Investigating the subjective cooling effect of eyelid cleansing gel on eyelid and ocular surface temperature

PurposeTo investigate if the application of Blephagel, an eyelid cleansing gel, causes subjective and/or objective cooling effects by measuring ocular symptomology and temperature. MethodsTwenty-five healthy subjects underwent baseline non-invasive temperature measurements on the closed upper eyelid (centrally, nasally, and temporally) and ocular surface temperature (OST) on both eyes using an infrared camera. A standard application of Blephagel was then applied to the closed upper eyelid and eyelashes with a sterile cotton-wool to one eye selected at random. Temperature measures were then repeated on both eyes after 30–60, 120–150, and 180–210 s. At each interval, subjects rated the comfort and any cooling sensation of each eye on a 0–10 scale. ResultsAfter application of the gel, there was a significant difference in temperature at all locations on the eyelid between the test and control eyes over time (F = 9.322, p < 0.001). Post hoc analysis revealed this was significant from 30 to 60 s interval (36.3 ± 1.1 °C versus 37.2 ± 0.7 °C; p < 0.001) and the 120–150 s interval (36.8 ± 0.8 °C versus 37.2 ± 0.6 °C; p < 0.001). There was no significant variation between the OST locations over time (F = 3.350, p = 0.07). With respect to symptoms, there was a significant increase in cooling sensation in the test eye compared to the control eye over time (F = 10.438, p < 0.001), that remained throughout the experiment. ConclusionsBlephagel produces a reduction in temperature of the eyelids that is accompanied with a subjective cooling sensation

Correlation of acromial morphology in association with rotator cuff tear : a retrospective study

Purpose: There have been many studies that have attempted to correlate radiographic acromial characteristics with rotator cuff tears, but the results have not been conclusive. Rotator cuff tears (RCT) are the common aetiology of shoulder pain. We assessed the association of rotator cuff tears with commonly used radiographic parameters of acromial morphology and their different radiographic characteristics. Material and methods: From a retrospective study of 98 patients, we characterised acromial type and measured acromial thickness (AT), critical shoulder angle (CSA), lateral acromial angle (LAA), acromiohumeral distance (AHD), and acromion index (AI) on a 1.5T MRI, from 68 patients with partial or full-thickness supraspinatus tendon tears and 30 controls without tears. Results: Out the 68 patients with rotator cuff tear, supraspinatus was the most commonly affected tendon, with 86% (59) cases showing abnormalities. The average age of the patients was 45.11 ± 21.45 years with male dominance (80%). Partial tears of rotator cuff were more common than complete tears. Forty-eight cases showed partial tears in supraspinatus as compared to 11 cases of complete tears. The acromial type did not show any correlation with any particular cuff lesion. The AT and AI of controls were significantly smaller than cuff-tear patients. The LAA of cuff-tear patients was significantly different from that of control patients. The impingement patients demonstrated a significantly greater acromial thickness, larger CSA, decreased AHD, and decreased LAA than their control counterparts. Conclusions: A higher prevalence of rotator cuff tears and impingement associated with low lateral acromial angle, larger CSA and decreased AHD was observed. AT and AI have a direct correlation with rotator cuff tear

Microwave decontamination of eyelid warming devices for the treatment of meibomian gland dysfunction

PURPOSE: The role of bacteria in meibomian gland dysfunction is unclear, yet contamination of compresses used as treatment may exacerbate this condition. This study therefore determined the effect of heating on bacteria on two forms of compress. METHODS: Cotton flannels and MGDRx EyeBags (eyebags) were inoculated by adding experimental inoculum (Staphylococcus aureus, Streptococcus pyogenes, Pseudomonas aeruginosa; one species for each set of 3 eyebags and flannels). One of each were then randomised in to 3 groups: no heating (control); therapeutic (47.4±0.7°C); or sanitisation (68±1.1°C). After treatment, bacteria cell numbers were calculated. The experiment was repeated in triplicate. RESULTS: There was a statistically significant difference between each treatment with the eyebag for S. aureus (control=7.15±0.11logC/ml, therapeutic heating=5.24±0.59logC/ml, sanitisation heating=3.48±1.43logC/ml; P<0.001) and S. pyogenes (7.36±0.13, 5.73±0.26, 4.75±0.54; P<0.001). P. aeruginosa also showed a significant reduction (P<0.001) from control (6.39±0.34) to therapeutic (0.33±0.26) and sanitisation (0.33±0.21), but the latter were similar (P=1.000). For the flannels, there was significant difference between each treatment for S. aureus (6.89±0.46, 3.96±1.76, 0.42±0.90; P<0.001). For S. pyogenes, there was a significant reduction (P<0.001) from control (7.51±0.10) to therapeutic (5.91±0.62) and sanitisation (5.18±0.8), but the latter were similar (P=0.07). For P. aeruginosa, there was a significant difference (P<0.001) from control (7.15±0.36) to sanitisation (5.83±0.44); but not to therapeutic (6.84±0.31) temperatures (P=0.07). CONCLUSIONS: Therapeutic heating produces a significant reduction in bacteria on the eyebags, but only sanitisation heating appears effective for flannels. However, patients should be advised to heat the eyebag to sanitisation temperatures on initial use

The influence of end of day silicone hydrogel daily disposable contact lens fit on ocular comfort, physiology and lens wettability

