OBJECTIVE: This study investigated the effects of an eye care protocol (ECP) on patients in the intensive care unit (ICU).
METHODS: This study utilized a randomized controlled design. Participants were patients who met the inclusion criteria and were admitted to the ICU (36 in the experimental group and 38 in the control group). The experimental group received an ECP, while the control group received standard eye care, starting the day after admission, for a duration of 10 days. The ECP classifies the degree of eyelid obstruction into three stages based on the degree of exposure to the lower eyelid conjunctiva and cornea. The protocol included cleansing with normal saline gauze, administering eye drops, applying silicone and polyurethane films, and recommending consultation with an ophthalmologist if necessary. The effectiveness of ECP was assessed by analyzing tear volume, hyperemia, chemosis, and eye discharge. Data analysis was conducted using SPSS 27.0, employing the Mann-Whitney U-test and generalized estimating equations.
RESULTS: On day 5, the experimental group demonstrated a significant increase in tear volume in both eyes compared with the control group. However, no statistically significant differences were observed in the incidence of hyperemia, chemosis, and eye discharge on days 5 and 10 of the intervention.
CONCLUSIONS: The application of the ECP in this study increased tear volume in ICU patients, thereby reducing discomfort caused by dry eyes. It has the potential to prevent complications such as damage to the surface of the eyeball resulting from decreased tear volume.

In this case report, we explore a complex and rare presentation of simultaneous aniridia, xerophthalmia, corneal ulcer, and keratomalacia in a 21-year-old patient with a congenital history of nystagmus and progressively diminishing visual acuity. The patient experienced a recent exacerbation of ocular pain and redness, primarily in the right eye, which led to a comprehensive ophthalmological evaluation. Examination revealed corneal ulceration, vascularization, and the absence of the iris, posing a unique clinical challenge. In this report, we detail the personalized management and therapeutic strategies employed in this case, emphasising the need for an integrated and holistic approach to treating complex ocular conditions. The outcomes highlight the importance of tailored treatment plans and a thorough understanding of the interplay between various eye pathologies to achieve better patient outcomes.

BACKGROUND: Vitamin A (VA) deficiency and excess negatively affect development, growth, and bone health. The World Health Organization\'s standard of care for xerophthalmia due to VA deficiency, is 3 high-dose VA supplements of 50,000-200,000 IU, based on age, which may cause hypervitaminosis A in some individuals.
OBJECTIVE: This study measured VA status following 3 VA doses in 2 piglet studies.
METHODS: In Study 1, 5 groups of piglets (n = 10/group) were weaned 10 d postbirth to VA-free feed and orally administered 0; 25,000; 50,000; 100,000; or 200,000 IU VA ester on days 0, 1, and 7. On days 14 and 15, the piglets underwent the modified relative dose-response (MRDR) test for VA deficiency, and were killed. Tissues were collected for high-pressure liquid chromatography analysis. Study 2 used the same design in 3 groups (n = 13/group) weaned at 16 d and administered 0; 25,000; and 200,000 IU doses.
RESULTS: In Study 1 (final weight: 3.6 ± 0.7 kg), liver VA concentration was hypervitaminotic in 40%, 90%, and 100% of 50,000; 100,000; and 200,000 IU groups, respectively. The 25,000 IU group was 100% adequate, and the placebo group was 40% deficient. In Study 2 (final weight: 8.7 ± 0.8 kg), where 200,000 IU could be prescribed to infants with a similar body weight, 31% of the piglets were hypervitaminotic, the 25,000 IU group was 100% VA adequate, and the placebo group was 100% deficient. The MRDR test measured deficiency in 50% and 70% of the placebo group in each study but had 3 false positives among hypervitaminotic piglets in Study 1.
CONCLUSIONS: Repeated high-dose VA may cause hypervitaminosis, indicating dose sizes may need reduction. The MRDR resulted in false positives in a hypervitaminotic state during malnutrition and should be paired with serum retinyl ester evaluation to enhance VA status assessment in populations with overlapping interventions.

