Benefits and Safety of Astaxanthin in the Treatment of Mild-To-Moderate Dry Eye Disease

Objectives: To evaluate the effect of astaxanthin in the treatment of mild-to-moderate dry eye disease (DED) in middle-aged and elderly patients.Methods: 120 eyes of 60 middle-aged and elderly patients with mild-to-moderate DED were enrolled in this prospective, one-group, quasi-experimental study. Six milligram Astaxanthin tablets (Weihong Haematococcus Pluvialis Astaxanthin, Hangzhou Xinwei Low Carbon Technology R&D Co., Ltd., China) were administered orally, twice daily for 30 ± 2 days. History of eye diseases, treatment, systemic disease, and medication before the test were recorded. In addition, the ocular surface disease index (OSDI) questionnaire, non-invasive tear break-up time (NIBUT), fluorescein break-up time (FBUT), corneal fluorescein staining (CFS) score, eyelid margin signs, meibomian gland (MG) expressibility, meibum quality, meibomian gland dropout (MGDR), Schirmer I test (SIt), tear meniscus height (TMH), bulbar conjunctiva congestion degree, blink frequency, incomplete blink rate, and thickness of tear film lipid layer were collected before treatment, 2 weeks after the initiation of treatment, and at the end of treatment. Visual acuity (VA), intraocular pressure (IOP), anterior segment, fundus, discomfort symptoms and other adverse reactions were also monitored throughout the study to assess the safety.Results: OSDI score, NIBUT, BUT, CFS score, eyelid margin signs, MG expressibility, meibum quality, and blink frequency improved significantly to varying degrees after treatment compared with those before the treatment (P < 0.05), while TMH, SIt, conjunctival congestion, the thickness of tear film lipid layer, MGDR, incomplete blink rate, VA and IOP did not differ (P > 0.05).Conclusions: Oral administration of astaxanthin improves the symptoms and signs of middle-aged and elderly patients with mild-to-moderate DED.

Pigmented Lesions of the Eyelid Margin

The eyelid area poses a diagnostic and therapeutic challenge due to its specific anatomy. The eyelid is composed of skin, orbicularis muscle, tarsus, and the eyelid margin is continuous with palpebral conjunctiva. Among pigmented tumors, benign lesions such as epidermal or intradermal nevi, freckles, lentigo, or seborrheic keratosis are the most common. Melanoma is relatively rare in this location. A suspicious lesion may be biopsied or excised. Surgery in the eyelid area requires special considerations to maintain a safe surgical margin, vital function of the eyelid, and acceptable cosmetic effect due to the exposure of the eyelid region of the face.

Scar formation after lower eyelid incision for reconstruction of the inferior orbital wall related to the lower eyelid crease or ridge in Asians

Background: Transcutaneous lower eyelid approaches are associated with a risk of postoperative scarring depending on the distance between the incision line and the lower eyelid margin. The lower eyelid crease of Caucasians corresponds to a ridge-shaped fold in young Asians. However, this relationship has not been sufficiently evaluated in the latter. The authors, therefore, investigated the location of the scar and the lower eyelid crease or ridge to find the optimal location for the incision line.Methods: This study included 60 out of 139 patients who underwent inferior orbital wall reconstruction through a lower eyelid skin incision between July 2019 and June 2020. According to the location of the scar, the patients were classified into three groups: group A ( ≥ 2 mm above the lower eyelid crease or ridge), group B (within the lower eyelid crease or ridge to 2 mm above the lower eyelid crease or ridge), and group C (within the lower eyelid crease or ridge to 2 mm below the lower eyelid crease or ridge). At 6 or 12 months after surgery, the Patient and Observer Scar Assessment Scale (POSAS) score was obtained, the distance between the lower eyelid margin and the scar (DMS) and the distance between the margins of the peripheral pupil and the lower eyelid (DMPE) were measured, and the occurrence of ectropion was evaluated.Results: Group B had the lowest POSAS score (A: 22.7 ± 8.0, B: 20.9 ± 2.4, C: 32.5 ± 4.1, p < 0.001). Linear regression analysis showed that the DMS was positively correlated with the POSAS score (p < 0.001) and that the risk of DMPE widening increased as the DMS decreased (p = 0.029). None of the patients had ectropion.Conclusion: When using the transcutaneous approach for inferior orbital wall reconstruction, the optimal incision site is within the lower eyelid crease or ridge to 2 mm above the lower eyelid crease or ridge.

