Dry eye disease, also known as keratoconjunctivitis sicca, is a condition caused by disturbances in the tear film that leads to an unstable tear film when the eye is open. It is a common reason for visits to ophthalmologists and affects about 75% of people over age 65, with the average patient being 54 years old. The disease involves inflammation that disrupts the normal feedback loop controlling tear production. Diagnosis involves tests like tear breakup time and Schirmer tests, and treatment focuses on replacing tears through artificial drops or increasing natural tear production through drugs like cyclosporine drops.
Ischemic optic neuropathy constitutes one of the major causes of blindness or seriously impaired vision among the middle-aged and elderly population.
Ischemic optic neuropathy is due to acute ischemia of the optic nerve. it can be classified into two, depending upon the part of the optic nerve involved:
1.Anterior ischemic optic neuropathy (AION)
-AION is due to acute ischemia of the front (anterior) part of the optic nerve (also called optic nerve head), which is supplied mainly by the posterior ciliary arteries.
-AION is divided into two types, depending on what causes it:
1.Arteritic AION: This is the most serious type and is due to a disease called giant cell arteritis or temporal arteritis.
2. Non-arteritic AION: This is the usual, most common type, with many different causes but not associated with giant cell arteritis.
2.Posterior ischemic optic neuropathy (PION). -
-PION is a much less common type. It is due to acute ischemia of the back (posterior) part of the optic nerve, located some distance behind the eyeball; this part of the optic nerve is NOT supplied by the posterior ciliary arteries
(Hayreh, 2009)
This presentation describes all the clinical aspects of keratoconus management
You can watch the illustrated presentation in this link :
https://www.youtube.com/watch?v=pYxwZPGm7e4&list=PLZ_mM13I_TrhWavjTmE9NjW1O5bGxkONO&index=13
Ischemic optic neuropathy constitutes one of the major causes of blindness or seriously impaired vision among the middle-aged and elderly population.
Ischemic optic neuropathy is due to acute ischemia of the optic nerve. it can be classified into two, depending upon the part of the optic nerve involved:
1.Anterior ischemic optic neuropathy (AION)
-AION is due to acute ischemia of the front (anterior) part of the optic nerve (also called optic nerve head), which is supplied mainly by the posterior ciliary arteries.
-AION is divided into two types, depending on what causes it:
1.Arteritic AION: This is the most serious type and is due to a disease called giant cell arteritis or temporal arteritis.
2. Non-arteritic AION: This is the usual, most common type, with many different causes but not associated with giant cell arteritis.
2.Posterior ischemic optic neuropathy (PION). -
-PION is a much less common type. It is due to acute ischemia of the back (posterior) part of the optic nerve, located some distance behind the eyeball; this part of the optic nerve is NOT supplied by the posterior ciliary arteries
(Hayreh, 2009)
This presentation describes all the clinical aspects of keratoconus management
You can watch the illustrated presentation in this link :
https://www.youtube.com/watch?v=pYxwZPGm7e4&list=PLZ_mM13I_TrhWavjTmE9NjW1O5bGxkONO&index=13
In today's digital environment Dry Eyes and associated symptoms have become an epidemic. This presentation was recently delivered at a Pharmacy convention in Sydney Australia. It is applicable for anyone with dry eye problems.
Dry Eye Disease (DED) has become a substantial economic burden to industrialized society. It is estimated to cost as much as $18K/year/patient in lost productivity for a total of $55B/year in the United States alone. Severe, untreated dry eye disease can result in significant morbidity and potential loss of vision. The role that diet plays in the inflammation and lipid abnormalities associated with dry eye disease has only recently been discovered and is still not widely accepted in the medical community.
Dry Eye Treatment - Artificial Tears and Punctal Plugsparkavenuelasek
Dr. Emil Chynn was the 1st eye surgeon in NYC to have LASIK himself (in 1999) but switched to the safer, noncutting SafeSight procedure in 2005 to avoid the night glare and dry eyes he and his patients had after LASIK. By avoiding cutting a flap, Dr. Chynn avoids cutting the corneal nerves, which causes dry eyes--so no dry eyes after LASEK!
Dry Eye and Ocular surface diseases in diabetes mellitusDhwanit Khetwani
RELATION OF DIABETES WITH DRY EYE AND OTHER OCULAR SURFACE DISEASES, MADE FOR THE PURPOSE PROTOCOL PRESENTATION. MADE BY DR DHWANIT KHETWANI OPHTHALMOLOGY RESIDENT
Deals with both dry eye and epiphora conditions. Dry eye includes Aqueous deficiency and evaporative varieties along with Meibomian gland dysfunction. Epiphora has both lacrimation and various anatomical and physiological blocks of the Nasolacrimal drainage system. This also includes the various tests required for diagnosing the different disorders. Chronic and Acute Dacryocystitis, Dacryoadenitis are also included.
