Methods of Screening for Meibomian Gland Dysfunction

The relevance of the modern diagnosis of meibomian glands dysfunction (MGD) increases daily. Firstly, it is caused by changing of the perception about the prevalence of this disease, according to various data it is from 40 to 71% of the population in different age groups. Considering the increasing number of patients suffering from MGD, there is the need to develop screening methods for diagnosis of this disease. Screening methods should be available not only for specialists involved in the treatment of xerosis keratoconjunctival in specialized ophthalmology clinics, but also in out-patient sector. An important aspect in the diagnosis of the severity of the functionaldisorders of the meibomian glands is the assessment of morphological status that determines the further choice of therapy. To evaluate the morphological and functional state of the meibomian glands proposed to use biometrics of meibomian glands. A slit lamp is used for examination. Furthermore, objective data characterizing the morpho-functional state of the meibomian glands, can be obtained by carrying out meibography. Authors used not only white light but also infrared light for the visualization of meibomian glands during meibography. The multifunctional ophthalmic devices equipped with infrared lighting can be used for lighting. For example, specialized slit lamps, corneal topographs, Sheympflyug camera, the fundus camera and others. We applied nonmidriatic fundus camera TOPCON TRC-NW300, using for fotoregistration of the ocular fundus. A feature of the proposed method — meyboskopy — was simplicity and absence of necessity of the investigator skills by scanning with the fundus camera of the inner surface of the eyelid. Meiboskopy doesn’t require  additional equipment and software of the fundus camera and allows to receive objective quality video of meibomian glands, it opens new diagnostic possibilities. Extending of the range of diagnostic capabilities in detecting of MGD based on the screening methods will allow time to assess the severity of this disease and to appoint pathogenetically substantiated therapy

Importance of ophthalmological examination in pregnancy

Obstetricians interest to the eye pathology is connected with the choice of tactics while looking after women expecting babies and the way of their childbirth if the pregnant patients have any eye pathology. Nowadays this question is opened to discussion, according to the literature. The frequency of performing Caesarian section reaches 10-30% if expectant mothers have any eye disease. Nevertheless, the reason for surgical childbirth is retinal detachment or its threat in most cases. The most frequent reason for retinal detachment is vitreochorioretinal retinal dystrophy, that about 14,6% of women at childbearing age are often ill. In this article the facts concerning ophthalmologic inspections of pregnant women have been systematized. All the women expecting babies must be examined by ophthalmologist before 28-30 week of pregnancy and must be examined using ophthalmoscopy in condition of the highest possible medical midriatic. If retinal tears or retinal detachment are found, laser photocoagulation is strongly recommended. If pregnant women have from high to medium myopia, they must be examined every 3 months. The next ophthalmologic examination is recommended during 32-36 week of pregnancy . After that ophthalmologist makes the final conclusion about the choice of way of childbirth considering ophthalmologic indications. Despite the fact, that ophthalmologist makes the conclusion about the preferred method of childbirth, the decision in each specific case must be made advisory together with obstetrician-gynecologist, who supervises the pregnant woman.Интерес акушеров-гинекологов к глазной патологии связан с выбором тактики ведения беременности и способа родоразрешения при наличии офтальмопатологии. В настоящее время по данным литературы вопрос о способах родоразрешения беременных с патологией органа зрения остается дискутабельным. Частота проведения операции кесарева сечения при наличии глазных заболеваний достигает 10-30%. При этом в большинстве случаев причиной оперативного родоразрешения служит наличие отслойки сетчатки или ее угрозы. В свою очередь, наиболее частой причиной отслойки сетчатки является периферическая витреохориоретинальная дистрофия, которая у женщин фертильного возраста достигает 14,6%. В работе были систематизированы данные, касающиеся офтальмологического обследования беременных. Все беременные должны быть своевременно осмотрены офтальмологом на не позднее 28-30-ой недели беременности с обязательным проведением офтальмоскопии в условиях максимального медикаментозного мидриаза. При обнаружении разрывов или отслойки сетчатки показано проведение отграничивающей лазерной коагуляции. При наличии миопии средней и высокой степени беременных необходимо осматривать в каждом триместре. Повторный осмотр офтальмологом показан на 32-36-й неделе беременности, при этом делают окончательное заключение о выборе метода родоразрешения по офтальмологическим показаниям. Несмотря на то, что офтальмолог дает заключение о предпочтительном способе родоразрешения, решение в каждой конкретной ситуации следует принимать консультативно совместно с акушером-гинекологом, курирующим беременную

Effects of Regular Physical Activity on the Visual Analyzer and the General Condition of Children and Adolescents

