The elderly, a target population for cataract surgery, which is the most prevalent ophthalmic procedure, frequently present with ocular surface disorders. The complexities of ocular surface diseases involve a multitude of causes and often lead to symptoms such as foreign body sensation, burning, fatigue, photophobia, redness or watering of the eyes, and decreased visual sharpness. This spectrum includes conditions with both immune and non-immune characteristics. Tear film disturbances, a potential consequence of cataract surgery, are known to impact the typical ocular surface milieu and can persist up to six months post-operatively. Patients with ocular surface diseases frequently encounter an amplified presence of these symptoms. The inherent complexity of cataract surgery is further amplified when patients exhibit associated ocular surface diseases, necessitating meticulous planning and execution. We analyze the nuanced aspects of preoperative planning and intraoperative alterations in cataract surgery to maximize outcomes in patients presenting with ocular surface disorders in this review.
The intricate treatment challenge stems from bilateral corneal blindness, severe dry eye disease (DED), total limbal stem cell deficiency, underlying corneal stromal scarring and vascularization, and the secondary adnexal complications of chronic cicatrizing conjunctivitis. Procedures like penetrating keratoplasty and limbal stem cell transplantation, implemented alone or in a combined fashion, cannot overcome the difficulties presented by such eyes. Geldanamycin A keratoprosthesis (Kpro), or artificial cornea, stands as the most promising solution in these eyes, resolving corneal blindness, even in cases of autoimmune conditions like Stevens-Johnson syndrome, ocular mucous membrane pemphigoid, and Sjogren's syndrome, and non-autoimmune ailments such as chemical or thermal ocular burns, all intricate pathologies. Kpro treatment in these eyes eliminates the requirement for systemic immunosuppression and might produce a relatively early return of vision. A second protective layer is essential to safeguard the donor cornea's region around the Kpro central cylinder from desiccation and the progression of stromal melt in the underlying cornea, a common complication of severe dry eye disease (DED). Kpro designs designed for survival in the hostile ocular environment of severe DED are the focus of this review. Their impacts, analyzed from the standpoint of such interpretations, will be examined.
Chronic ocular discomfort and pain are defining features of dry eye disease (DED), a condition affecting all age groups, thus significantly impacting the quality of life. Lacrimal gland damage in patients with ocular surface disease (OSD) can diminish tear secretion, ultimately manifesting as aqueous-deficient dry eye disease (DED). Even with the use of common management methods like lubricating eye drops, topical corticosteroids, autologous serum eye drops, or punctal plugs, many patients continue to experience debilitating symptoms. In addressing ocular surface disease (OSD), contact lenses are experiencing growing adoption, offering hydration to the ocular surface, shielding it from environmental factors, preventing damage from abnormal eyelids, and enabling constant drug delivery of medications. A description of soft and rigid gas permeable scleral lenses' roles in addressing dry eye disease (DED) resulting from ocular surface disorders (OSD) is provided in this review. Specific indications necessitate a review of contact lens performance, lens selection, and the achieving of optimal fit.
Contact lens use is advantageous in managing a variety of ocular conditions, including high refractive errors, irregular astigmatism, corneal ectasias, corneal dystrophies, post-keratoplasty, post-refractive surgical procedures, trauma, and ocular surface diseases. The applications of contact lenses have been expanded due to the novel innovations in highly oxygen-permeable materials. Therapeutic contact lenses serve a medical purpose, effectively managing a broad range of corneal conditions and ocular surface diseases. These lenses provide pain relief, corneal healing, ocular homeostasis maintenance, and drug delivery capabilities. Contact lens drug delivery systems show potential for enhancing topical treatments. The rigid, gas-permeable scleral contact lens offers symptomatic relief for painful corneal conditions like bullous keratopathy, corneal epithelial abrasions, and erosions in the modern era. It has demonstrably improved therapeutic management and visual rehabilitation by bolstering the ocular surface and protecting the cornea from detrimental environmental factors. Utilizing the existing body of evidence, this review highlights the various applications of contact lenses in addressing ocular surface diseases. This approach can potentially improve comprehension and handling of ocular surface ailments related to contact lens usage within the context of our everyday ophthalmology procedures.