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.
Dry eye disease is a common condition that occurs when your tears aren't able to provide adequate lubrication for your eyes. Tears can be inadequate and unstable for many reasons. For example, dry eyes may occur if you don't produce enough tears or if you produce poor-quality tears. This tear instability leads to inflammation and damage of the eye's surface.
Dry eyes feel uncomfortable. If you have dry eyes, your eyes may sting or burn. You may experience dry eyes in certain situations, such as on an airplane, in an air-conditioned room, while riding a bike or after looking at a computer screen for a few hours
fungal / mycotic corneal ulcer power point presentation for O.A 2nd year stud...Vinitkumar MJ
Belong suborder Acanthopodina and the genus Acanthamoeba
• Family of free-living cyst-forming protozoans that are ubiquitous in air, soil, dust and water.
• 11 species of which A. Castellanii and A. polyphaga are the most common in keratitis
• Life cycle consist of motile trophozoite and cyst dormant stage
HOT NEW PRODUCT! BIG SALES FAST SHIPPING NOW FROM CHINA!! EU KU DB BK substit...GL Anaacs
Contact us if you are interested:
Email / Skype : kefaya1771@gmail.com
Threema: PXHY5PDH
New BATCH Ku !!! MUCH IN DEMAND FAST SALE EVERY BATCH HAPPY GOOD EFFECT BIG BATCH !
Contact me on Threema or skype to start big business!!
Hot-sale products:
NEW HOT EUTYLONE WHITE CRYSTAL!!
5cl-adba precursor (semi finished )
5cl-adba raw materials
ADBB precursor (semi finished )
ADBB raw materials
APVP powder
5fadb/4f-adb
Jwh018 / Jwh210
Eutylone crystal
Protonitazene (hydrochloride) CAS: 119276-01-6
Flubrotizolam CAS: 57801-95-3
Metonitazene CAS: 14680-51-4
Payment terms: Western Union,MoneyGram,Bitcoin or USDT.
Deliver Time: Usually 7-15days
Shipping method: FedEx, TNT, DHL,UPS etc.Our deliveries are 100% safe, fast, reliable and discreet.
Samples will be sent for your evaluation!If you are interested in, please contact me, let's talk details.
We specializes in exporting high quality Research chemical, medical intermediate, Pharmaceutical chemicals and so on. Products are exported to USA, Canada, France, Korea, Japan,Russia, Southeast Asia and other countries.
Lung Cancer: Artificial Intelligence, Synergetics, Complex System Analysis, S...Oleg Kshivets
RESULTS: Overall life span (LS) was 2252.1±1742.5 days and cumulative 5-year survival (5YS) reached 73.2%, 10 years – 64.8%, 20 years – 42.5%. 513 LCP lived more than 5 years (LS=3124.6±1525.6 days), 148 LCP – more than 10 years (LS=5054.4±1504.1 days).199 LCP died because of LC (LS=562.7±374.5 days). 5YS of LCP after bi/lobectomies was significantly superior in comparison with LCP after pneumonectomies (78.1% vs.63.7%, P=0.00001 by log-rank test). AT significantly improved 5YS (66.3% vs. 34.8%) (P=0.00000 by log-rank test) only for LCP with N1-2. Cox modeling displayed that 5YS of LCP significantly depended on: phase transition (PT) early-invasive LC in terms of synergetics, PT N0—N12, cell ratio factors (ratio between cancer cells- CC and blood cells subpopulations), G1-3, histology, glucose, AT, blood cell circuit, prothrombin index, heparin tolerance, recalcification time (P=0.000-0.038). Neural networks, genetic algorithm selection and bootstrap simulation revealed relationships between 5YS and PT early-invasive LC (rank=1), PT N0—N12 (rank=2), thrombocytes/CC (3), erythrocytes/CC (4), eosinophils/CC (5), healthy cells/CC (6), lymphocytes/CC (7), segmented neutrophils/CC (8), stick neutrophils/CC (9), monocytes/CC (10); leucocytes/CC (11). Correct prediction of 5YS was 100% by neural networks computing (area under ROC curve=1.0; error=0.0).
CONCLUSIONS: 5YS of LCP after radical procedures significantly depended on: 1) PT early-invasive cancer; 2) PT N0--N12; 3) cell ratio factors; 4) blood cell circuit; 5) biochemical factors; 6) hemostasis system; 7) AT; 8) LC characteristics; 9) LC cell dynamics; 10) surgery type: lobectomy/pneumonectomy; 11) anthropometric data. Optimal diagnosis and treatment strategies for LC are: 1) screening and early detection of LC; 2) availability of experienced thoracic surgeons because of complexity of radical procedures; 3) aggressive en block surgery and adequate lymph node dissection for completeness; 4) precise prediction; 5) adjuvant chemoimmunoradiotherapy for LCP with unfavorable prognosis.
