CORRELATION BETWEEN UREA LEVELS IN LACRIMAL FLUID AND PATHO-PHYSIOLOGY OF DRY EYE SYNDROMES

Introduction : In the ocular surface there is a well- coordinated system of enzymes that can produce urea independent of external urea supply. Urea locally formed from ocular tissues is important for the composition of the tear fluid. In eyes with dry syndromes this production is affected. Estimation of urea levels in the lacrimal fluid may prompt a newer treatment for dry eyes utilising urea. This study was done to evaluate the correlation between serum urea levels and pathophysiology of dry eye syndromes. Materials and methods: A prospective, observational, single-centre study. 50 patients of dry eye disease were included in the subjects and 50 controls were included in the study based on schirmer’s test. Tear film urea was estimated wih semi autoanalyser erba chem 5. When sample volume was not sufficient it was diluted with sterile water and urea was estimated after calculating for dilution factor. Blood urea was estimated with Erba Chem EM 360 working on similar principle Results: In the test group, the urea level in tear film ranged from 14.01 mg % to 39 mg % with a mean of 26.78 +/- 5.70 mg %. In the controls the levels of urea in the tear film ranged from 21.06 mg% to 56.00 mg% with a mean of 41.72±6.86 mg%. Conclusions: Levels of urea in tear film in normal individuals without dry eyes is similar to urea levels in the blood. Tear film urea levels were significantly lower in patients with dry eye diagnosed with Schirmer’s Test. Decreased tear film urea level in dry eyes is unrelated to blood urea levels and may play a role in the pathophysiology of dry eyes. This needs further investigation.

Dry Eye Syndrome in Intensive Care Units: a concept analysis

ABSTRACT Purpose: To analyse the concept of Dry Eye Syndrome in patients admitted to Intensive Care Units (ICU). Method: This is a concept analysis, according to Walker’s and Avant’s method, conducted using an integrative review, through search in the database. Science Direct, Scopus, Cinahl, Pubmed, Lilacs, Cochrane and Web of Science. The following keywords were used: “Keratoconjuntivite Sicca”, “Risk Factors”, “Dry eye Syndromes” and “Intensive Care Units”. After selection, 85 articles have been kept. Results: Antecedents found: age, lagophthalmos, environmental factors, use of medications, systemic diseases, mechanical ventilation and eye surgeries. Attributes: Tear Break-up Time < 10 s, Schirmer’s test I < 10 mm, Schirmer’s test II < 5 mm and signs and symptoms. Consequents: eye damage and discomfort; unstable vision. The Model Case and the Contrary Case were used to illustrate it. Conclusion: The research provided clarification of the concept and consequent understanding of the Dry Eye Syndrome, which is preventable especially in ICU.