Purpose: To quantify the end-of-day silicone-hydrogel daily disposable contact lens fit and its influence of on ocular comfort, physiology and lens wettability. Methods: Thirty-nine subjects (22.1. ±. 3.5 years) were randomised to wear each of 3 silicone-hydrogel daily-disposable contact lenses (narafilcon A, delefilcon A and filcon II 3), bilaterally, for one week. Lens fit was assessed objectively using a digital video slit-lamp at 8, 12 and 16. h after lens insertion. Hyperaemia, non-invasive tear break-up time, tear meniscus height and comfort were also evaluated at these timepoints, while corneal and conjunctival staining were assessed on lens removal. Results: Lens fit assessments were not different between brands (P > 0.05), with the exception of the movement at blink where narafilcon A was more mobile. Overall, lag reduced but push-up speed increased from 8 to 12. h (P 0.05). Movement-on-blink was unaffected by wear-time (F = 0.403, P = 0.670). A more mobile lens fit with one brand did not indicate that person would have a more mobile fit with another brand (r = -0.06 to 0.63). Lens fit was not correlated with comfort, ocular physiology or lens wettability (P > 0.01). Conclusions: Among the lenses tested, objective lens fit changed between 8. h and 12. h of lens wear. The weak correlation in individual lens fit between brands indicates that fit is dependent on more than ocular shape. Consequently, substitution of a different lens brand with similar parameters will not necessarily provide comparable lens fit

Ruptured Sinus of Valsalva Aneurysm Causing Aorto–Atrial Fistula and Acute Heart Failure: A Rare Encounter

A ruptured sinus of Valsalva aneurysm as a cause of aorto–atrial fistula is very rare. We present the case of a 53-year-old female who presented with symptoms of acute heart failure and suspicion of an aorto–atrial fistula found on a transthoracic echocardiogram, which was confirmed on transesophageal echocardiography. A coronary angiogram showed normal coronary arteries but confirmed the right aorto–atrial fistula on aortogram. She underwent successful surgical repair of the fistula. Her postoperative echocardiogram showed a normal right atrium and right ventricle with no shunt. A ruptured sinus of Valsalva aneurysm is a devastating event and presents as acute heart failure. Prompt diagnosis and surgical repair is necessary to prevent mortality

Impact of Bariatric Surgery-Induced Weight Loss on Anterior Eye Health in Patients with Obesity

The aim of the present research was to assess the effect of bariatric surgery-induced weight loss on the tear film and ocular surface of patients with obesity. A total of 29 participants with obesity (aged 47.2 10.1 years, 8 male) were measured at baseline and followed up one year after Roux-en-Y gastric bypass (RYGB) surgery. General anthropometric data, as well as serum lipid markers of cholesterol, were assessed in all individuals. Bilateral anterior eye measurements of tear meniscus height (TMH), non-invasive tear breakup time, bulbar and limbal redness and infrared meibography were captured using the Keratograph K5M (Oculus) and ocular surface damage was evaluated using fluorescein sodium and lissamine green staining. Bariatric surgery resulted in significant loss of weight (body mass index p 0.05). Although there were trends for a reduced TMH and a decrease in meibomian gland dropout after bariatric surgery, these differences were also insignificant (p > 0.05). In conclusion, weight reduction through bariatric surgery did not have an effect on the tear film or ocular surface in unselected patients with obesity

Agreement and repeatability of four different devices to measure non-invasive tear breakup time (NIBUT)

Purpose: Since tear film stability can be affected by fluorescein, the Dry Eye Workshop (DEWSII) recommended non-invasive measurement of tear breakup time (NIBUT). The aim of this study was to investigate the agreement and repeatability of four different instruments in the measurement of NIBUT. Methods: 72 participants (mean 24.2 ± 3.6 years) were recruited for this multi-centre, cross-sectional study. NIBUT was measured three times from one eye using each of the instruments in randomized order on two separate sessions during a day, separated by at least 2 h. NIBUT was performed at three sites (Switzerland, Germany and UK) using three subjective instruments, Tearscope Plus (Keeler, Windsor, UK) (TS), Polaris (bon Optic, Lübeck, Germany) (POL), EasyTear Viewplus (Easytear, Rovereto, Italy) (ET) and the objective Keratograph 5 M (Oculus Optikgeräte GmbH, Wetzlar, Germany) (KER). As the latter instrument only analyses for 24 s, all data was capped at this value. Results: NIBUT measurements (average of both sessions) between the four instruments were not statistically significantly different: TS (median 10.4, range 2.0–24.0 s), POL (10.1, 1.0–24.0 s), ET (10.6, 1.0–24.0 s) and KER (11.1, 2.6–24.0 s) (p = 0.949). The objective KER measures were on average (1.2 s ± 9.6 s, 95 % confidence interval) greater than the subjective evaluations of NIBUT with the other instruments (mean difference 0.4 s ± 7.7 s, 95 % confidence interval), resulting in a higher limits of agreement. The slope was -0.08 to 0.11 indicating no bias in the difference between instruments with the magnitude of the NIBUT. Repeated measurements from the two sessions were not significantly different for TS (p = 0.584), POL (p = 0.549), ET (p = 0.701) or KER (p = 0.261). Conclusions: The four instruments evaluated for their measurement of tear stability were reasonably repeatable and give similar average results

Ventricular fibrillation treated by cryotherapy to the right ventricular outflow tract: a case report.

BACKGROUND: Arrhythmias originating from the right ventricular outflow tract are generally considered benign but cases of cardiac arrest have been described, usually associated with polymorphic ventricular tachycardia or extrasystoles with short coupling intervals. CASE PRESENTATION: We report the case of a 54-year-old Caucasian woman with symptomatic right ventricular outflow tract arrhythmias without structural heart disease who suffered a ventricular fibrillation arrest without prior malignant clinical features. Cryoablation was performed and an implantable cardioverter defibrillator was implanted. She has since been free of arrhythmia for 7 years and has asked that the implantable cardioverter defibrillator not be replaced when the battery becomes depleted. CONCLUSIONS: Although usually benign, right ventricular outflow tract tachycardia can be life-threatening. Even the most malignant cases can be cured by ablation