New Directions in Targeted Therapeutic Approaches for Older Adults With Mantl...i3 Health
i3 Health is pleased to make the speaker slides from this activity available for use as a non-accredited self-study or teaching resource.
This slide deck presented by Dr. Kami Maddocks, Professor-Clinical in the Division of Hematology and
Associate Division Director for Ambulatory Operations
The Ohio State University Comprehensive Cancer Center, will provide insight into new directions in targeted therapeutic approaches for older adults with mantle cell lymphoma.
STATEMENT OF NEED
Mantle cell lymphoma (MCL) is a rare, aggressive B-cell non-Hodgkin lymphoma (NHL) accounting for 5% to 7% of all lymphomas. Its prognosis ranges from indolent disease that does not require treatment for years to very aggressive disease, which is associated with poor survival (Silkenstedt et al, 2021). Typically, MCL is diagnosed at advanced stage and in older patients who cannot tolerate intensive therapy (NCCN, 2022). Although recent advances have slightly increased remission rates, recurrence and relapse remain very common, leading to a median overall survival between 3 and 6 years (LLS, 2021). Though there are several effective options, progress is still needed towards establishing an accepted frontline approach for MCL (Castellino et al, 2022). Treatment selection and management of MCL are complicated by the heterogeneity of prognosis, advanced age and comorbidities of patients, and lack of an established standard approach for treatment, making it vital that clinicians be familiar with the latest research and advances in this area. In this activity chaired by Michael Wang, MD, Professor in the Department of Lymphoma & Myeloma at MD Anderson Cancer Center, expert faculty will discuss prognostic factors informing treatment, the promising results of recent trials in new therapeutic approaches, and the implications of treatment resistance in therapeutic selection for MCL.
Target Audience
Hematology/oncology fellows, attending faculty, and other health care professionals involved in the treatment of patients with mantle cell lymphoma (MCL).
Learning Objectives
1.) Identify clinical and biological prognostic factors that can guide treatment decision making for older adults with MCL
2.) Evaluate emerging data on targeted therapeutic approaches for treatment-naive and relapsed/refractory MCL and their applicability to older adults
3.) Assess mechanisms of resistance to targeted therapies for MCL and their implications for treatment selection
The prostate is an exocrine gland of the male mammalian reproductive system
It is a walnut-sized gland that forms part of the male reproductive system and is located in front of the rectum and just below the urinary bladder
Function is to store and secrete a clear, slightly alkaline fluid that constitutes 10-30% of the volume of the seminal fluid that along with the spermatozoa, constitutes semen
A healthy human prostate measures (4cm-vertical, by 3cm-horizontal, 2cm ant-post ).
It surrounds the urethra just below the urinary bladder. It has anterior, median, posterior and two lateral lobes
It’s work is regulated by androgens which are responsible for male sex characteristics
Generalised disease of the prostate due to hormonal derangement which leads to non malignant enlargement of the gland (increase in the number of epithelial cells and stromal tissue)to cause compression of the urethra leading to symptoms (LUTS
Knee anatomy and clinical tests 2024.pdfvimalpl1234
This includes all relevant anatomy and clinical tests compiled from standard textbooks, Campbell,netter etc..It is comprehensive and best suited for orthopaedicians and orthopaedic residents.
Recomendações da OMS sobre cuidados maternos e neonatais para uma experiência pós-natal positiva.
Em consonância com os ODS – Objetivos do Desenvolvimento Sustentável e a Estratégia Global para a Saúde das Mulheres, Crianças e Adolescentes, e aplicando uma abordagem baseada nos direitos humanos, os esforços de cuidados pós-natais devem expandir-se para além da cobertura e da simples sobrevivência, de modo a incluir cuidados de qualidade.
Estas diretrizes visam melhorar a qualidade dos cuidados pós-natais essenciais e de rotina prestados às mulheres e aos recém-nascidos, com o objetivo final de melhorar a saúde e o bem-estar materno e neonatal.
Uma “experiência pós-natal positiva” é um resultado importante para todas as mulheres que dão à luz e para os seus recém-nascidos, estabelecendo as bases para a melhoria da saúde e do bem-estar a curto e longo prazo. Uma experiência pós-natal positiva é definida como aquela em que as mulheres, pessoas que gestam, os recém-nascidos, os casais, os pais, os cuidadores e as famílias recebem informação consistente, garantia e apoio de profissionais de saúde motivados; e onde um sistema de saúde flexível e com recursos reconheça as necessidades das mulheres e dos bebês e respeite o seu contexto cultural.
