Rosaria Spinella

Meibomian gland dysfunction and ocular discomfort in video display terminal workers

PurposeMeibomian gland dysfunction (MGD) is one of the most common ocular disorders encountered in clinical practice. The clinical manifestations of MGD are related to the changes in the tear film and ocular surface with symptoms of ocular discomfort. In recent years, many surveys have evaluated symptoms associated with the use of Video Display Terminals (VDT), and VDT use is recognized as a risk factor for eye discomfort.The aim of the present study was to determine if the presence of MGD contributes to the signs and symptoms of ocular discomfort during the use of VDT.MethodsIn course of a routine health surveillance programme, a group of 70 subjects fulfilled the inclusion criteria and responded to a questionnaire about symptoms of ocular discomfort. The following ocular tests were performed: tear break-up time, fluorescein corneal stain, and basal tear secretion test.ResultsA total of 52 subjects out of 70 (74.3%) had MGD. A statistically significant correlation between the symptoms of ocular discomfort and hours spent on VDT work was observed in the total population (r=0.358; P=0.002; 95% CI 0.13–0.54) and in the group of subjects with MGD (r=0.365; P=0.009; 95% CI 0.103–0.58). Such correlation was not shown in subjects without MGD.ConclusionsThe high prevalence of MGD among the subjects with symptoms of ocular discomfort suggests that this diagnosis should be considered when occupational health practitioners encounter ocular complaints among VDT operators. It appears that MGD can contribute to the development of ocular discomfort in VDT operators.

Age and Metabolic Control Influence Lens Opacity in Type I, Insulin-Dependent Diabetic Patients

Cataract is a frequent ocular complication in diabetic patients, but few data are available concerning early modifications occurring in the lens of these patients and their relationship with metabolic control and other clinical parameters. We measured lens opacity in 73 type I, insulin-dependent diabetic patients aging 50 years or less and without clinical evidence of cataract, and in 46 healthy volunteers of similar age. We used a quick, simple, and reliable instrument, the Lensmeter 701, which is based on a back-light scattering quantification system and is able to quantify lens transparency along the nuclear axis. Mean lens opacity was significantly (p = 0.0001) higher in diabetic patients than in the control group, and multiple regression analysis showed that it correlated with age (p = 0.0001) and HbA1c levels (p = 0.009). Moreover in the younger group of patients (age < or =20 years) the only observed correlation was that with Hba1c (p = 0.03), whereas in the older ones (age 21-30 and >30 years) lens opacity correlated with age (p = 0.02 and p = 0.01). These data indicate that early opacifications of the lens occur in type I, insulin-dependent diabetic patients and are influenced by the degree of the metabolic control in the younger ones, whereas the well-known role of aging on lens transparency became prevalent in the older patients. Only longitudinal studies, however, can demonstrate whether these alterations represent any early stage of cataractagenesis and the role of good metabolic control in preventing this ocular complication.

Safety and efficacy of 0.1% clobetasone butyrate eyedrops in the treatment of dry eye in Sjögren syndrome

Purpose To study the effects of a low administration rate and low concentration (0.1%) of clobetasone butyrate eyedrops in patients with Sjögren syndrome (SS). Methods This prospective, double-masked, randomized, placebo-controlled study included 40 subjects divided into 2 treatment groups: group 1 (2% polyvinylpyrrolidone eyedrops and placebo) and group 2 (2% polyvinylpyrrolidone and 0.1% clobetasone butyrate, 1 drop BID). The treatment lasted for 30 days, with visits at enrollment, baseline, day 15, day 30, and after 15 days of treatment discontinuation. At each visit, symptoms questionnaire, tear film break-up time, corneal fluorescein stain, lissamine green stain, conjunctival impression cytology for human leukocyte antigen–DR (HLA-DR) expression, intraocular pressure (IOP) measurement, and fundus examination were performed. Results No changes in IOP or fundus examination were observed in either group at each time point. Group 1 patients showed at day 30 a statistically significant amelioration of symptoms and reduction of HLA-DR expression. No changes in other parameters were detected. Group 2 patients showed at day 15 a statistically significant improvement of corneal and conjunctival stain versus baseline values and group 1 at the same time; after 30 days the symptoms score was statistically significantly better than baseline values and group 1 at the same time. The HLA-DR expression and the epithelial cells area were statistically significantly reduced versus baseline and group 1 at the same time. Conclusions Anti-inflammatory therapy is critical for the treatment of SS dry eye. Clobetasone butyrate, at low dosage, proved to be safe and effective in treating this condition.

