Topic- ''Eyelid/Meibomian Gland Evaluation''
Speaker: Dr Christine W. Sindt
Hello Everyone, Namaste!!
We would like to notify you all that Mero Eye Foundation is going to conduct an "EYE TALKS-Webinar", and we will be having our session live broadcasted on YouTube (Session No. 90)
DATE – Thurs, 08:00 p.m NPT, 07:45 p.m IST,
July 23th, 2020
YouTube LIVE : https://youtu.be/FBwoRQuDYlU
This document provides an overview of different types of corneal dystrophies, including their classification, clinical features, histopathology, and management. It discusses epithelial and subepithelial dystrophies, corneal dystrophies of Bowman's layer, stromal corneal dystrophies, and Descemet membrane and endothelial dystrophies. The key points are that corneal dystrophies are inherited, bilateral, and slowly progressive disorders that begin early in life and are characterized by corneal opacification without relationship to environmental factors. Diagnosis involves classification based on the anatomical layer affected and treatment typically involves managing symptoms although surgery may be needed if vision is impaired.
TFOS was incorporated and integrated in 2000 as a non-profit international organization “committed to advancing the research, literacy and educational aspects of the scientific field of the tear film and ocular surface.” Its members have been involved with the innumerous collaborative research projects, educational symposia, and peer-reviewed publications. They sponsored the2008 International Dry Eye Workshop (DEWS) comprised of an international team of expertise who gathered over a 4-year period and published an evidence-based review of classification, epidemiology, diagnosis, and management of the dry eye disease (Hartsehuh et al., 1983). The DEWS report highlighted the significance of inflammation in the development of dry eye disease
Techniques of tear film evaluation by Raju KaitiRaju Kaiti
The document summarizes techniques for evaluating the tear film, which has three layers: an outer lipid layer, intermediate aqueous layer, and inner mucous layer. Non-invasive techniques discussed include tear break-up time tests, lipid layer evaluation using interferometry, and inferior tear meniscus height measurements. Invasive techniques involve Schirmer's tests to evaluate tear secretion, fluorescein and rose bengal staining of the ocular surface, and conjunctival impression cytology to examine goblet cell density. The document provides details on procedures and normal results for each evaluation method.
Keratoconus is a degenerative eye condition where the cornea thins and changes shape, causing vision problems. The cause is unknown but risk factors include eye rubbing and genetics. Symptoms include progressively worsening vision not fully corrected by glasses. Diagnosis involves examining the cornea shape using keratometry and topography to detect thinning, steepening, and irregular astigmatism. Mild cases may need no treatment, while progressive cases can be managed with contact lenses or corneal cross-linking depending on severity.
clinical case presentation on anterior uveitisSamten Dorji
This clinical case presentation summarizes a 38-year-old male gardener who presented with right eye pain and redness for 5 days. On examination, his right eye showed circumcorneal congestion, grade +4 cells and grade +3 flare in the anterior chamber with posterior synechiae and miosis. He was diagnosed with acute anterior uveitis based on the unilateral eye symptoms and anterior chamber inflammation seen on examination. He was prescribed cycloplegic, antibiotic, and steroid eye drops as well as oral steroids to treat the condition.
Vitreous substitutes are substances used during vitreoretinal surgery to re-establish intraocular volume, assist with separating membranes from the retina, and manipulate and flatten detached retina. They are also used postoperatively as long-term tamponading agents to maintain the retina in apposition. Common vitreous substitutes used include balanced salt solution, air, viscoelastic fluids, silicone liquid, and perfluorocarbon liquids. Gases such as air, SF6, and C3F8 are employed during retinal detachment surgery to provide internal tamponade and are chosen based on their duration, expansion properties, and buoyancy effects. Complications can include increased intraocular pressure, lens opac
Lamellar keratoplasty involves replacing only a partial thickness of the diseased cornea, sparing the healthy posterior layers. It is less invasive than penetrating keratoplasty. Anterior lamellar keratoplasty techniques aim to replace the anterior corneal layers above Descemet's membrane for conditions like scars, dystrophies, or infections. The big bubble technique using injected air is effective at separating the layers, while viscoelastic dissection and hydrodelamination are alternatives. Outcomes depend on the dissection method and surgeon experience.
VKC is a chronic allergic inflammation of the ocular surface that is more common in children under 10 years of age. It involves the conjunctiva and cornea and causes symptoms like itching, redness, watering and sensitivity to light. Signs include thick mucus, transient yellow-white deposits called Horner-Tranta's dots, and large papillae on the conjunctiva that are graded based on their size. Corneal involvement can lead to punctate keratitis, erosions, ulcers and scarring if left untreated. The disease is seasonal in onset but may become perennial over time.
This document provides an overview of different types of corneal dystrophies, including their classification, clinical features, histopathology, and management. It discusses epithelial and subepithelial dystrophies, corneal dystrophies of Bowman's layer, stromal corneal dystrophies, and Descemet membrane and endothelial dystrophies. The key points are that corneal dystrophies are inherited, bilateral, and slowly progressive disorders that begin early in life and are characterized by corneal opacification without relationship to environmental factors. Diagnosis involves classification based on the anatomical layer affected and treatment typically involves managing symptoms although surgery may be needed if vision is impaired.
TFOS was incorporated and integrated in 2000 as a non-profit international organization “committed to advancing the research, literacy and educational aspects of the scientific field of the tear film and ocular surface.” Its members have been involved with the innumerous collaborative research projects, educational symposia, and peer-reviewed publications. They sponsored the2008 International Dry Eye Workshop (DEWS) comprised of an international team of expertise who gathered over a 4-year period and published an evidence-based review of classification, epidemiology, diagnosis, and management of the dry eye disease (Hartsehuh et al., 1983). The DEWS report highlighted the significance of inflammation in the development of dry eye disease
Techniques of tear film evaluation by Raju KaitiRaju Kaiti
The document summarizes techniques for evaluating the tear film, which has three layers: an outer lipid layer, intermediate aqueous layer, and inner mucous layer. Non-invasive techniques discussed include tear break-up time tests, lipid layer evaluation using interferometry, and inferior tear meniscus height measurements. Invasive techniques involve Schirmer's tests to evaluate tear secretion, fluorescein and rose bengal staining of the ocular surface, and conjunctival impression cytology to examine goblet cell density. The document provides details on procedures and normal results for each evaluation method.
Keratoconus is a degenerative eye condition where the cornea thins and changes shape, causing vision problems. The cause is unknown but risk factors include eye rubbing and genetics. Symptoms include progressively worsening vision not fully corrected by glasses. Diagnosis involves examining the cornea shape using keratometry and topography to detect thinning, steepening, and irregular astigmatism. Mild cases may need no treatment, while progressive cases can be managed with contact lenses or corneal cross-linking depending on severity.
clinical case presentation on anterior uveitisSamten Dorji
This clinical case presentation summarizes a 38-year-old male gardener who presented with right eye pain and redness for 5 days. On examination, his right eye showed circumcorneal congestion, grade +4 cells and grade +3 flare in the anterior chamber with posterior synechiae and miosis. He was diagnosed with acute anterior uveitis based on the unilateral eye symptoms and anterior chamber inflammation seen on examination. He was prescribed cycloplegic, antibiotic, and steroid eye drops as well as oral steroids to treat the condition.
Vitreous substitutes are substances used during vitreoretinal surgery to re-establish intraocular volume, assist with separating membranes from the retina, and manipulate and flatten detached retina. They are also used postoperatively as long-term tamponading agents to maintain the retina in apposition. Common vitreous substitutes used include balanced salt solution, air, viscoelastic fluids, silicone liquid, and perfluorocarbon liquids. Gases such as air, SF6, and C3F8 are employed during retinal detachment surgery to provide internal tamponade and are chosen based on their duration, expansion properties, and buoyancy effects. Complications can include increased intraocular pressure, lens opac
Lamellar keratoplasty involves replacing only a partial thickness of the diseased cornea, sparing the healthy posterior layers. It is less invasive than penetrating keratoplasty. Anterior lamellar keratoplasty techniques aim to replace the anterior corneal layers above Descemet's membrane for conditions like scars, dystrophies, or infections. The big bubble technique using injected air is effective at separating the layers, while viscoelastic dissection and hydrodelamination are alternatives. Outcomes depend on the dissection method and surgeon experience.