Estas diretrizes consolidadas apresentam algumas recomendações novas e já bem fundamentadas sobre cuidados pós-natais de rotina para mulheres e neonatos que recebem cuidados no pós-parto em unidades de saúde ou na comunidade, independentemente dos recursos disponíveis.
É fornecido um conjunto abrangente de recomendações para cuidados durante o período puerperal, com ênfase nos cuidados essenciais que todas as mulheres e recém-nascidos devem receber, e com a devida atenção à qualidade dos cuidados; isto é, a entrega e a experiência do cuidado recebido. Estas diretrizes atualizam e ampliam as recomendações da OMS de 2014 sobre cuidados pós-natais da mãe e do recém-nascido e complementam as atuais diretrizes da OMS sobre a gestão de complicações pós-natais.
O estabelecimento da amamentação e o manejo das principais intercorrências é contemplada.
Recomendamos muito.
Vamos discutir essas recomendações no nosso curso de pós-graduação em Aleitamento no Instituto Ciclos.
Esta publicação só está disponível em inglês até o momento.
Prof. Marcus Renato de Carvalho
www.agostodourado.com
Flu Vaccine Alert in Bangalore Karnatakaaddon Scans
As flu season approaches, health officials in Bangalore, Karnataka, are urging residents to get their flu vaccinations. The seasonal flu, while common, can lead to severe health complications, particularly for vulnerable populations such as young children, the elderly, and those with underlying health conditions.
Dr. Vidisha Kumari, a leading epidemiologist in Bangalore, emphasizes the importance of getting vaccinated. "The flu vaccine is our best defense against the influenza virus. It not only protects individuals but also helps prevent the spread of the virus in our communities," he says.
This year, the flu season is expected to coincide with a potential increase in other respiratory illnesses. The Karnataka Health Department has launched an awareness campaign highlighting the significance of flu vaccinations. They have set up multiple vaccination centers across Bangalore, making it convenient for residents to receive their shots.
To encourage widespread vaccination, the government is also collaborating with local schools, workplaces, and community centers to facilitate vaccination drives. Special attention is being given to ensuring that the vaccine is accessible to all, including marginalized communities who may have limited access to healthcare.
Residents are reminded that the flu vaccine is safe and effective. Common side effects are mild and may include soreness at the injection site, mild fever, or muscle aches. These side effects are generally short-lived and far less severe than the flu itself.
Healthcare providers are also stressing the importance of continuing COVID-19 precautions. Wearing masks, practicing good hand hygiene, and maintaining social distancing are still crucial, especially in crowded places.
Protect yourself and your loved ones by getting vaccinated. Together, we can help keep Bangalore healthy and safe this flu season. For more information on vaccination centers and schedules, residents can visit the Karnataka Health Department’s official website or follow their social media pages.
Stay informed, stay safe, and get your flu shot today!
Title: Sense of Taste
Presenter: Dr. Faiza, Assistant Professor of Physiology
Qualifications:
MBBS (Best Graduate, AIMC Lahore)
FCPS Physiology
ICMT, CHPE, DHPE (STMU)
MPH (GC University, Faisalabad)
MBA (Virtual University of Pakistan)
Learning Objectives:
Describe the structure and function of taste buds.
Describe the relationship between the taste threshold and taste index of common substances.
Explain the chemical basis and signal transduction of taste perception for each type of primary taste sensation.
Recognize different abnormalities of taste perception and their causes.
