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Current Opinion in Ophthalmology May 2019The prevalence and burden of dry eye disease continues to grow at a rapid pace, creating an increased need for new therapies. In a sector once limited to only a handful... (Review)
Review
PURPOSE OF REVIEW
The prevalence and burden of dry eye disease continues to grow at a rapid pace, creating an increased need for new therapies. In a sector once limited to only a handful of treatments, clinicians now have multiple options available for patients who fail traditional therapies. This review summarizes the various treatment options available to clinicians treating complex dry eye disease patients.
RECENT FINDINGS
As we better understand the multifactorial mechanisms leading to dry eye disease, treatments increasingly focus on the amelioration of the underlying deficiencies and inflammation, rather than on transient symptomatic relief alone. Most topical medications seek to replace deficient growth factors and/or decrease inflammation on the ocular surface. The majority of new devices and procedures seek to treat meibomian gland dysfunction, with one new device stimulating tear production through utilizing the nasolacrimal reflex pathway.
SUMMARY
Clinicians have more options at their disposal in the treatment of dry eye disease than ever before, including topical medications and devices.
Topics: Dry Eye Syndromes; Eyelid Diseases; Humans; Meibomian Glands; Tears
PubMed: 30883442
DOI: 10.1097/ICU.0000000000000569 -
Indian Journal of Ophthalmology Jul 2017The human face is composed of small functional and cosmetic units, of which the eyes and periocular region constitute the main point of focus in routine face-to-face... (Review)
Review
The human face is composed of small functional and cosmetic units, of which the eyes and periocular region constitute the main point of focus in routine face-to-face interactions. This dynamic region plays a pivotal role in the expression of mood, emotion, and character, thus making it the most relevant component of the facial esthetic and functional unit. Any change in the periocular unit leads to facial imbalance and functional disharmony, leading both the young and the elderly to seek consultation, thus making blepharoplasty the surgical procedure of choice for both cosmetic and functional amelioration. The applied anatomy, indications of upper eyelid blepharoplasty, preoperative workup, surgical procedure, postoperative care, and complications would be discussed in detail in this review article.
Topics: Blepharoplasty; Eyelid Diseases; Eyelids; Humans
PubMed: 28724810
DOI: 10.4103/ijo.IJO_540_17 -
Ophthalmology Nov 2017To discuss the pathology, causes, and ocular surface impact of meibomian gland disease (MGD), as well as its relationship to dry eye. (Review)
Review
TOPIC
To discuss the pathology, causes, and ocular surface impact of meibomian gland disease (MGD), as well as its relationship to dry eye.
CLINICAL RELEVANCE
MGD is a common disorder with various contributing mechanisms and clinical manifestations. Understanding MGD pathophysiology and its relationship to dry eye is important in order to optimize diagnosis and treatment algorithms.
METHODS
A review of current literature was performed to discern MGD in terms of pathophysiology, risk factors, and ocular surface impact, and the relationship to dry eye.
RESULTS
Meibomian gland obstruction and meibocyte depletion are important components of MGD. Many pathologies can disrupt function of meibomian glands, ranging from congenital to acquired causes. Once gland disruption occurs, the quality and quantity of meibum is altered, with a negative impact on the ocular surface. Increased tear evaporation, tear hyperosmolarity, increased ocular surface staining, increased inflammation, symptomatic irritation of the eyelid and globes, as well as decreased visual acuity have all been observed.
CONCLUSION
MGD leads to changes in meibum quality and quantity that can cause evaporative dry eye and ocular surface disruption, leading to dry eye symptoms in some individuals.
