Saturday, July 26, 2008

Abstract: Wet at the lower altitudes, dry higher up... (so to speak)

Dry eye as a side effect of medications for overactive bladder.

Comparison of fesoterodine and tolterodine in patients with overactive bladder.
BJU Int. 2008 Jul 21. [Epub ahead of print]
Chapple CR, Van Kerrebroeck PE, J√ľnemann KP, Wang JT, Brodsky M.

OBJECTIVE To compare, in a post hoc analysis of a phase III trial, the maximum recommended doses of fesoterodine (8 mg) and tolterodine (4 mg) for improving overactive bladder (OAB) symptoms and health-related quality of life (HRQoL), as fesoterodine effectively reduces OAB symptoms vs placebo....

RESULTS... Adverse events reported most commonly with active treatment included dry mouth, constipation, dry eye, dry throat, and nausea. CONCLUSIONS Both fesoterodine and tolterodine ER significantly improved OAB symptoms and HRQoL, with statistically significant advantages for fesoterodine 8 mg compared with tolterodine ER on several important endpoints.

Abstract: Glaucoma and dry eye - large scale study

Wow - first thing of it's kind I remember coming across. More than 20,000 patients.

As always I'm glad to see anything underscoring and exploring the unique needs of glaucoma patients because of BAK risk issues. This one emphasizes yet another angle (see highlighted text in Conclusions) - I assume what they mean is patients failing to use their glaucoma drops because they themselves associate them with their increased dry eye symptoms.

German register for glaucoma patients with dry eye. I. Basic outcome with respect to dry eye.
Graefes Arch Clin Exp Ophthalmol. 2008 Jul 22. [Epub ahead of print]
Erb C, Gast U, Schremmer D

BACKGROUND: The purpose of this register was to determine the links between glaucoma, age, concomitant disease, medication, and dry eye in a large group of glaucoma patients.

METHODS: A total of 20,506 patients from 900 centers across Germany were included. The first 30 consecutive glaucoma patients at each center were recruited. Epidemiological data as well as information on glaucoma, medication, concomitant diseases, dry eye, and local symptoms were elicited by means of a questionnaire. We analyzed primary open-angle glaucoma (POAG), pseudoexfoliation glaucoma (PEX), and pigmentary glaucoma (PDG).

RESULTS: According to the register data, more women develop dry eye and glaucoma than men (56.9 vs. 45.7%). The most frequent concomitant systemic diseases were hypertension (48.1%), diabetes mellitus (22.5%), and dry mouth, nose, and skin (11.3%). As expected, the highest incidence of dry eye was found in those patients with dry mouth, nose, and skin. Dry eye occurred with dissimilar frequencies in association with the various glaucoma types: PEX>POAG>PDG. The incidence of dry eye increases with age. The gender difference in the occurrence of dry eye becomes apparent from the age of 50. Dry eye occurred more frequently when three or more antiglaucoma drugs were used and increased with the duration of glaucoma disease. CONCLUSIONS: We publish the first results from the German Glaucoma and Dry Eye Register. We found that the occurrence of dry eye is linked to several factors. Thus, the type of glaucoma has an impact on the risk of dry eye. The quantity of eye drops applied also plays a role in the development of the dry eye syndrome if more than three medications are used. While POAG is usually treated with one drug, PEX and PDG tend to be treated with multiple drugs. The gender difference in the occurrence of dry eye becomes apparent from the age 50 years. Because of the vicious circle of dry eye, antiglaucoma eye drops containing benzalkonium chloride compromises patient compliance. The results of the register are therefore of key relevance for the care of glaucoma patients.

Thursday, July 24, 2008

Newsblurb: In-flight eye protection

One of those little seasonal reminders that news outfits are always running...

Eye irritants take flight on airplanes
The Herald News

...Airport hassles might have you red in the face, but have you also noticed that your eyes are red as well after sitting on the plane?

"The reused air circulating throughout the airplane cabin can dry out your eyes, leading to irritation and redness," says New Jersey-based optometric physician Dr. Leonard J. Press. "While dry, bloodshot eyes are common side effects of air travel, there are things you can do to help minimize the problem."