Key Topics:
Significance of Taste Sensation:
Differentiation between pleasant and harmful food
Influence on behavior
Selection of food based on metabolic needs
Receptors of Taste:
Taste buds on the tongue
Influence of sense of smell, texture of food, and pain stimulation (e.g., by pepper)
Primary and Secondary Taste Sensations:
Primary taste sensations: Sweet, Sour, Salty, Bitter, Umami
Chemical basis and signal transduction mechanisms for each taste
Taste Threshold and Index:
Taste threshold values for Sweet (sucrose), Salty (NaCl), Sour (HCl), and Bitter (Quinine)
Taste index relationship: Inversely proportional to taste threshold
Taste Blindness:
Inability to taste certain substances, particularly thiourea compounds
Example: Phenylthiocarbamide
Structure and Function of Taste Buds:
Composition: Epithelial cells, Sustentacular/Supporting cells, Taste cells, Basal cells
Features: Taste pores, Taste hairs/microvilli, and Taste nerve fibers
Location of Taste Buds:
Found in papillae of the tongue (Fungiform, Circumvallate, Foliate)
Also present on the palate, tonsillar pillars, epiglottis, and proximal esophagus
Mechanism of Taste Stimulation:
Interaction of taste substances with receptors on microvilli
Signal transduction pathways for Umami, Sweet, Bitter, Sour, and Salty tastes
Taste Sensitivity and Adaptation:
Decrease in sensitivity with age
Rapid adaptation of taste sensation
Role of Saliva in Taste:
Dissolution of tastants to reach receptors
Washing away the stimulus
Taste Preferences and Aversions:
Mechanisms behind taste preference and aversion
Influence of receptors and neural pathways
Impact of Sensory Nerve Damage:
Degeneration of taste buds if the sensory nerve fiber is cut
Abnormalities of Taste Detection:
Conditions: Ageusia, Hypogeusia, Dysgeusia (parageusia)
Causes: Nerve damage, neurological disorders, infections, poor oral hygiene, adverse drug effects, deficiencies, aging, tobacco use, altered neurotransmitter levels
Neurotransmitters and Taste Threshold:
Effects of serotonin (5-HT) and norepinephrine (NE) on taste sensitivity
Supertasters:
25% of the population with heightened sensitivity to taste, especially bitterness
Increased number of fungiform papillae
Couples presenting to the infertility clinic- Do they really have infertility...Sujoy Dasgupta
Dr Sujoy Dasgupta presented the study on "Couples presenting to the infertility clinic- Do they really have infertility? – The unexplored stories of non-consummation" in the 13th Congress of the Asia Pacific Initiative on Reproduction (ASPIRE 2024) at Manila on 24 May, 2024.
NVBDCP.pptx Nation vector borne disease control programSapna Thakur
NVBDCP was launched in 2003-2004 . Vector-Borne Disease: Disease that results from an infection transmitted to humans and other animals by blood-feeding arthropods, such as mosquitoes, ticks, and fleas. Examples of vector-borne diseases include Dengue fever, West Nile Virus, Lyme disease, and malaria.
263778731218 Abortion Clinic /Pills In Harare ,sisternakatoto
263778731218 Abortion Clinic /Pills In Harare ,ABORTION WOMEN’S CLINIC +27730423979 IN women clinic we believe that every woman should be able to make choices in her pregnancy. Our job is to provide compassionate care, safety,affordable and confidential services. That’s why we have won the trust from all generations of women all over the world. we use non surgical method(Abortion pills) to terminate…Dr.LISA +27730423979women Clinic is committed to providing the highest quality of obstetrical and gynecological care to women of all ages. Our dedicated staff aim to treat each patient and her health concerns with compassion and respect.Our dedicated group ABORTION WOMEN’S CLINIC +27730423979 IN women clinic we believe that every woman should be able to make choices in her pregnancy. Our job is to provide compassionate care, safety,affordable and confidential services. That’s why we have won the trust from all generations of women all over the world. we use non surgical method(Abortion pills) to terminate…Dr.LISA +27730423979women Clinic is committed to providing the highest quality of obstetrical and gynecological care to women of all ages. Our dedicated staff aim to treat each patient and her health concerns with compassion and respect.Our dedicated group of receptionists, nurses, and physicians have worked together as a teamof receptionists, nurses, and physicians have worked together as a team wwww.lisywomensclinic.co.za/
Tom Selleck Health: A Comprehensive Look at the Iconic Actor’s Wellness Journeygreendigital
Tom Selleck, an enduring figure in Hollywood. has captivated audiences for decades with his rugged charm, iconic moustache. and memorable roles in television and film. From his breakout role as Thomas Magnum in Magnum P.I. to his current portrayal of Frank Reagan in Blue Bloods. Selleck's career has spanned over 50 years. But beyond his professional achievements. fans have often been curious about Tom Selleck Health. especially as he has aged in the public eye.
Follow us on: Pinterest
Introduction
Many have been interested in Tom Selleck health. not only because of his enduring presence on screen but also because of the challenges. and lifestyle choices he has faced and made over the years. This article delves into the various aspects of Tom Selleck health. exploring his fitness regimen, diet, mental health. and the challenges he has encountered as he ages. We'll look at how he maintains his well-being. the health issues he has faced, and his approach to ageing .
Early Life and Career
Childhood and Athletic Beginnings
Tom Selleck was born on January 29, 1945, in Detroit, Michigan, and grew up in Sherman Oaks, California. From an early age, he was involved in sports, particularly basketball. which played a significant role in his physical development. His athletic pursuits continued into college. where he attended the University of Southern California (USC) on a basketball scholarship. This early involvement in sports laid a strong foundation for his physical health and disciplined lifestyle.
