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Medical Hypothesis, Discovery &... 2023Bell's phenomenon, also known as the palpebral oculogyric reflex, is a critical reflex that protects the cornea. We developed an innovative, simple, and practical...
BACKGROUND
Bell's phenomenon, also known as the palpebral oculogyric reflex, is a critical reflex that protects the cornea. We developed an innovative, simple, and practical grading scale for Bell's phenomenon that includes the inverse Bell's phenomenon. Using this scale, we investigated the characteristics of Bell's phenomenon among asymptomatic individuals in different age groups and examined the frequency of ocular surface lesions in asymptomatic and symptomatic participants with different grades.
METHODS
In this cross-sectional study, we randomly included 330 eyes of 165 asymptomatic, healthy, White Turkish individuals who attended the outpatient eye clinic, with a male-to-female ratio of 1:1.4, in the control group. These were categorized into four age groups: 4 - 20 years, 21 - 40 years, 41 - 60 years, and > 60 years. Eighty eyes from 40 patients with ocular surface lesions and absence of grade + 2 Bell's phenomenon were included in the symptomatic group. Bell's phenomenon was classified into five grades: grade + 2 (strong positive), grade + 1 (weak positive), grade 0 (no Bell's phenomenon, no eye movement), grade -1 (weak inverse), and grade -2 (strong inverse).
RESULTS
We detected higher frequencies of grade + 2, + 1, and 0 in individuals aged 4 - 40, 41 - 60, and > 60 years, respectively. There was a significant difference between age groups in the frequencies of different grades ( < 0.001). Pairwise analysis revealed a significantly lower frequency of grade + 2 in the age group > 60 years compared with the 4 - 20 and 21 - 40 year groups (both < 0.05). Grade + 2 was the most frequent in both sexes. We detected grade 0 in 27.1% of men and 22.1% of women in the control group, with no significant difference in the frequencies of different grades between sexes ( > 0.05). We observed significant differences between grades with respect to the frequency of ocular surface lesions ( < 0.001). Pairwise analysis revealed a significantly higher frequency of ocular surface lesions in asymptomatic individuals with grade 0 and all four other grades (all < 0.001). However, the frequency of ocular surface lesions was comparable between sexes ( > 0.05). Of the 40 symptomatic individuals, 28 (70%), 5 (12.5%), 4 (10%), and 3 (7.5%) had grade 0, + 1, -1, and -2, respectively. The number of symptomatic patients was higher in grade 0 (n = 28) than in other grades (grade + 1, -1, and -2: n = 12 patients), and these individuals had a higher frequency of ocular surface lesions (n = 38 lesions) than others (grade + 1, -1, and -2: 7 lesions).
CONCLUSIONS
Using a simple, practical grading scale for Bell's phenomenon that includes inverse Bell's phenomenon, we observed that inverse Bell's phenomenon is a reflex that may be present in healthy individuals and could have a protective effect on the eye, although not to such a degree as a strong Bell's phenomenon. Our observations imply that bilateral conjunctival calcifications/Vogt's limbal girdle may be associated with grades 0 and + 1 Bell's phenomenon. Further large-scale studies are needed to determine the frequency of Bell's phenomenon in the general population using this innovative, simple, practical grading scale, and to identify the protective or injurious effect of each grade on the ocular surface.
PubMed: 38601052
DOI: 10.51329/mehdiophthal1484 -
Clinical Ophthalmology (Auckland, N.Z.) 2014To evaluate the clinical characteristics of patients with conjunctivochalasis (CCh).
PURPOSE
To evaluate the clinical characteristics of patients with conjunctivochalasis (CCh).
METHODS AND MATERIALS
This retrospective study enrolled 30 subjects diagnosed with conjunctivochalasis. Complete ophthalmic examination, including visual acuity assessment, slit-lamp examination, applanation tonometry, dilated funduscopy, tear break-up time, Schirmer 1 test, and fluorescein staining were performed in all patients. Age, sex, laterality, ocular history, symptoms, and clinical findings were recorded.