Comparison of Ocular Surface Disease Index and Tear Osmolarity as Markers of Ocular Surface Dysfunction in Video Terminal Display Workers

PURPOSE To compare the Ocular Surface Disease Index (OSDI) questionnaire and tear osmolarity, to screen ocular surface alterations in video display terminal (VDT) users. DESIGN Cross-sectional study. METHODS Sixty-four VDT workers were screened for ocular surface alterations using OSDI and tear osmolarity. Furthermore, tear film break-up time (TBUT), fluorescein corneal stain, and assessment for meibomian glands dysfunction (MGD) were carried out. The alteration of 2 or more among these parameters was considered a sign of ocular surface dysfunction. Data for the statistical analysis were obtained from the eyes with the worst tear osmolarity score. Main outcome measures were OSDI and tear osmolarity. For the statistical analysis the receiver operating characteristic (ROC) curves and Spearman correlation coefficient were used. A P < .05 was considered statistically significant. RESULTS The area under the ROC curve (AUC) for tear osmolarity (ranging from 0.71 to 0.86) showed, for all the classification variables considered, statistically significantly higher values than those obtained with OSDI (ranging from 0.51 to 0.58) (P < .01). Furthermore, tear osmolarity showed a direct correlation with corneal stain and ocular surface dysfunction and an inverse correlation for TBUT. No correlation was found between OSDI and the parameters considered. CONCLUSIONS Tear osmolarity can be considered a more reliable test than OSDI, when screening VDT users for possible ocular surface alterations.

Morphologic and Confocal Investigation on Salzmann Nodular Degeneration of the Cornea

PURPOSE To investigate the ultrastructure of advanced Salzmann nodular degeneration (SND) and to correlate it to confocal in vivo findings. METHODS The corneal degenerative nodules from four patients with SND were examined with confocal microscopy and then removed and processed for light microscopy (LM) and transmission electron microscopy (TEM). RESULTS The confocal examination revealed elongated basal epithelial cells and activated keratocytes in the anterior stroma near the nodules. Occasional subbasal nerves and tortuous stromal nerve bundles were observed. With LM and TEM, five zones were described: one internodular and four pertaining the nodule, each characterized by peculiar aspects of the epithelium and stroma. As also confirmed by the morphometry, in the zones corresponding to the nodules, the epithelium was lower and with fewer cell layers than the peripheral zones. Over the nodules, the basement membrane was discontinuous or absent and the Bowmans layer, when present, had a granular-filamentous appearance. The nodular stroma was formed by many activated keratocytes and irregular lamellae. Subbasal nerves were always isolated and had degenerative changes in the center of the nodule. CONCLUSIONS This work illustrates the confocal microscopic findings associated with LM and TEM observations in patients with advanced SND. Our data revealed milder changes of the epithelium together with more pronounced changes of the basement membrane and Bowmans layer, which are aspects of increased keratocyte activity and an altered nerve pattern. All of these structures seem to contribute to the characteristic corneal disorganization of SND.

Effects of amino acids enriched tears substitutes on the cornea of patients with dysfunctional tear syndrome.

Purpose:  To evaluate the effect of aminoacid enriched artificial tears on the ocular surface of patients with dysfunctional tear syndrome (DTS).

Morphological and Morphometric Study of the Pecten Oculi in the Budgerigar (Melopsittacus undulatus)

The pecten oculi is a highly vascular and pigmented organ placed in the vitreous body of the avian eye. As no data are currently available on the morphological organization of the pecten in the Psittaciformes, the pecten oculi of the budgerigar (Melopsittacus undulatus) was studied. The eyes from adult male budgerigars were examined by light, transmission, and scanning electron microscopy and a morphometric study on both light and transmission electron microscopy specimens was also performed in the different parts of the organ. In the budgerigar, the type of the pecten oculi was pleated. Its basal part had a cranio‐caudal and postero‐anterior course; its body consisted of 10–12‐folds joined apically by a densely pigmented bridge. The pecten showed many capillaries, whose wall was thick and formed by pericytes and endothelial cells. These latter had a large number of microfolds, rectilinear on their luminal surface and tortuous on their abluminal surface. Interstitial pigment cells were placed among the capillaries, filled with melanin granules and showed many cytoplasmic processes. The morphometric analysis demonstrated significant differences among the three parts of the organ relative to the length of the endothelial processes and to the number and size of the pigment granules. The morphological and morphometric analysis showed that the bridge of the budgerigar, different from the other birds, had a large number of capillaries, so that this part of the organ could also play a trophic role for the retina in addition to the choriocapillaris. Anat Rec, 2012.