VKC is a chronic allergic inflammation of the ocular surface that is more common in children under 10 years of age. It involves the conjunctiva and cornea and causes symptoms like itching, redness, watering and sensitivity to light. Signs include thick mucus, transient yellow-white deposits called Horner-Tranta's dots, and large papillae on the conjunctiva that are graded based on their size. Corneal involvement can lead to punctate keratitis, erosions, ulcers and scarring if left untreated. The disease is seasonal in onset but may become perennial over time.
This document provides information on hereditary macular dystrophies and macular function tests. It begins by describing the anatomical landmarks of the macula, including the fovea and foveola. It then discusses psychophysical macular function tests such as visual acuity testing, color vision testing, photostress testing, and Amsler grid testing. The document also covers electrophysiological tests like electroretinography (ERG) which objectively measures retinal electrical activity in response to light. ERG testing analyzes the a-wave from photoreceptors and b-wave from bipolar cells.
This document discusses neovascular glaucoma, also known as rubeotic glaucoma. It begins by defining the terminology and describing the clinical features. The main causes of neovascular glaucoma are diabetic retinopathy, central retinal vein occlusion, and carotid artery occlusive disease, all of which result in ocular tissue hypoxia. This hypoxia leads to the release of angiogenic factors like vascular endothelial growth factor that induce new blood vessel growth on the iris and in the anterior chamber angle, causing glaucoma. Later sections discuss theories of neovasculogenesis, angiogenic and vasoinhibitory factors, clinical course, differential diagnosis, medical management, and surgical options.
Ocular injuries can be classified as open globe, closed globe, or periocular injuries. Open globe injuries involve a full thickness break in the eye wall, while closed globe injuries do not penetrate the full thickness. Periocular injuries involve the tissues surrounding the eye. Common closed globe injuries include conjunctival and corneal abrasions, hyphema, and retinal detachment. Lid lacerations may require repair depending on their location. Blunt eye trauma requires examination of visual acuity and eye anatomy to check for injuries like ruptured globe or optic nerve damage. Suspected open globe injuries or those with vision loss require emergent ophthalmology referral.
Toxic amblyopia is caused by damage to the optic nerve or retina due to exogenous or endogenous poisons. It can be caused by substances like tobacco, alcohol, methyl alcohol, quinine, and ethambutol. Tobacco and alcohol amblyopia typically affect the central vision and cause fogginess and difficulty with near work. Methyl alcohol amblyopia is usually acute and can cause complete and permanent blindness due to optic nerve damage. Testing is important to differentiate functional and organic amblyopia and guide appropriate treatment.
This document summarizes Herpes Simplex Virus (HSV) keratitis and Herpes Zoster Ophthalmicus. It discusses the pathology, clinical features, diagnosis, and treatment of HSV epithelial keratitis and stromal/endothelial keratitis. It presents two case scenarios of recurrent HSV keratitis. It also summarizes the findings of the Herpetic Eye Disease Study regarding the efficacy of antivirals and steroids for treating HSV eye infections.
This document summarizes different types of corneal dystrophies. It classifies corneal dystrophies into 4 main categories based on the affected anatomical level: epithelial dystrophies, Bowman's layer dystrophies, stromal dystrophies, and Descemet's membrane and endothelial dystrophies. For each category and subtype, it discusses inheritance, pathology, signs, symptoms, onset, histology where relevant, and treatment options. The document provides detailed information on various corneal dystrophies including Cogan's epithelial dystrophy, lattice corneal dystrophy, granular corneal dystrophy, Fuchs' endothelial dystrophy, and congenital hereditary endothelial dystrophy.
This document discusses various refractive surgery procedures used to correct refractive errors of the eye, including incisional keratotomy techniques, lamellar procedures, laser ablation procedures, corneal implants, and lens-based procedures. It provides details on common procedures like radial keratotomy, LASIK, PRK, and LASEK. It covers patient evaluation, surgical techniques, potential complications, and advantages of different approaches. Wavefront-guided customized excimer laser surgery is also introduced to correct higher-order aberrations in addition to spherical and cylindrical errors.
Dr. Monika Soni presented on the topic of tear film at the upgraded department of ophthalmology at MGMMC & MYH Indore. The presentation discussed the anatomy and physiology of tear film, including the three layers of the tear film, mechanisms of tear secretion and distribution, functions of the tear film, tests to evaluate tear film such as tear breakup time, Schirmer's test, and osmolarity. A variety of glands contribute secretions to form and maintain the tear film, which is essential for maintaining a clear cornea and proper vision.
- Three cases of bilateral corneal opacities are presented
- All cases show central corneal opacity without signs of inflammation or vascularization
- This suggests a diagnosis of corneal dystrophy, which is a hereditary condition causing bilateral corneal opacity that is non-inflammatory in nature
- Corneal dystrophy can be classified anatomically based on the layer of the cornea involved, or by the new IC3D classification system which integrates phenotype, pathology, and genetics
Ocular Surface Squamous Neoplasia (OSSN) is a spectrum of dysplastic and malignant epithelial lesions of the conjunctiva and cornea. It is most commonly caused by ultraviolet radiation exposure and can range from benign dysplasia to invasive squamous cell carcinoma. Clinical features may include elevated, variably shaped lesions near the limbus. Differential diagnosis includes pterygium, papilloma, and melanoma. Treatment involves surgical excision combined with cryotherapy or topical chemotherapy depending on size and invasiveness of the lesion.
This document provides guidance on evaluating patients presenting with gradual loss of vision. It outlines taking a history to determine factors like onset, progression, associated symptoms and medical history. The physical exam involves assessing visual acuity, the red reflex, visual fields and optic nerve/macula. Common causes of gradual vision loss include glaucoma, refractive error, cataract, diabetic retinopathy and age-related macular degeneration. Treatment depends on the underlying cause but may involve prescription lenses, medical management or referral for further evaluation.
This document discusses corneal collagen cross linking (C3R), a treatment for keratoconus. It begins by describing keratoconus and its symptoms. It then discusses the original C3R protocol developed by Seiler and Spoerl, which involves removing the corneal epithelium, soaking the cornea in riboflavin, and exposing it to UV light. Modifications to the protocol aim to reduce complications by using higher irradiance for less time, different riboflavin delivery methods, and leaving the epithelium intact. Studies show C3R increases corneal collagen bonds and rigidity while halting keratoconus progression in most cases. Contraindications and post-op care are also outlined
Trichiasis is a condition characterized by misdirected eyelashes that rub against the cornea. It can be caused by entropion due to conditions like trachoma or scarring. Symptoms include irritation, pain, and blurred vision. Treatment options include epilation, cryotherapy, or electrolysis to remove misdirected eyelashes. Lagophthalmos is incomplete eye closure that can result from lid paralysis or contraction. It puts the cornea at risk for drying and infection if not treated with lubricants, taping, or tarsorrhaphy surgery. Ptosis refers to drooping of the upper eyelid and can be congenital, neurogenic, myogenic, or involutional in nature. The
Dry eye is a disease of the tear film and ocular surface caused by reduced tear production or increased tear evaporation. It results in eye discomfort, visual disturbance, and potential ocular surface damage. Dry eye can be caused by problems with the lacrimal functional unit such as aging, autoimmune disease like Sjogren's syndrome, or environmental factors. Diagnosis involves evaluating tear production via tests like Schirmer's test and tear breakup time, and assessing ocular surface staining. Treatment depends on dry eye severity and may include artificial tears, anti-inflammatories, punctal plugs, and management of underlying conditions. The goal is to supplement tears, reduce evaporation, stimulate natural tear production, and minimize
Corneal dystrophy is a group of inherited bilateral corneal conditions characterized by progressive corneal opacity. There are several classifications of corneal dystrophy based on the layer of the cornea affected, including epithelial dystrophy affecting the epithelium and basement membrane, Bowman's layer dystrophy, stromal dystrophy affecting the stroma, and Descemet's membrane and endothelial dystrophy affecting the inner layers. Diagnosis involves slit lamp examination to determine the opacity pattern, location, and characteristics in direct and retroillumination. Treatment depends on the severity and type but may include lubricants, therapeutic contact lenses, corneal transplantation, or newer procedures like DSAEK.
Posterior vitreous detachment (PVD) occurs when the vitreous gel in the eye separates from the retina. It is a natural aging process that usually happens in people's 60s and 70s. PVDs are often asymptomatic, but can sometimes cause floaters, flashes of light, or a cobweb-like visual effect. While PVD itself does not affect vision, on rare occasions it can cause retinal tears or detachments, which require prompt treatment to prevent vision loss if left untreated. PVD is typically diagnosed via dilated eye exam but may also require tests like OCT or ultrasound. No treatment is needed for most PVDs but follow up exams are recommended to check for complications.