Purpose. to study the effect of physical exertion on the visual analyzer and the general functional state in children and adolescents who regularly engage in sports. Material and Methods. The study was conducted in a group of 600 children and adolescents aged from 8 to 17 years who were divided into two groups of 300 people: the I group — “athletes” (regularly engaged in sports), the second group — “schoolchildren” (those engaged in sports less than 3 hours per week). Each group was divided into two subgroups of 150 people — “emmetrops” and “myopes”. The parameters of visual acuity, axial eye length, indices of regional eye hemodynamics were evaluated. Results. After 12 months, the group “athletes” showed a statistically significant decrease in refraction on average by 0.14 ± 0.18 on the background of stable visual acuity. In the group “schoolchildren” there was a significant reduction in visual acuity without correction by 0.06 ± 0.19 (p = 0.004) and refractive indices by 0.35 ± 0.61 (p < 0.001) on the average. After 12 months, among the emmetrops, myopia was diagnosed in 6 % of cases in the “athletes” group and 10 % in the “schoolchildren” group. Among the “myopes” in both groups there was a significant increase in the body mass index and the number of persons with impaired functional state of the musculoskeletal system in the form of a violation of posture and shape of the foot in comparison with the “emmetrops”. Сonclusion. Regular physical activity can be considered as one of the factors preventing the development and progression of myopia, and functional disorders of the musculoskeletal system in the form of violation of posture and shape of the foot and excessive body weight — as possible risk factors for the development of myopia

Clinical Features of the Ophthalmic Status in Pregnant Women

Ophthalmologist consultation has an important role in the examination of pregnant women. In some cases, his conclusion can play a decisive role in choice of delivery method. Obstetricians-gynecologists rely on ophthalmologist opinion for determining the severity of preeclampsia; it affects the treatment tactics and the life of mother and child. Examination of a pregnant woman has a number of characteristics, with regard to them, 3 groups of patients, which can be identified: the first group — Physiological pregnancywithout ophthalmological pathology. The second group: Physiological pregnancy with eye pathology in the anamnesis: myopia, peripheral choriovitreoretinal dystrophy; retinal detachment, vitreous body, vascular membrane, etc. Third group — Pathologically flowing pregnancy with pathology resulting from pregnancy: pre-eclampsia, anemia, diabetes and others pregnant. In physiological pregnancy without ophthalmological pathology, the most common physiological changes are increased pigmentation around the eyes, ptosis, a decrease of conjunctival capillaries, changes of cornea sensitivity and thickness, and, consequently, a change in refraction with a myopic shift, a decrease of tolerance to contact lenses, a decrease intraocular pressure, hemeralopia. It is necessary to differentiate the physiological feature of pregnancy, which include, in particular, the shift of refraction to the myopia, from pathological manifestations such as retinal angiopathy, macular edema, central serous chorioretinopathy and others. An important aspect is the  identification of potentially dangerous conditions of laser retina coagulation no later than 34 weeks of gestation with considering thepossibility of rheumatogenic retinal detachment and dystrophic changes in the delivery. This procedure can allow avoiding operativedelivery in the second group of patients. Timely detection of angiospasm on fundus in patients with pre-eclampsia from the third group, will make the right choice in the tactics of managing a pregnant woman. Carrying out the minimum instillation medication regime, especially in the first trimester of pregnancy, will make it possible to reduce the negative impact of therapy on the mother and chil

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

MODERN POSSIBILITIES FOR PROPHYLAXIS OF CATARACT PROGRESSION

Cataract is one of the  most  common  diseases, especially in the  elderly. Despite  the  fact that  the  share of elderly people  in economically developed countries is higher than  in developing countries, the incidence  of cataract in people over 50 years  in Western countries is 15% and it is about  40%  in developing countries. The reasons are  unbalanced nutrition,  lack of specialized ophthalmic  care  at the initial stages of the disease, the impact of adverse environmental conditions,  etc.  Surgical treatment is the only curative method. However, there are  not always enough indications for this treatment on the one hand, and it is not always possible due to patient’s unfavorable physical status, on the other  hand.  The supportive anti-cataract therapy  should be provided with the dynamic follow-up in such  cases. The pharmaceutical industry offers anti-cataract drugs  with a different composition  and properties, they are  based on the  mechanisms of the  onset  and development of the  disease. “Oxidative stress” is one  of the  main factors, which can  be the  cause of both  nuclear  and  cortical  cataracts. There  are scattering zones in the mature nucleus  of the lens, an increase in extracellular  spaces between corrugated membrane protein-like deposits in case of cataract. It is generally believed that  the  basis  of these deposits are  denatured, initially water-soluble  proteins, which turn  into opaque  substances due to the action of quinoids products formed through  the disturbed metabolism of aromatic aminoacids (tryptophan, tyrosine,  etc.).  Based  on this theory, an anti-cataract substance — pirenoxine was developed.  It inhibits the action of quinoids and prevents the formation of the len’s opacities  and the cataracts progression

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

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

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

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