Press offers the following tips:

• Drink a lot of water during and after the flight.
• Avoid alcoholic or salty beverages, like tomato juice, during your flight. These drinks will only dehydrate you even more.
• Use lubricating eye drops to combat dry eye and irritation....



That's all well and good for the general public. For people with real dry eye like our DEZ members... come visit DryEyeTalk for more serious tips. Here's a few off the top of my head:

- Bring a damp cloth in a sealed plastic bag to use as a compress.
- Use tranquileyes moisture goggles or a sleep mask when you're dozing.
- If you're reading, working or watching movies, Onion Goggles may be helpful.

Abstract: Autologous serum in Germany

This is just covering a survey of practices in Germany, discussing issues with regulatory compliance among other things, and does not touch on clinical results. There were no complications reported amongst the group surveyed in 2007... however, with a 55% response rate, I don't know what that means. Anyway, clearly there are motivated people out there trying to get this treatment modality better accepted and more available.

[On the use of autologous serum eyedrops in Germany : Results of a survey among members of the Cornea Section of the German Ophthalmological Society (DOG).][Article in German]
2008 Jul;105(7):644-9.
Kasper K, Godenschweger L, Hartwig D, Unterlauft JD, Seitz B, Geerling G

PURPOSE: The use of serum eye drops has become more common for treating ocular surface diseases such as persistent epithelial defect and dry eye. For the production and use of blood products, regulatory restrictions apply. We surveyed the practice of production and application of serum eyedrops among the members of the Cornea Section of the German Ophthalmological Society (DOG) in Germany.

METHODS: A questionnaire concerning the application of topical blood-derived therapeutic agents for use in the eye was sent to 103 institutions in 2005 and 2007. The questionnaire included 14 groups of questions.

RESULTS: The rate of response was 49% in 2005 and 55% in 2007. Sixty-five percent (2005: 48%) of the institutions used blood-derived products as therapeutic agents in the eye (in 96%, serum eye drops). In 2007, 17% of the centers stated that they had a license to produce serum eye drops according to the official regulations (2005: 10%). Three hospitals stopped using serum eyedrops for regulatory reasons. In 2007 1,237 patients were treated (2005: 1,389); 36% of the ophthalmic departments produced the serum eye drops themselves (2005: 55%) and 43% produced them in cooperation together with or exclusively in another institution. Quality controls (e.g., virus serology and sterility checks) were performed in 47% (2005: 24%). In 2005, one corneal fibrin deposit was described. In 2007, no complication was reported.

CONCLUSION: Although fewer patients were treated in total in 2007, the number of centers using serum eye drops increased between 2005 and 2007. Serious complications were not described. Some hospitals stopped the production and use of serum eye drops because of regulatory reasons or had the drops produced by nonophthalmic institutions with a license to produce blood-derived products. In view of prospective randomized clinical trials showing that autologous serum support ocular surface wound healing, this therapy should be accepted as a standard of care.

Abstract: More on autologous serum...

For those considering autologous serum treatment and want to delve into the nitty-gritty details, this looks promising as a source of information on preparation protocol (as I recall some of the best info on this in the past has been from Germany) but also describing alternative/related blood products.

[Autologous serum and alternative blood products for the treatment of ocular surface disorders.]Ophthalmologe. 2008 Jul;105(7):623-31.
[Article in German]
Geerling G, Unterlauft JD, Kasper K, Schrader S, Opitz A, Hartwig D

Eye drops made from autologous serum have been increasingly used in the past decade to treat ocular surface disorders such as persistent epithelial defects and dry eye. Due to biologically active ingredients such as growth factors, vitamins, and nutrients, they can be used to lubricate the ocular surface and support epithelial wound healing. According to current legal requirements, they can be dispensed only for outpatient treatment if the producer has obtained a license from the appropriate local authorities. Therefore, the production and dispensing of autologous serum eye drops in Germany is currently limited to a very few institutions and their patients. We review the current evidence on the use of serum eye drops, recommend a standard protocol for their production, and describe a number of recently emerging alternative blood products for the treatment of ocular surface diseases along with their potential advantages and limitations.