This document provides an overview of vitreous substitutes used in retinal surgery, focusing on intraocular gases. It discusses the anatomy and functions of the vitreous humour. The history and various types of vitreous substitutes are described, including intraocular gases, silicone oil, and perfluorocarbon liquids. Properties, dynamics, clinical applications, and complications of commonly used intraocular gases like air, sulfur hexafluoride and perfluorocarbons are summarized in detail. Postoperative care involving face down positioning is also mentioned.
This document discusses episcleritis and scleritis. Episcleritis is inflammation of the connective tissue between the sclera and conjunctiva that causes redness and mild pain. Scleritis is a more severe inflammation that occurs within the sclera and can be associated with connective tissue diseases. Scleritis can lead to complications like glaucoma if not treated. The document describes diagnostic tests and treatment options for episcleritis and different types of scleritis, which involve lubricants, topical steroids, oral steroids, and immunosuppressive drugs depending on severity.
This document provides an overview of blepharitis, including its pathogenesis, diagnosis, and treatment. It defines blepharitis as a chronic condition characterized by an intricate relationship between ocular flora and meibomian gland dysfunction leading to lid inflammation. Key factors in blepharitis include abnormal secretions, organisms like staphylococcus, and a dysfunctional tear film. Diagnosis is mainly clinical but can include cultures, gland expression testing, and meibography. Treatment focuses on lid hygiene like warm compresses, scrubs, and massage as well as managing meibomian gland dysfunction and underlying causes like bacteria, Demodex, or rosacea.
This document provides information on hereditary macular dystrophies and macular function tests. It begins by describing the anatomical landmarks of the macula, including the fovea and foveola. It then discusses psychophysical macular function tests such as visual acuity testing, color vision testing, photostress testing, and Amsler grid testing. The document also covers electrophysiological tests like electroretinography (ERG) which objectively measures retinal electrical activity in response to light. ERG testing analyzes the a-wave from photoreceptors and b-wave from bipolar cells.
This document discusses neovascular glaucoma, also known as rubeotic glaucoma. It begins by defining the terminology and describing the clinical features. The main causes of neovascular glaucoma are diabetic retinopathy, central retinal vein occlusion, and carotid artery occlusive disease, all of which result in ocular tissue hypoxia. This hypoxia leads to the release of angiogenic factors like vascular endothelial growth factor that induce new blood vessel growth on the iris and in the anterior chamber angle, causing glaucoma. Later sections discuss theories of neovasculogenesis, angiogenic and vasoinhibitory factors, clinical course, differential diagnosis, medical management, and surgical options.
Ocular injuries can be classified as open globe, closed globe, or periocular injuries. Open globe injuries involve a full thickness break in the eye wall, while closed globe injuries do not penetrate the full thickness. Periocular injuries involve the tissues surrounding the eye. Common closed globe injuries include conjunctival and corneal abrasions, hyphema, and retinal detachment. Lid lacerations may require repair depending on their location. Blunt eye trauma requires examination of visual acuity and eye anatomy to check for injuries like ruptured globe or optic nerve damage. Suspected open globe injuries or those with vision loss require emergent ophthalmology referral.
Toxic amblyopia is caused by damage to the optic nerve or retina due to exogenous or endogenous poisons. It can be caused by substances like tobacco, alcohol, methyl alcohol, quinine, and ethambutol. Tobacco and alcohol amblyopia typically affect the central vision and cause fogginess and difficulty with near work. Methyl alcohol amblyopia is usually acute and can cause complete and permanent blindness due to optic nerve damage. Testing is important to differentiate functional and organic amblyopia and guide appropriate treatment.
This document summarizes Herpes Simplex Virus (HSV) keratitis and Herpes Zoster Ophthalmicus. It discusses the pathology, clinical features, diagnosis, and treatment of HSV epithelial keratitis and stromal/endothelial keratitis. It presents two case scenarios of recurrent HSV keratitis. It also summarizes the findings of the Herpetic Eye Disease Study regarding the efficacy of antivirals and steroids for treating HSV eye infections.
This document summarizes different types of corneal dystrophies. It classifies corneal dystrophies into 4 main categories based on the affected anatomical level: epithelial dystrophies, Bowman's layer dystrophies, stromal dystrophies, and Descemet's membrane and endothelial dystrophies. For each category and subtype, it discusses inheritance, pathology, signs, symptoms, onset, histology where relevant, and treatment options. The document provides detailed information on various corneal dystrophies including Cogan's epithelial dystrophy, lattice corneal dystrophy, granular corneal dystrophy, Fuchs' endothelial dystrophy, and congenital hereditary endothelial dystrophy.
This document discusses various refractive surgery procedures used to correct refractive errors of the eye, including incisional keratotomy techniques, lamellar procedures, laser ablation procedures, corneal implants, and lens-based procedures. It provides details on common procedures like radial keratotomy, LASIK, PRK, and LASEK. It covers patient evaluation, surgical techniques, potential complications, and advantages of different approaches. Wavefront-guided customized excimer laser surgery is also introduced to correct higher-order aberrations in addition to spherical and cylindrical errors.
Dr. Monika Soni presented on the topic of tear film at the upgraded department of ophthalmology at MGMMC & MYH Indore. The presentation discussed the anatomy and physiology of tear film, including the three layers of the tear film, mechanisms of tear secretion and distribution, functions of the tear film, tests to evaluate tear film such as tear breakup time, Schirmer's test, and osmolarity. A variety of glands contribute secretions to form and maintain the tear film, which is essential for maintaining a clear cornea and proper vision.
- Three cases of bilateral corneal opacities are presented
- All cases show central corneal opacity without signs of inflammation or vascularization
- This suggests a diagnosis of corneal dystrophy, which is a hereditary condition causing bilateral corneal opacity that is non-inflammatory in nature
- Corneal dystrophy can be classified anatomically based on the layer of the cornea involved, or by the new IC3D classification system which integrates phenotype, pathology, and genetics
Ocular Surface Squamous Neoplasia (OSSN) is a spectrum of dysplastic and malignant epithelial lesions of the conjunctiva and cornea. It is most commonly caused by ultraviolet radiation exposure and can range from benign dysplasia to invasive squamous cell carcinoma. Clinical features may include elevated, variably shaped lesions near the limbus. Differential diagnosis includes pterygium, papilloma, and melanoma. Treatment involves surgical excision combined with cryotherapy or topical chemotherapy depending on size and invasiveness of the lesion.
This document provides guidance on evaluating patients presenting with gradual loss of vision. It outlines taking a history to determine factors like onset, progression, associated symptoms and medical history. The physical exam involves assessing visual acuity, the red reflex, visual fields and optic nerve/macula. Common causes of gradual vision loss include glaucoma, refractive error, cataract, diabetic retinopathy and age-related macular degeneration. Treatment depends on the underlying cause but may involve prescription lenses, medical management or referral for further evaluation.
This document discusses corneal collagen cross linking (C3R), a treatment for keratoconus. It begins by describing keratoconus and its symptoms. It then discusses the original C3R protocol developed by Seiler and Spoerl, which involves removing the corneal epithelium, soaking the cornea in riboflavin, and exposing it to UV light. Modifications to the protocol aim to reduce complications by using higher irradiance for less time, different riboflavin delivery methods, and leaving the epithelium intact. Studies show C3R increases corneal collagen bonds and rigidity while halting keratoconus progression in most cases. Contraindications and post-op care are also outlined
Trichiasis is a condition characterized by misdirected eyelashes that rub against the cornea. It can be caused by entropion due to conditions like trachoma or scarring. Symptoms include irritation, pain, and blurred vision. Treatment options include epilation, cryotherapy, or electrolysis to remove misdirected eyelashes. Lagophthalmos is incomplete eye closure that can result from lid paralysis or contraction. It puts the cornea at risk for drying and infection if not treated with lubricants, taping, or tarsorrhaphy surgery. Ptosis refers to drooping of the upper eyelid and can be congenital, neurogenic, myogenic, or involutional in nature. The
Dry eye is a disease of the tear film and ocular surface caused by reduced tear production or increased tear evaporation. It results in eye discomfort, visual disturbance, and potential ocular surface damage. Dry eye can be caused by problems with the lacrimal functional unit such as aging, autoimmune disease like Sjogren's syndrome, or environmental factors. Diagnosis involves evaluating tear production via tests like Schirmer's test and tear breakup time, and assessing ocular surface staining. Treatment depends on dry eye severity and may include artificial tears, anti-inflammatories, punctal plugs, and management of underlying conditions. The goal is to supplement tears, reduce evaporation, stimulate natural tear production, and minimize
Corneal dystrophy is a group of inherited bilateral corneal conditions characterized by progressive corneal opacity. There are several classifications of corneal dystrophy based on the layer of the cornea affected, including epithelial dystrophy affecting the epithelium and basement membrane, Bowman's layer dystrophy, stromal dystrophy affecting the stroma, and Descemet's membrane and endothelial dystrophy affecting the inner layers. Diagnosis involves slit lamp examination to determine the opacity pattern, location, and characteristics in direct and retroillumination. Treatment depends on the severity and type but may include lubricants, therapeutic contact lenses, corneal transplantation, or newer procedures like DSAEK.
