Objective: This study determined the prevalence of dry eye disease (DED) in a community located in a highaltitude tropical city in the Philippines. Methods: This was a cross-sectional study conducted in Barangay Lualhati in Baguio City from March 2019 to September 2022. Convenience sampling was done in recruiting adult permanent residents of the community. The participants underwent standardized DED evaluation consisting of symptom questionnaire, Ocular Surface Disease Index (OSDI) scoring, slit-lamp examination, fluorescein tear break-up time (TBUT) measurement, ocular surface fluorescein and lissamine green staining, and Schirmer test with and without topical anesthesia. DED was classified as aqueous tear deficiency type, evaporative type, or mixed type. Results: Data from 272 participants were analyzed which represented 23% of the adult population of the community. There were 111 participants who fulfilled the DED definition, and the prevalence rate of DED was 41%. The mean age of those with DED was 43.0 ± 17.6 years while the mean age of those without DED was 51.8 ± 16.6 years (p<0.001). More females (60%) had DED than males (40%). Majority (82%) reported use of digital devices as the main exacerbating factor. Mean OSDI score was significantly higher in those with DED than in those without DED (27.2 + 6.8 and 10.7 ± 6.4, respectively) (p<0.001). Corneal and conjunctival staining scores were also significantly higher in subjects with DED. Evaporative DED was the most common (88.3%). Mixed-type DED was seen in 11.7%. None had pure aqueous tear deficiency dry eye. Conclusion The prevalence rate of DED is greater in areas of higher altitude and DED can be exacerbated by prolonged screen time. This condition is no longer just a problem of the elderly and is now also seen in younger patients. All symptomatic patients should undergo tear break-up time evaluation since evaporative or short TBUT is the predominant type of DED.
Dry Eye Syndromes ; Eye ; Eye Disease

PURPOSE: This study was performed to evaluate the long-term effect of 0.05% cyclosporine A emulsion (Restasis, Allergan Inc. USA.) on dry eye associated with graft-versus-host disease (GVHD). METHODS: Sixteen eyes of 8 patients with severe dry eye associated with GVHD were treated with 0.05% cyclosporine A emulsion twice a day. Tear film parameters were evaluated before treatment and after 1, 3, 6, and 12 months of treatment. RESULTS: One month after treatment, tear break-up time improved from 3.88+/-1.78 s to 4.17+/-1.90 s (P=0.02). Three months after treatment, symptom score and basal secretion improved from 3.00+/-0.38 and 4.44+/-1.59 mm to 2.33+/-0.52 (P=0.04) and 5.42+/-2.50 mm (P=0.04), respectively. Twelve months after treatment, the keratoepitheliopathy score improved from 2.38+/-1.31 to 1.13+/-0.35 (P=0.02). CONCLUSIONS: Use of a 0.05% cyclosporine A emulsion is effective for dry eye associated with GVHD as it helps to increase tear secretion and to relieve symptoms. Treatment with 0.05% cyclosporine A emulsion for longer than 1 year may be necessary to improve keratoepitheliopathy.
Cyclosporine ; Dry Eye Syndromes ; Eye ; Graft vs Host Disease ; Humans ; Tears

Autoimmunity associated with severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) has been well-described as the mechanism of development of thyroid dysfunction following Coronavirus Disease 19 (COVID-19) infection and SARS-CoV-2 vaccination. However, the occurrence of thyroid eye disease (TED) after SARS-CoV-2 vaccination is scarcely described. The postulated mechanisms include immune reactivation, molecular mimicry and the autoimmune/inflammatory syndrome induced by adjuvants (ASIA). We report a case of new-onset TED after receiving the SARSCoV- 2 vaccine.
Thyroid eye disease ; SARS-CoV-2 vaccine ; Molecular Mimicry