Effect of hypothyroidism on postnatal conjunctival development in rats.

Aim: To study the conjunctival development in hypothyroid genetically epilepsy-prone rats (GEPRs) with serum T3 and T4 significantly lower than in normal rats. Methods: A structural, ultrastructural and histochemical study on the conjunctival epithelium of GEPRs and of control Sprague-Dawley (SD) rats before and after eyelid opening, with particular regard to goblet cell differentiation. Results: From birth to day 12, no goblet cells were demonstrated on the conjunctival surface of both strains, so that the epithelium was formed only by a cuboidal basal layer and by a superficial layer of roundish or flattened cells. On day 16, after the eyelid opening, Alcian blue (AB)-positive goblet cells filled with homogeneous granules were demonstrated isolated, in GEPRs, or clustered, in SD rats, in both the fornices and palpebral conjunctiva. The epithelium showed a basal layer and many layers of flattened cells and was taller in SD rats (8–10 layers) than in GEPRs (6–7 layers). At 3 months, the epithelium in SD rats was higher with generally clustered goblet cells, whilst in GEPRs goblet cells were both isolated or clustered. In both strains, the goblet cells showed a marked AB/periodic acid-Schiff positivity all over the conjunctival surface and were filled with granules of different density. In both strains, goblet cells were absent at birth and their appearance, as AB-positive cells, was concomitant with eyelid opening. Conclusions: Hypothyroid rats showed a conjunctival development different than that of normothyroid rats for both epithelial and goblet cells. It appears that thyroid hormone imbalance may influence conjunctival development.

Recurrence of Salzmann nodular degeneration of the cornea in a Crohn's disease patient.

The purpose of this study is to describe a recurrence of Salzmann nodular degeneration (SND) concurrent with the clinical onset of severe Crohn’s disease. The method used in this study is single observational case report. A 43-year-old male was treated for bilateral advanced SND by manual asportation of the corneal nodules. Two years after the treatment Crohn’s disease was diagnosed and during the following year a rapid bilateral and symmetric recurrence of the nodules was observed with progressive visual impairment. In conclusion, the timing of the recurrence of Salzmann nodules and the clinical manifestations of severe Crohn’s disease might suggest a link between the diseases.

the cornea in mucopolysaccharidosis IH-s: structural and ultrastructural study

Type I mucopolysaccharidoses (MPS I) include three autosomal recessive disorders (Hurler, MPS IH; Scheie, MPS IS; and Hurler-Scheie, MPS IH-S) caused by the deficient activity of the lysosomal hydrolase α-L-iduronidase with the consequent accumulation of dermatan and heparan sulfate in the lysosomes of several cell types [1]. MPS IH-S is an attenuated disease and the patients show minor facial and skeletal dysmorphism, regular intelligence, mild cardiac and respiratory disease, hepatosplenomegaly, and a normal lifespan. The most common feature is corneal opacification [2], whose morphological basis was not studied in detail. In this work we performed a structural and ultrastructural analysis of the cornea in a patient with MPS IH-S. The patient underwent penetrating keratoplasty and the corneal button was immediately processed for light and electron microscopy. From the micrographs a morphometric analysis was also performed. The corneal epithelium showed superficial cells with few microfolds and evident intercellular spaces. The wing cell layer was formed either by cells with well-evident tonofilaments and small peripheral clear vesicles, or with bilobed nucleus and large paranuclear vesicles filled with granular material. The basal cells showed polygonal shape, with many small vesicles, placed generally in the supranuclear cytoplasm: the intercellular space was enlarged by granular material. The Bowman’s layer was either normal in thickness and structure, or thinner and formed by granular material of variable electron density. The stroma was formed by irregular lamellae of differently oriented collagen, by a large number of keratocytes filled with vesicles, and by intercellular granular material. The corneal endothelium showed degenerative changes. The morphometric analysis of the collagen fibrils diameter provided a mean diameter of 21.71±2.09 nm. Hemidesmosomes were less numerous in the basal cells when compared to the normal cornea. Stromal keratocytes were reduced in their number, particularly in the anterior stroma. Our data showed in MPS IH-S patient pronounced changes of the epithelium, of the Bowman’s layer and of the stroma, consistent with the corneal opacity. As the etiology of the disease is a deficiency of α-L-iduronidase and the consequent accumulation of glycosaminoglycans, we are of the opinion that the stromal keratocytes are the first cells to be involved in the pathogenesis of the corneal disease. The accumulation of the aberrant products seems able to induce morphological changes of both the Bowman’s layer and the corneal epithelium.