RESUMEN
Meibomian gland (MG) dysfunction (MGD) is a multifactorial, chronic condition of the eyelids, leading to eye irritation, inflammation and ocular surface disease. Initial conservative therapy often includes a combination of warm compresses in addition to baby shampoo or eyelid wipes. The practice of lid hygiene dates back to the 1950s, when selenium sulfide-based shampoo was first used to treat seborrhoeic dermatitis of the eyelids. Today, tear-free baby shampoo has replaced dandruff shampoo for MGD treatment and offers symptom relief in selected patients. However, many will not achieve significant improvement on this therapy alone; some may even develop an allergy to the added dyes and fragrances in these products. Other manual and mechanical techniques to treat MGD include MG expression and massage, MG probing and LipiFlow(®). While potentially effective in patients with moderate MGD, these procedures are more invasive and may be cost prohibitive. Pharmacological treatments are another course of action. Supplements rich in omega-3 fatty acids have been shown to improve both MGD and dry eye symptoms. Tea tree oil, specifically the terpenin-4-ol component, is especially effective in treating MGD associated with Demodex mites. Topical antibiotics, such as azithromycin, or systemic antibiotics, such as doxycycline or azithromycin, can improve MGD symptoms both by altering the ocular flora and through anti-inflammatory mechanisms. Addressing and treating concurrent ocular allergy is integral to symptom management. Topical N-acetylcysteine and topical cyclosporine can both be effective therapeutic adjuncts in patients with concurrent dry eye. A short course of topical steroid may be used in some severe cases, with monitoring for steroid-induced glaucoma and cataracts. While the standard method to treat MGD is simply warm compresses and baby shampoo, a more tailored approach to address the multiple aetiologies of the disease is suggested.
Asunto(s)
Diseño de Fármacos , Enfermedades de los Párpados/tratamiento farmacológico , Glándulas Tarsales/fisiopatología , Antiinflamatorios/administración & dosificación , Antiinflamatorios/uso terapéutico , Enfermedades de los Párpados/fisiopatología , Preparaciones para el Cabello/química , Humanos , Inflamación/tratamiento farmacológico , Inflamación/fisiopatologíaRESUMEN
PURPOSE: Postoperative agitation is common in adults and children following the use of several anesthetics, particularly inhalation anesthetics. This behavior has detrimental effects both physically for the patient following the procedure and psychologically for the parent or guardian. The authors propose that clonidine, an alpha-2 agonist, would provide a reduction in children's postoperative agitation and, in turn, improve parent satisfaction in children undergoing strabismus surgery. METHODS: Fifty children were prospectively randomized to receive either clonidine or placebo in a double-blind fashion prior to surgery. The children were evaluated using preoperative and postoperative parent questionnaires and postoperative behavioral evaluation using standardized scales including the Pediatric Anesthesia Emergence Delirium and Watcha scales. RESULTS: Children receiving clonidine immediately after anesthesia induction had statistically significant improvement in postoperative agitation at the 15-minute mark (P = .096) and last score obtained (P = .095) using the Watcha scale. The clonidine group spent an insignificantly longer time in the post-anesthesia care unit (average: 54 minutes) than the placebo group (average 47 minutes) (P = .17). Seventy-one percent of parents reported being "very satisfied" with their child's recovery from anesthesia in the clonidine group compared to 46% in the placebo group, although this was not statistically significant (P = .34). CONCLUSIONS: Children receiving clonidine prior to undergoing strabismus surgery have a small but noticeable reduction in postoperative agitation, stay slightly longer in the post-anesthesia care unit, and have higher rates of parent satisfaction.