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The Non-Invasive Assessment of the Diurnal Variation in Corneal Sensitivity and Thickness
TEAR FILM & OCULAR SURFACE THE NON-INVASIVE ASSESSMENT OF THE DIURNAL VARIATION IN CORNEAL SENSITIVITY AND THICKNESS. Paul J Murphy and Anna M Ntola. Cardiff University, School of Optometry and Vision Sciences, Cardiff, UK. Purpose. To assess the diurnal change in corneal sensitivity (CS) and corneal thickness (CT). Methods. Twenty Caucasians subjects were recruited (males=7, females=13, mean age=23.7±3.18). Subjects with any ocular condition known to affect CS were excluded. Ethical approval was obtained and subjects were asked to sign a consent form prior to participating. Central CS was assessed using both the Non-Contact Corneal Aesthesiometer (NCCA) and Cochet-Bonnet Aesthesiometer (C-BA). The NCCA stimulates the cold C fibers, while the C/BA stimulates the A mechano-sensory fibers. CT was measured using the Haag-Streit optical pachometer. All measurements were taken on the left eye, which was patched overnight. The patch was removed 5 minutes before commencing measurements in order to create a standard starting time point for all subjects. Measurements were taken every hour from 8am to 12pm, and then every 2 hours from 2pm to 10pm. The order of measurements was randomized at each time period. To assess patient training with the NCCA, the CS of seven subjects were re-measured on a second day. Results. A significant diurnal change in CS was found with the NCCA, with sensitivity lower in the morning and higher in the evening (ANOVA, p<0.0001). No significant change was found using the C-BA (ANOVA, p=0.0545). With CT a significant change was found from 8am to 12pm (ANOVA, p=0.0401), but no significant change was found from 2pm to 10pm (ANOVA, p=0.9693). A significant correlation between the first and second 2
measurements, for the re-test subgroup of NCCA was found (R =0.9655). Conclusions. 1) The NCCA was able to detect the diurnal variation in sensitivity of the C-fibers. 2) The C-BA was unable to detect any variation, due to its truncated stimulus range. 3) CT decreased through the day, having 2
an inverse relationship with CS (NCCA) (R =0.8033). 4) Measurement of corneal sensitivity with the NCCA has only a small, but consistent, learning component. Support: AMN is supported by a Greek State Foundation Scholarship (IKY)
CLASSIFICATION OF THE DRY EYE SYNDROMES. Juan Murube del Castillo, MD, PhD. University of Alcala, Madrid, Spain. History of Dry Eye has 3 main steps: The first, until the end of the 19th century the only known insufficiency of the lacrimal film was xerophthalmos or absolute dryness of the ocular surface. The second, the “Sjögren´s syndrome era” occupies almost the 20th century, and was centered on this syndrome with occasional deviations. The third, the present moment, obviously with roots in the past centuries, faces the tear film insufficiency as a polycausal, polymorphic and polytreatmental syndrome. Many classifications have been developed, giving more or less importance to the immunologic system, the associations, the subtypes of affected dacryoglands, the types of treatment, etc. May be most of them are good for their specific aims, objectives and uses. For a clinician, the final aim –to treat the patients-, determines the classification. The author -a clinicianpresents here the Madrid Triple Classification of Dry Eye for clinical use (Murube J, Benítez del Castillo JM, ChenZhuo L, Berta A, Rolando M. The Madrid triple classification of dry eye. Arch Soc Españ Oftalmol 2003:78 587-594). Any patient should be classified at least with 3 main parameters: A: Etiopathogenic: 1. Age-related. 