Search

Purpose: The aim of this paper was to investigate the degree of inflammation and dry-eye disease (DED) in recurrent pterygium. Methods: Fifty-five patients with a history of pterygium excision were divided into 3 groups – Group 1: no recurrence after the first excision; Group 2: recurrence after the first excision; Group 3: no recurrence after the second excision. Dry-eye symptoms and tear production were elicited for each patient. Results: A high prevalence of DED was observed in patients with primary and recurrent pterygium based on self-reported dry-eye symptoms (63.6%) and an abnormal Schirmer test result (78.1%). There was a statistically significant difference (p = 0.025) in the Schirmer test values between patients with (5.6 mm) and without (11.4 mm) recurrence after surgery for primary pterygium. Patients who were cured after a second excision had an improved Schirmer test value (9.5 mm), although this was not significant. Conclusion: Pterygium recurrence is associated with a greater severity of dry eye, possibly by perpetuating ocular surface inflammation in the postoperative period.

Background Epidermolysis bullosa (EB) and autoimmune blistering diseases (AIBD) describe a group of rare chronic dermatoses characterized by cutaneous fragility and blistering. Although uncommon, significant ocular surface disease (OSD) may occur in both and require ophthalmological assessment. Disease scoring systems have a critical role in providing objective and accurate assessment of disease severity. The objectives of this report were, firstly, to document the prevalence and severity of ocular involvement in EB/AIBD. Secondly, to review and evaluate existing ocular and systemic scoring systems for EB/AIBD. Finally, to identify areas where further development of ocular specific tools in EB/AIBD could be pursued. Methods A literature search was performed in October 2017 utilising Medline, Embase, and Scopus databases. The results were restricted by date of publication, between 01.01.1950 and 31.10.2017. The reference lists of these articles were then reviewed for additional relevant publications. Articles of all languages were included if an English translation was available. Articles were excluded if they were duplicates, had no reference to ocular involvement in EB/AIBD or described ocular involvement in other diseases. Results Descriptions of ocular involvement in EB/AIBD were identified in 88 peer-reviewed journal articles. Findings reported include but are not limited to: cicatrising conjunctivitis, meibomian gland dysfunction, dry eye disease, trichiasis, symblepharon, fornix fibrosis, keratopathy, ectropion/entropion, ankyloblepharon, corneal ulceration, visual impairment and blindness. Although scoring systems exist for assessment of OSD in mucous membrane pemphigoid, no such tools exist for the other AIBD subtypes or for EB. Several systemic scoring systems exist in the dermatological literature that are efficacious in grading overall EB/AIBD severity, but have limited inclusion of ocular features. To the best of our knowledge, there is no recognised or validated scoring systems which comprehensively stages or grades the spectrum of ocular manifestations in EB/AIBD. Conclusions There are a range of ocular complications documented in EB and AIBD. Development of a comprehensive ocular scoring system for EB/AIBD which incorporates the delineation between ‘activity’ and ‘damage’ would facilitate more objective patient assessment, improved longitudinal monitoring, comparison of intervention outcomes, and provide commonality for discussion of these patients due to the multidisciplinary nature of their care.

To report on a case of autoconjunctival graft compromise after pterygium surgery in a patient on long-term anti-vascular endothelial growth factor (anti-VEGF) therapy, due to the deleterious effects of anti-VEGF agents on ocular wound healing. A white female in her early eighties presented with large right nasal pterygium, first noted 5 years previously. She also had macular degeneration and had been receiving monthly injections of ranibizumab, which was later switched to aflibercept. She proceeded to have a right nasal pterygium excision with a conjunctival autograft, 9 days after her last dose of intravitreal aflibercept. Surgery was uneventful; however, at the week 2 postoperative review, there was conjunctival graft dehiscence with melting of the graft and underlying sclera. The patient was administered hyperbaric oxygen treatments, topical antibiotics, steroids, and lubricating eye drops, and aflibercept injections ceased. The scleral melt slowly resolved and her aflibercept was restarted 3 months later. This case highlights the potential hazards of performing elective surgery in patients on VEGF inhibitors and the need for an appropriate interval between cessation/subsequent restart of anti-VEGF agents and surgery to be established.

To report a novel intervention for the treatment of conjunctival lymphangiectasia-subconjunctival injection of bevacizumab.A 53-year-old white male presented with a 3-month history of right ocular discomfort and redness unresponsive to conventional topical treatment of lubricants and steroids. A clinical diagnosis of conjunctival lymphangiectasia was confirmed by biopsy. Bevacizumab (25 mg/mL) was injected subconjunctivally into the affected area.An improvement in the degree of conjunctival chemosis was evident at 5 days postinjection. At 1-month follow-up, symptoms had fully resolved. No recurrence had been observed at 3 years' follow-up.Subconjunctival bevacizumab injection may be an effective treatment for conjunctival lymphangiectasia.

Dry eye is prevalent in many parts of the world. As a result, ophthalmologists and other health care professionals, such as optometrists and general practitioners, often help these patients manage their symptoms. The most common form of treatment for management of dry eye is over-the-counter tear lubricants. A number of tear lubricant formulations are available that vary by their mechanism of action. This article suggests simple guidelines on how lubricants can be selected for patients with mild to moderate dry eye. Side effects of lubricants, such as burning on instillation because of mismatches of eye drop with tear acidity, are also discussed.