Transition to Acting
Selleck's transition from an athlete to an actor came with its physical demands. His first significant role in "Magnum P.I." required him to perform various stunts and maintain a fit appearance. This role, which he played from 1980 to 1988. necessitated a rigorous fitness routine to meet the show's demands. setting the stage for his long-term commitment to health and wellness.
Fitness Regimen
Workout Routine
Tom Selleck health and fitness regimen has evolved. adapting to his changing roles and age. During his "Magnum, P.I." days. Selleck's workouts were intense and focused on building and maintaining muscle mass. His routine included weightlifting, cardiovascular exercises. and specific training for the stunts he performed on the show.
Selleck adjusted his fitness routine as he aged to suit his body's needs. Today, his workouts focus on maintaining flexibility, strength, and cardiovascular health. He incorporates low-impact exercises such as swimming, walking, and light weightlifting. This balanced approach helps him stay fit without putting undue strain on his joints and muscles.
Importance of Flexibility and Mobility
In recent years, Selleck has emphasized the importance of flexibility and mobility in his fitness regimen. Understanding the natural decline in muscle mass and joint flexibility with age. he includes stretching and yoga in his routine. These practices help prevent injuries, improve posture, and maintain mobilit
Prix Galien International 2024 Forum ProgramLevi Shapiro
June 20, 2024, Prix Galien International and Jerusalem Ethics Forum in ROME. Detailed agenda including panels:
- ADVANCES IN CARDIOLOGY: A NEW PARADIGM IS COMING
- WOMEN’S HEALTH: FERTILITY PRESERVATION
- WHAT’S NEW IN THE TREATMENT OF INFECTIOUS,
ONCOLOGICAL AND INFLAMMATORY SKIN DISEASES?
- ARTIFICIAL INTELLIGENCE AND ETHICS
- GENE THERAPY
- BEYOND BORDERS: GLOBAL INITIATIVES FOR DEMOCRATIZING LIFE SCIENCE TECHNOLOGIES AND PROMOTING ACCESS TO HEALTHCARE
- ETHICAL CHALLENGES IN LIFE SCIENCES
- Prix Galien International Awards Ceremony
micro teaching on communication m.sc nursing.pdfAnurag Sharma
Microteaching is a unique model of practice teaching. It is a viable instrument for the. desired change in the teaching behavior or the behavior potential which, in specified types of real. classroom situations, tends to facilitate the achievement of specified types of objectives.
2. What is Dry Eye Disease?
Disease of ocular surface caused by
disturbances of natural function and
protection of external eye leading to an
unstable tear film when eye is open
3. Prevalence of Dry Eye Disease
Average age of a dry eye patient is 54;
most are women.
Dry Eye Syndrome affects 75% of
people over age 65.
Common reason for ophthalmologist
visits.
4.
5. Normal tearing
depends on a
neuronal feedback
loop
Secretomotor
Nerve Impulses
Lacrimal
Glands Tears Support and Maintain
Ocular Surface
Ocular Surface
Neural Stimulation
6. Inflammation disrupt
normal neuronal
Lacrimal Glands:
control of tearing.
• Neurogenic Interrupted Secretomotor
Inflammation Nerve Impulses
• T-cell Activation
• Cytokine
Secretion into
Tears
Tears Inflame Ocular Surface
Cytokines
Disrupt Neural Arc
7. A complex mixture of
proteins, mucin, and
electrolytes
Antimicrobial proteins:
Lysozyme, lactofer rin
Growth factors &
suppressor s of
inflammation: EGF, IL-1RA
Soluble mucin 5AC
secreted by goblet cells
for viscosity
Electrolytes for proper
osmolarity
8. Decrease in many proteins
Decreased growth factor
concentrations
Altered cytokine balance
promotes inflammation
Soluble mucin -5AC g reatly
decreased
Due to goblet cell loss
Impacts viscosity of
tear film
Pr oteases activated
Increased electrolytes
10. AQUEOUS TEAR DEFICIENCY:
also known as KCS
seen in 1.congenital alacramia
2.paralytic hyposecretion
3.1˚& 2˚ sjogrens disease
4.Riley day syndrome
5.Idiopathic
• MUCIN DEFICIENCY: occurs when goblet cells
damaged
1.hypovitaminosis A
2.trachoma
3.chemical burns & radiations
4.ocular pemphigoid, SJS
11. LIPID DEFICIENCY:
Rare phenomena
Congenital anhydrotic ectodermal dysplasia with
absence of meibomian glands
Chronic blepharitis and chronic meibomitis
IMPAIRED EYELID FUNCTION:
.Bells palsy .Lagophthalmus
.Exposure keratitis .ectropion
.Dellen
.Sympblepheron
13. Medications T hat May
Contribute
to Dr y Eye Disease
Systemic
Antihyper tensives • Topical
Antiandr ogens – Preservatives in
Anticholiner gics Tears
Antidepr essants
Antiar rhythmic
Dr ugs
Par kinson’s Disease
Agents
Antihistamines
14. SYMPTOMS
Ir ritation
For eign body sensation
Itching
Non specific ocular
discomfor t
Chr onicall y sor e eyes
not responding to variety
of dr ops instilled
15. SIGNS
String y mucus and par ticulate
matter in tear film
Lustureless ocular surface
Conjunctival xer osis
Cor neal changes - punctate epithelial
er osions and filaments
16. Patient Types with High
Incidence of Dr y Eye
Disease
Women aged 50 or older
Women using
postmenopausal hor mone
replacement therapy
T hose with ocular
comorbidities
Contact lens wearer s
Smoker s
1
Schaumberg et al. Am J Ophthalmol. 2003;
2
Schaumberg et al. JAMA. 2001;
3
Lemp. CLAO J. 1995;
4
Multi-Sponsor Surveys, Inc. The 2005 Gallup Study of Dry Eye Sufferers. 2005.