Abstract: Contacts and tear film proteins

An interesting one relating to potential explanations for contact lens tolerance.

Albumin adsorption to contact lens materials: A review.
Cont Lens Anterior Eye. 2008 Jul 4. [Epub ahead of print]
Luensmann D, Jones L

During contact lens wear, tear film components such as lipids, mucins and proteins tend to deposit on and within the lens material and may cause discomfort, reduced vision and inflammatory reactions. The tear film protein that has attracted most interest when studying contact lens deposition is the small (14kDa), positively charged protein lysozyme. Albumin, which is a much larger protein (66kDa) with an overall net negative charge is also of interest, and shows very different adsorption patterns to lysozyme. The concentration of albumin in the tear film is relatively low compared to the concentration in blood serum, but this value increases markedly under various conditions, including when the eye is closed, during contact lens wear and in various dry eye states. Gaining an understanding of the manner in which albumin deposits on biomaterials is of importance for contact lens wear, as well as for other medical applications where HEMA-based materials are used for implants, artificial blood vessels or drug delivery devices. This review paper summarizes the impact of individual material compositions, water content, hydrophobicity and electrostatic attraction on the adsorption behavior of the protein albumin.

Newsblurb: LASIK & dry eye... Come again???

I take exception to the highlighted paragraph in this , which after stating that serious complications are less than 1%, does not clarify whether "dry eye, glare/halos and double vision" are "serious complications" - if so, then this information contradicts reams of medical literature, but if not, the percentages MUST be stated to avoid creating the impression that dry eye is among the <1% complications rate.

Questions About LASIK: Find Out If It’s Right For You
Eye On Health

(NAPSI)-LASIK, the popular vision correction procedure, was the topic of a recent FDA panel meeting in which its safety and effectiveness were reaffirmed.

Scientific data presented during the meeting showed that 95.4 percent of patients worldwide are satisfied with their results.

“As one of the most studied medical procedures, LASIK is well established and has an exceptional track record,” said Kerry D. Solomon, M.D., a world-renowned ophthalmologist and refractive surgeon at the Storm Eye Institute. “Today’s modern LASIK delivers superior safety and better visual outcomes than ever before.”

...

Q: Should I be afraid? Does it hurt?

A: LASIK today is fast and virtually painless. But remember, LASIK is surgery. Understanding both the benefits and the risks is important.

Serious complications are less than 1 percent. Complications may include dry eye, glare/halos and double vision, which typically resolve over time, or in some cases can be managed with enhancements or other therapy such as drops to replace the eye’s moisture.

“LASIK changes lives for the better, and with all of today’s advanced technologies, there simply is no better time to have LASIK,” said Dr. Solomon.

For more information, visit www.ascrs.org or check out www.thelasikfacts.com.

LASIK vision correction is performed on 700,000 people annually and has a 95.4 percent satisfaction rate.

Abstract: Literature review by Dr. Lemp

Another "state of the union" about tear system study and the challenges we face - among which as always the "signs vs symptoms" problem continues to figure prominently. It will be interesting to see over the next few years whether the use of "objective biomarkers" for disease severity really are able to bridge that gap.

Advances in Understanding and Managing Dry Eye Disease.Am J Ophthalmol. 2008 Jul 1. [Epub ahead of print]
Lemp MA


PURPOSE: To present evidence from the literature and scientific meetings to support fundamental changes in concepts regarding the prevalence, pathogenesis, definition, diagnosis, management of dry eye disease (DED) and the prospects for the development of new therapies.

DESIGN: Analysis and clinical perspective of the literature and recent presentations.

METHODS: Review and interpretation of literature.

