Homeostasis Changes of Tear-Producing System with the Background of Cosmetic Procedures in Periorbital Area

Modern ophthalmological practice is inseverable linked with cosmetology and esthetic medicine. Every year, the number of patients, especially women, who received various types of cosmetology procedures (botulinum toxin injections, eyelash extensions, eyelid tattooing, dermal fillers injections, etc.) in facial area increases, in particular in the periorbital zone. Purpose: to conduct a comprehensive assessment of clinical and functional parameters characterizing the state of the ocular surface and the tear-producing system in case applying cosmetic procedures in the periorbital area (Botox injections, eyelid tattooing, eyelash extension). Patients and methods. The study included 106 women (212 eyes). Exclusion criteria: early postoperative period after ophthalmosurgical intervention, acute inflammatory diseases of anterior and posterior eye segment, glaucoma, the presence of intraocular pathological changes (hemophthalmia, detachment of the eye membranes, tumors). The average age of the patients included in the study was 36.37 ± 9.0 years. Results and discussion. The results of a comparative evaluation of two groups of patients — a group with a history of cosmetic procedures (tattooing the eyelids, botulinum toxin, dermal fillers, eyelash extensions) in the periorbital zone and patients who did not use such procedures, has showed that cosmetic procedures affect on the clinical and functional eye surfaces state and on morphofunctional state of meibomian glands. Thus, the frequency of detection of symptomocomplex of dry eye syndrome was on 36 % more often determined in the group of patients received cosmetic procedures. It has been shown that the combined effect of cosmetological procedures (tattooing the eyelids, eyelash extensions, injections of dermal fillers and botulinum toxin in the periorbital region) aggravates the course and prognosis of Dry Eye Syndrome and meibomian glands dysfunction. A direct correlation between the severity of complaints characteristic of Dry Eye Syndrome and the number of procedures was found (r = 0.4982, p = 0.0000); the frequency of detecting complaints of dryness and discomfort and the number of procedures (r = 0.6427, p = 0.0000); compression test indices and the number of procedures (r = –0.4712, p = 0.0000); the frequency of occurrence of inflammatory reactions of ocular surface and the number of procedures (r = 0.3778, p = 0.0001). The risk of tear production disturbance — dry eye syndrome and dysfunction of the meibomian glands is higher in patients using botulinum toxin injections and eyelash extension in comparison with patients using eyelid tattooing and injections of fillers with hyaluronic acid in the periorbital zone

Diseases of the Ocular Surface Associated with Eyelid Makeup and Eyelash Extensions. Clinical Examples

The environmental factors influence, quite often, negatively affects the state of health. Many of them, such as smoking, deterioration in ecology, uncontrolled alcohol intake, are in detail studied in terms of harm to a human body. Nevertheless, new technologies which action is insufficiently studied, are actively introduced into modern life. So, the use of cosmetology procedures can be a striking example. Now the prevalence of such procedures as eyelash extension, a permanent make-up a century, botulotoxin injections in a periorbital zone, assumes a wide scale. In foreign and domestic literature there are more and more messages about development of the complications which arose owing to use of the above-stated procedures. There are two clinical examples from our practice in this article. They demonstrate the complications which arose after holding a procedure of eyelash extension — acute toxic-allergic conjunctivitis and after a permanent make-up — a chemical burn of a cornea. In these clinical cases of a complication arose due to aggressive action of a chemical basis of the glue applied at eyelash extension and cream-anesthetic which is applied on eyelids before a permanent make-up a century. Treatment of patients included antiinflammatory, antihistaminic, antibacterial therapy and also a long course of the tear replacement therapy applied as keratoproteсtive therapy and for prevention of development of a dry eye syndrome. Considering scales of prevalence of cosmetology procedures in recent years, it is necessary to inform specialists and patients on potential risk of development of the complications connected with the above-stated procedures. The clinical examples given in the article and literature data, demonstrate that in case of cosmetology procedures complications it is necessary to carry out timely rendering the qualified medical ophthalmologic care. It is connected with the fact that, quite often, the cosmetology manipulations, even positioned as harmless, in particular, a permanent make-up of eyelid and eyelash extension can lead to heavy complications, up to vision loss

