RESUMEN
PURPOSE: To investigate the potential effect of dietary supplementation with omega-3 fatty acid on lipid composition of meibum, aqueous tear evaporation, and tear volume in patients with dry eye. METHODS: In a pilot, prospective, randomized, double-masked study, patients with dry eye received a daily dose of fish oil, containing 450 mg of eicosapentaenoic acid, 300 mg of docosahexaenoic acid, and 1000 mg of flaxseed oil (TheraTears Nutrition; Advanced Vision Research, Woburn, MA) for 90 days. There were 2 patient visits: baseline and final. At these visits, patients completed the ocular surface disease index to score subjective symptoms, and slit-lamp examinations, breakup time, corneal staining, Schirmer type I, fluorophotometry, evaporometry, and collection of meibomian gland secretion samples for lipid composition analysis were performed. RESULTS: A total of 36 patients with dry eye completed the study. At the end of the study, 70% of the patients became asymptomatic, whereas for the placebo group, 37% [corrected] of the symptomatic patients became asymptomatic. Schirmer testing and fluorophotometry suggested that the omega-3 supplement increased tear secretion. The lipid composition of the samples collected from the omega-3 group was found to be very similar to that from the placebo group. No trends between groups were seen for other objective parameters. CONCLUSIONS: Dietary supplementation with omega-3 fatty acids in dry eye showed no significant effect in meibum lipid composition or aqueous tear evaporation rate. On the other hand, the average tear production and tear volume was increased in the omega-3 group as indicated by both Schirmer testing and fluorophotometry.
Asunto(s)
Suplementos Dietéticos , Síndromes de Ojo Seco/tratamiento farmacológico , Ácidos Grasos Omega-3/administración & dosificación , Adulto , Anciano , Anciano de 80 o más Años , Cápsulas , Cromatografía Líquida de Alta Presión , Registros de Dieta , Método Doble Ciego , Síndromes de Ojo Seco/metabolismo , Femenino , Fluorofotometría , Humanos , Metabolismo de los Lípidos , Lípidos/análisis , Masculino , Glándulas Tarsales/efectos de los fármacos , Glándulas Tarsales/metabolismo , Persona de Mediana Edad , Proyectos Piloto , Estudios Prospectivos , Espectrometría de Masa por Ionización de Electrospray , Encuestas y Cuestionarios , Lágrimas/metabolismoRESUMEN
PURPOSE: To report a successful medical treatment of a case of keratitis caused by Paecilomyces lilacinus. METHODS: A 68-year-old woman developed an infection of the left cornea after minor trauma. The causative organism was found to be a particularly virulent organism, P. lilacinus. The patient was initially treated with natamycin topically and itraconazole orally, but the organism was resistant and failed to respond. She was then switched to topical voriconazole and oral terbinafine. RESULTS: The patient was successfully treated with these medications without surgical intervention, an unusual outcome for this organism. CONCLUSIONS: If one encounters a case of fungal keratitis that fails to respond to the more commonly used agents, one should suspect a resistant organism such as Paecilomyces and should switch to voriconazole and/or terbinafine both topically and orally.