BACKGROUND: The monitoring and assessment of the upper tarsal conjunctiva can be enhanced by the use of a grading scale. The aim of this study was to categorise the appearance of normal tarsal conjunctiva among young adults in Malaysia using the Institute for Eye Research grading scale and to investigate inter- and intra-observer agreement.
METHODS: The appearance of the upper tarsal conjunctiva of 416 non-contact lens wearing subjects aged between 19 to 24 years was assessed by two separate observers for roughness and redness in three separate zones using the Institute for Eye Research grading scale. The average grade for each zone and overall grade for roughness and redness were calculated. Inter- and intra-observer agreements were analysed.
RESULTS: Subjects were categorised for ethnicity and the roughness and redness were calculated. No significant differences were found between Malay and Chinese eyes (p > 0.05). The average grades for the upper tarsal conjunctiva redness and roughness were 0.90 ± 0.25 and 0.86 ± 0.43, respectively. Significantly higher roughness scores were found in zone 1 compared to the other two zones (p = 0.03). Significant association was also found between tarsal conjunctiva redness and roughness (Spearman ρ= 0.45, p < 0.001). Correlation between redness and roughness with age (p = 0.48, p = 0.65) and gender (p = 0.30, p = 0.79) were not significant. Only 2.2 per cent of subjects had scores higher than 2.0 for roughness or redness. Inter- and intra-observer analysis showed good agreement between two observers during the study.
CONCLUSION: The roughness and redness of normal tarsal conjunctiva among young adults in Malaysia were found to be less than two units. Results of this study might be beneficial in clinical trials using contact lenses where changes in the tarsal conjunctiva are commonly used as an outcome measure.
Study site: Universiti Kebangsaan Malaysia, Kuala Lumpur, Malaysia
A young Chinese female presented with severe bilateral chemosis without any other systemic evidence ofoedema or systemic lupus erythematosus (SLE). Investigations confirmed the diagnosis of SLE with early diffuse proliferative glomerulonephritis. The condition improved with steroid therapy.
PURPOSE: To evaluate the prevalence of ocular surface disease (OSD) in glaucoma and nonglaucoma subjects using different clinical tests and to determine the effect of number of antiglaucoma medications and preservatives on OSD.
METHODS: This is a cross-sectional, case-comparison study at the Eye Clinic of the University of Malaya Medical Centre, Malaysia, between June 2012 and January 2013. Glaucoma subjects (n = 105) using topical antiglaucoma medications were compared with control subjects (n = 102) who were not on any topical medications. The presence of OSD was assessed using the tear film breakup time (TBUT) test, corneal staining, Schirmer test, and Ocular Surface Disease Index (OSDI) questionnaire grading.
RESULTS: The prevalence of OSD varied from 37 to 91% in the glaucoma group, depending on the type of clinical test. More subjects in the glaucoma group had corneal staining (63% vs. 36%, p = 0.004), abnormal Schirmer tests (39% vs. 25%, p = 0.049), and moderate OSDI symptoms (17% vs. 7%, p = 0.028). The percentage with abnormal TBUT increased with higher numbers of topical medications and was high with both benzalkonium chloride-containing and preservative-free eye drops (90% and 94%, respectively, both p < 0.001). Benzalkonium chloride was associated with a nearly three times higher odds ratio of showing abnormal OSDI.
CONCLUSIONS: Ocular surface disease is common in those using topical antiglaucoma medications. Abnormal TBUT is associated with increasing number of eye drops and benzalkonium chloride-containing eye drops, although this also occurs with the use of preservative-free eye drops.
Study site: Eye Clinic, University of Malaya Medical Centre (UMMC), Kuala Lumpur, Malaysia,
Replacement therapy for toxoplasmosis was not a clear-cut choice since most of anti-parasitic agents available are also associated with Steven Johnson Syndrome. Further more the therapy has to be effective to control infection, which was previously achieved by oral Fansidar in this patient. Oral Azithromycin was seen as a drug of choice for these reasons. Corticosteroids were maintained since it was relatively indicated in both toxoplasmosis and SJS. Both conditions can results in visual impairment. SJS can be a life threathening condition and its ocular complications include conjunctivitis, ectropion or entropion, symblepharon, vascularization of the cornea, chronic dry eyes, and ankylosymblepharon. Proper management in dealing with both diseases is mandatory in order to prevent mortality and minimize the ocular complications. It has been shown in this case that the challenging part in managing patient with both diseases is to balance out between prevention of fatal consequences and the need control to the infection and preserving vision. Decisions on medical treatment for both conditions will remain controversial till reliable prospective randomized control trials are done to address the issues
The purpose of this study was to compare the use of autologous fibrin to human amniotic membrane (HAM) as a scaffold in cultivating autologous conjunctiva for transplantation in treatment of conjunctival defect. An experimental study was performed using 18 adult New Zealand white strain rabbits which were divided into 3 groups. Each group consists of 6 rabbits. The conjunctiva on the temporal site was excised to create a conjunctival epithelial defect. The excised area in the Group 1 was transplanted with autologous conjunctiva cultivated on autologous fibrin; Group 2 was transplanted with autologous conjunctiva cultivated on HAM and Group 3 was left bare. The rabbits were followed up at regular intervals until 6 weeks. The mean period of complete conjunctival epithelization was 11.50 ± 8.22 days for the autologous fibrin group, 15.33 ± 11.80 days for the HAM group and 25.33 ± 5.32 days in the bare sclera group. The epithelization rate for the autologous fibrin group was faster compared to the other two groups. However all the results were not statistically significant (p value >0.05). There were no postoperative complications noted during the follow up. Autologous fibrin is comparable to HAM as a scaffold for cultivation of conjunctiva in the treatment of conjunctival defect.
A 47-year-old woman with poorly controlled asthma and allergic rhinitis presented with recurrent episodes of bilateral upper eyelid swelling associated with forniceal conjunctival mass for the past 10 years. Routine blood investigations showed raised IgE levels and raised eosinophil counts. The diagnosis of Churg-Strauss syndrome (CSS) was made following biopsy of the conjunctival mass. The symptoms responded well to oral steroid treatment but recurred following cessation of the therapy. The patient was co-managed with a rheumatologist and the patient currently remains stable and is on oral Methotrexate and low dose oral steroids. Ocular involvement in CSS is unusual but this unique presentation of CSS was successfully managed, and the patient remains in remission.