PURPOSE: Retinoblastoma (RB) is the most common primary malignant intraocular tumor in children. Although systemic chemotherapy has been the primary treatment, intra-arterial chemotherapy (IAC) represents a new treatment option. Here, we performed alternate systemic chemotherapy and IAC and retrospectively reviewed the efficacy and safety of this approach. METHODS: Patients diagnosed with intraocular RB between January 2000 and December 2011 at Severance Children's Hospital, Yonsei University, were reviewed. Before February 2010, the primary treatment for RB was chemotherapy (non-IAC/CTX). Since February 2010, the primary treatment for RB has been IAC (IAC/CTX). External beam radiotherapy or high-dose chemotherapy were used as "last resort" treatments just prior to enucleation at the time of progression or recurrence during primary treatment. Enucleation-free survival (EFS) and progression-free survival were assessed. RESULTS: We examined 19 patients (median age, 11.9 months; range, 1.4 to 75.6 months) with a sum of 25 eyes, of which, 60.0% were at advanced Reese Ellsworth (RE) stages. The enucleation rate was 33.3% at early RE stages and 81.8% at advanced RE stages (P=0.028). At 36 months, EFS was significantly higher in the IAC/CTX group than in the non-IAC/CTX group (100% vs. 40.0%, P=0.016). All 5 patients treated with IAC achieved eye preservation, although most patients were at advanced RE stages (IV-V). CONCLUSION: Despite the limitation of a small sample size, our work shows that an alternative combined approach using IAC and CTX may be safe and effective for eye preservation in advanced RB.
Child ; Disease-Free Survival ; Drug Therapy, Combination ; Eye ; Eye Enucleation ; Humans ; Infusions, Intra-Arterial ; Recurrence ; Retinoblastoma ; Retrospective Studies ; Sample Size

PURPOSE: To evaluate the effects of systemic steroid therapy on the development of dry eye syndrome (DES) in graft-versus-host disease (GVHD) resulting from hematopoietic stem cell transplantation (HSCT) in hematologic malignancy (HM) patients. METHODS: We analyzed 108 HSCT patients. We measured tear film break up time (BUT) and basal tear secretion, and checked for corneal lesions. BUT under 10 seconds and basal tear secretion under 10 mm gave a diagnosis of DES. Significant corneal lesions were also described in this gorup. We compared the clinical aspect and frequency of dry eye according to GVHD and also compared clinical aspects of dry eye in GVHD patients before and after systemic steroid therapy. RESULTS: Fifty-six patients (51.9%) developed GVHD, including 51 patients (91.1%) in the GVHD group and 31 patients (59.6%) in the non-GVHD group. The frequency of DES was statistically significant in the GVHD group (p<0.05). BUT and basal tear secretions were 4.08+/-1.76 sec and 6.05+/-2.57 mm in the GVHD group and 5.37+/-1.83 sec and 7.08+/-1.54 mm. There were 32 peoples (57.1%) with corneal lesions in the GVHD group and 13 peoples (25.0%) in the non-GVHD group. Based on these results, DES was statistically significant in the GVHD group. In the GVHD group, BUT and basal tear secretion levels were 4.08+/-1.76 sec and 6.05+/-2.57 mm before systemic steroid therapy and 5.20+/-2.91 sec and 6.73+/-1.80 mm after the therapy. The difference was statistically significant (p<0.05), so we concluded that systemic steroid therapy relieved DES. Before steroid therapy, 32 peoples (57.1%) had corneal lesions, and this number decreased to 25 peoples (44.6%) after steroid therapy. The difference was not statistically significant, but we presumed that steroid therapy improved the corneal lesions (p>0.05). CONCLUSIONS: The severity and frequency of DES were high in the GVHD group. At the same time, systemic steroid therapy could relieve DES in GVHD patients. Therefore, proper medical treatment and ocular examinations should be performed for HSCT patients.
Dry Eye Syndromes ; Eye ; Graft vs Host Disease ; Hematologic Neoplasms ; Hematopoietic Stem Cell Transplantation ; Hematopoietic Stem Cells ; Humans ; Tears ; Transplants