Posterior vitreous detachment (PVD) occurs when the vitreous gel in the eye separates from the retina. It is a natural aging process that usually happens in people's 60s and 70s. PVDs are often asymptomatic, but can sometimes cause floaters, flashes of light, or a cobweb-like visual effect. While PVD itself does not affect vision, on rare occasions it can cause retinal tears or detachments, which require prompt treatment to prevent vision loss if left untreated. PVD is typically diagnosed via dilated eye exam but may also require tests like OCT or ultrasound. No treatment is needed for most PVDs but follow up exams are recommended to check for complications.
This document provides an overview of vitreous substitutes used in retinal surgery, focusing on intraocular gases. It discusses the anatomy and functions of the vitreous humour. The history and various types of vitreous substitutes are described, including intraocular gases, silicone oil, and perfluorocarbon liquids. Properties, dynamics, clinical applications, and complications of commonly used intraocular gases like air, sulfur hexafluoride and perfluorocarbons are summarized in detail. Postoperative care involving face down positioning is also mentioned.
This document discusses episcleritis and scleritis. Episcleritis is inflammation of the connective tissue between the sclera and conjunctiva that causes redness and mild pain. Scleritis is a more severe inflammation that occurs within the sclera and can be associated with connective tissue diseases. Scleritis can lead to complications like glaucoma if not treated. The document describes diagnostic tests and treatment options for episcleritis and different types of scleritis, which involve lubricants, topical steroids, oral steroids, and immunosuppressive drugs depending on severity.
This document provides an overview of blepharitis, including its pathogenesis, diagnosis, and treatment. It defines blepharitis as a chronic condition characterized by an intricate relationship between ocular flora and meibomian gland dysfunction leading to lid inflammation. Key factors in blepharitis include abnormal secretions, organisms like staphylococcus, and a dysfunctional tear film. Diagnosis is mainly clinical but can include cultures, gland expression testing, and meibography. Treatment focuses on lid hygiene like warm compresses, scrubs, and massage as well as managing meibomian gland dysfunction and underlying causes like bacteria, Demodex, or rosacea.
This document discusses dry eyes, also known as aqueous tear deficiency. It defines dry eyes as a non-infectious ocular surface disorder caused by a lack of tear fluid. The three layers of the normal tear film are described: the lipid layer from meibomian glands, the aqueous layer from lacrimal glands, and the mucin layer from goblet cells. Various causes of dry eyes are classified, including deficiencies in the aqueous, lipid, or mucin layers. Signs, symptoms, and diagnostic tests are outlined. Management involves tear supplementation, preservation, treatment of underlying conditions, punctal plugs, anti-inflammatories, and surgery in severe cases.
The document describes the anatomy and common diseases of the eyelids. It discusses the layers of the eyelid including skin, muscles, glands and conjunctiva. It describes common inflammatory conditions like blepharitis which can affect the eyelid margins and meibomian glands. The document also discusses structural abnormalities of the eyelids including entropion, ectropion, ptosis and distichiasis. Surgical treatments are mentioned for some conditions.
Dry eye is a common disease caused by insufficient tear production or increased tear evaporation. It affects 10-15% of the population and prevalence is higher in females and older individuals. The tear film consists of an outer lipid layer, middle aqueous layer, and inner mucus layer which together form a smooth optical surface and nourish the cornea. Dry eye is diagnosed based on symptoms, tear film breakup time, Schirmer's test, and ocular surface staining. Treatment involves artificial tears, punctal plugs, anti-inflammatories, and managing underlying conditions. Advanced cases may require punctal occlusion, contact lenses, or autologous serum tears.
Dry eye disease (DED), also known as dry eye syndrome, is a multifactorial disease characterized by deficient tear production and/or excessive tear evaporation, leading to loss of homeostasis of the tear film. DED affects the ocular surface and results in ocular irritation, visual disturbance, and in rare cases can threaten sight. It has multiple potential causes, including lacrimal gland deficiencies, meibomian gland dysfunction, exposure issues, medications, and autoimmune diseases like Sjögren's syndrome. Diagnosis considers symptoms, signs, tear film tests, and histopathology findings. Treatment aims to supplement or stimulate tears and treat ocular surface inflammation.
The document summarizes key aspects of the tear film and blinking. It describes the tear film as having three layers - an outer lipid layer, middle aqueous layer, and inner mucus layer. It discusses tear film composition, dimensions, dynamics of secretion, distribution, stability, flow, and drainage. Functions of the tear film include optical, protective, lubricative, osmotic, and nutritional roles. Blinking is described as the coordinated opening and closing of the eyelids, which aids tear secretion and distribution. Clinical tests for assessing tear quantity such as the Schirmer test and fluorescein clearance are also summarized.
this PPT contain platelets (structure and functions) and coagulation, Role of Platelets in coagulation, intrinsic and extrinsic mechanism, applied, haemophelia, DIC, Thrombocytopenia etc
It explains the secretion of the tear film,its importance and the pathologies that can happen when its not being secreted well and as well as the pathophysiology of.It also addresses the different layers of the tear film and the various ways that it can lead to the different diseases of the eye
the paper addresses the different scretory pathways and it speaks about the regulation of the production of the tear film in that the various
Layers of skin of the Eye Lids, Eye Lashes, Eye Lid Pathology, Anatomy of Con...Nina Ko
This document describes the anatomy and common pathologies of the eyelids. It discusses the layers of the eyelid including the epidermis, dermis and subcutaneous layer. It describes the meibomian glands, glands of Zeis and glands of Moll. Common infections like hordeolum, chalazion and blepharitis are summarized. Anatomical deformities including entropion, ectropion, trichiasis and distichiasis are covered. Finally, the document outlines common benign and malignant tumors of the eyelids such as papillomas, xanthelasma, hemangiomas and basal cell carcinoma.
The eyelids are mobile tissue curtains placed in front of the eyeballs. These act as shutters protecting the eyes from injuries and excessive light. These also perform an important function of spreading the tear film over the cornea and conjunctiva and also help in drainage of tears by lacrimal pump system.
This document discusses diseases of the salivary glands, focusing on inflammatory disorders of the parotid gland. It describes various causes of parotid inflammation including viral infections like mumps, bacterial infections, HIV-associated sialadenitis, and obstructive disorders. It also discusses benign conditions such as sialadenosis and Sjogren's syndrome. The document outlines the indications for and steps of parotid surgery including superficial parotidectomy, total parotidectomy, and radical parotidectomy. Post-surgical complications like Frey's syndrome are also mentioned.
This document discusses meibomian gland dysfunction (MGD), including its definition, prevalence, anatomy, pathophysiology, clinical evaluation, treatment options, case examples, and billing considerations. Key points include: MGD is a chronic abnormality of the meibomian glands characterized by terminal duct obstruction and/or changes in glandular secretion, which can result in dry eye symptoms and ocular surface disease. Evaluation involves assessing symptoms, eyelids, meibomian glands, tear film, and ocular surface. Treatment options include topical medications, oral antibiotics, in-office procedures like gland expression, and home lid hygiene. Emerging therapies and the importance of understanding MGD are also emphasized.
The lacrimal apparatus consists of the main lacrimal gland, accessory lacrimal glands, and lacrimal passages. Tears are produced in three layers - an inner mucus layer from goblet cells, a middle aqueous layer secreted by the lacrimal glands, and an outer lipid layer from Meibomian glands. Tears drain from the puncta through the lacrimal passages into the nasal cavity, powered by blinking and the lacrimal pump mechanism.
1. The document describes various diseases and conditions that can affect the eyelids including inflammatory conditions like blepharitis and hordeolum, infections like molluscum contagiosum, benign growths like chalazions, and positional abnormalities of the eyelids.
2. The anatomy of the eyelid is also summarized including its layers and muscle components.
3. Specific conditions are further described like types of ectropion and entropion and their clinical features, testing, and treatment options.
