Dry eye can be caused by a variety of iatrogenic interventions. The increasing number of patients looking for eye care or cosmetic procedures involving the eyes, together with a better understanding of the pathophysiological mechanisms of dry eye disease (DED), have led to the need for a specific report about iatrogenic dry eye within the TFOS DEWS II. Topical medications can cause DED due to their allergic, toxic and immuno-inflammatory effects on the ocular surface. Preservatives, such as benzalkonium chloride, may further aggravate DED. A variety of systemic drugs can also induce DED secondary to multiple mechanisms. Moreover, the use of contact lens induces or is associated with DED. However, one of the most emblematic situations is DED caused by surgical procedures such as corneal refractive surgery as in laser-assisted in situ keratomileusis (LASIK) and keratoplasty due to mechanisms intrinsic to the procedure (i.e. corneal nerve cutting) or even by the use of postoperative topical drugs. Cataract surgery, lid surgeries, botulinum toxin application and cosmetic procedures are also considered risk factors to iatrogenic DED, which can cause patient dissatisfaction, visual disturbance and poor surgical outcomes. This report also presents future directions to address iatrogenic DED, including the need for more in-depth epidemiological studies about the risk factors, development of less toxic medications and preservatives, as well as new techniques for less invasive eye surgeries. Novel research into detection of early dry eye prior to surgeries, efforts to establish appropriate therapeutics and a greater attempt to regulate and oversee medications, preservatives and procedures should be considered.

TFOS DEWS II iatrogenic report.

The treatment of ocular pterygium has been subjected to the development and application of various new strategies in the last few years. The worrisome problem of recurrence seems to have been significantly reduced with the newer methods of treatment. The field is however, still evolving. This review sets out to examine the various newer approaches to treating pterygium and in spite of the recent developments, to highlight the remaining challenges thereby suggesting the possible direction of future research. Also, to suggest treatment options for Ophthalmologists working in environments with limited resources. A library search and Internet search of PubMed and Google was conducted in 2010. Search terms included "pterygium in combination with surgery", "radiotherapy", "chemotherapy", "graft", and "recurrence." Abstracts were reviewed and relevant articles especially those published from the year 2000 to date were given more attention and when possible, reviewed in full. The relevant references in such articles were also reviewed. In conclusion, excision and adjunctive treatment with mitomycin C or conjunctival autograft is the most acceptable and most popular mode of treating both primary and recurrent pterygium. Outcomes seem to have been further improved with adjuvant combination therapy and the introduction of newer approaches to treatment.

/pdf/treatment-of-pterygium-4m5hmva3b7.pdf

Treatment of pterygium.

Objective
To evaluate the evidence in the peer-reviewed literature regarding the use of tear osmolarity as a physiological marker to diagnose, grade severity, and track therapeutic response in dry eye disease (DED). In addition, to review the evidence for the role of tear osmolarity in the pathophysiology of DED and ocular surface disease.

/pdf/tear-film-osmolarity-and-dry-eye-disease-a-review-of-the-4k1oiccqui.pdf

Tear film osmolarity and dry eye disease: a review of the literature.

http://www.webaigo.it/download/Barkun%202013.pdf

Topical hemostatic agents: a systematic review with particular emphasis on endoscopic application in GI bleeding

Diabetes mellitus is a chronic disease that results from inadequate insulin production or ineffective insulin utilization. It is one of the most common systemic diseases worldwide with increasing prevalence. Diabetes mellitus is associated with premature mortality, macrovascular complications such as cardiovascular disease, and microvascular complications, including nephropathy leading to kidney failure, potentially blinding diabetic retinopathy, and diabetic neuropathy. While the retinal complications of diabetes are well recognized by eye care professionals, the effects on the ocular surface are poorly understood. Recent studies have reported on the association between peripheral neuropathy and corneal neuropathy, showing the latter to be of predictive value for the systemic disease. Corneal neuropathy can lead to loss of corneal sensation and can ultimately result in neurotrophic ulcers and significant visual morbidity. The epithelial fragility and poor wound healing that result from reduced epithelial adhesion to the underlying basement membrane in diabetes, together with corneal neuropathy, are thought to increase the susceptibility to persistent corneal erosions and infection, as well as to increase the risk of post-surgical complications. The aim of this article is to review the impact of diabetes on corneal nerve morphology and ocular surface integrity. Changes in the tear film and ocular surface microbiome are highlighted in discussion of the mechanisms that underpin ocular surface changes that increase the susceptibility to corneal erosion and infection.