RESULTS
The study included 50 eyes from 30 cases. Ages ranged from 45 to 80 years, with a mean age of 65±10 years. CChs grading were as follows: 30 (60%) eyes with grade 1 CCh; 15 (30%) eyes with grade 2 CCh; and five (10%) eyes with grade 3 CCh. CCh was located in the inferior bulbar conjunctiva in 45 (90%) eyes, and in the remaining five (10%) CCh was located in the superior bulbar conjunctiva. Ten (33.3%) patients had no symptoms. Dryness, eye pain, redness, blurry vision, tired eye feeling, and epiphora were the symptoms encountered in the remaining twenty (63.6%) patients. Altered tear meniscus was noted in all cases. The mean tear break-up time was 7.6 seconds. The mean Schirmer 1 test score was 7 mm. Pinguecula was found in ten patients.
CONCLUSION
Dryness, eye pain, redness, blurry vision, and epiphora were the main symptoms in patients with CCh. Dryness, eye pain, and blurry vision were worsened during downgaze and blinking. So CCh should be taken into consideration in the differential diagnosis of chronic ocular irritation and epiphora.
PubMed: 25210435
DOI: 10.2147/OPTH.S61851 -
Clinical Optometry 2021Ultraviolet radiation is electromagnetic radiation or light having a wavelength of less than 400 nm but greater than 100 nm. Ultraviolet radiation, majorly from...
BACKGROUND
Ultraviolet radiation is electromagnetic radiation or light having a wavelength of less than 400 nm but greater than 100 nm. Ultraviolet radiation, majorly from sunlight, can potentially damage any organ that is exposed to any part of its spectrum. Aside from the skin, the organ most susceptible to sunlight-induced damage is the eye. Ultraviolet radiation is reported to be the cause of multiple ocular problems ranging from benign conditions like pterygium and pinguecula to ocular malignancies such as basal cell carcinoma which finally leads to visual impairment and blindness. Protection practice is mandatory to avoid the burden of diseases caused by ultraviolet exposure and maximizing the protection measures implementation is important. To maximize this, it is essential to know the current practice and the associated factors affecting the usage of protective devices in the study area.
METHODS
Community-based cross-sectional study was conducted from April to May 2019 on 453 study participants. The study participants were selected through a systematic random sampling method. Data were collected using a pretested structured questionnaire. The analyzed result was summarized and presented using texts, tables and charts. A Chi-square test was applied to assess the significant association.
RESULTS
A total of 430 study subjects were participated and completed the questionnaire with a response rate of 94.92%. The mean age of the study participants was 35.3 (SD±6.68). Two hundred forty-three (56.5%) study participants were males. About 228 (53%) of participants were married, and 356 (82.8%) were Christian in religion. From the total study participants, 173 (40.23%) had good practice in protecting the eye from ultraviolet radiation damages while the remaining 59.77% had poor practice. A significant association was found between sex and protection practice of the eye from ultraviolet radiation damages.
CONCLUSION
The majority of the study participants had poor protection practice of the eye from ultraviolet radiation damages. Improving awareness and protection practice are vital to reduce the burden of ocular abnormalities due to excessive exposure to ultraviolet radiation.
PubMed: 33519252
DOI: 10.2147/OPTO.S291916 -
Journal of Ophthalmic & Vision Research 2017To evaluate the risk factors for pterygium in the dry, high altitude province of Ilam, Iran.
PURPOSE
To evaluate the risk factors for pterygium in the dry, high altitude province of Ilam, Iran.
METHODS
The study included patients who presented to ophthalmology clinic. The patients were divided into two groups: 210 diagnosed with pterygium or pinguecula (unilateral or bilateral), and 210 healthy controls. Demographic variables, living environment, disease type, disease laterality, family history of pterygium as well as history of smoking, working outdoors, baking, welding, ocular conditions (trachoma keratopathy, glaucoma, refractive error, and dry eye), use of glasses, ultraviolet light exposure, and systemic conditions were collected from both groups and compared for risk assessment.