RESULTS: The tear film and ocular surface form an integrated physiologic unit linking the surface epithelia and secretory glands via a neural network. This sensory-driven network regulates secretory activity in quantity and composition, supporting the homeostasis of the system. The tear film forms a metastable covering between blinks, subserving clear vision, and maintains the health and turnover of the ocular surface cells. Disturbance of intrinsic factors such as increasing age; hormonal balance; systemic or local autoimmune disease, or both; systemic drugs or extrinsic factors including topical medications; environmental stress; contact lens wear; or refractive surgery result in a final common pathway of events at the tear film and ocular surface, resulting in DED. Diagnosis of DED and the design of clinical trials for new drugs have been hampered by a lack of correlation between signs and symptoms and flawed endpoints; successful new drug applications likely will require new approaches, such as the use of objective biomarkers for disease severity.

CONCLUSIONS: Recent advances in our knowledge of the causation of DED open opportunities for improving diagnosis and disease management and for developing new, more effective therapies to manage this widely prevalent and debilitating disease state.

Abstract: "Urban Eye Allergy"

This sure rings some bells....

Urban eye allergy syndrome: a new clinical entity?Curr Med Res Opin. 2008 Jun 28. [Epub ahead of print]
Leonardi A, Lanier B

BACKGROUND: A significant number of patients present with conjunctivitis that is not strictly speaking of allergic, infectious, or dry eye origin. Patients affected by this pseudo-allergic form of vasomotor or idiopathic conjunctivitis usually live in urban polluted areas and may be affected by a new clinical entity called the 'urban eye allergy syndrome'.

SCOPE: To identify the incidence, pathogenesis and therapeutic response of this condition by collecting from the literature experimental evidence on the relationship between air pollution, allergy, and conjunctival disease.

FINDINGS: Allergen susceptibility might be increased in areas with increased air pollutants. Both allergens and pollutants can directly initiate specific and nonspecific mucosal inflammation through several interweaving mechanisms.

CONCLUSIONS: The present commentary introduces the concept of 'urban eye allergy syndrome' discussing interactions between air pollutants and pollens, the increase of allergic signs and symptoms by pollutants, the prevalence of urban allergy, preliminary data from a single restricted geographical area, and proposed mechanisms of action.

Newsblurb: Eyelid surgery for ptosis

Another sign, albeit slight, of progress... Lately I've occasionally been seeing snippets in the press connecting cosmetic eyelid surgeries and dry eye. This one also mentions (though it doesn't explain the connection) LASIK.

Droopy Eyelids
Jen Christensen

Droopy eyelids, also called ptosis, is a condition that affects one or both upper eyelids. Patients may experience increased tearing, irritation or difficulty closing the eye(s). Ptosis can also cause problems with vision, especially during reading, leading to headaches, eye fatigue and double vision....

Corrective surgery for ptosis is called blepharoplasty. The American Society for Aesthetic Plastic Surgery estimates, last year, more than 240,000 of the procedures were performed in the U.S. The surgery is typically done for cosmetic reasons to balance the look of the eyelids or rejuvenate the face. But it can also be used to correct droopy eyelids that cause vision problems for the patient....

[Dr. Wulc] recommends a consultation with an ophthalmologist to reduce risk of potential complications, like dry eye. Patients who have had LASIK surgery should wait at least six months before having eyelid surgery. Conversely, patients who have had eyelid surgery should wait at least six months before having LASIK.

Newsblurb: Pets, peepers & pain

This one caught my eye after reading on DryEyeTalk posts from members whose doctors frankly disbelieved their description of the pain they were in. If somebody out there cares enough about what dogs suffer from dry eye, erosions and ulcers, there are caring human eye doctors out there too, somewhere. (Doctors fitting this description, please raise your hands and make yourselves known. We need you!)

Your pet's eyes: Don't let problems go unseen
Dr. Jill Thompson
wnewsj.com

Concerned pet owners call the hospital almost every day with a question about their pet’s eyes.

The eyes may be too watery, too red, too squinty and so on. These are not problems that can be addressed over the phone. Many eye issues are not only a source of worry but true emergencies. If you have not been working with a veterinarian regarding your pet’s eye problems, plan on your pet being seen for its ocular irregularities.