2. Hormonal (menopause, antiandrogenic prostatic cancer treatment), 3. Immunologic (Stevens-Johnson syndrome, Sjögren syndrome, graft vs host disease), 4. Pharmacologic (anxiolytics, hypnotics), 5 Hyponutritional (avitaminosis A, chronic alcoholism) 6, Dysgenetic (alacrima, dysplasia ectodermica, aniridia), 7. Inflammatory (dacryoadenitis, blepharitis, trachoma), 8. Traumatic (lacrimal gland radiation, lid rim transposition, conjunctiva caustication), 9. Neurologic (afferent and efferent nervous damage, central hyposecretion), and 10. Tantalic (lagophthalmos, ectropion, exophthalmos). The first 5 groups are usually polyexocrinic, affecting many exocrinic glands. The last five groups are usually lacrimal, affecting only the eye or even- at least at the beginning of the syndrome-, only one type of dacryogland (aqueous, lipid, or mucinic). B: Histopathologic or ALMEN: Aquodeficient, Lipodeficient, Mucodeficient, Epitheliopathic, and Non ocular deficiencies (nose, mouth, vagina). C: Grade of Severity: Grade 1: Mainly symptoms with no or inconspicuous signs. Grade 2: Symptoms with evident but reversible signs (short BUT, keratitis punctata, etc.) and Grade 3: Symptoms with no reversible signs (corneal vascularization, corneal scarring). Grade 1 minus can be specified when symptoms appear only under overexposure of the ocular surface, and Frade 3 plus for cases with permanent visual loss. CLINICAL INFLUENCE OF TOPIC CYCLOSPORIN A ON KERATOCONJUNCTIVITIS SICCA. J. Nepp, Jörg Schauersberger, Gebtraud Schild, Ognjen Markovic, Marion Funk, Andreas Wedrich. Department of Ophthaolmology and Optometry, Medical University of Vienna, Austria. Purpose. Topical cyclosporin was dedected to influence the immunologic system. The background of Dry eyes are inflammatoric reactions, Therefore we observed the clinical reaction of topical cyclosporin A on any kind of dry eyes syndromes. Our question was, if there is a difference of the effect on immunologic caused versus non immunologic caused dry eyes. Methods. 77 patients with dry eyes syndome, especiallay who did not respond on any artificial tears were treated with topical cyclosporin A 0,4%. To compare the severness of the dry eyes syndrome the sicca score was used. Examinations were performed before application of topical cyclosporin, after one week and one month and 6 months. The Schirmer’s test (II)without anesthesia, the break up time, the lipid layer thickness and stainings of rosa-bengal and fluorescein was used. We compared the patients with immunologic dry eyes like Sjogren’s Syndrome with dry eyes of patients without immunologic backgrounds. For statistics we used the paired students t-test. Results. The Sicca-Score was 0,64 average before application of topical cyclosporin A, and decreased to 0,38 average at the last examination. There was a marked decrease of symptoms in patients with immunological background, compared with non immunological caused dryness the difference was statistical significance. The effect decreased in both groups from first to the last observation. Conclusion. We could observe an influence on the severeness and symptoms especially on immunological based symptoms. The results show the clinical advantages of the well known immunological backgorund of the topical Cyclosporin A. Commercial Relationship(s): None; Support: None
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measurements, for the re-test subgroup of NCCA was found (R =0.9655). Conclusions. 1) The NCCA was able to detect the diurnal variation in sensitivity of the C-fibers. 2) The C-BA was unable to detect any variation, due to its truncated stimulus range. 3) CT decreased through the day, having 2
an inverse relationship with CS (NCCA) (R =0.8033). 4) Measurement of corneal sensitivity with the NCCA has only a small, but consistent, learning component. Support: AMN is supported by a Greek State Foundation Scholarship (IKY)