The Functional State of Meibomian Glands and Tear Production in Pregnant Women

Pregnant women are objects of special medical attention due to the fact that the new life — the life of her child — depends on the health  and quality of life of the future mother. Pregnancy is a physiological  load. It makes temporary changes in the functional state of all  organs and systems, including the organ of vision. This study was  aimed at identifying risk factors for the occurrence of disturbances in the tear-producing system — dysfunction of the Meibomian glands  and/or dry eye syndrome (SSH), as well as to develop recommendations for compensating of disturbance. The  study showed that physiological pregnancy does not affect to the  condition of the ocular surface in case of absence of dry eye  syndrome manifestations and Meibomian gland dysfunction before  pregnancy. However, there is a predisposition for the development of the symptom complex of dry eye syndrome — a reliable decrease  Schirmer test indicators of the test of in the group of pregnant  women, it requires preventive control, — reduction in the mode of  wearing contact lenses, which are a risk factor for the development  of dry eye syndrome. It was determined that in vitro fertilization  (IVF) affects to the condition of the ocular surface, namely, on the  occurrence of dysfunction of Meibomian glands and dry eye  syndrome, and is accompanied by corresponding complaints. There  is a direct correlation between the duration of gestation, age  indicators, the severity of complaints and their relationship to  pregnancy. A direct was established, with a noticeable tightness of  communication, between taking thyrotrophic drugs and complaints  on dryness and discomfort. Therefore, special attention should be  given to pregnant patients taking thyrotrophic medications and using contact lenses, since both of these factors provoke the development  of the dry eye symptom complex. Patients with IVF pregnancy and  accompanied by taking thyrotrophic drugs are recommended to limit  the mode of wearing contact lenses, in case of complaints on  dryness, discomfort, it is necessary to conduct therapeutic and  prophylactic effects in the form of non-conserved tear-replacement  therapy and eyelid hygiene. Timely diagnosis and subsequent  prevention of Meibomian glands and dry eye syndrome in pregnant  women will improve the quality of life of this patients group and  prevent the development of complications related to this condition

Effect of Cosmetic Procedures in the Periorbital Area on the Organ of Vision: Overview

Practitioners in ophthalmology in recent years often face the effects of cosmetic procedures on the paraorbital area, as well as directly on the eyelids. Such influences include botox injections in paraorbital area, blepharoplasty, eyelash extensions, injections of various fillers, etc. These manipulations are widely used and often lead to various complications of the vision organ. Eyelash extensions are a popular procedure, especially among urban, young women, but there are potential health risks from the procedure. Tattooing of eyelids leads is the cause of dysfunction of meibomian glands, which can lead to the dry eye syndrome, manifested as complaints about a feeling of chronic discomfort in the eyes. Due to the growing popularity of the age tattoo, it is necessary to pay close attention to the training of specialists who conduct this procedure. The procedure for permanent eyelid make-up should be performed after careful consideration of possible complications, and by special trained professionals. In recent years, various cosmetic procedures for rejuvenating the face plays great role, for example, injections of botulinum toxin, as well as various dermal fillers — the application of which is aimed at eliminating the aging signs. The qualification of the specialist his awareness of the occurrence of possible complications, as well as the awareness of patients who undergo this procedure is an important aspect in the application of botulinum toxin, both for therapeutic and cosmetic purposes. Of great interest are the complications associated with ischemia in the form of soft tissue necrosis and vascular occlusion caused by fillers introduction. It is reported that the frequency of vascular occlusion with dermal fillers is up to 3 per 1000 injections. The only proven elimination of soft tissue ischemia in case of a hyaluronic acid filler use is early high-dose hyaluronidase injections, since this drug helps deactivate the action of hyaluronic acid. Modern ophthalmologic practice is inextricably linked with the latest methods of modern cosmetology medicine, the results of it can effect on the functions of the whole organism as the organ of vision in particular. This fact and the specificity of possible complications arising from cosmetic procedures in the periorbital zone should be taken into account during the anamnesis collecting anamnesis, and examining patients, including preoperative preparation, and in choosing the treatment method

Causes of Iris Depigmentation in Young and Middle Age. Clinical Example

The spontaneous change of eyes’ color is a quite rare complain in ophthalmological clinical practice for young and middle-aged patients. We consulted the 18-year-old patient complained that a month ago she noticed a change of the iris’ color. It was symmetrical in both eyes, which had lightened and acquired a “spotty appearance”. Before the appearance of these complaints, the patient had eyes of a rich dark brown color. After a comprehensive examination, the bilateral acute iris depigmentation (BADI) was diagnosed. BADI is bilateral symmetrical iris depigmentation followed by focal or diffuse stromal atrophy and pigment dispersion in the anterior segment. It is more common for young and middle-aged women, and is often asymptomatic. BADI has bilateral symmetrical iris depigmentation followed by focal or diffuse stromal atrophy and pigment dispersion in the anterior eye segment of the eye, which may affect the trabecular network. A feature of this disease is the absence of transillumination, changes in the shape of the pupil, and an inflammatory reaction. In some cases, repigmentation may occur spontaneously during the next few years. Therefore, from a prognostic point this disease has a favorable prognosis. However, patients with BADI syndrome should undergo regular ophthalmological examinations, including measurement of intraocular pressure to exclude the development of secondary open-angle pigmented glaucoma, and use sunglasses when the sun is bright. BADI syndrome must be differentiated with the following diseases: Fuchs heterochromic iridocyclitis, viral iridocyclitis caused by HSV and CMV, pigment dispersion syndrome and pseudo exfoliative glaucoma, as well as bilateral acute iris transillumination (BAIT) syndrome to make a correct diagnosis and apply adequate treatment tactics

The Antibacterial Eye Ointments in the Treatment of Eyelids and Conjunctiva Acute and Chronic Diseases