Redness, tearing and squinting can all be signs of more ominous issues. Pets with allergies may experience eye problems, but this condition usually affects both eyes. Pets with problems in one eye may have an injury or underlying condition that needs attention. Pets with problems in both eyes also need a closer look from your veterinarian.

We commonly see pets with ulcers on the surface of the eye or cornea. This can be secondary to a scratch, dry eye or other causes. No matter the inciting cause, corneal ulcers are painful. They need to be addressed immediately to avoid further injury and discomfort. Your veterinarian can use a special stain to identify the ulcer and gauge the severity and prognosis. Dogs and cats that are brachycephalic (have a short nose often with prominent eyes) are at an increased risk for corneal injury. Their eyes are more likely to meet with injury because of their position.

Abstract: Genetics & dry eye & more

This falls into a class of "high falutin' science" that I have to read twice slowly and will still find that it's way, way, way over my head, BUT I'm including it here because (a) it's potentially relevant to some of the more stubborn+mysterious dry eye cases on DEZ and (b) I found the conclusions really very interesting: That evaporative dry eye and non-sjogrens aqueous deficient dry eye are "different but related" possibly via a genetic factor having to do with a mucin, making them more susceptible to ocular surface damage.

MUC1 and estrogen receptor alpha gene polymorphisms in dry eye patients.
Exp Eye Res. 2008 Jun 20. [Epub ahead of print]
Imbert Y, Foulks GN, Brennan MD, Jumblatt MM, John G, Shah HA, Newton C, Pouranfar F, Young WW Jr.

Dry eye syndrome is a collection of common disorders of multifactorial etiology. Although the epidemiology of dry eye has been well studied, reports of genetic patterns that might influence susceptibility to dry eye are few. We reported that the frequency of non-Sjogren's aqueous deficient dry eye patients expressing only the MUC1/A splice variant of the mucin MUC1 may be lower than that of a normal control group [Imbert, Y., Darling, D.S., Jumblatt, M.M., Foulks, G.N., Couzin, E.G., Steele, P.S., Young, W.W., Jr., 2006. MUC1 splice variants in human ocular surface tissues: possible differences between dry eye patients and normal controls. Exp. Eye Res. 83, 493-501]. Also, He et al. [He, Y., Li, X., Bao, Y., Sun, J., Liu, J., 2006. The correlation of polymorphism of estrogen receptor gene to dry eye syndrome in postmenopausal women. Yan. Ke. Xue. Bao. 22, 233-236] reported a difference between Chinese dry eye and control groups in the frequency of a polymorphism in estrogen receptor alpha (ERalpha). In the present study we determined the statistical significance and generality of these observations and tested if the MUC1 splice variant difference between subject groups reflected a difference in the MUC1 variable number of tandem repeat (VNTR) size class. There was a perfect correlation between the MUC1/A or MUC1/B splice variant pattern and the SNP genotype frequency of the SNP (rs4072037) controlling that splicing event. In contrast, western and Southern blotting indicated that MUC1 VNTR size class corresponded to the MUC1 SNP genotype in only 80% of cases. We determined the status of the MUC1 SNP in normal and dry eye populations all of whom were female Caucasians. The MUC1 SNP genotype frequency of the normal control group was statistically different from both the non-Sjogren's aqueous deficient dry eye group with ocular surface staining (P=0.017) and the evaporative dry eye group (P=0.015). We also tested SNP rs2234693 to analyze the polymorphism in the ERalpha gene and found no significant difference in the SNP genotype frequency between the control group and either of the dry eye subtypes. Thus, among Caucasians there is no evidence for an association of the ERalpha gene polymorphism with dry eye syndrome as previously described in a Chinese population. In conclusion, the etiologies of evaporative dry eye and non-Sjogren's aqueous deficient dry eye are known to be different. However, our results suggest that both these subtypes of dry eye disease may share a common mechanism or factor related to MUC1 genotypic differences that affects susceptibility to ocular surface damage. This altered susceptibility may not be related to the MUC1 VNTR size class. Therefore, mechanisms influencing protection of the ocular surface against inflammation and damage in different types of dry eye disease warrant further investigation particularly in relation to MUC1 genotype.