In human physiology, the steroid hormone Vitamin D plays a key role, extending beyond calcium homeostasis to encompass immunomodulation, cellular differentiation, and proliferation. Ocular surface immune and structural cells are demonstrably affected by the immunomodulatory properties of vitamin D, a well-known fact. The part played by vitamin D in the development and treatment of ocular surface conditions, specifically dry eye, keratoconus, and post-surgical complications, has been thoroughly examined. In both clinical practice and pre-clinical models, vitamin D supplementation is shown to improve DED. Managing ocular surface conditions like dry eye disease (DED) and keratoconus (KC) might hinge on the efficacy of anti-inflammatory agents. Vitamin D's multifaceted action in corneal wound healing is driven by its anti-inflammatory effects and its capacity for remodeling the extracellular matrix. This review delves into the methods of handling patients with DED and those undergoing refractive surgery, building upon the current basic and clinical understanding of vitamin D's function in these conditions. We strive to demonstrate the importance of clinically leveraging vitamin D's capacity to modulate natural immune-inflammatory responses, combined with current standard therapies, to reduce the severity and duration of ocular surface diseases.
Ocular discomfort and visual disturbances can arise from dry eye disease (DED). inundative biological control Advanced age correlates with a greater likelihood of experiencing DED. Subsequently, a heightened possibility of retinal conditions, such as diabetic retinopathy and age-related macular degeneration, arises, potentially requiring surgical treatments, laser applications, and intravitreal administrations. Dry eye symptoms might be worsened or developed as a side effect of posterior segment eye surgery, despite being generally temporary. Although anatomical and functional improvements were evident, ocular surface dysfunctions can still have a substantial impact on patient satisfaction with retinal treatment, thereby lowering quality of life. Intraoperative tissue management, preexisting dry eye conditions, and postoperative therapies can all heighten the severity of ocular surface dysfunction. extrusion-based bioprinting This article scrutinizes all the significant studies on the evolution of ocular surface changes and dry eye disease (DED), including the implications of vitreoretinal surgical procedures and their effects on the ocular surface.
The growing numbers of bone marrow transplants for hematologic malignancies and non-malignant reasons are contributing to an upward trend in the incidence of ocular graft-versus-host disease (oGVHD). The eye's response to graft-versus-host disease (GVHD) presents a complex and largely uncharted territory for researchers. Our PubMed search encompassed all articles using the keywords oGVHD, dry eye, hematopoietic stem cell transplantation (HSCT), acute GVHD, and chronic GVHD. The review's central theme revolves around the existing gaps in the definition of diagnostic criteria. Criteria established by the National Institutes of Health Consensus Conference (NIH CC) or the International Chronic oGVHD (ICCGCHD) consensus group are instrumental in the diagnosis of ocular GVHD involvement. To grade the severity of oGVHD's conjunctival involvement, one uses the Jab's or Robinson's system. The NIH CC and ICCGVHD scoring systems are still the most widely used. Handling ocular involvement during an acute graft-versus-host disease (GVHD) attack is a complex issue, but chronic graft-versus-host disease (oGVHD), in its less serious presentations, is usually manifested as dry eye and treated as appropriate. The clinical features, diagnostic criteria, and pathogenesis of this entity are still accompanied by multiple unanswered questions. Large-scale prospective investigations, with input from oncologists and ophthalmologists, are crucial for formulating guidelines and resolving pertinent questions.
Dry eye disease often follows corneal laser refractive surgery, including LASIK, SMILE, and PRK, emerging as a widespread complication and a significant source of patient complaint. A complex, multifaceted etiology underlies its presentation, which is highly variable. Minimizing postoperative dry eye after refractive surgery hinges on a detailed preoperative ocular surface assessment and optimization. Postrefractive surgery dry eye diagnosis poses a significant problem since no single symptom or clinical factor conclusively indicates the condition. Symptoms and signs often show a poor relationship. Achieving an individualized therapeutic approach necessitates a thorough understanding of the disease's pathophysiological underpinnings and its spectrum of clinical presentations for every patient. Various facets of dry eye following refractive surgery, including its prevalence, causes, associated factors, diagnosis, and management strategies, are examined in this article.
Variations in the presentation of dry eye disease are substantial, including overlapping subtypes.