Favorable effects of lacrimal plugs in patients with an anophthalmic socket

BACKGROUND: The use of punctal plugs in the treatment of dry eyes is well established. Anophthalmic patients have less tears in the anophthalmic socket in comparison to their normal side, due to an absent corneal reflex (Lee & Elsie, 1981a,b). Many of those patients complain of dry eye symptoms, even when they are treated with tear replacement therapy. The authors wished to examine whether they could improve their dry socket complaints with punctal plugs. PURPOSE: To evaluate the clinical efficacy and tolerability of punctal plug (Smart Plugs) insertion in anophthalmic patients with symptoms of dry eye. PATIENTS AND METHODS: Interventional case series. Fifteen anophthalmic patients with dry eye symptoms, a Schirmer test of less than 3 mm and an open lacrimal passage were examined before and after insertion of punctal plugs. The patients were asked for their subjective evaluation of the treatment and were examined to evaluate the change. Schirmer tests were compared. Bacterial cultures were taken at both visits. RESULTS: Schirmer results of less than 3 mm in the anophthalmic socket were obtained in 75% of patients with dry eyes symptoms; 87% of patients in whom punctal plugs were inserted reported an improvement in dry eye sensation. More than half of the patients demonstrated less discharge (p < or = 0.05). Schirmer tests improved from 1.4 mm to 1.9 mm (p < or = 0.05). Patients with a Schirmer outcome of 2 mm or more tended to have less pathogenic bacterial cultures (p = 0.11). CONCLUSION: Punctal plugs improve the symptoms and signs of dry socket. Punctal plugs seem to reduce the pathogenic bacterial growth in the anophthalmic socke

Graves’ orbitopathy in a patient with adrenoleukodystrophy after bone marrow transplantation

OBJECTIVE: For many years, the treatment of X-linked childhood cerebral adrenoleukodystrophy (XALD) consisted of hydrocortisone replacement and a mixture of short chain-fatty acids, known as 'Lorenzo's oil'. Recently, bone marrow transplantation (BMT) has also been used. CASE REPORT: We report the case of a patient affected by XALD who developed Graves' hyperthyroidism (GH) and Graves' orbitopathy (GO) after BMT and who we could follow-up for 6.5 years afterwards. EVIDENCE SYNTHESIS: A boy affected by XALD was treated at the age of 6 years, with a whole BMT from his sister. One year after BMT, the transplanted patient presented TSH at the lower normal value and 3 years later he developed thyrotoxicosis. After a further 2 years, the patient developed GO, which showed clinical evidence of reactivation 5 years after its onset as a consequence of an attempt to treat thyrotoxicosis by means of I(131) (300 MBq). Seven years after BMT, the donor showed alterations of thyroid autoimmunity and 1 year thereafter she developed GH. She never presented GO during a subsequent 5 year follow-up. CONCLUSIONS: This case illustrates that autoimmunity originating from a pre-symptomatic donor can be transferred into the host during allogeneic stem cell transplantation. In cases where autoimmune phenomena are recognized in the donor prior to donation, alternative donors or T-cell manipulation of the graft might be considered

Graves' orbitopathy in a patient with adrenoleukodystrophy after bone marrow transplantation

Objective: For many years. the treatment of X-linked childhood cerebral adrenoleukodystrophy (XALD) consisted of hydrocortisone replacement and a mixture of short chain-fatty acids, known as 'Lorenzo's oil'. Recently. bone marrow, transplantation (BMT) has also been used. Case report: We report the case of a patient affected by XALD who developed Graves' hyperthyroidism (GH) and Graves' orbitopathy (GO) after BMT and who we could follow-up for 6.5 years afterwards. Evidence synthesis: A boy affected by XALD was treated at the age of 6 years. with a whole BMT front his sister. One year after BMT. the transplanted patient presented TSH at the lower normal Value and 3 years later he developed thyrotoxicosis. After it further 2 years. the patient developed GO, which showed clinical evidence of reactivation 5 years after its onset as a consequence of an attempt to treat thyrotoxicosis by means of I-131 (300 MBq). Seven years after BMT. the donor showed alterations of thyroid autoimmunity and 1 year thereafter she developed GH. She never presented GO during it Subsequent 5 year follow-up Conclusions: This case illustrates that autoimmunity originating Front it pre-symptomatic donor can be transferred into the host during allogeneic stem cell transplantation. In cases where autoimmune phenomena are recognized in the donor prior to donation. alternative donors or T-cell manipulation of the graft might be considere

Socket Inflammation and Infection

Although an anophthalmic socket is by definition “without an eye,” all of the major supportive tissues for both eye and socket health typically remain behind after surgery. These include the eyelids and Meibomian glands, the palpebral and forniceal conjunctiva, the goblet cells, the glands of Krause and Wolfring, the lacrimal gland, and the nasolacrimal drainage system. In addition to performing their major natural functions, these tissues also have to adapt and tolerate the presence of a chronic foreign body, i.e., an ocular prosthesis, in patients who have been rehabilitated after eye removal. Retention of a comfortable and cosmetically appealing prosthesis is a key concern of patients with anophthalmic sockets. However, complaints of watering, discharge, and pain are not uncommon and may originate from both socket inflammation and infection. Rarely, uncontrolled socket inflammation may result in the growth of pyogenic granulomas which render prosthesis wear difficult or exposure of the underlying ocular implant which may become secondarily infected and require surgical removal