Composition and Diversity of the Ocular Surface Microbiota in Patients With Blepharitis in Northwestern China

Purpose: To investigate the composition and diversity of the microbiota on the ocular surface of patients with blepharitis in northwestern China via 16S rDNA amplicon sequencing.Methods: Thirty-seven patients with blepharitis divided into groups of anterior, posterior and mixed blepharitis and twenty healthy controls from northwestern China were enrolled in the study. Samples were collected from the eyelid margin and conjunctival sac of each participant. The V3–V4 region of bacterial 16S rDNA in each sample was amplified and sequenced on the Illumina HiSeq 2500 sequencing platform, and the differences in taxonomy and diversity among different groups were compared.Results: The composition of the ocular surface microbiota of patients with blepharitis was similar to that of healthy subjects, but there were differences in the relative abundance of each bacterium. At the phylum level, the abundances of Actinobacteria, Cyanobacteria, Verrucomicrobia, Acidobacteria, Chloroflexi, and Atribacteria were significantly higher in the blepharitis group than in the healthy control group, while the relative abundance of Firmicutes was significantly lower (p &lt; 0.05, Mann-Whitney U). At the genus level, the abundances of Lactobacillus, Ralstonia, Bacteroides, Akkermansia, Bifidobacterium, Escherichia-Shigella, Faecalibacterium, and Brevibacterium were significantly higher in the blepharitis group than in the healthy control group, while the relative abundances of Bacillus, Staphylococcus, Streptococcus, and Acinetobacter were significantly lower in the blepharitis group (p &lt; 0.05, Mann-Whitney U). The microbiota of anterior blepharitis was similar to that of mixed blepharitis but different from that of posterior blepharitis. Lactobacillus and Bifidobacterium are biomarkers of posterior blepharitis, and Ralstonia is a biomarker of mixed blepharitis. There was no significant difference in the ocular surface microbiota between the eyelid margin and conjunctival sac with or without blepharitis.Conclusion: The ocular surface microbiota of patients with blepharitis varied among different study groups, according to 16S rDNA amplicon sequencing analysis. The reason might be due to the participants being from different environments and having different lifestyles. Lactobacillus, Bifidobacterium, Akkermansia, Ralstonia, and Bacteroides may play important roles in the pathogenesis of blepharitis.

The Ocular Surface Characteristics in Prostate Cancer Patients Treated with Androgen Deprivation Therapy

Background.To investigate the association of long-term androgen deprivation therapy (ADT) with ocular surface characteristics in prostate cancer patients. Methods. A total of 30 male prostate cancer patients who received ADT were selected. All candidates were scored using the Ocular Surface Disease Index (OSDI) and subsequently divided into two groups containing 9 symptomatic patients (scores >12) and 21 asymptomatic patients ( scores ≤ 12 ). Another 20 healthy age-matched males were selected as the control group. Each candidate was assessed with respect to eyelid margin abnormality, tear film break-up time (NI-BUT), tear meniscus height (TMH), meiboscore, meibum expressibility, and demodex infection. Results. The NI-BUT in the ADT group was significantly shorter than that in the control group. The scores for OSDI, eyelid margin abnormality, meibum expressibility, and meiboscores were significantly higher in the ADT group ( P < 0.05 ). Moreover, the NI-BUT in the symptomatic ADT group was significantly shorter than that in the asymptomatic ADT group ( P < 0.05 ). The meiboscores and meibum expressibility score in the symptomatic ADT group were significantly higher than those in the asymptomatic ADT group ( P < 0.05 ). The presence of demodex in the symptomatic ADT group was also higher than that in the asymptomatic ADT group ( P < 0.05 ).The length of time that patients had been taking ADT was positively correlated with meiboscores and negatively correlated with NI-BUT. Conclusion. Androgen levels were associated with significant changes in relative meibomian gland function. Subjective symptoms, such as dryness and foreign body sensation, were more obvious in prostate cancer patients receiving ADT, which may be caused by MGD and demodex infection. It’s recommended that more attention be paid to the ocular surface in prostate cancer patients taking ADT by performing examination of NI-BUT and meibomian gland morphology and function with a view to providing more comprehensive prevention and treatment protocols.