PURPOSE: We report a patient with strabismus associated with thyroid ophthalmopathy whose condition changed remarkably for 6 years of a natural course. CASE SUMMARY: A 69-year-old woman with Graves' disease presented with diplopia in April 1999. On examination, she showed left hypotropia of 50 prism diopters (Delta) accompanied by supraduction limitation and lid lag in the left eye. She was diagnosed with strabismus associated with thyroid ophthalmopathy and was observed without any intervention. In October 2000, her left hypotropia decreased to 16Delta, and esotropia of 14Delta developed. Both eyes showed limitation of supraduction, and the left eye showed limitation of abduction. In December 2003, the esotropia increased to 35Delta, and the direction of vertical strabismus changed to 40Delta of right hypotropia. Supraduction limitation of the right eye and abduction restriction of both eyes increased, and infraduction limitation of the left eye developed. In April 2005, esotropia increased to 75Delta, and the amount of right hypotropia was 35Delta. The abduction limitation of both eyes increased. CONCLUSION: The natural course of strabismus associated with thyroid ophthalmopathy can show continuous and remarkable changes.
Aged ; Diplopia ; Esotropia ; Eye ; Female ; Graves Disease ; Humans ; Strabismus ; Thyroid Gland

OBJECTIVE : We investigated the relationship between the severity of the disease and the abnormality of some ocular movements in parkinson's disease. BACKGROUND: Disorders of eye movements have been described in diseases of the basal ganglia for over a century and ocular motor deficits of the saccadic and pursuit system have been reported in parkinsonian patients. METHOD : We studied the electro-oculography of the eye tracking and saccadic movement in 26 patients (11 males, 15 females) with Parkinson's disease. The severity of the disease was divided into two groups by Hoehn & Yahr(H-Y) staging, H-Y stage 1, 2(group A) and H-Y stage 3, 4 (Group B). Some patients antiparkinsonian drugs of L-dopa, dopamine agonist and anticholinergics. RESULT : The velocity of smooth pursuit and the velocity and latency of saccade were calculated and compared between two groups. Eye tracking test revealed decreased pursuit velocity leading to catch-up saccades, but normal phase relationship between eye and target movement, while saccadic eye movement had increased latency. These results showed more profound severity in more advanced stages of the disease. CONCLUSION : We suggest that ocular movement be often chosen as a simple but relevant example of general motor function, as well as criteria for staging of Parkinson's disease and basal ganglia play significant role in ocular movement.
Basal Ganglia ; Cholinergic Antagonists ; Dopamine Agonists ; Eye Movements ; Humans ; Levodopa ; Male ; Parkinson Disease* ; Pursuit, Smooth ; Saccades

BACKGROUND AND OBJECTIVES: It has been reported that vibration applied either on the mastoid or the sternocleidomastoid (SCM) muscles induces nystagmus in patients after unilateral vestibular neuritis. The aims of the study were to characterize the vibration-induced nystagmus (VIN) in patients with various vestibular disorders and to compare the results of VIN to unilateral weakness in caloric test. MATERIALS AND METHODS:Fifthy-four patients with Meniere's disease, 58 patients with unilateral vestibular neuritis, 170 patients with migraine-associated dizziness, and 78 patients with chronic recurrent vestibulopathy were included. We recorded eye movements during unilateral 100-Hz vibration on the mastoids and SCM muscles. The bithermal caloric test was also performed. Abnormal criteria of VIN were slow-phase slow-phase velocity (SPV) at 4 all different conditions > or = 2degrees/s with the same directions or mean of SPV at vibration on both mastoids or both SCM muscles > or = 5degrees/s with the same directions. RESULTS: In Meniere's disease, 28 of 57 (49.1%) of patients show pathologic VIN, 21 of 57 (36.8%) show pathologic canal paresis. 14 of 57 (24.6%) show abnormalities in both tests, and 35 of 57 (61.4%) show any abnormalities in either test. In unilateral vestibular neuritis, 43 of 58 (77.6%) showed pathologic VIN, 58 of 58 (100%) show canal paresis. In migraine-associated dizziness, 48 of 170 (28.2%) showed pathologic VIN, 58 of 170 (18.8%) show canal paresis. 15 of 170 (8.8%) showed abnormalities in both tests, and 65 of 170 (38.2%) show any abnormalities in either test. In chronic recurrent vestibulopathy, 23 of 78 (29.5%) of patients show pathologic VIN and 17 of 78 (21.8%) show pathologic canal paresis. Seven of 78 (9.0%) showed abnormalities in both tests, and 33 of 78 (42.3%) show any abnormalities in either test. CONCLUSION: VIN test can increase the sensitivity in detecting vestibular imbalance in vestibular disorders when combined with caloric test.
Caloric Tests ; Dizziness ; Eye Movements ; Humans ; Mastoid ; Meniere Disease ; Muscles ; Paresis ; Vestibular Neuronitis ; Vibration