17. DRY EYE
SYNDROMES
XEROSIS(XEROPHTHALMIA)
Dry lustureless condition of conjunctiva due to
deficiency of mucin
LOCAL OCULAR GENERAL DISEASE
AFFECTION
a) Trachoma , burns, Deficiency of vitamin A
pemphigoid, diphtheria
Cicatricial degeneration Occurrence of bitots
of conjunctival spots
epithelium
b) Ectropion or proptosis
18. KERATOCONJUNCTIVITIS SICCA:
deficiency of aqueous component of
tear s i.e lacrimal tear s
primar y
secondar y
kcs & xer ostomia kcs & rheumatoid
ar thritis
Pathologically focal accumulation &
infiltr ation with l ymphocytes & plasma
cells
Tear lysozyme r atio of 0.1 -> KCS
19. DIAGNOSIS
1.TEAR FILM BREAK UP TIME(BUT):
interval between complete blink & appearance of first
randomly distributed dry spot on cornea
After instilling drops of fluorescein dye, examintion
under SLE is carried out with cobalt blue light
NORMAL – 15 -35 SECONDS
<10 SECS- UNSTABLE TEAR FILM
BUT- an indicator of adequacy of mucin component
20. Schirmer Test: 5 * 35 mm strip of
w hatman 41 filter
paper folded 5mm
fr m one end kept
in lower for nix at
jn of lateral 1/3 rd &
medial 2/3 rd
NORMAL
>15mm
MILD TO MODERATE
KCS 5-10
mm
23. 4. Restasis ™
Ophthalmic emulsion of cyclosporine
0.05%.
Prescription therapy for dry eye disease.
Restasis™ is FDA approved to increase tear production
in patients whose tear production may be reduced
by inflammation of the eye associated with
keratoconjunctivitis sicca.
24. 5.PRESERVATION OF EXISTING
TEARS
BY REDUCING DECREASING
EVAPORATION DRAINAGE:
1. Room temperature 1.Collagen implants
2. Moist chambers 2.Electrocauterisation
3. Protective glasses 3.Cyanoacrylate tissue
adhesives
4.Argon laser & surgical
occlusions.
Editor's Notes
Dry eye disease Results from localized immune-mediated inflammation that ultimately affects the entire ocular surface/lacrimal gland/neural feedback functional unit. The main and accessory lacrimal glands: Susceptible to inflammation due to decreased neural or androgen support. Activation of lymphocytes leads to T-cell-mediated inflammation, cytokine production, the presence of cytokines in tears, and acinar cell apoptosis. The ocular surface: Cytokines in tears trigger inflammation (T-cell and epithelial cell activation, leukocyte recruitment) on the ocular surface, disrupt epithelial cell function, interfere with mucin production. Irritation can also trigger chemically mediated inflammation leading to activation of trafficking lymphocytes (T cells). The neural feedback loop: Sensory activity on the ocular surface is disrupted by pro-inflammatory cytokines and compromised epithelial cells, impacting afferent signaling. Sensory input to the lacrimal glands is decreased by disruption of the neuronal loop and by the direct inhibitory effect of inflammatory cytokines in the glands on secretomotor nerve endings. Dysfunction in any one element can lead to dysfunction in all elements, with subsequent development of chronic inflammation and dry eye disease. Inadequate tear production, altered tear composition, or secretion of inflammatory substances into tears can result in ocular surface inflammation. Stern et al, Cornea. 1998;17:584; Nelson et al, Adv Ther. 2000:17:84.