We describe a 28-year-old Malaysian Australian man of Han Chinese descent with toxic epidermal necrolysis (TEN), occurring 2 weeks after commencing carbamazepine. He was subsequently found to be positive for human leukocyte antigen (HLA)-B*1502. Carbamazepine-induced Stevens–Johnson syndrome/TEN is strongly associated with the HLA-B*1502 allele, which is highly prevalent in Han Chinese, Malay, Thai and Indian populations. Prospective screening for the allele may prevent this cutaneous adverse drug reaction from occurring, but many neurologists and other medical practitioners are still unaware of the medico-legal risks of prescribing carbamazepine in susceptible populations and the availability of HLA-B*1502 testing. Performing HLA-B*1502 genotyping and avoiding carbamazepine in at-risk individuals has been proven to decrease incidences of drug-induced TEN. This test is widely available at most large pathology services in Australia, with results available within 2 weeks. The recommendation by regulatory bodies should be strengthened to ensure that the broad medical community is made more aware of this pertinent issue.

To study the range of ocular manifestations in an Australian cohort of patients with pemphigus and bullous pemphigoid (BP), including a detailed assessment for dry eye syndrome (DES).Twenty-two patients with pemphigus vulgaris, pemphigus foliaceus, and BP were referred for a detailed ophthalmology review between September 2011 and March 2012.A total of 44 eyes of 22 patients with pemphigus vulgaris, pemphigus foliaceus, and BP were examined. Photophobia was the most common symptom reported. The most common ocular signs found in both groups were blepharitis (68.1%), conjunctival hyperemia (22.7%), and limbal broadening (18.2%). In our DES assessment, 92.9% of patients had a reduced Schirmer test score and an abnormal tear break-up time was recorded in 100% of patients. The ocular surface disease index score ranged from 0 to 47.2, with a median score of 10.The high occurrence of patient-reported ocular symptoms and clinical evidence of dry eye on Schirmer testing and break-up time demonstrate high prevalence of DES in our cohort of pemphigus and BP patients, which is a novel finding. Limbal broadening was another common finding not previously reported.

The integument is often overlooked when focusing on the clinical features of EB, but there are important clinical clues to the subtyping of EB which may be gleaned from these tissues, as well as special complications. One of the areas of the body that is not affected by EB is the placenta and amnion, yet there are still many questions related to pregnancy in EB which few books address, which are answered here.

Autoimmune blistering skin disease (AIBD) is a term used to describe a heterogeneous group of cutaneous and mucosal diseases with significant morbidity and mortality. A range of ocular complications can occur in patients with AIBD, due to the underlying blistering disease or as side effects of the medications used to treat these diseases. The most common ocular presentation of AIBD is a chronic conjunctivitis, which can progress to conjunctival fibrosis and eventually chronic cicatricial conjunctivitis. Cicatrisation leads to ocular complications that include symblepharon, fornix foreshortening, entropion, trichiasis, corneal damage and neovascularisation. Clinical features in the eye overlap between the types of AIBD. Early recognition and treatment of the disease is essential to prevent irreversible scarring and progression to blindness in certain cases.

Importance Quality-of-life (QOL) evaluation is an increasingly important outcome measure in dermatology, with disease-specific QOL instruments being the most sensitive to changes in disease status. Objective To develop a QOL instrument specific to autoimmune bullous disease (AIBD). Design A comprehensive item generation process was used to build a 45-item pilot Autoimmune Bullous Disease Quality of Life (ABQOL) questionnaire, distributed to 70 patients with AIBD. Experts in bullous disease refined the pilot ABQOL before factor analysis was performed to yield the final ABQOL questionnaire of 17 questions. We evaluated validity and reliability across a range of indices. Setting Australian dermatology outpatient clinics and private dermatology practices. Patients and Exposure Patients with a histological diagnosis of AIBD. Main Outcomes and Measures The development of an AIBD-specific QOL instrument. Results Face and content validity were established through the comprehensive patient interview process and expert review. In terms of convergent validity, the ABQOL was found to have a moderate correlation with scores on the Dermatology Life Quality Index ( R = 0.63) and the General Health subscale of the 36-Item Short Form Health Survey ( R = 0.69; P = .009) and low correlation with the Pemphigus Disease Area Index ( R = 0.42) and Autoimmune Bullous Disease Skin Disorder Intensity Score ( R = 0.48). In terms of discriminant validity, the ABQOL was found to be more sensitive than the Dermatology Life Quality Index ( P = .02). The ABQOL was also found to be a reliable instrument evaluated by internal consistency (Cronbach α coefficient, 0.84) and test-retest reliability (mean percentage variation, 0.92). Conclusions and Relevance The ABQOL has been shown to be a valid and reliable instrument that may serve as an end point in clinical trials. Future work should include incorporating patient weighting on questions to further increase content validity and translation of the measure to other languages. Clinical Trial Registration anzctr.org.au Identifier:ACTRN12612000750886

Dry eye is a very common condition in many parts of the world. Both ophthalmologists and other healthcare professionals, such as optometrists and general practitioners, are often involved in the care of these patients. The main thrust of dry eye management is over-the-counter tear lubricants. There is a wide range of tear lubricants available today. These lubricants vary in viscosity, duration of action, type of preservatives, osmolarity/osmolality and pH. This article aims to educate healthcare professionals on 1) how to assess and manage patients with mild to moderate dry eyes and 2) how to identify patients who may need a referral to an ophthalmologist. Strategies on the use of available treatments and their limitations, as well as factors that may affect patient compliance will be discussed.