RESULTS
Univariate analysis revealed that age ( = 0.001), sex ( = 0.001), family history of pterygium ( = 0.001), positive history of smoking ( < 0.001), history of baking ( = 0.045), welding experience ( < 0.001), severe blepharitis ( < 0.001), hyperopia ( < 0.001), dry eye ( < 0.001), hypertension ( < 0.001), ischemic heart disease ( < 0.001), obesity ( = 0.038), and primary residential area ( = 0.025) had significant associations with increased incidence of pterygium. However, in multivariate analysis, only family history of pterygium, cigarette smoking, history of baking, age, and severe blepharitis were significantly associated with the incidence of pterygium (<0.001, <0.001, = 0.002, = 0.023 and = 0.002, respectively).
CONCLUSION
This study tested more risk factors related to the prevalence of pterygium compared to previous studies. It also confirmed previously established risk factors. Family history of pterygium and blepharitis were risk factors that have not been reported in previous studies and were found to be significantly associated with the development of pterygium in this study.
PubMed: 28791059
DOI: 10.4103/jovr.jovr_85_16 -
Korean Journal of Ophthalmology : KJO Dec 2013To analyze the autofluorescence (AF) properties of pinguecula using cobalt-blue and yellow filters and to investigate the nature and pathogenesis of pingueculae using...
PURPOSE
To analyze the autofluorescence (AF) properties of pinguecula using cobalt-blue and yellow filters and to investigate the nature and pathogenesis of pingueculae using histochemical and immunohistochemical staining.
METHODS
Fifty pingueculae in 40 patients were included in this study. AF of the pingueculae was observed and analyzed using a cobalt-blue filter with an additional yellow filter on a slit-lamp. Hematoxylin-eosin and immunohistochemical stainings were performed on surgical specimens of pingueculae that were prepared from each patient. Immunohistochemical staining included Congo red, Oil Red O, periodic acid-Schiff (PAS), Masson's trichrome, transglutaminase-2 (TG-2), mesenchymal stem cell markers CD29 (β-1-integrin), and CD34.
RESULTS
AF images revealed hyper-AF in the pinguecula area. The AF lesions of pingueculae showed superficial punctuate erosions and avascular lesions. Deposition of eosinophilic and amorphous materials in the subepithelial layer of the pinguecula were observed on hematoxylin-eosin staining. Historeactivities to Congo red, PAS, Oil Red O, alcian blue, and Masson's trichrome were not detected, but immunoreactivities to CD29, CD34, and TG-2 were detected in the pingueculae with AF. However, CD29, CD34, and TG-2 were not detected in the pingueculae without AF.
CONCLUSIONS
The AF of pingueculae may be related to CD29, CD34, and TG-2. We suggest that pingueculae with AF have a different pathogenesis compared to pingueculae without AF.
Topics: Aged; Coloring Agents; Female; Fluorescence; Follow-Up Studies; Hematoxylin; Humans; Immunohistochemistry; Male; Microscopy, Confocal; Middle Aged; Pinguecula; Retrospective Studies
PubMed: 24311926
DOI: 10.3341/kjo.2013.27.6.416 -
Industrial Health Jul 1997Pinguecula and pterygium are speculated to be associated with corneal and conjunctival microtrauma from exposure to sunlight and/or dust. Occupational motorcycle driving...
PURPOSE
Pinguecula and pterygium are speculated to be associated with corneal and conjunctival microtrauma from exposure to sunlight and/or dust. Occupational motorcycle driving is suspected to be associated with such exposure, so we investigated the prevalence of pingueculae and pterygia in motorcycle policemen.
METHOD
Silt lamp finding obtained by periodic eye checkup for policemen (783 motorcycle policemen and 207 control indoor workers) together with questionnaire were used for analyses. All pingueculae and pterygia were diagnosed under the definite criteria.
RESULTS
The overall prevalence of pingueculae was 590/1,566 eyes (37.7%) among motorcycle policemen against 127/414 eyes (30.6%) among the indoor workers (p < 0.01). Besides, with increasing age, the prevalence of pingueculae in the motorcycle policemen clearly exceeded those among the indoor controls. The prevalence of pterygia were very small to be analysed.
