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A.E. Elizondo, M.A. Di Pascuale, Y.–Y. Gao, A. Baradaran–Rafii, C.–L. Kuo, S.C. G. Tseng; Detection of Blink Related Microtrauma by Kinetic Analysis of Tear Interference Images in Patients With Steven Johnson Syndrome and Toxic Epidermal Necrolysis Syndrome . Invest. Ophthalmol. Vis. Sci. 2005;46(13):2654.
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Purpose: We recently report a strong clinical correlation between the severity of eyelid/margin pathologies and cornea complications in patients with Stevens Johnson Syndrome and Toxic Epidermal Necrolysis (SJS/TENS) (Di Pascuale et al Ophthalmology, 2005). We hypothesize that kinetic analysis of tear interference images is able to detect blink–related microtrauma in eyes without notable corneal complications. Methods: We retrospectively reviewed 25 eyes of 13 patients (9 females and 4 males) with 31.1 ± 16.8 (4 to 51) years of age, diagnosed with SJS/TENS from January 2002 to November 2004. Data of the latest photographic documentation and eye examination were correlated with those of kinetic analysis of tear interference images obtained by our published method using a DR–1® (Kowa Inc., Japan) interference camera on the central 8 mm of the pre–corneal lipid tear film. To further substantiate our hypothesis we compared these results before and after application of a synthetic meibum in one patient. Results: Even though all 25 eyes had a clear cornea, their eyelids showed variable extents of lid margin keratinisation and tarsal scar, which could be classified as mild (12 eyes), moderate (8 eyes) and severe (5 eyes). Interestingly, all patients with severe lid/tarsal changes were well protected by a scleral contact lens. The analysis of tear interference image showed that all eyes (100%) with moderate and severe eyelid/tarsal pathologies had a vertical pattern of lipid tear deficiency (LTD) and a very thin lipid film with the thickness of 41.6 ± 20.5 nm. Ten eyes (83.3%) with mild eyelid/tarsal pathologies had a vertical LTD pattern; 2 eyes (16.6%) had a normal horizontal pattern. The lipid tear film in mild cases was 58.3 ± 18 nm, which was significantly thicker than that of moderate and severe cases (P=0.03). In one patient, topical application of synthetic meibum resulted in a rapid change of a vertical pattern to a horizontal pattern and symptomatic improvement in dry eyes. Conclusions: Kinetic analysis of tear interference images allows us to confirm the presence of LTD even in eyes with mild eyelid margin/tarsal pathologies but without notable corneal complications. These abnormalities together lead to blink–related microtrauma. Supplement of meibum may help prevent eye irritation caused by LTD and blink–related microtrauma.
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