Dry eye ( investiigations & basic )Vinitkumar MJ
Dry eye, also known as keratoconjunctivitis sicca, is a condition caused by either a deficiency in tear production or abnormalities in the tear film that lead to increased tear evaporation. There are two main types - aqueous deficiency dry eye and evaporative dry eye. Common tests used to diagnose dry eye include tear film break-up time (TBUT), Schirmer test to measure tear production, and rose Bengal staining to detect damage to the ocular surface. Signs and symptoms include irritation, dryness, redness, and punctate erosions seen on fluorescein staining of the cornea. Treatment focuses on managing the underlying cause, supplementing tears, and preventing further tear film evaporation
This document discusses various disorders of the eyelids including benign and malignant lesions, disorders of eyelashes, and ptosis. Benign eyelid lesions covered include chalazion (meibomian cyst), hordeolum (stye), molluscum contagiosum, strawberry hemangioma, port wine stain, keratoacanthoma, pigmented nevi, and other miscellaneous lesions such as cysts. Signs, symptoms, and treatment are described for each condition. Malignant eyelid tumors and disorders such as entropion, ectropion, and ptosis are also mentioned.
Pseudoexfoliative syndrome and pigment dispersion syndrome and glaucomaBipin Bista
This document discusses pseudoexfoliative syndrome and pigment dispersion syndrome, which are disorders of the iris that can lead to glaucoma.
It first covers pseudoexfoliative syndrome, noting that it is a systemic disorder involving zonular instability that commonly causes open-angle glaucoma worldwide. It then discusses the epidemiology, clinical features including changes to the cornea, lens, zonules and ciliary body, iris, and angle appearance on gonioscopy. Management typically involves prostaglandin analogs, laser trabeculoplasty, or filtering surgeries.
The document next addresses pigment dispersion syndrome, covering characteristics like affecting young myopic males and signs such as Krukenberg
Dry eye syndrome is a common condition characterized by discomfort, visual disturbance, and tear film instability. It results from reduced tear production or increased tear evaporation, causing tear hyperosmolarity and ocular surface inflammation. Diagnosis involves evaluating tear production via tests like Schirmer's test and tear breakup time, and examining the ocular surface for signs of damage. Treatment focuses on replacing tears and reducing inflammation with artificial tears, cyclosporine drops, and punctal plugs. More severe cases may require procedures like tarsorrhaphy.
This document discusses several age-related diseases that can affect the ocular adnexa. The eyelids are susceptible to ectropion, entropion, dermatochalasis, ptosis, and madarosis due to changes like laxity of tissues, loss of elasticity, and muscle weakening. The lacrimal apparatus can develop dry eye or dacryocystitis from reduced tear production and inflammation. The orbit may experience enophthalmos from shrinking fat pads or bulging fat into the eyelids. Other common age-related eye conditions discussed include presbyopia, cataracts, floaters, glaucoma, macular degeneration, retinal detachment, conjunctivitis,
Similar to Comprehensive meibomian gland evaluation (20)
Lets fight with amblyopia || Optom Puneet Mero Eye
1. This document presents a case study of a 15-year-old female boxing player with amblyopia in the left eye who was undergoing active vision therapy.
2. Over the course of 3 visits spanning 1 month, the patient's visual acuity and stereopsis improved significantly in the left eye through continued use of active vision therapy techniques like Hart charts and Marsden balls instead of occlusion therapy.
3. The goal of vision therapy is to make the patient happy by providing faster and more effective treatment compared to traditional occlusion patching with less embarrassment and risk of reversal or non-compliance.
Velocity of sound is greater in solids than liquids and gases. It increases with increasing temperature, pressure, and humidity in gases. Stationary waves are produced in organ pipes and stretched strings. Open organ pipes allow all harmonics, while closed pipes allow only odd harmonics. End correction accounts for the pipe diameter. Velocity in strings increases with square root of tension. Interference of waves produces maxima and minima intensities, with the ratio of max to min intensity increasing with amplitude ratio.
This document discusses parallel plate capacitors and capacitor basics. It defines the capacitance of a parallel plate capacitor and explains how capacitance is affected by changing the plate area, distance between plates, and inserting a dielectric material. It also covers energy stored in a capacitor, electric field and potential, equipotential surfaces, and static electricity examples. Key points covered include the formula for capacitor capacitance and energy storage, and that capacitance increases when the plate area or dielectric constant increases but decreases when the distance between plates increases.
This document discusses the efficiency of a Carnot engine. It defines the efficiency formula as efficiency = (1 - T2/T1) x 100%, where T2 is the temperature of the heat sink and T1 is the temperature of the heat source. It then provides examples of efficiency calculations for Carnot engines working between different temperature ranges. It also discusses the temperature of the heat sink and source needed to achieve a given efficiency.
Speaker Name: Anjali
Topic: "Demystifying Nystagmus"
Hello Everyone, Namaste!! We would like to notify you all that Mero Eye Foundation is going to conduct an "EYE TALKS-Webinar", and we will be having our session live broadcast on YouTube (Session No. 118)
DATE: at, 07:300 PM NPT, 07:15 PM IST, 22nd May 2021.
YouTube links: https://youtu.be/b4G12rRvXFc
The document describes features of several ophthalmic devices from Nidek, including:
1. The AL SCAN OPTICAL BIOMETER which can measure 6 clinical parameters in 10 seconds and perform IOL power calculations.
2. The RS-3000 ADVANCE 2 OPTICAL COHERENCE TOMOGRAPHY which provides retina and glaucoma analysis with selectable OCT sensitivity.
3. The CV-9000R OPHTHALMIC SURGICAL SYSTEM which supports reusable equipment and intuitive touch screen controls for cataract surgery.
The document provides information about products from various ophthalmic equipment companies available through Vaishno Medisales. It details diagnostic devices such as topographers, OCT systems, and tonometers from Oculus, Heidelberg Engineering, and G-Medics. Refraction charts, lensometers, and slit lamps from Appasamy Associates are also summarized. The document aims to inform attendees of the Advancing Optometry Education conference about the ophthalmic solutions and technologies available through Vaishno Medisales.
The document provides information about products from various ophthalmic equipment companies that will be displayed at the Advancing Optometry Education 2021 virtual conference. It lists companies such as Oculus, Heidelberg Engineering, Metrovision, Takagi, and G-Medics and provides brief descriptions of 1-3 of their key products, such as the Pentacam HR, Spectralis OCT, Myopia Master, Corvis ST, and portable non-contact tonometer. The document aims to inform conference attendees about the latest ophthalmic technologies and equipment that will be showcased.
This document provides an overview of the anatomy of the conjunctiva and sclera. It discusses the embryology, parts, histology, blood supply, nerve supply, and clinical correlations of the conjunctiva. It also reviews the anatomy of the sclera and episclera, as well as inflammation of the sclera and episclera. The document is organized into sections covering the embryology, anatomy, blood supply, nerve supply, and clinical applications of the conjunctiva and sclera.
The document discusses the anatomy and functions of the extraocular muscles (EOMs). It describes the embryology, origin, course, insertion, nerve supply, and blood supply of the four rectus muscles and two oblique muscles. The rectus muscles originate from a common tendinous ring and insert on the sclera in a spiral pattern. Each EOM is innervated by a specific cranial nerve. Isolated paralysis of individual EOMs can cause disorders like strabismus. Conditions like dysthyroid ophthalmopathy involve hypertrophy and fibrosis of the EOMs. In summary, the document provides a detailed overview of the anatomy and clinical significance of the extraocular muscles.
Eyelids: Different Layer, Nerve Supply, Vascular Supply & Functions of LidsMero Eye
The document describes the anatomy of the eyelids. It discusses the embryology, layers, muscles, glands, nerve and blood supply of the eyelids. The eyelids are derived from surface ectoderm and have multiple layers including skin, muscle, fibrous tissue and conjunctiva. The main muscles are the orbicularis oculi and levator palpebrae superioris. Important glands are meibomian, zeis and moll glands. The eyelids receive motor innervation from cranial nerves and sensory innervation from the trigeminal nerve. Blood supply is from branches of the ophthalmic artery.
This document provides an overview of the anatomy of the uveal tract, which includes the iris, ciliary body, and choroid. It begins with an introduction and overview of the embryology and development of the uveal tract. It then discusses the anatomy and microstructure of each part of the uveal tract in detail, including their nerve and blood supply. It also briefly discusses some congenital anomalies that can affect the uveal tract.
Special tests for sensory and motor anomaliesMero Eye
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These lecture slides, by Dr Sidra Arshad, offer a quick overview of the physiological basis of a normal electrocardiogram.