Dry eye disease (DED) is pathogenetically based on inflammation of the ocular surface. A step-by-step approach to DED treatment involves early initiation of anti-inflammatory therapy, including instillation of cyclosporine A (CsA). However, recommendations for the use of topical CsA in clinical practice are limited. This article presents an expert consensus on practical recommendations for the management of patients with DED, including indications, time of initiation and duration of CsA therapy, comparison of CsA forms currently registered in the Russian Federation, as well as issues of patient education.
Синдром «сухого глаза» (ССГ) является заболеванием, в основе патогенеза которого лежит воспаление глазной поверхности. Поэтапный подход к лечению ССГ подразумевает раннее начало противовоспалительной терапии, включая инстилляции циклоспорина A (ЦсА). Однако рекомендации по использованию в клинической практике топического ЦсА носят ограниченный характер. Настоящий консенсус экспертов содержит практические рекомендации по тактике ведения пациентов с ССГ, включая показания, время начала и длительность лечения ЦсА, сравнение зарегистрированных в настоящее время в Российской Федерации форм ЦсА, а также вопросы обучения пациентов с ССГ.

In developed countries, vitamin A deficiency (VAD) remains rare but is a leading cause of global blindness. We describe the case of a 10-year-old girl with autism spectrum disorder (ASD) initially presenting mild VAD symptoms, escalating to severe photophobia and reluctance to leave a darkened room due to a self-restricted diet of fast-food french fries. A timely examination revealed severe VAD and vitamin A supplementation resolved her symptoms in three weeks. This case highlights the challenge of obtaining accurate patient history in ASD, emphasizing the need for routine dietary discussions and micronutrient testing, especially at ages nine and 13 when the United States Department of Agriculture (USDA) recommends increased vitamin A intake. Early intervention can prevent micronutrient deficiencies in pediatric patients, particularly those with ASD.

UNASSIGNED: Vitamin A is a fat-soluble vitamin, obtained through diet. Vitamin A deficiency is the leading cause of preventable blindness in children in developing countries due to impaired intake (Phanachet et al. 2018). Nevertheless, it is uncommon in the developed world where malabsorption takes a prominent role.
UNASSIGNED: A fifty-one-year-old female presented complaining of foreign body sensation, pain, tearing, fluctuating visual acuity, nyctalopia, diarrhea, polyphagia and weight loss. She had history of Roux-en-Y gastro-jejunal bypass, Lynch syndrome and right hemicolectomy with ileo-colonic anastomosis, she also referred to an additional unspecified bowel resection. In the ophthalmologic examination, best corrected visual acuity was 20/30, intraocular pressure was 11 mmHg in both eyes. Anterior segment biomicroscopy revealed a dry and thickened conjunctiva with wrinkles, multiple grey-white small, round, confluent, foamy lesions in the interpalpebral conjunctiva of both eyes, compatible with Bitot\'s spots, and superficial punctate keratitis.
UNASSIGNED: The rise of bariatric surgery, inflammatory bowel disease and end stage liver disease has led to an increase in cases of malabsorption syndrome and nutrient deficiencies in the developed world. Retinoids are essential for corneal and conjunctival epithelial cells differentiation and its deficiency is associated with a wide spectrum of ocular surface manifestations known as xerophthalmia. In this case, a gastric bypass and another unspecified bowel resection should raise the suspicion of malabsorption and nutrient deficiencies. In our patient, the diagnosis was made early and appropriate treatment was implemented before irreversible damage arose, however, vitamin A deficiency can be easily overlooked.
UNASSIGNED: In patients with xerophthalmia, interrogation should include previous history of gastrointestinal surgery, especially since bariatric surgery has become a popular technique. This is, to our knowledge, the first case report of xerophthalmia in a patient with Lynch syndrome.