Currently, there are many studies on the effectiveness of ointment ophthalmological medicines. Ophthalmic ointments are unique because they have a multi-component action mechanism. On the one hand, the action of the medicinal substance itself is prolonged due to the ointment base, and on the other hand, due to the structural features of the conjunctival cavity mucosa, these medicinal substances are very rapidly absorbed. In the treatment of ocular surface pathology, including as meibomiitis, barley and chalazions, local therapy and ointment forms are preferred. The purpose of the study was the investigation the antibacterial eye ointment effectiveness of domestic production Oftocipro — a fluoroquinolone derivative for the treatment of acute and chronic eyelid and conjunctiva diseases. During the study patients were divided into 2 groups with acute and chronic inflammatory diseases of the eyelids and conjunctiva in the acute stage. It is known that chronic pathological processes are often stopped in longer periods. This fact was a prerequisite for assessing the effectiveness of Ontocipro with a comparative analysis of the dynamics of subjective (patient complaints) and objective (biomicroscopy, tear production tests) indicators characterizing the severity of the inflammatory process. The study has showed a high drug efficacy, when it is applied topically 3–4 times a day. The average time to relieve the inflammatory process was 3–7 days. The possibility of using the drug Oftocipro locally, when it is applied to the eyelid area, without affecting the conjunctival cavity, allows to minimize the impact area due to the ointment base and limit the risk of side effects in the form of a violation of the natural conjunctival microflora. Considering high level of tolerance and low allergenicity of the drug Oftotsipro, it can be recommended for widespread use for the treatment of acute and chronic blepharoconjunctivitis, barley and chalazion in the acute stage, as well as meibomiitis

Current Concepts about the Etiology of Dry Eye Syndrome

The revolution in understanding the etiology and clinical manifestations of the disruption of the tearing process and the development of dry eye syndrome (CVS) has occurred in last 20–30 years. It has been established that the loss of the tear film homeostasis can occur not only because of a violation of systemic and autoimmune disorders, but also as a result of a blinking disorder and distribution of the tear film over the ocular surface. Therefore, new pathogenetic disease development mechanisms have been identified. The prevalence of diseases of the ocular surface and CVD in recent years has increased significantly. It is mostly caused not only by scientific discoveries in the field of understanding, for example, the etiological and pathophysiological role of the neurosensory mechanism of development of CVS. An important aspect is the emergence of new risk factors that potentiate the development of ocular surface diseases and CVL. These factors include the use of various drugs — antidepressants, antihistamines, hormone therapy, and others; instillation of eye drops — antiglaucoma drugs, etc., as well as the appearance of little-studied factors such as cosmetology procedures (eyelids tattooing, eyelash extensions, botulinum toxin injections for aesthetic purposes, etc.). They are carried out in proximate close to the eye and eyelids, causing multiple pathological reaction. The experience of observing patients, literature data, and the conducted study have showed that various cosmetological effects in the periorbital zone, whose popularity has increased in recent years, may cause the appearance of iatrogenic dry eye syndrome. The following most vivid clinical examples will help, encountered in our practice, to illustrate the data presented. Collecting the anamnesis, it is necessary to identify the presence of risk factors for the development of diseases of the ocular surface and CVD, to eliminate them, if possible, and to carry out adequate pathogenically based therapy

The Treatment Algorithm for Meibomyitis, Hordeolum and Halazion

Despite the fact that the frequency of treatment the eyelids inflammatory diseases affecting the modified sebaceous glands (Meibomian glands, Zeiss glands) is very high in outpatient clinical practice, and the basic principles of treating this pathology are well known to everyone, there are always many questions. Therefore, interdisciplinary approach with gastroenterologists, dermatologists,  endocrinologists and other specialists is often required treatment of this patients group. In addition, the transition of the inflammatory process to a chronic form and the encapsulation of the inflammatory focus and / or the formation of a halazion requires an accurate algorithm of actions from the practitioner, which depends on the duration of the pathological process. There is always a question — what form of an antibacterial drug is better to prescribe — ointment or drops? In addition, there is no consensus on the use of hormone therapy in the treatment of meibomyitis, hordeolum and chalazion. This article presents an algorithm for the prevention and treatment of this group of patients, which involves a certain sequence of therapeutic and preventive measures, depending on the severity and duration of the inflammatory process. Eyelid hygiene (warm compresses + self-massage of the eyelids with gel) is recommended in case of chronic blepharitis clinical signs, complaints of dryness, discomfort, wearing contact lenses. In case of the acute inflammatory process — meibomyitis and/or hordeolum in addition to eyelid hygiene, local antibiotic therapy is recommended. If a halazion is forming the choice of treatment tactics (local instillation therapy, intracapsular administration of a prolonged corticosteroid or surgical treatment) depends on the halazion duration (more or less than 2 months). The presented algorithm has the practical importance, since adequate treatment will not only eliminate the focus of chronic infection on the eyelids, but also improve the patient’s quality of life, since the presence of such a disease gives pronounced psycho-emotional discomfort because of its localization zone