Learning objectives:
1. Define an electrocardiogram (ECG) and electrocardiography
2. Describe how dipoles generated by the heart produce the waveforms of the ECG
3. Describe the components of a normal electrocardiogram of a typical bipolar lead (limb II)
4. Differentiate between intervals and segments
5. Enlist some common indications for obtaining an ECG
6. Describe the flow of current around the heart during the cardiac cycle
7. Discuss the placement and polarity of the leads of electrocardiograph
8. Describe the normal electrocardiograms recorded from the limb leads and explain the physiological basis of the different records that are obtained
9. Define mean electrical vector (axis) of the heart and give the normal range
10. Define the mean QRS vector
11. Describe the axes of leads (hexagonal reference system)
12. Comprehend the vectorial analysis of the normal ECG
13. Determine the mean electrical axis of the ventricular QRS and appreciate the mean axis deviation
14. Explain the concepts of current of injury, J point, and their significance
Study Resources:
1. Chapter 11, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 9, Human Physiology - From Cells to Systems, Lauralee Sherwood, 9th edition
3. Chapter 29, Ganong’s Review of Medical Physiology, 26th edition
4. Electrocardiogram, StatPearls - https://www.ncbi.nlm.nih.gov/books/NBK549803/
5. ECG in Medical Practice by ABM Abdullah, 4th edition
6. Chapter 3, Cardiology Explained, https://www.ncbi.nlm.nih.gov/books/NBK2214/
7. ECG Basics, http://www.nataliescasebook.com/tag/e-c-g-basics
8 Surprising Reasons To Meditate 40 Minutes A Day That Can Change Your Life.pptxHolistified Wellness
We’re talking about Vedic Meditation, a form of meditation that has been around for at least 5,000 years. Back then, the people who lived in the Indus Valley, now known as India and Pakistan, practised meditation as a fundamental part of daily life. This knowledge that has given us yoga and Ayurveda, was known as Veda, hence the name Vedic. And though there are some written records, the practice has been passed down verbally from generation to generation.
Integrating Ayurveda into Parkinson’s Management: A Holistic ApproachAyurveda ForAll
Explore the benefits of combining Ayurveda with conventional Parkinson's treatments. Learn how a holistic approach can manage symptoms, enhance well-being, and balance body energies. Discover the steps to safely integrate Ayurvedic practices into your Parkinson’s care plan, including expert guidance on diet, herbal remedies, and lifestyle modifications.
Muktapishti is a traditional Ayurvedic preparation made from Shoditha Mukta (Purified Pearl), is believed to help regulate thyroid function and reduce symptoms of hyperthyroidism due to its cooling and balancing properties. Clinical evidence on its efficacy remains limited, necessitating further research to validate its therapeutic benefits.
Local Advanced Lung Cancer: Artificial Intelligence, Synergetics, Complex Sys...Oleg Kshivets
Overall life span (LS) was 1671.7±1721.6 days and cumulative 5YS reached 62.4%, 10 years – 50.4%, 20 years – 44.6%. 94 LCP lived more than 5 years without cancer (LS=2958.6±1723.6 days), 22 – more than 10 years (LS=5571±1841.8 days). 67 LCP died because of LC (LS=471.9±344 days). AT significantly improved 5YS (68% vs. 53.7%) (P=0.028 by log-rank test). Cox modeling displayed that 5YS of LCP significantly depended on: N0-N12, T3-4, blood cell circuit, cell ratio factors (ratio between cancer cells-CC and blood cells subpopulations), LC cell dynamics, recalcification time, heparin tolerance, prothrombin index, protein, AT, procedure type (P=0.000-0.031). Neural networks, genetic algorithm selection and bootstrap simulation revealed relationships between 5YS and N0-12 (rank=1), thrombocytes/CC (rank=2), segmented neutrophils/CC (3), eosinophils/CC (4), erythrocytes/CC (5), healthy cells/CC (6), lymphocytes/CC (7), stick neutrophils/CC (8), leucocytes/CC (9), monocytes/CC (10). Correct prediction of 5YS was 100% by neural networks computing (error=0.000; area under ROC curve=1.0).
Travel vaccination in Manchester offers comprehensive immunization services for individuals planning international trips. Expert healthcare providers administer vaccines tailored to your destination, ensuring you stay protected against various diseases. Conveniently located clinics and flexible appointment options make it easy to get the necessary shots before your journey. Stay healthy and travel with confidence by getting vaccinated in Manchester. Visit us: www.nxhealthcare.co.uk
- Video recording of this lecture in English language: https://youtu.be/kqbnxVAZs-0
- Video recording of this lecture in Arabic language: https://youtu.be/SINlygW1Mpc
- Link to download the book free: https://nephrotube.blogspot.com/p/nephrotube-nephrology-books.html
- Link to NephroTube website: www.NephroTube.com
- Link to NephroTube social media accounts: https://nephrotube.blogspot.com/p/join-nephrotube-on-social-media.html
Our backs are like superheroes, holding us up and helping us move around. But sometimes, even superheroes can get hurt. That’s where slip discs come in.
One health condition that is becoming more common day by day is diabetes.
According to research conducted by the National Family Health Survey of India, diabetic cases show a projection which might increase to 10.4% by 2030.
These lecture slides, by Dr Sidra Arshad, offer a simplified look into the mechanisms involved in the regulation of respiration:
Learning objectives:
1. Describe the organisation of respiratory center
2. Describe the nervous control of inspiration and respiratory rhythm
3. Describe the functions of the dorsal and respiratory groups of neurons
4. Describe the influences of the Pneumotaxic and Apneustic centers
5. Explain the role of Hering-Breur inflation reflex in regulation of inspiration
6. Explain the role of central chemoreceptors in regulation of respiration
7. Explain the role of peripheral chemoreceptors in regulation of respiration
8. Explain the regulation of respiration during exercise
9. Integrate the respiratory regulatory mechanisms
10. Describe the Cheyne-Stokes breathing
Study Resources:
1. Chapter 42, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 36, Ganong’s Review of Medical Physiology, 26th edition
3. Chapter 13, Human Physiology by Lauralee Sherwood, 9th edition
Hiranandani Hospital in Powai, Mumbai, is a premier healthcare institution that has been serving the community with exceptional medical care since its establishment. As a part of the renowned Hiranandani Group, the hospital is committed to delivering world-class healthcare services across a wide range of specialties, including kidney transplantation. With its state-of-the-art facilities, advanced medical technology, and a team of highly skilled healthcare professionals, Hiranandani Hospital has earned a reputation as a trusted name in the healthcare industry. The hospital's patient-centric approach, coupled with its focus on innovation and excellence, ensures that patients receive the highest standard of care in a compassionate and supportive environment.
Histololgy of Female Reproductive System.pptxAyeshaZaid1
Dive into an in-depth exploration of the histological structure of female reproductive system with this comprehensive lecture. Presented by Dr. Ayesha Irfan, Assistant Professor of Anatomy, this presentation covers the Gross anatomy and functional histology of the female reproductive organs. Ideal for students, educators, and anyone interested in medical science, this lecture provides clear explanations, detailed diagrams, and valuable insights into female reproductive system. Enhance your knowledge and understanding of this essential aspect of human biology.
Does Over-Masturbation Contribute to Chronic Prostatitis.pptxwalterHu5
In some case, your chronic prostatitis may be related to over-masturbation. Generally, natural medicine Diuretic and Anti-inflammatory Pill can help mee get a cure.
3. Objective
Understanding how to evaluate the
Meibomian Glands is the first step
in an effective treatment plan.
This course reviews the
definitions, structure/ anatomy
and diagnosis of Meibomian gland
dysfunction and how to effectively
incorporate it into everyday
practice.
4. Learning objectives
1) Understand the lexicon of Meibomian gland dysfunction
2) Understand the Meibomian gland structure: both normal and transformation to
abnormal
3) Understand diagnostic techniques necessary for differentiation, treatment and
follow up.
5. Meibum
■ The meibomian glands are the main
source of lipids for the human tear
film.
■ The meibomian gland secretions
consist of a complex mixture of
various polar and nonpolar lipids
containing cholesterol and wax
esters, diesters, triacylglycerol, free
cholesterol, free fatty acids, and
phospholipids.