We report the manifestations of vitamin A deficiency (VAD) in three children with underlying autism of different stages. These children were under developmental paediatrician follow-up for autism, and the VAD was not detected until these children presented to Ophthalmology screening for varying stages of signs and symptoms. On further assessment, all of our patients have VAD secondary to poor dietary intake, as autistic patients are associated with having selective eating habits. In our case series, we discuss the spectrum of xerophthalmia presentations, which can be mild and can manifest as punctate epithelial erosions to the more blinding complications at the advanced stage of the disease, mainly irreversible optic neuropathy. The primary management is to address the dietary routine coupled with systemic administration of vitamin A.

Due to lymphocytic infiltration of the salivary and lacrimal glands, Sjogren\'s syndrome (SS), a systemic autoimmune illness that mostly affects the exocrine glands, causes dry mouth (xerostomia) and dry eyes (xerophthalmia). Additionally, SS is associated with various comorbidities such as cardiovascular diseases, infections, musculoskeletal diseases, and cancers. Among patients with SS, xerophthalmia frequently arises as a complication, leading to insufficient tear production or rapid tear evaporation, thereby causing discomfort, irritation, and a gritty sensation in the eyes. This article aims to examine recent advancements in the imaging of the lacrimal gland in Sjögren\'s syndrome and briefly discusses the utilization of various imaging examinations for the lacrimal gland in this particular disease.