CONCLUSION
Our results exhibited a significant relationship between occupational motorcycle driving and the prevalence of pingueculae. Thus it is strongly suggested that they should wear eye protection equipment (goggles, face shield and so on) to prevent from developing these lesions.
Topics: Adult; Chi-Square Distribution; Conjunctival Diseases; Cross-Sectional Studies; Eye Protective Devices; Humans; Japan; Logistic Models; Male; Middle Aged; Motorcycles; Multivariate Analysis; Occupational Diseases; Prevalence; Pterygium; Surveys and Questionnaires; Ultraviolet Rays
PubMed: 9248214
DOI: 10.2486/indhealth.35.325 -
Annals of Medicine and Surgery (2012) Nov 2023Systemic sclerosis is a connective tissue condition presented with clinical manifestations, including ocular involvement in a small percentage. A few cases of uveitis...
INTRODUCTION
Systemic sclerosis is a connective tissue condition presented with clinical manifestations, including ocular involvement in a small percentage. A few cases of uveitis were described in the literature, especially in CREST syndrome.
CASE PRESENTATION
The authors reported a case of a 48-year-old male with a blurred vision in his left eye that diagnosed with recurrent uveitis in the setting of CREST syndrome, treated with prednisolone, methotrexate, and golimumab, with improvement.
DISCUSSION
Ocular manifestations of systemic sclerosis include palpebral alterations, keratoconjunctivitis, sicca syndrome, cataracts, pinguecula, and blepharitis. To our knowledge, this is the fifth case of uveitis in a setting of CREST syndrome in the literature, and the first one in sex involvement, as the previous cases were females, and in its treatment by golimumab, an anti-tumor necrosis factor inhibitor.
CONCLUSION
Although this association is low, we believe that it should be taken into consideration when treating these situations to obtain better treatment results. Collaboration between rheumatologists and ophthalmologists is necessary in deciding on treatment.
PubMed: 37915625
DOI: 10.1097/MS9.0000000000001282 -
South African Medical Journal =... Oct 2023The pattern of HIV-associated eye disease has changed with ongoing advancements in highly active antiretroviral therapy (HAART). HIV-infected individuals now live...
BACKGROUND
The pattern of HIV-associated eye disease has changed with ongoing advancements in highly active antiretroviral therapy (HAART). HIV-infected individuals now live longer, enabling us to observe the long-term effects of HIV and HAART on the eye. There are few recent studies on HIV-related ocular disease in sub-Saharan Africa.
OBJECTIVES
To describe the ocular manifestations of HIV in patients attending the Nthabiseng HIV clinic at Chris Hani Baragwanath Academic Hospital, Johannesburg, South Africa.
METHODS
A cross-sectional study was conducted in 2021 and 2022 using convenience sampling of patients at the HIV clinic. The participants' clinical history was taken, their files were reviewed, and they underwent ocular examination. Correlation between eyes was managed by taking disease in one eye as the presence of disease in the participant. Descriptive statistics were used to summarise participant characteristics. Univariate and multivariate logistic regression models were used to assess the odds ratio (OR) of developing HIV-associated ocular diseases, and a p-value of <0.05 was used to define statistical significance.
RESULTS
There were 182 participants (139 females and 43 males), with a mean (standard deviation) age of 48.9 (10.6) years. The most common anterior segment diagnoses were conjunctival microangiopathy (34.6%), pinguecula (31.3%) and cataracts (30.2%), while the most common posterior segment finding was peripheral retinal scarring with features in keeping of previous cytomegalovirus retinitis (24.2%). Notably, only 1.1% of patients had HIV retinopathy. A CD4 count <200 cells/μL showed an increased OR for cataracts (OR 4.24; p=0.003) and any anterior segment diagnoses (OR 10.05; p=0.029), while a CD4 count ≥200 cells/μL showed an increased risk of conjunctival microangiopathy (OR 2.14; p=0.017).
CONCLUSION
With the advent of HAART, ocular manifestations of HIV are changing and the incidence of severe ocular opportunistic infections and HIV retinopathy has decreased precipitously. Although this study has shown that patients with a CD4 count <200 cells/μL are at increased risk of developing anterior ocular manifestations of HIV, including cataracts, these diseases are relatively innocuous or easily treatable. Routine ocular screening of HIV patients seems to be substantially less important now than it was in the pre-HAART era.