Invest Ophthalmol Vis Sci. 2011 Mar; 52(4): 1930–1937
6. The Functions of Healthy Meibomian Lipids
■ Provide a smooth optical surface for the cornea at the air-lipid interface
■ Reduce evaporation of the tear film
■ Enhance the stability of the tear film
■ Enhance spreading of the tear film
■ Prevent spillover of tears from the lid margin
■ Prevent contamination of the tear film by sebum
■ Seal the apposing lid margins during sleep
Invest Ophthalmol Vis Sci. 2011 Mar; 52(4): 1930–1937
8. The Normal EyeLid Margin
■ Large sebaceous glands located in the tarsal plates of the eyelids
■ No contact with hair follicles
■ Synthesize and secrete lipids and proteins that are delivered at the upper and lower eyelid
margins just anterior to the mucocutaneous junctions
■ Glandular lipids spread onto the tear film, promote its stability, and prevent its evaporation.
9. ■ Length
– Follows the Tarsus
■ 5.5- 10mm long in upper
■ 2-5mm long in lower
■ Number
– More in the Upper lid (30-40)
– Less in the Lower lid (20-30)
■ Volume
– Higher in the upper lid
■ 26ul vs. 13ul
■ Relative functional contribution
(upper vs lower) to the tear film lipid
is unknown
10. Acini
■ Each gland contains 10-15 acini filled
with secretory cells
■ readily be judged in young,
uninflamed lids
■ the visibility of the acini decreases
with:
– age
– chronic conjunctival
inflammation.
■ Acini empty into a central duct
– Holocrine secretions
– Meibocyte nuclei shrink and
disintegrate- forming oil product
■ Constant secretions
12. Anterior Blepharitis
■ Inflammation of the lid margin
anterior to the gray line and
centered around the lashes
■ Gray line represents the location of
the marginal region of the
orbicularis muscle (the muscle of
Riolan) seen through the lid skin
■ May be accompanied by squamous
debris or collarettes around the
base of the lashes and vascular
changes of the lid skin
Invest Ophthalmol Vis Sci. 2011 Mar; 52(4): 1930–1937
13. Posterior Blepharitis
■ Term used to describe inflammatory
conditions of the posterior lid margin,
of which MGD is only one cause
– Other causes include infectious
or allergic conjunctivitis and
systemic conditions such as
acne rosacea
■ Posterior lid margin contains:
– marginal mucosa
– mucocutaneous junction
– meibomian gland orifices and
associated terminal ductules
– neighboring keratinized skin
Invest Ophthalmol Vis Sci. 2011 Mar; 52(4): 1930–1937
14. Meibomian gland dysfunction (MGD)
■ Chronic, diffuse abnormality of the meibomian
glands
■ Characterized by
– terminal duct obstruction and/or
– qualitative/quantitative changes in the
glandular secretion.
■ Result in
– alteration of the tear film
– symptoms of eye irritation
– clinically apparent inflammation
– ocular surface disease.
International Workshop on Meibomian Gland Dysfunction
Invest Ophthalmol Vis Sci. 2011 Mar; 52(4): 1930–1937
17. ■ Meibomian glands are densely innervated, and their function is regulated by
androgens, estrogens, progestins, retinoic acid, and growth factors, and possibly by
neurotransmitters.
■ Meibum delivery onto the lid margin occurs with muscular contraction during lid
movement.
■ The obstruction may lead to intraglandular cystic dilatation, meibocyte atrophy,
gland dropout, and low secretion, effects that do not typically involve inflammatory
cells.
■ The outcome of MGD is a reduced availability of meibum to the lid margin and tear
film.
– The consequence of insufficient lipids may be increased evaporation,
hyperosmolarity and instability of the tear film, increased bacterial growth on
the lid margin, evaporative dry eye, and ocular surface inflammation and
damage.
18. HOWEVER…recent literature suggests
atrophy may be the cause not the result.
■ In both mouse and humans
– There is an anterior displacement of the mucocutaneous junction
– Loss of fully keratinized epithelium around the meibomian gland orifice
■ Desiccating stress induces proliferative changes in the gland leading to retention of
protein the meibomian gland lipid that could alter lipid fluidity and stiffness.
– BMC Ophthalmol. 2015; 15(Suppl 1): 156
■ Clinically non-apparent inflammation may affect MG function and pain
– Eye (Lond). 2015 Aug; 29(8): 1099–1110.
22. Lid margin
■ Thickness
– 2 mm thick
■ Thickening of the lid is a common feature
of meibomian gland disease
– difficult to measure because of the
rounded contour of the anterior
margin.
– best measured from the posterior
margin to the posterior lash line,
■ Rounding of the posterior lid margin is
often associated with thickening and
interferes with the normal apposition of lid
to globe.
23. Lid margin
■ Telangectasia
■ Vascularization increases with age.
– telangiectasia, and cutaneous
hyperkeratinization are
significantly more common in
the lower lid.
■ Increased inflammatory cytokines:
– interleukin-1β)
– tumor necrosis factor-α
– matrix metalloproteinase-9.
24. Lid margin
■ Irregularity of the lid
– often in the region of
obliterated meibomian orifices
– will occur with more gross
distortions of lid architecture in
cicatricial and ulcerative lid
disease.
25. Mucocutaneous junction
■ Immediately posterior to the
meibomian gland orifices.
– at the junction of the anterior
two thirds and posterior one
third of the lid
– No significant age-related
changes in the position or form
of the MCJ have been noted.
– Changes are seen in disease
states, such as MGD, acne
rosacea, and severe atopic eye
disease.
■ Best identified by specular reflection
26. Mucocutaneous junction
■ In MGD, the mucosa may spread
forward, so that the orifices appear
to lie in mucosal tissue.
29. Orifices
■ Capping.
– Dome of oil with a tough
■ underlying orifice may be ulcerated and the cap epithelialized.
■ Capping usually affects only occasional orifices and may be found in otherwise
normal lids.
30. Orifices
■ Pouting or plugging- minimal expression of oil
– Can be early sign of MGD
– Orifice not flush with the surface.
– May eventually lead to obliteration of orifices with atrophy of gland and duct.
31. Orifices
■ Obliteration narrowing.
– The punctum of the orifice may not be visible.
– The appearance of narrowing is accompanied by absent expressability of lipid.
32. Concretions
■ deposits of lime salts within acini
■ follow the line of the meibomian
glands.
■ corresponding ductile orifice is
occluded, with no oil being
expressible.
■ Cystoid dilatation of duct
33. Chalazia
■ Chalazia
– meibomian gland
lipogranuloma
– More frequently under the
upper than the lower lid
Before Chalazion After Chalazion
34. Secretions
■ Decrease in the quantity of secretion
occurs with age
– fewer orifices freely expressing
meibomian secretions
– not accompanied by an increased
opacity or viscosity of the secretions
■ Changes in secretions represent markers
of disease
■ Assessed indirectly by compressing the
tarsal plate locally in relation to individual
groups of orifices.
– may be performed with finger
pressure, a cotton tip, or a glass rod
or with the Korb expression device
– Nasal more active than temporal
35. Assessment scale
■ Number of glands expressed on lower lid
– 4(or more) = normal
– 3 = mildly reduced
– 2 = moderately reduced
– 1 (or less) = severely reduced
36. Secretion Quality
■ Clear (i.e., normal).
■ Cloudy: diffusely turbid fluid
secretions.
■ Granular: usually turbid fluid
secretions, but contains particulate
matter. The color of these secretions
varies from whitish-gray to yellow.
■ Inspissated: a semisolid plug or a
substance of toothpaste-like
consistency; may be extruded as a
plug or curled thread. Expression is
usually delayed or requires extra
pressure. The material contains
keratinized epithelial cells
37. Tear break up time (TBUT)
■ Measure of tear film instability
■ Level 0: break-up (average) >=14s
(stable tear film)
■ Level 1: break-up (average) >=7s
bis <14s (critical tear film stability)
■ Level 2: break-up (average) <7s
(unstable tear film/dry eye)
39. Tortuosity
■ The glands of the upper lid are
more bent (tortuosity) than that of
the lower lid, which might be a more
anatomical issue than impacted
due to dysfunction of these glands.
– H. Pult, B.H. Riede-Pult and J.J. Nichols, Optom. Vis.
Sci., 2012;89:310–315
■ People with repeated allergic
reaction of the tarsal conjunctiva
showed more bent glands than
normal patients
– R. Arita et al., Jpn J. Ophthalmol., 2012;56:14–19.
40. Upper vs Lower
■ Lower lid glands are significantly
wider than of the upper lid
– might be due to having less
space
– the number of glands is larger
in the upper lid.
– H. Pult, B.H. Riede-Pult and J.J. Nichols, Optom. Vis. Sci.,
2012;89:310–315
■ Meibography of the lower eyelid
seemed to offer the greatest
effectiveness as a single measure.