Abstract: Autologous serum eyedrops on the NHS

Here's one for our UK members...

[Experiences with a centralised national service for autologous serum eyedrops in England.][Article in German]
Ophthalmologe. 2008 Jul;105(7):639-43.
Maclennan S, Hartwig D, Geerling G.

The majority of patients with dry eye syndromes respond to conventional treatment aimed at optimising the ocular surface environment. There are some, however, who do not respond adequately to conventional lubricants. The first description of the use of autologous serum as a nutrient tears substitute was published more than 20 years ago. In 1997, NHS Blood and Transplant (NHSBT) developed a reliable and reproducible method for the production of eyedrops derived from autologous serum according to GMP Guidelines. The current cost of a batch of eyedrops (i. e. the product from one donation episode) is approximately 1300 GBP - this covers costs of collection, processing, testing and distribution. One "batch" of eyedrops will last for approximately 5 months if a bottle a day is used. A 6 month shelf life is put on the product and patients keep them in their domestic freezer.

Wednesday, July 23, 2008

Abstract: IBD and dry eye

This study was done at the university in Ioannina, a town in northwestern Greece where my husband lived for several years in his teens. It's a very friendly town... and home of the world's best bougatsa-me-krema (drool). Well, twenty years ago anyway. I wonder if anyone reading this knows whether those little bougatsa shops are still around.

Spectrum and frequency of ophthalmologic manifestations in patients with inflammatory bowel disease: A prospective single-center study.
Inflamm Bowel Dis. 2008 Jul 14. [Epub ahead of print]
Felekis T, Katsanos K, Kitsanou M, Trakos N, Theopistos V, Christodoulou D, Asproudis I, Tsianos EV

Background: The frequency and spectrum of ophthalmologic manifestations in patients with inflammatory bowel disease (IBD) has been reported to vary among studies; however, rare and silent manifestations have not been extensively studied.Methods: This was a prospective study of 60 patients diagnosed with IBD who underwent full ophthalmologic examination, including visual acuity, slit lamp examination of the anterior segments, intraocular pressure, and fundus examination accompanied by color photography. Thirty-seven (61,7%) patients were diagnosed with ulcerative colitis (UC) and 23 (38,3%) with Crohn's disease (CD). Data from 276 control individuals were used for the determination of the prevalence of dry eye in our area.Results: Ophthalmologic manifestations were diagnosed in 26 (43%) patients (14 UC, 12 CD; 12 males and 14 females). Conjunctivitis was diagnosed in 1 patient (CD), episcleritis in 2 patients (UC), and iridocyclitis in 3 (CD). Fundus examination showed 1 patient (CD) with unilateral choroiditis, 1 (UC) with retinal vasculitis, and 1 (CD) with optic neuritis. Retinal pigment epithelium disturbances (RPED) were present in 3 patients (1 CD, 2 UC) and 2 had serous retinal detachment. In total, 13/60 patients (22%) had dry eye compared with the 11% prevalence in controls. Eight patients developed glucocorticosteroid-induced cataracts, 2 of them treated surgically.Conclusions: This study demonstrated the prevalence of the spectrum of ophthalmologic manifestations in the IBD population, including some rare and silent findings that may merit consideration and early intervention.(Inflamm Bowel Dis 2008).

Abstract: Radiosurgery treatment for trigeminal neuralgia

Here's one for our members with trigeminal neuralgia. 2% dry eye incidence is a small percentage but for those with pre-existing dry eye, it's as well to be aware.