To understand dry eye disease as a disorder of the tear film, we need to appreciate the components of tears and their functions in the normal, healthy tear film. Normal, healthy tears contain, in addition to water, a complex mixture of proteins, mucins, and electrolytes. The most abundant proteins have antimicrobial functions: lysozyme and lactoferrin. Immunoglobulins, such as IgA, IgG, and IgM, also have protective functions. Cells are constantly sloughed off and lost from the most superficial layer of ocular epithelia. Growth factors are very small proteins that regulate the process for replacement of epithelial cells and are necessary for wound healing. Many growth factors are present in tears, including epidermal growth factor (EGF), as shown here. Mucins are critical for the viscosity of the tear film. The soluble mucin (mucin 5AC) is secreted by conjunctival goblet cells, whereas membrane-bound mucins originate from the epithelial cells they are bound to. The electrolyte concentrations in healthy tears are maintained in the proper ranges to ensure correct osmolarity, which is important for many aspects of epithelial and nerve cell function. Reference Stern ME, Beuerman RW, Pflugfelder SP. The normal tear film and ocular surface. In: Pflugfelder SP, Beuerman RW, Stern ME, eds. Dry Eye and Ocular Surface Disorders . New York, NY: Marcel Dekker; 2004:41-62.
Now let’s look at the abnormal composition of tears that are characteristic of chronic dry eye. The concentrations of many tear proteins, including those with antimicrobial functions, are reduced. Growth factor concentrations are reduced as well. The soluble mucin 5AC is greatly reduced in concentration because of the profound loss of goblet cells from the conjunctival epithelium that is typical of chronic dry eye. This impacts the viscosity of the tear film. Proteases, which are normally latent and inactivated in healthy tears, become activated. They can degrade the extracellular matrix and the tight junctions between adjacent cells of the corneal epithelium. Activated proteases are also responsible for cleavage of many cytokines into an activated pro-inflammatory form. The concentration of electrolytes increases, meaning that the osmolarity of the tear film is increased in chronic dry eye. References Solomon A, Dursun D, Liu Z, Xie Y, Macri A, Pflugfelder SC. Pro- and anti-inflammatory forms of interleukin-1 in the tear fluid and conjunctiva of patients with dry-eye disease. Invest Ophthalmol Vis Sci. 2001;42:2283-2292. Zhao H, Jumblatt JE, Wood TO, Jumblatt MM. Quantification of MUC5AC protein in human tears. Cornea. 2001;20:873-877. Ogasawara K, Mitsubayashi K, Tsuru T, Karube I. Electrical conductivity of tear fluid in healthy persons and keratoconjunctivitis sicca patients measured by a flexible conductimetric sensor. Graefes Arch Clin Exp Ophthalmol. 1996;234:542-546.
The prevalence of dry eye increases with age, particularly for women age 50 or older, and among postmenopausal women using hormone replacement therapy. This association with postmenopausal status is consistent with the known role of androgens in stimulation of the lacrimal and meibomian glands, which help maintain a normal tear film. Androgen levels naturally decline after menopause. Ocular comorbidities such as graft-versus-host disease, xerophthalmia, cicatricial pemphigoid, atopic keratoconjunctivitis, and ocular rosacea are also associated with increased risk of dry eye disease. Smokers are also at risk, perhaps due to repeated irritation of the ocular surface by smoke. Patients who feel the need to use artificial tears 3 or more times per day should always be evaluated further for dry eye disease. References Schaumberg DA, Sullivan DA, Buring JE, Dana MR. Prevalence of dry eye syndrome among US women. Am J Ophthalmol. 2003;136:318-326. Schaumberg DA, Buring JE, Sullivan DA, Dana MR. Hormone replacement therapy and dry eye syndrome. JAMA. 2001;286:2114-2119. Lemp MA. Report of the National Eye Institute/industry workshop on clinical trials in dry eyes. CLAO J. 1995;21:221-232. Multi-Sponsor Surveys, Inc. The 2005 Gallup Study of Dry Eye Sufferers; Princeton, NJ: 2004.
The Schirmer test (minus anesthesia) measures reflex tear secretion “ Schirmer I” With anesthesia (“Schirmer II”), eliminates stimulated tearing Stimulated tearing can occur because of introduction of the filter paper strip Measures so-called “basal” tearing A filter paper strip is introduced to the lower lid of the eye. Dry eye is indicated if less than 10 mm of the strip becomes wet with tears after 5 minutes of exposure. Lemp, CLAO J. 1995;21:221-232.
What Is Restasis ™ ? Emulsion of cyclosporine 0.05% for human ocular use Unique emulsion technology allows a low concentration of cyclosporine to be effective Cyclosporine is an immunomodulator with anti-inflammatory effects Low concentrations of cyclosporine are effective Specifically targets an underlying pathology of dry eye disease, immune-mediated inflammation, by inhibiting T-cell activation