– L.C. McCann et al., Eye Contact Lens, 2009;35:203–208.
■ FBUT better correlation to the upper
lid
– Eye Contact Lens. 2016 Jul 27
Same patient
41. Meibomian Gland Loss (Dropout)
■ MGL is significantly higher in contact
lens wearers than in non-lens wearers
– R. Arita et al., Ophthalmology, 2009;116:379–384
■ MGL occurs in Ocular Rosacea
– Curr Eye Res. 2015 Dec 7:1-6
■ MGL occurs normally with age
– accompanied by reduced quality
and quantity of the meibum
produced
■ MGL not significantly correlated to
symptoms unless there is tear film
disruption.
– Invest Ophthalmol Vis Sci. 2016 Aug 1;57(10):3996-4007
43. Meiboscale
■ Area of loss of MG (MGL) is significantly
correlated to lipid layer thickness,
noninvasive break-up time and dry eye
symptoms
– H. Pult and B.H. Riede-Pult, Cont. Lens Anterior Eye,
2011;2012:77–80.
– H. Pult and B. Riede-Pult, Invest. Ophthalmol. Vis. Sci.,
2012;ARVO E-Abstract 53:588
■ Threshold of dry eye.
– Loss of 16.9% of the upper lid MG
– Loss of 28.7% of the lower lid MG
– R. Arita et al., ARVO E-Abstract, 2012;53:1283
44. Best Meibo-Images
■ Flat images
■ All in the same plane
■ No reflections
■ Entire lid
■ No obstructions in the way
– fingers
48. Infection
■ Hordeolum/Chalazion
– Demodicosis more prevalent
than in controlgroup (69.2% vs
20.3%)
– D Brevis more common than D
Folliculorum (2.82:1)
– 33% recurrence
Am J Ophthalmol. 2014 Feb;157(2):342-348
49.
50. ■ 8 legged mite which lives in hair follicles and oil glands.
■ 65+ species of Demodex,
– only 2 live on humans (folliculorum and brevis)
– not the same mites which affect pets.
■ spread either through direct contact or in dust and towels
containing eggs.
■ eat skin cells, hormones and oils in the follicles and glands
■ Major cause, if not the cause, of rosacea, seborrheic
dermatitis and other skin conditions.
What is Demodex?
52. ■ Life span 2-3 weeks
■ Light sensitive
– Come out at night to breed
■ Prevalence:
– Acquired shortly after birth
– 25% age 25 to near 100% age
70
– Bioload increases with age
53. Signs
Anterior blepharitis
■ Studies show nearly 100% if people
with blepharitis have Demodex
– Statistically significant
correlation
■ Cylindrical dandruff
■ “volcano-like” lash base
■ folliculitis
55. Symptom
Dry Eye
■ Increased Demodex with increased
OSDI
■ Normal shirmer’s with mite
infestation
■ >85% of patients with evaporative
dry eye have demodex (MGD)
56. Symptoms
Allergy
■ Positive correlation to Demodex and
conjunctival papillary changes
■ Itching
■ DR’s and patients often treat for
allergies when actually mites
■ Mite debris and waste elicit
inflammatory response
57. Associated with other ocular disease
states
■ Salzman nodular degeneration
■ Ocular rosacea
– Stem cell failure
■ Peripheral ulcers
– Aka clpu, staph marginal
keratitis
58. 1. Dryness
2. Blurred vision
3. Itching
4. FBS/ irritation
5. Glare
6. Crusting, redness
7. Many people have lived with their Demodex symptoms for so long that they consider
them normal.
Symtoms
59. Past History
■ Patients may have a history of trying treatments with little to no success
■ Drop out of contact lens wear
■ Past treatments may include:
– Artificial tears
– Cyclosporine
– Antihistamines
– Doxycycline/ tetracycine
■ Oral
■ Topical
– Lid hygiene (baby shampoo)
– Steroids – increases mite counts
60. How do mites cause symptoms
■ Demodex is colonized with bacteria
■ Decaying mite bodies elicit inflammation
■ Increasing mite counts
■ Immune response to mites
■ IL-17 tear concentrations higher in demodex colonized
patient than non-colonized patients
– IL-17 causes inflammation of ocular surface and lid margins
62. ■ Demodex associated with CL drop out/ dry eye
– May be a major cause!
– I have successfully treated Demodex and patient regained CL
wear
■ Confused with seasonal allergy
– Pt self treating allergy
■ Need better treatment/ awareness
– Cliradex
– Long time course for improvement- months
– Need quality patient instructions
■ No procedure codes for in office diagnosis o treatment
■ Need more studies
Challenges
63. ■ Nearly impossible to eradicate
■ All members of household should be checked
■ Heat kills mites in bedding
■ Scrubbing off debris (baby shampoo very bad) helps
■ Tea tree oil?
■ Manuka honey?
■ Colloidal silver?
■ Other Essential oils?
■ Hypochlorous acid?
■ High patient compliance once they see their own mites
Treatment
64. Treatment
■ Ivermectin
– Antiparasitic
– Paralyzes and kills parasites
– Oral
■ Single dose 3mg tabs)
■ Based on weight
■ Call pharmacist
– Topical
■ 1% ivermectin
■ Hard to find for humans.
■ OTC for pets (1.87%)
65. Treatment
skin- not eyes
■ Permethrin cream 5%
– BID
– More effective the 0.75% metroidazole
– No eye indication
■ Eurax cream (crotamiton) 10%
66. EyeLid Hygiene
■ Reasons not to use baby shampoo
– Dermatitis
■ JAMA Ophthalmol. 2014 Mar;132(3):357-9
– Excessive drying
– Burning
– Damage lipid layer
■ Clin Ophthalmol. 2012; 6: 1689–1698.
– Does not effect bacterial colinization of eyelids
■ Can J Ophthalmol. 2010;45(6):637–641
– Dermatologists won’t use it on their babies!
67. Hot Compresses
■ Warm compresses applied to the outer lid must maintain a temp of 113oF in order to
reach the MG, 4-6 minutes.
■ Cornea temperature increases
– Cornea. 2013 Jul;32(7):e146-9
■ Moisture help soften collarettes
■ Hot water increases evaporation off periorbital skin
– Increased drying and discomfort
68.
69. Cleansing Oils
■ Reduce surfactant induced
skin irritation
– Polar oils bond with proteins
and protect skin
– Sunflower oil better than
mineral oil
– Int J Cosmet Sci. 2015 Feb
6.
■ Coconut oil has higher
saponification
■ Improved epidermal
barrier loss and cutaneous
inflammation
– Int J Dermatol. 2014
Jan;53(1):100-8
71. Coconut oil
■ Clinically: what I have found
■ Adds oil to the tear film
– Severe evap dry eye patients report improved comfort while using it
■ No need to hot soaks to remove scurf
■ Reduced collarettes
■ Reduced lid inflammation
■ Better long term compliance
72. Coconut oil regime
■ Apply small amount to lid margin
■ Let soak in about 20 minute
– Brush teeth
– Get in jammies
– Etc…
■ Wipe off with dry wash cloth or gauze pad
– Apply firm but not excessive pressure
■ If patient complains of lingering blurred vision: used too much
75. Tea Tree Oil
■ Tea tree treatments with
50% lid scrubs in office
■ 5-15% TTO at home
■ Multiple Properties
– Anti-microbial
– Anti-inflammatory
– Anti-protozoal
– Anti-viral
■ Toxic to the Ocular surface!
77. Manuka honey
■ Made in New Zealand by bees that
pollinate the native manuka bush.
■ UMF (Unique Manuka Factor)
determines antibiotic effectiveness.
■ Manuka honey used is
pharmaceutical/medical grade and
highly sterilized.
78. Manuka Honey
■ principle antibacterial components
– methylglyoxal and hydrogen
peroxide
Manuka-type honeys can eradicate biofilms produced by Staphylococcus aureus strains with different biofilm-f
PeerJ. 2014 Mar 25;2
79. Betadine
■ Betadine 5% Ophthalmic Prep
Solution
– Povidone-Iodine
■ Normal surgical scrub is 10%
■ Intended for:
– Irrigation of cornea, conj.
– Periocular antiseptic
■ Wide range of bacteria
– Effective against biofilm
– Inhibits release of exotoxins
■ Possible Treatment for EKC
80. Hypochlorous Acid .01%
•Excellent activity
against a broad
range of
pathogens
•Fast acting onset
of activity
•Effective against
pathogens
commonly found
on the lids &
lashes
80
*Data on file