucoma, pseudoexfoliation glaucoma, pigmentary glaucoma or treated ocular hypertension. Control patients had no prior or current use of glaucoma medication. Recorded parameters included OSD signs and symptoms, used glaucoma medications during the past 6 months, and the product name and type of used antiglaucoma drugs.Results: Glaucoma patients (n = 564) showed higher severity of OSD sign parameters excluding Schirmer’s test, as well as increased dry eye sensation compared to controls (n = 51). Beta-blockers and preservative-free prostaglandins had the smallest effect on all parameters. The increasing number of active compounds and administered eye drops per day showed an association with increasing severity of OSD signs and symptoms.Conclusion: Glaucoma patients show higher prevalence of OSD signs and dry eye sensation compared to non-glaucomatous population. The use of preserved glaucoma medication, as well as high number of active compounds and eye drops increase the severity of these parameters. There are significant differences between the types of glaucoma medication used, and therefore the selection of them is important especially in patients suffering from OSD.

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