Prognostic factors for radiosurgery treatment of trigeminal neuralgia.
Neurosurgery. 2008 May;62(5 Suppl):A53-60; discussion A60-1.
Chen JC, Greathouse HE, Girvigian MR, Miller MJ, Liu A, Rahimian J

OBJECTIVE: Trigeminal neuralgia treatment results are thought to be highly dependent upon selection criteria. We retrospectively analyzed a series of patients to determine the likelihood of treatment success for patients treated with radiosurgery. METHODS: A retrospective analysis of 82 patients treated with linear accelerator radiosurgery was undertaken with a median follow-up period of 18 months. Patients were evaluated with a standard inventory using the Barrow Neurological Institute pain scale as the primary means of outcome measurement. Patients were treated with a linear accelerator using a single isocenter plan delivered via a 4-mm collimator, typically with seven noncoplanar arcs to a peak dose of 85 or 90 Gy in primary treatments and 60 Gy in retreatments. The primary target was the cisternal component of the trigeminal nerve. Posttreatment outcomes were analyzed in light of pretreatment patient characteristics, including age, sex, anticonvulsant responsiveness, quality and pattern of pain, length of disease, number of previous procedures, and radiation dose exposure to the root entry zone. Univariate analysis and multivariate logistic regression analysis were used to determine the prognostic significance of various pretreatment variables. RESULTS: Good results as defined by a Barrow Neurological Institute outcome score of IIIb or better were seen in 85.3% of patients. Excellent results as defined by a Barrow Neurological Institute outcome score of I were seen in 49% of patients. The median time to satisfactory improvement of pain was 4 weeks. Only one variable, sensitivity to anticonvulsant medication, was found to be statistically significant in both univariate (P = 0.003) and multivariate analysis (P = 0.025). All other variables analyzed failed to reach statistical significance. Complications were not common, with seven patients (8.5%) developing new-onset hypoesthesia and two patients (2%) developing dry eye symptoms. CONCLUSION: Anticonvulsant responsiveness is the single most important prognostic indicator of treatment success for patients presenting with facial pain. Other predictive factors generally failed to reach statistical significance. Linear accelerator radiosurgery for trigeminal neuralgia is a safe and effective treatment for well-selected patients, with results similar to those obtained with gamma unit radiosurgery.

Abstract: Lid surgery & paralytic lagophthalmos...

This is not directly related to dry eye but we have so many members whose primary dry eye cause is lagophthalmos from a variety of causes that I want to make sure and cover it all (no pun intended).

This one's a review of success to date with temporalis muscle transfer as a treatment of paralytic lagophthalmos.

J Plast Reconstr Aesthet Surg. 2008 Jul 16. [Epub ahead of print]
Retrospective outcome analysis of temporalis muscle transfer for the treatment of paralytic lagophthalmos.
Miyamoto S, Takushima A, Okazaki M, Momosawa A, Asato H, Harii K.

Temporalis muscle transfer for paralytic lagophthalmos, which was first proposed by Gillies and later developed by Andersen, has been one of the most common treatment modalities for paralytic lagophthalmos. However, there have been no scientific reports statistically analysing the efficacy of temporalis muscle transfer. We, therefore, retrospectively analysed the functional and aesthetic results of temporalis muscle transfer. Between 1994 and 2006, we carried out temporalis muscle transfer (the so-called Gillies-Andersen method) on 95 established facial paralysis patients. We sent a postal questionnaire to these patients and 47 of them responded. The functional and aesthetic results were analysed based on the patients' replies together with clinical records and photographs, and unfavourable factors of this procedure were investigated. After surgery, most ocular symptoms (mechanical irritation, dry eye, soreness, and discharge) improved significantly. Achievement rate of complete eye closure was 78.7%. A morphometric study revealed that possible unfavourable factors (old age, intracranial disease, use of dentures, etc.) did not affect the achievement rates of complete eye closure. Deformity of eyelid fissure due to undue tension of the temporal fascia fixation was found in nine patients (19.1%) and six of these patients underwent secondary revision. Unlike lid loading with a gold implant, the results of temporalis muscle transfer depend greatly on the surgeon's skill. However, if this procedure is performed properly, strong eye closure can be obtained. We, therefore, recommend temporalis muscle transfer as the preferred option for reconstruction of paralytic lagophthalmos.

I'm back!

Sorry for the extended silence... just got busy with one thing and another, then had a little back trouble, and it's taken a little while to get caught up with everything. I'll try to catch us up with Medline and other dry eye news over the next day or so.