Blepharoplasty and Eyelid Reconstruction

A mastery of facial and eyelid anatomy is paramount to perform oculoplastic surgery safely and successfully. An understanding of periocular structures, vasculature, and innervation highlights the delicate relationship between form and function, which establishes the foundation for cosmetic and reconstructive procedures. This knowledge, coupled with an appreciation for the patient’s goals – both functional and aesthetic – and expectations for the outcome of surgery allows one to complete an effective, multidimensional pre-operative assessment encompassing patient selection, history, physical examination, and ancillary testing. Ultimately, the synthesis of these principles guides the selection and execution of appropriate and efficacious surgical technique for blepharoplasty and eyelid reconstruction. This review contains 15 figures and 28 references Keywords: Eyelid anatomy, Eyelid crease, Eyelid margin, Canthal tendons, Lacrimal system, Blepharoplasty, Tenzel flap, Hughes flap, Cutler-Beard procedure, Canthotomy and cantholysis

Blepharoplasty and Eyelid Reconstruction

A mastery of facial and eyelid anatomy is paramount to perform oculoplastic surgery safely and successfully. An understanding of periocular structures, vasculature, and innervation highlights the delicate relationship between form and function, which establishes the foundation for cosmetic and reconstructive procedures. This knowledge, coupled with an appreciation for the patient’s goals – both functional and aesthetic – and expectations for the outcome of surgery allows one to complete an effective, multidimensional pre-operative assessment encompassing patient selection, history, physical examination, and ancillary testing. Ultimately, the synthesis of these principles guides the selection and execution of appropriate and efficacious surgical technique for blepharoplasty and eyelid reconstruction. This review contains 15 figures and 28 references Keywords: Eyelid anatomy, Eyelid crease, Eyelid margin, Canthal tendons, Lacrimal system, Blepharoplasty, Tenzel flap, Hughes flap, Cutler-Beard procedure, Canthotomy and cantholysis

An Outperforming Artificial Intelligence Model to Identify Referable Blepharoptosis for General Practitioners (Preprint)

BACKGROUND Accurate identification and prompt referral for blepharoptosis can be challenging for general practitioners. An artificial intelligence-aided diagnostic tool could underpin decision-making. OBJECTIVE To develop an AI model which accurately identifies referable blepharoptosis automatically and to compare the AI model’s performance to a group of non-ophthalmic physicians. METHODS Retrospective 1,000 single-eye images from tertiary oculoplastic clinics were labeled by three oculoplastic surgeons with ptosis, including true and pseudoptosis, versus healthy eyelid. The VGG (Visual Geometry Group)-16 model was trained for binary classification. The same dataset was used in testing three non-ophthalmic physicians. The Gradient-weighted Class Activation Mapping (Grad-CAM) was applied to visualize the AI model RESULTS The VGG16-based AI model achieved a sensitivity of 92% and a specificity of 88%, compared with the non-ophthalmic physician group, who achieved a mean sensitivity of 72% [Range: 68% - 76%] and a mean specificity of 82.67% [Range: 72% - 88%]. The area under the curve (AUC) of the AI model was 0.987. The Grad-CAM results for ptosis predictions highlighted the area between the upper eyelid margin and central corneal light reflex. CONCLUSIONS The AI model shows better performance than the non-ophthalmic physician group in identifying referable blepharoptosis, including true and pseudoptosis, correctly. Therefore, artificial intelligence-aided tools have the potential to assist in the diagnosis and referral of blepharoptosis for general practitioners.