BACKGROUND AND OBJECTIVES: Qualitative oculomotor abnormalities have been reported in parkinsonian patients for many years, but conflicting results have been obtained. This study was performed to evaluate the correlation between the severity of the disease and the abnormalities of the ocular movements in idiopathic parkinson's disease. METHODS: We gave the vestibular function tests in patients with idiopathic parkinson's disease and normal controls. Eye movement recordings were made with automated electronystagmography and rotation test was performed. A total of 46 patients (mean age : 61.2+/-6.7) and 24 controls (mean age : 60.5+/-4.3) were studied. The severity of the disease was divided into two groups by modified Hoehn & Yahr staging ; H-Y stage 1 and 2 as a mild group and stage 3 and 4 as a severe group. RESULTS: Saccadic latency and accuracy, pursuitic gain and velocity, vestibulo-ocular reflex (VOR) suppression by vision were significantly altered in patients, whereas mean velocity of optokinetic nystagmus (OKN) and VOR gain in darkness were normal. Alteration of saccadic latency and accuracy, pursuitic gain and velocity, VOR suppression by vision were profound in the severe group compared with a mild group and controls, but the above parameters did not differ between a mild group and controls. In a hemiparkinson's group, saccadic latency and accuracy, pursuitic gain, OKN mean velocity and gain was not different between the both sides. CONCLUSION: The results indicate that severe Parkinson's disease damages nigrostriatal or other specific pathways which were involved in the regulation of the saccadic, pursuitic and pursuitic-mediated visual fixation system. In a hemiparkinson's group asymmetric damage of dopaminergic innervation which was involved in the regulation of ocular movements was not found.
Darkness ; Electronystagmography ; Eye Movements ; Humans ; Nystagmus, Optokinetic ; Parkinson Disease* ; Reflex, Vestibulo-Ocular ; Vestibular Function Tests

PURPOSE: To investigate the efficacy of combined treatment with 0.05% cyclosporine A and 20% umbilical cord serum eye drops for severe dry eye associated with graft-versus-host disease (GVHD). METHODS: Eighteen patients with severe dry eye associated with GVHD were treated with 0.05% cyclosporine A and 20% umbilical cord serum eye drops (group 1, n = 16), 0.05% cyclosporine A eye drops (group 2, n = 10) or artificial tears only (group 3, n = 10). Tear film break up time (BUT), Schirmer test, tear clearance rate (TCR), and keratoepithelio pathy score were measured before and 1, 3 and 6 months after treatment. RESULTS: In group 1, significant improvement was observed in tear film BUT (from 3.25 +/- 1.18 s to 6.63 +/- 0.96 s, p < 0.01), TCR (from 2.38 +/- 0.72 to 3.13 +/- 0.72, p < 0.01) and keratoepithelio pathy score (from 6.31 +/- 2.15 to 0.88 +/- 0.89, p < 0.01) 6 months after treatment. Compared with group 2 and group 3, group 1 showed significant improvement in BUT (3 and 6 months after treatment) and keratoepitheliopathy score (1, 3 and 6 months after treatment). CONCLUSIONS: Combined treatment with 0.05% cyclosporine A and 20% umbilical cord serum eye drops is effective for severe dry eye associated with GVHD.
Cyclosporine ; Eye ; Graft vs Host Disease ; Humans ; Ophthalmic Solutions ; Tears ; Umbilical Cord