EFETIVIDADE DO FILME DE POLIETILENO NA PREVENÇÃO DE OLHO SECO EM PACIENTES CRÍTICOS: REVISÃO SISTEMÁTICA

Objetivo: identificar o efeito do filme de polietileno na prevenção de olho seco em pacientes críticos internados em unidade de terapia intensiva para adultos. Metodologia: estudo de revisão sistemática, guiada pelas recomendações do PRISMA. Realizou-se busca em sete bases de dados por meio de estratégias que envolveram o cruzamento dos descritores: Dry Eye Syndromes, Keratoconjunctivitis Sicca, Corneal Diseases, Risk Factors, Intensive Care Units, Hospital e Nursing. Resultados: foram identificados 784 estudos primários, avaliados 35 e selecionados quatro, nos quais houve referência à utilização do filme de polietileno para a prevenção de olho seco. Observou-se discreta superioridade na efetividade do filme de polietileno em relação às demais intervenções. Conclusão: as evidências não foram suficientes para afirmar se a eficácia do filme de polietileno é superior às outras intervenções. Sugere-se realização de ensaio clínico randomizado para verificar a eficácia de diferentes intervenções de enfermagem na prevenção de olho seco em pacientes críticos.Descritores: Síndromes do Olho Seco, Unidades de Terapia Intensiva, Enfermagem.POLYETHYLENE FILM EFFECTIVENESS IN DRY EYE IN CRITICAL PATIENTS PREVENTION: SYSTEMATIC REVIEWObjective: To identify the effect of polyethylene film on the prevention of dry eye in critically ill patients admitted to an adult intensive care unit. Methodology: A systematic review study, guided by PRISMA recommendations. Seven databases were searched through strategies that involved the cross-referencing of Dry Eye Syndromes, Keratoconjunctivitis Sicca, Corneal Diseases, Risk Factors, Intensive Care Units, Hospital and Nursing. Results: A total of 784 primary studies were identified, 35 were evaluated and four were selected, with reference to the use of polyethylene film for the prevention of dry eye. There was a slight superiority in the effectiveness of the polyethylene film in relation to the other interventions. Conclusion: The evidence was not sufficient to establish whether the efficacy of the polyethylene film is superior to that of other interventions. We suggest performing a randomized clinical trial to verify the efficiency of different nursing interventions in the prevention of dry eye in critically ill patients.Descriptors: Dry Eye Syndromes, Intensive Care Units, Nursing.EFICACIA DE LA PELÍCULA DE POLIETILENO EN OJO SECO EN CRÍTICO PACIENTES PREVENCIÓN: REVISIÓN SISTEMÁTICAObjetivo: Identificar el efecto de película de polietileno para evitar que el ojo seco en pacientes en estado crítico en la unidad de cuidados intensivos para adultos. Metodologia: estudio de revisión sistemática, guiándose por las recomendaciones PRISMA. Se llevó a cabo la búsqueda en siete bases de datos a través de estrategias que implican el cruce de descriptores: Dry Eye síndromes, queratoconjuntivitis seca, enfermedades de la córnea, factores de riesgo, unidades de cuidados intensivos, del hospital y de enfermería. Resultados: Se encontraron 784 estudios primarios identificados, evaluados y seleccionados de cuatro 35 en la que se hizo referencia a la utilización de una película de polietileno para la prevención del ojo seco. Hubo una ligera superioridad en la eficacia de la película de polietileno en relación con otras intervenciones. Conclusión: La evidencia no es suficiente para afirmar que la eficacia de la película de polietileno es superior a otras intervenciones. Se sugiere la realización de un ensayo clínico aleatorizado para verificar la eficacia de diferentes intervenciones de enfermería para evitar que el ojo seco en pacientes críticamente enfermos.Descriptores: Síndrome de Ojo Seco, Unidades de Cuidados Intensivos, Enfermería.

The eye

The ophthalmologist has a large part to play in the management of many rheumatological diseases. These diseases can cause a number of symptoms from mild ocular discomfort to sudden blindness. In addition, many rheumatological diseases have helpful ophthalmic signs, which can aid diagnosis. This chapter has been written to help rheumatologists identify these signs and symptoms. We have started by summarizing the common pathology found in patients with rheumatological diseases (dry eye syndromes, conjunctivitis, episcleritis, scleritis, uveitis, and optic neuropathy). This has been arranged working backwards from the front of the eye towards the retina and optic nerve. The rheumatological conditions that give rise to ophthalmic signs (giant cell arteritis, systemic lupus erythematosus, polyarteritis nodosa, Wegner’s granulomatosis, systemic sclerosis, rheumatoid arthritis, seronegative arthropathies, sarcoidosis, and Behçet’s disease) have then been summarized, including a section of paediatric conditions (juvenile idiopathic arthritis, spondyloarthropathies, and multisystemic illness). Finally, treatment regimes and recent guidelines have been covered for the screening of uveitis in juvenile idiopathic arthritis and the management of patients taking hydroxychloroquine. We hope that both rheumatologists in training and consultants find this chapter a useful clinical aid, and that it encourages them to look closely for subtle signs that will help improve the management of their patients.