Off the Cuff: Technology Matters

Researchers sought to evaluate ocular surface changes in patients with Hashimoto's thyroiditis without thyroid ophthalmopathy to elucidate the relationship between dry eye syndrome and meibomian gland dysfunction (MGD) in cases of Hashimoto's thyroiditis. This prospective study included 105 patients with Hashimoto's thyroiditis and 105 age- and sex-matched controls. The 12-item Ocular Surface Disease Index (OSDI) questionnaire was administered to all patients. Both eyes affected by Hashimoto's thyroiditis and normal eyes were evaluated and compared with regard to the following parameters: Hertel exophthalmometry, palpebral fissure height, tear-film breakup time (TBUT), Schirmer 1 test, area and density scores for corneal fluorescein staining, eyelid abnormality, meibomian gland expression, meibography scores and areas of meibomian gland loss.

The eyes affected by Hashimoto's thyroiditis demonstrated significantly lower TBUTs, Schirmer 1 test scores and meibomian gland expression, and significantly higher OSDI scores, corneal fluorescein staining results, eyelid abnormality scores, meibography scores and areas of meibomian gland loss. Ocular Surface Disease Index scores were significantly positively correlated with eyelid abnormality scores, meibography scores and areas of meibomian gland loss, and negatively correlated with meibomian gland expression. The duration of Hashimoto's thyroiditis was significantly positively correlated with MGD.

Researchers wrote that dry eye syndrome and ocular discomfort symptoms were significantly more common among patients with Hashimoto's thyroiditis, even in the absence of thyroid ophthalmopathy. They added that dry eye syndrome in patients with Hashimoto's thyroiditis is believed to result from MGD and is correlated with the duration of the thyroid disease.

Evaluation and management of eye trauma is daunting to many practitioners. For general medical emergencies, the familiar ABCs mnemonic serves to both recompose the provider as well as provide a logical order for evaluation and action. We recently adapted an ABCs mnemonic to provide non-ophthalmologists with a familiar method for systematically evaluating and managing eye trauma.

A=ACUITY. Visual acuity is the most important piece of information in eye trauma. B=BEST exam of BOTH eyes. Starting with acuity, examination proceeds from the front to the rear of the eye. Examine the uninjured eye first. C=CONTIGUOUS STRUCTURES and CONTACT LENSES. Examine structures contiguous to the apparent injury. Inspect for contact lens wear. D=DRUGS, DIAGNOSTIC IMAGING and the DON'TS. Start antibiotics, antiemetics and analgesics. Administer tetanus. Obtain computerized tomography if available. Do not attempt ocular ultrasound or magnetic resonance imaging. Do not apply pressure to the eye. Do not patch the eye or apply any medication. E=EYE SHIELD and EVACUATE. Shield and ship to ophthalmology.

The mnemonic was adapted to reflect current Joint Trauma Services and Tactical Combat Casualty Care practice guidelines. The authors believe this familiar mnemonic can serve as a useful tool in enabling non-ophthalmologists to comfortably and safely evaluate an eye for trauma.

Glaucoma is a group of optic neuropathies characterized by a progressive degeneration of retinal ganglion cells (RGCs) and their axons that precedes functional changes detected on the visual field. The macular ganglion cell complex (GCC), available in commercial Fourier-domain optical coherence tomography, allows the quantification of the innermost retinal layers that are potentially involved in the glaucomatous damage, including the retinal nerve fiber (RNFL), ganglion cell and inner plexiform layers.

The researchers wrote that the average GCC thickness and its related parameters represent a reliable biomarker in detecting preperimetric glaucomatous damage. Further, they added, the most accurate GCC parameters are represented by average and inferior GCC thicknesses, and they can be associated with progressive visual field loss. Although, they noted, that the diagnostic accuracy increases with more severe glaucomatous damage and higher signal strength values, it is not affected by increasing axial length, resulting in a more accurate discrimination of glaucomatous damage in myopic eyes with respect to the traditional RNFL thickness.

The researchers reported that the analysis of the structure-function relationship reveals a good agreement between the loss in retinal sensitivity and GCC thickness. They noted that the use of a 10-2 degree visual field grid, adjusted for the anatomical RGCs displacement, describes more accurately the relationship between RGC thickness and visual field sensitivity loss.