The Ocular Surface: The Challenge to Enable and Protect Vision

Gipson, Ilene K.

doi:10.1167/iovs.07-0770

Cited by 271 publications

(242 citation statements)

References 46 publications

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“…For non-sedated patients, corneal damage usually results in severe pain due to the presence of rich innervation of this highly sensitive anatomic area, with robust nerve networks located between the epithelial cells of the corneal surface [22]. Unfortunately, in the ICU, symptoms may not be readily communicated by the patient or promptly detected by healthcare personnel, leading to delayed detection and treatment of EK.…”

Section: Exposure Keratopathy: Pathophysiology Diagnosis Symptoms mentioning

confidence: 99%

Exposure Keratopathy in the Intensive Care Unit: Do Not Neglect the Unseen

Bird¹,

Dingley²,

Stawicki³

et al. 2018

Vignettes in Patient Safety - Volume 2

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Exposure keratopathy (EK) is a frequently overlooked complication seen in nearly 60% of sedated or intubated intensive care unit (ICU) patients. Signs and symptoms of EK often start as mild subjective complaints of eye pain and irritation, but can progress to vision loss in the most severe cases. For many critically ill patients, the presence of sedation effectively precludes their ability to communicate clinical complaints typically associated with EK. This, combined with the potentially severe sequelae, makes EK a potentially preventable complication and a patient safety issue. Clinical management of EK can be challenging for both providers and patients due to the nature of treatment with eye drops and ointments as well as the burden and expense of associated procedural interventions. Risk factors for EK have been extensively described in the literature, and wider dissemination of this knowledge should facilitate education of physicians and nurses regarding EK prevention. The most common risk factors include lagophthalmos, chemosis, Bell's palsy, and congenital deformities. Additionally, critically ill patients are less likely to be promptly diagnosed due to the focus of staff on life-threatening problems over ocular prophylaxis. However, the potential severity of complications associated with EK mandates that prevention remains a crucial component of the care of at-risk patients. The reader will explore the broad category of adverse medical occurrences included under the umbrella term, "errors of omission" (EOO): an error category that is most likely to culminate in EK. The most critical preventive measure is education of health care providers, although this may not be enough by itself. To this end, universal precautions against EK in combination with education may be used to help combat the relatively high incidence of this easily preventable ocular pathology.

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Section: Exposure Keratopathy: Pathophysiology Diagnosis Symptoms mentioning

confidence: 99%

Exposure Keratopathy in the Intensive Care Unit: Do Not Neglect the Unseen

Bird¹,

Dingley²,

Stawicki³

et al. 2018

Vignettes in Patient Safety - Volume 2

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“…The decrease in binding of the antibody to the ocular surface increases with severity of the disease (Gipson, I.K., 2007). It is not known if the alteration in MUC16 seen in dry eye is a result of decrease in expression of the mucin, an increase in shedding of its ectodomain from the epithelial surface, or a change in glycosylation of the mucin, resulting in the diminishment of the H185 epitope.…”

Section: Disease Involvementmentioning

confidence: 99%

Focus on Molecules: Human mucin MUC16

Perez

Gipson

2008

Experimental Eye Research

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“…It is critical to have a correct volume and stability of the tear film to maintain the integrity of the ocular surface. The loss of the ocular homeostasis provokes serious clinical manifestations as a dry eye, infections of epithelial defects (Gipson, 2007;Knop and Knop, 2007;Paulsen, 2008).…”

Section: Ocular Surfacementioning

confidence: 99%

The role of dinucleoside polyphosphates on the ocular surface and other eye structures

Carracedo

Crooke

Guzmán-Aránguez

et al. 2016

Progress in Retinal and Eye Research

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a b s t r a c tDinucleoside polyphosphates comprises a group of dinucleotides formed by two nucleosides linked by a variable number of phosphates, abbreviated NpnN (where n represents the number of phosphates). These compounds are naturally occurring substances present in tears, aqueous humour and in the retina. As the consequence of their presence, these dinucleotides contribute to many ocular physiological processes. On the ocular surface, dinucleoside polyphosphates can stimulate tear secretion, mucin release from goblet cells and they help epithelial wound healing by accelerating cell migration rate. These dinucleotides can also stimulate the presence of proteins known to protect the ocular surface against microorganisms, such as lysozyme and lactoferrin. One of the latest discoveries is the ability of some dinucleotides to facilitate the paracellular way on the cornea, therefore allowing the delivery of compounds, such as antiglaucomatous ones, more easily within the eye. The compound Ap 4 A has been described being abnormally elevated in patient's tears suffering of dry eye, Sjogren syndrome, congenital aniridia, or after refractive surgery, suggesting this molecule as biomarker for dry eye condition. At the intraocular level, some diadenosine polyphosphates are abnormally elevated in glaucoma patients, and this can be related to the stimulation of a P2Y 2 receptor that increases the chloride efflux and water movement in the ciliary epithelium. In the retina, the dinucleotide dCp 4 U, has been proven to be useful to help in the recovery of retinal detachments. Altogether, dinucleoside polyphosphates are a group of compounds which present relevant physiological actions but which also can perform promising therapeutic benefits.

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The Ocular Surface: The Challenge to Enable and Protect Vision

Cited by 271 publications

References 46 publications

Exposure Keratopathy in the Intensive Care Unit: Do Not Neglect the Unseen

Exposure Keratopathy in the Intensive Care Unit: Do Not Neglect the Unseen

Focus on Molecules: Human mucin MUC16

The role of dinucleoside polyphosphates on the ocular surface and other eye structures

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