Topics: Animals; Dry Eye Syndromes; Eyelid Diseases; Humans; Meibomian Glands
PubMed: 29055358
DOI: 10.1016/j.ophtha.2017.05.031 -
American Family Physician Jul 2015The swollen red eyelid is a common presentation in primary care. An understanding of the anatomy of the orbital region can guide care. Factors that guide diagnosis and... (Review)
Review
The swollen red eyelid is a common presentation in primary care. An understanding of the anatomy of the orbital region can guide care. Factors that guide diagnosis and urgency of care include acute vs. subacute onset of symptoms, presence or absence of pain, identifiable mass within the eyelid vs. diffuse lid swelling, and identification of vision change or ophthalmoplegia. Superficial skin processes presenting with swollen red eyelid include vesicles of herpes zoster ophthalmicus; erythematous irritation of contact dermatitis; raised, dry plaques of atopic dermatitis; and skin changes of malignancies, such as basal or squamous cell carcinoma. A well-defined mass at the lid margin is often a hordeolum or stye. A mass within the midportion of the lid is commonly a chalazion. Preseptal and orbital cellulitis are important to identify, treat, and differentiate from each other. Orbital cellulitis is more often marked by changes in ability of extraocular movements and vision as opposed to preseptal cellulitis where these characteristics are classically normal. Less commonly, autoimmune processes of the orbit or ocular tumors with mass effect can create an initial impression of a swollen eyelid.
Topics: Diagnosis, Differential; Edema; Eyelid Diseases; Eyelids; Humans
PubMed: 26176369
DOI: No ID Found -
Hong Kong Medical Journal = Xianggang... Feb 2019Dry eye disease is one of the most common ophthalmic complaints; it results from the activity of various pathways and is considered a multifactorial disease. An... (Review)
Review
Dry eye disease is one of the most common ophthalmic complaints; it results from the activity of various pathways and is considered a multifactorial disease. An important factor that contributes to the onset of dry eye disease is meibomian gland dysfunction. Meibomian gland dysfunction causes a disruption in the tear film lipid layer which affects the rate of tear evaporation. This evaporation leads to tear hyperosmolarity, eventually triggering the onset of dry eye disease. Dry eye disease and meibomian gland dysfunction are strongly associated with each other, such that many of their risk factors, signs, and symptoms overlap. This review aimed to provide an update on the association between dry eye disease and meibomian gland dysfunction. A stepwise approach for diagnosis and management is summarised.
Topics: Diagnostic Imaging; Dry Eye Syndromes; Eyelid Diseases; Fluorescent Dyes; Humans; Meibomian Glands; Randomized Controlled Trials as Topic; Risk Factors; Slit Lamp; Staining and Labeling; Tears
PubMed: 30713149
DOI: 10.12809/hkmj187331 -
The British Journal of Ophthalmology Nov 1988Blepharochalasis is an uncommon disorder distinguished by recurrent episodes of eyelid oedema in young patients. A hypertrophic form, manifested as fat herniation, and...
Blepharochalasis is an uncommon disorder distinguished by recurrent episodes of eyelid oedema in young patients. A hypertrophic form, manifested as fat herniation, and an atrophic form, manifested as fat atrophy, have been described. Ptosis with excellent levator function, laxity of the lateral canthal structures with rounding of the lateral canthal angle, nasal fat pad atrophy, and redundant eyelid skin develop after many episodes of eyelid swelling. Fine wrinkling, atrophy, and telangiectasias characterise the excess eyelid skin. We describe four cases of this syndrome in which external levator aponeurosis tuck, blepharoplasty, lateral canthoplasty, and dermis fat grafts were used to correct atrophic blepharochalasis after the syndrome had run its course.
Topics: Adolescent; Adult; Atrophy; Edema; Eyelid Diseases; Eyelids; Female; Humans
PubMed: 3207663
DOI: 10.1136/bjo.72.11.863 -
Acta Medica Portuguesa Jun 2019
Topics: Adult; Atrophy; Eyelid Diseases; Eyelids; Humans; Male; Photography; Pigmentation Disorders
PubMed: 31292031
DOI: 10.20344/amp.11246 -
BMJ Case Reports Feb 2018Periocular necrotising fasciitis is a rare but sight-threatening condition, which relies on clinical judgement to detect in a timely manner. A 51-year-old woman...