OBJECTIVE: To observe the effect of acupuncture on the ocular surface symptoms and the protein expression of vasoactive intestinal peptide (VIP) / cyclic adenosine monophosphate (cAMP)/protein kinase A (PKA) / aquaporin 5(AQP5) signaling pathway in lacrimal gland tissue of aqueous tear deficiency (ATD) type dry eye model, so as to investigate its mechanism underlying improvement of ATD.
METHODS: British shorthair guinea pigs were randomly divided into blank control, model, acupuncture, sham-acupuncture and medication group, with 8 guinea pigs in each group. The ATD model was established by subcutaneous injection of scopolamine hydrobromide (0.6 mg/dose, 4 times/d for 10 days). For guinea pigs of the acupuncture group, filiform needles were inserted into bilateral \"Jingming\"(BL1), \"Cuanzhu\"(BL2), \"Sizhukong\"(TE23), \"Taiyang\"(EX-HN5), and \"Tongziliao\"(GB1) for 15 min. For guinea pigs of the sham-acupuncture group, a blunt filiform needle was used to repeatedly prick (not pierce) the skin of the same acupoints mentioned above. The treatment in the above two groups was conducted once daily for 14 days. The guinea pigs in the medication group received administration of sodium hyaluronate eye drops in both eyes, three times a day for 14 days. The objective tests of tear film break-up time (BUT), corneal fluorescein staining score (FLS) and phenol red thread (PRT) test were conducted before and after modeling and after the intervention. After the intervention, the lacrimal index (weight of lacrimal gland/body weight) was calculated. Histopathological changes of the lacrimal gland were observed after H.E. staining. The expression of AQP5 in the lacrimal gland were detected by immunofluorescence, and the contents of VIP and AQP5 in the lacrimal gland were measured by ELISA, the protein expression levels of VIP, cAMP, PKA, p-PKA and AQP5 in the lacrimal gland were detected by Western blot.
RESULTS: In comparison with the blank control group, the PRT, BUT, lacrimal index, AQP5 immunoactivity, contents of VIP and AQP5, and protein expression levels of VIP, cAMP, PKA, p-PKA and AQP5 were significantly decreased(P<0.01, P<0.05), and FLS was obviously increased (P<0.01) in the model group . Compared to the model group, the PRT, BUT, lacrimal index, AQP5 immunoactivity, contents of VIP and AQP5, and expression levels of VIP and AQP5 in both acupuncture and medication groups, and the expression levels of cAMP, PKA, p-PKA in the acupuncture group were considerably increased (P<0.01, P<0.05), while the FLS was markedly decreased in both acupuncture and medication groups (P<0.01, P<0.05). Compared with the medication group, the acupuncture group had increased PRT (P<0.05).
CONCLUSIONS: Acupuncture intervention is effective in reducing ocular surface damage and promoting tear secretion in guinea pigs with ATD, which may be related to its function in activating VIP/cAMP/PKA signaling, and promoting the expression of AQP5 in the lacrimal gland.
目的: 观察针刺对水液缺乏型干眼（ATD）豚鼠眼表症状及泪腺组织中血管活性肠肽（VIP）/环磷酸腺苷（cAMP）/蛋白激酶A（PKA）/水通道蛋白5（AQP5）信号通路相关蛋白表达的影响，探讨针刺治疗ATD的作用机制。方法: 40只豚鼠随机分为空白组、模型组、针刺组、假针组和西药组，每组8只。皮下注射氢溴酸东莨菪碱复制ATD模型。针刺组针刺双侧“睛明”“攒竹”“丝竹空”“太阳”“瞳子髎”，每次15 min，每日1次；假针组每5 min钝针点压上述穴位1次，共3次；西药组双眼滴玻璃酸钠滴眼液，3次/d，每次1滴。以上3组均治疗14 d。分别于造模前、造模后及干预后进行酚红棉线泪液分泌量（PRT）实验、测定泪膜破裂时间（BUT）和角膜荧光素钠染色评分（FLS）。干预后泪腺称重，计算泪腺指数；HE染色法观察泪腺组织病理形态变化；免疫荧光染色法检测泪腺组织AQP5的表达；ELISA法检测泪腺组织VIP和AQP5含量；Western blot法检测泪腺组织VIP、cAMP、PKA、磷酸化（p）-PKA及AQP5蛋白表达。结果: 造模后，与空白组比较，其余4组PRT减少、BUT缩短（P<0.01，P<0.05），FLS升高（P<0.05，P<0.01）。干预后，与空白组比较，模型组PRT减少、BUT缩短（P<0.01），FLS升高（P<0.01），泪腺指数降低（P<0.01），泪腺组织VIP含量、AQP5免疫荧光强度及含量降低（P<0.01），VIP、cAMP、PKA、p-PKA和AQP5蛋白表达降低（P<0.01，P<0.05）。干预后，与模型组比较，针刺组和西药组PRT增多、BUT延长（P<0.01，P<0.05），FLS降低（P<0.01，P<0.05），泪腺指数升高（P<0.05），泪腺组织VIP含量、AQP5免疫荧光强度及含量升高（P<0.01）；针刺组泪腺组织VIP、cAMP、PKA、p-PKA、AQP5蛋白表达升高（P<0.05，P<0.01）；西药组VIP和AQP5的蛋白表达升高（P<0.05）。与假针组比较，针刺组和西药组PRT增多、BUT延长（P<0.01，P<0.05），FLS降低（P<0.01，P<0.05），泪腺组织VIP含量、AQP5免疫荧光强度及含量升高（P<0.05，P<0.01）；针刺组泪腺组织VIP、cAMP、PKA、AQP5蛋白表达升高（P<0.05，P<0.01）；西药组AQP5的蛋白表达升高（P<0.05）。与西药组比较，针刺组PRT增多（P<0.05）。空白组泪腺结构无明显异常；模型组和假针组泪腺上皮细胞明显萎缩，可见淋巴细胞浸润；针刺组和西药组泪腺上皮细胞结构基本正常，部分腺腔扩张，可见少量淋巴细胞浸润。结论: 针刺可减轻干眼眼表损伤，促进泪液分泌，其作用机制可能与激活 VIP/cAMP/PKA/AQP5 信号通路，增强泪腺分泌功能有关。.

Sjogren syndrome (SS) is a common autoimmune disease associated with the immune-mediated destruction of exocrine glands, primarily the salivary and lacrimal glands. As a result, patients have xerophthalmia and xerostomia (Sicca syndrome). The diagnosis of SS can be difficult due to its multifactorial nature and often insidious symptoms, and there is no one test for its diagnosis. The many oral manifestations in SS stemming from the xerostomia present challenges to the treating dentist. Dentists should be knowledgeable about SS and its palliative care to help improve their patients\' quality of life.