CLASSIFICATION OF THE DRY EYE SYNDROMES. Juan Murube del Castillo, MD, PhD. University of Alcala, Madrid, Spain. History of Dry Eye has 3 main steps: The first, until the end of the 19th century the only known insufficiency of the lacrimal film was xerophthalmos or absolute dryness of the ocular surface. The second, the “Sjögren´s syndrome era” occupies almost the 20th century, and was centered on this syndrome with occasional deviations. The third, the present moment, obviously with roots in the past centuries, faces the tear film insufficiency as a polycausal, polymorphic and polytreatmental syndrome. Many classifications have been developed, giving more or less importance to the immunologic system, the associations, the subtypes of affected dacryoglands, the types of treatment, etc. May be most of them are good for their specific aims, objectives and uses. For a clinician, the final aim –to treat the patients-, determines the classification. The author -a clinicianpresents here the Madrid Triple Classification of Dry Eye for clinical use (Murube J, Benítez del Castillo JM, ChenZhuo L, Berta A, Rolando M. The Madrid triple classification of dry eye. Arch Soc Españ Oftalmol 2003:78 587-594). Any patient should be classified at least with 3 main parameters: A: Etiopathogenic: 1. Age-related. 2. Hormonal (menopause, antiandrogenic prostatic cancer treatment), 3. Immunologic (Stevens-Johnson syndrome, Sjögren syndrome, graft vs host disease), 4. Pharmacologic (anxiolytics, hypnotics), 5 Hyponutritional (avitaminosis A, chronic alcoholism) 6, Dysgenetic (alacrima, dysplasia ectodermica, aniridia), 7. Inflammatory (dacryoadenitis, blepharitis, trachoma), 8. Traumatic (lacrimal gland radiation, lid rim transposition, conjunctiva caustication), 9. Neurologic (afferent and efferent nervous damage, central hyposecretion), and 10. Tantalic (lagophthalmos, ectropion, exophthalmos). The first 5 groups are usually polyexocrinic, affecting many exocrinic glands. The last five groups are usually lacrimal, affecting only the eye or even- at least at the beginning of the syndrome-, only one type of dacryogland (aqueous, lipid, or mucinic). B: Histopathologic or ALMEN: Aquodeficient, Lipodeficient, Mucodeficient, Epitheliopathic, and Non ocular deficiencies (nose, mouth, vagina). C: Grade of Severity: Grade 1: Mainly symptoms with no or inconspicuous signs. Grade 2: Symptoms with evident but reversible signs (short BUT, keratitis punctata, etc.) and Grade 3: Symptoms with no reversible signs (corneal vascularization, corneal scarring). Grade 1 minus can be specified when symptoms appear only under overexposure of the ocular surface, and Frade 3 plus for cases with permanent visual loss. CLINICAL INFLUENCE OF TOPIC CYCLOSPORIN A ON KERATOCONJUNCTIVITIS SICCA. J. Nepp, Jörg Schauersberger, Gebtraud Schild, Ognjen Markovic, Marion Funk, Andreas Wedrich. Department of Ophthaolmology and Optometry, Medical University of Vienna, Austria. Purpose. Topical cyclosporin was dedected to influence the immunologic system. The background of Dry eyes are inflammatoric reactions, Therefore we observed the clinical reaction of topical cyclosporin A on any kind of dry eyes syndromes. Our question was, if there is a difference of the effect on immunologic caused versus non immunologic caused dry eyes. Methods. 77 patients with dry eyes syndome, especiallay who did not respond on any artificial tears were treated with topical cyclosporin A 0,4%. To compare the severness of the dry eyes syndrome the sicca score was used. Examinations were performed before application of topical cyclosporin, after one week and one month and 6 months. The Schirmer’s test (II)without anesthesia, the break up time, the lipid layer thickness and stainings of rosa-bengal and fluorescein was used. We compared the patients with immunologic dry eyes like Sjogren’s Syndrome with dry eyes of patients without immunologic backgrounds. For statistics we used the paired students t-test. Results. The Sicca-Score was 0,64 average before application of topical cyclosporin A, and decreased to 0,38 average at the last examination. There was a marked decrease of symptoms in patients with immunological background, compared with non immunological caused dryness the difference was statistical significance. The effect decreased in both groups from first to the last observation. Conclusion. We could observe an influence on the severeness and symptoms especially on immunological based symptoms. The results show the clinical advantages of the well known immunological backgorund of the topical Cyclosporin A. Commercial Relationship(s): None; Support: None
S94
THE OCULAR SURFACE / JANUARY, 2005, VOL. 3, NO. 1 / SUPPLEMENT