Periocular necrotising fasciitis is a rare but sight-threatening condition, which relies on clinical judgement to detect in a timely manner. A 51-year-old woman presented to a rural hospital with rapid onset bilateral eye swelling, erythema and pain and was started on broad spectrum intravenous antibiotics. Upon admission, she became septic and required fluid resuscitation and transfer to a higher level of care. She received debridement and continued intravenous antibiotics, with step down to oral when clinically stable. Rapid recognition and treatment of her condition resulted in a positive outcome.
Topics: Administration, Intravenous; Anti-Bacterial Agents; Diagnosis, Differential; Eyelid Diseases; Eyelids; Fasciitis, Necrotizing; Female; Humans; Middle Aged; Penicillanic Acid; Piperacillin; Piperacillin, Tazobactam Drug Combination; Streptococcal Infections; Streptococcus pyogenes; Vancomycin
PubMed: 29472418
DOI: 10.1136/bcr-2017-220962 -
Arquivos Brasileiros de Oftalmologia 2015Life expectancy is increasing in most countries. With increasing age, many individuals may develop involutional ophthalmic diseases, such as eyelid aging.... (Review)
Review
Life expectancy is increasing in most countries. With increasing age, many individuals may develop involutional ophthalmic diseases, such as eyelid aging. Dermatochalasis, ptosis, ectropion, and entropion are common disorders in middle-aged and older adults. This review outlines the pathophysiology and clinical management of these involutional eyelid disorders. Recently, a decrease in elastic fibers with ultrastructural abnormalities and an overexpression of elastin-degrading enzymes have been demonstrated in involutional ectropion and entropion. This may be the consequence of local ischemia, inflammation, and/or chronic mechanical stress. Eyelid aging with progressive loss of tone and laxity may affect the ocular surface and adnexal tissues, resulting in different clinical symptoms and signs. Surgical management depends on the appropriate correction of the underlying anatomical defect.
Topics: Elastic Tissue; Elastin; Eyelid Diseases; Eyelids; Female; Humans; Male; Skin Aging
PubMed: 26466237
DOI: 10.5935/0004-2749.20150087 -
Acta Ophthalmologica Aug 2022Eyelid warming is an important treatment for meibomian gland dysfunction (MGD). Specialized chambered devices, using warm moist air have been developed. (Review)
Review
BACKGROUND
Eyelid warming is an important treatment for meibomian gland dysfunction (MGD). Specialized chambered devices, using warm moist air have been developed.
PURPOSE
To critically evaluate the literature on the safety and efficacy of chambered warm moist air devices in MGD treatment and pinpoint areas of future research.
METHODS
PubMed and Embase were searched on 06 June 2021. The search term was '(warm OR heat OR steam OR goggle OR spectacle OR moist air) AND (meibomian OR MGD OR blepharitis OR eyelid OR dry eye OR DED)'. All relevant articles with available English full text were included.
RESULTS
Eighteen articles assessing the application of chambered warm moist air eyelid warming devices were identified. In single-application studies, steam-based eyelid warming increased the eyelid temperature and improved symptoms, lipid layer thickness, and tear film breakup time (TBUT). In treatment studies, the steam-based devices improved TBUT and symptom scores. However, in the only randomized controlled trial (RCT) comparing chambered steam-based heat to hot towel treatment, there was no difference between groups for the primary outcome measure; the proportion of subjects noting symptom improvement after 4 weeks.
CONCLUSION
Currently available chambered warm moist air eyelid warming devices are safe and effective at raising eyelid temperature to therapeutic levels and improving signs and symptoms of dry eye. However, it is not clear if they provide a greater benefit than other eyelid warming therapies. Further well-conducted RCTs comparing moist and dry heat devices should be conducted on patients across the range of DED severities and subtype spectrum.
Topics: Dry Eye Syndromes; Eyelid Diseases; Humans; Meibomian Gland Dysfunction; Meibomian Glands; Steam; Tears
PubMed: 34750979
DOI: 10.1111/aos.15052