Topics: Male; Female; Humans; Middle Aged; HIV Infections; South Africa; Cross-Sectional Studies; Retinal Diseases; Antiretroviral Therapy, Highly Active; CD4 Lymphocyte Count; Vascular Diseases; Cataract; Hospitals
PubMed: 37881908
DOI: 10.7196/SAMJ.2023.v113i10.950 -
Acta Ophthalmologica Aug 2012To study the morphological patterns of pterygia and pingueculae using high-resolution anterior segment spectral domain optical coherence tomography (SD-OCT).
PURPOSE
To study the morphological patterns of pterygia and pingueculae using high-resolution anterior segment spectral domain optical coherence tomography (SD-OCT).
METHODS
Prospective cross-sectional study of 25 eyes presented with pterygia and pingueculae was conducted, and the eyes were examined by anterior segment SD-OCT.
RESULTS
We examined 25 eyes, including 13 eyes with primary pterygia, six eyes with recurrent pterygia, one case with a pseudopterygium and five eyes with pingueculae. Primary pterygia revealed elevation of the corneal epithelium by a wedge-shaped mass of tissue separating the corneal epithelium from the underlying Bowman's membrane, which became wavy and interrupted. We found satellite masses of pterygium tissue advanced under the epithelium beyond the clinically seen pterygium margins. In recurrent pterygia, we detected that the central tip of the pterygium was more advanced and creeping beneath the basal corneal epithelium than the primary pterygium. In pseudopterygium, the SD-OCT images showed that the overgrowing membrane was not really attached to the underlying cornea. In cases of pingueculae, SD-OCT revealed a wedge-shaped mass that was nearly similar in pattern to that of the pterygia but stopped at the limbal region. Immediately after removal of pterygia, we noticed many remnants of the pterygia masses over the corneal stroma in spite of the clinically clear appearance of cornea.
CONCLUSIONS
SD-OCT provided us with high-resolution images of the pterygium and the pinguecula and showed clearly the anatomical relationship between the corneal tissues and these lesions. The use of this new modality of imaging may help to decrease the current recurrence rates after pterygium excision through using the anterior segment SD-OCT in the evaluation of these lesions.
Topics: Adult; Aged; Anterior Eye Segment; Cross-Sectional Studies; Female; Humans; Male; Middle Aged; Pinguecula; Prospective Studies; Pterygium; Recurrence; Tomography, Optical Coherence
PubMed: 21040504
DOI: 10.1111/j.1755-3768.2010.01994.x -
BMJ Case Reports May 2021Diagnosis of rare disorders requires heightened clinical acumen. When such disorders present with atypical or novel features, it adds to the diagnostic challenge. A...
Diagnosis of rare disorders requires heightened clinical acumen. When such disorders present with atypical or novel features, it adds to the diagnostic challenge. A 9-month-old female infant who had received a diagnosis of neonatal hepatitis due to cytomegalovirus infection at 2 months of age presented to our institute with developmental delay, fever, vomiting, feeding difficulty, breathlessness and features of elevated intracranial pressure due to hydrocephalus. Key examination findings with cholestatic jaundice as an early manifestation led to suspicion of type 4 Farber disease. Observation of hydrocephalus, hypertension, bilateral pinguecula and Erlenmeyer flask deformity of the femur were unusual findings for Farber disease. The child had few features (pinguecula, Erlenmeyer flask deformity and hydrocephalus) overlapping with Gaucher disease. Alternatively, prosaposin deficiency (Farber disease type 7) was another differential diagnosis. Diagnosis of Farber disease was confirmed by detection of foamy macrophages on skin biopsy and two homozygous missense variants in gene.
Topics: Child; Farber Lipogranulomatosis; Female; Femur; Gaucher Disease; Humans; Infant; Infant, Newborn; Mutation, Missense; Skin
PubMed: 34045195
DOI: 10.1136/bcr-2020-240742