The impact of diabetes on corneal nerve morphology and ocular surface integrity

Purpose:
To compare various techniques of pterygium surgery including bare sclera, intraoperative mitomycin C application, conjunctival flap reconstruction, and conjunctival autografting technique.

https://www.dovepress.com/getfile.php?fileID=3973

Comparing techniques for pterygium surgery.

Objective To determine concurrent changes in corneal thickness, intraocular pressure (IOP), and corneal topography measurements during normal pregnancy. Design Prospective cohort study. Participants We studied 50 eyes from 25 healthy women whose ages ranged from 21 to 35 years and who were first seen during the 10th week of pregnancy. Methods Measurements included IOP (noncontact tonometry); corneal thickness (ultrasound pachymetry); and corneal topography (TMS 2N, TOMEY, Nagoya, Japan). Changes in IOP, central corneal thickness (CCT), and corneal power were calculated at 4 time periods: first trimester, second trimester, third trimester, and 3 months postpartum. Results The mean IOPs in the second and third trimesters of pregnancy were found to be lower than those in the first trimester and at 3 months postpartum ( p = 0.001). The mean CCT in the second and third trimester of pregnancy was measured to be higher than in the first trimester and at 3 months postpartum ( p Conclusions An increase in CCT was accompanied by a decrease in IOP in the second and third trimesters. Physiologic changes occurring in CCT and IOP should be considered in the management of glaucoma during pregnancy.

The course of corneal and intraocular pressure changes during pregnancy.

Purpose: To compare tear film osmolarity (TFO) between patients with diabetes mellitus (DM) and normal healthy individuals. Methods: In this prospective case-controlled study, the TFO in 46 normal subjects (control group) and 55 patients with DM (study group) was evaluated. TFO in milliosmole (mOsm) was measured by using an auto-osmometer. The serum levels of glycosylated hemoglobin (HbA1c) and blood glucose in all participants were also measured. Mean outcome measures were TFO and its relationship with HbA1c level and duration of DM. Results: Mean TFO was 320.40 ± 21.80 mOsm/l in the study group and 308.22 ± 18.16 mOsm/l in the control group (p 1c level (r = 0.225, p = 0.114). Conclusions: The study shows a significantly higher TFO in patients with DM than in the healthy controls. TFO also correlates with the duration of DM.

Tear film osmolarity in patients with diabetes mellitus.

Harlequin sign and harlequin syndrome, which are used interchangeably in the literature, are characterized by sudden onset of hemifacial sweating and flushing, induced by exercise and heat. Hemifacial sweating and flushing with normal ocular sympathetic innervation, known as harlequin syndrome, is rarely associated with tonic pupils, parasympathetic oculomotor lesion and pre- or postganglionic sudomotor sympathetic deficit. In the literature, hemifacial sweating and flushing in patients with apparently abnormal ocular sympathetic innervation has been defined as harlequin sign. To date, a few reports of excessive hemifacial sweating and flushing in structural lesion have been documented. Herein, we report five patients with excessive hemifacial sweating and flushing, two of whom had a syrinx. In presenting the patients, we have attempted to distinguish harlequin syndrome from harlequin sign. With this in mind, Case 1 can be described as harlequin syndrome resembling Ross syndrome, Case 2 as harlequin syndrome with normal ocular sympathetic innervation, Case 3 as harlequin sign with congenital Horner syndrome, Case 4 as harlequin sign with sympathetic and parasympathetic denervation sensitivity, and Case 5 as harlequin syndrome associated with occult sympathetic denervation sensitivity. These cases are discussed together with a review of the literature.

Unnoticed dysautonomic syndrome of the face: Harlequin syndrome.

The aim of this study was to determine the nature and prevalence of ophthalmologic abnormalities in deaf children. Complete ophthalmologic examinations were performed on 104 children aged 7 to 20 years from a Turkish school for the deaf. Of 104 children, 42 children (40.4%) had some form of ophthalmologic abnormality, with the vast majority (31 patients, 29.8%) being refractive errors. The prevalence of hypermetropia, myopia and astigmatism was found to be higher over the general population. Of 104 children, 19 (18.2%) had ocular motility disturbances and one had external adnexal anomaly. Two (1.8%) children had anterior segment and nine (8.6%) children had posterior segment pathologies. Routine ophthalmologic examinations should be carried out in this population because deaf children use sight to compensate for hearing problems. Ophthalmologists play an important role in the diagnosis and correction of ophthalmologic abnormalities.

Atilla Alpay

Papers

Comparing techniques for pterygium surgery.

The course of corneal and intraocular pressure changes during pregnancy.

Tear film osmolarity in patients with diabetes mellitus.

Unnoticed dysautonomic syndrome of the face: Harlequin syndrome.

Ophthalmologic abnormalities in children from a Turkish school for the deaf.