Conjunctival lymphangiectasia: a report of 11 cases and review of literature

Conjunctival lymphangiectasia is an uncommon clinical condition in which there is dilatation of lymphatic channels in the bulbar conjunctiva. Conjunctival lymphangiectasia is a rarely appreciated ocular surface disorder that typically occurs as a secondary phenomenon in response to local lymphatic scarring or distal obstruction. Conjunctival lymphangiectasia can either be unilateral or bilateral with focal or diffuse bulbar chemosis. We present 11 cases of biopsy-proven conjunctival lymphangiectasia. Of the 11 cases, 3 presented with bilateral diffuse bulbar chemosis, 1 had diffuse unilateral chemosis, and the remaining 7 presented with focal (<90°) bulbar chemosis. Three of these cases had co-existing pterygium, and one case presented with focal bulbar chemosis and a conjunctival keratin horn. All underwent surgical excision of the involved conjunctiva, either with no graft (n = 6), combined with amniotic membrane transplant (n = 3), or combined with conjunctival autograft (n = 2).     

Osmolality and tear film dynamics

The tear film is a nourishing, lubricating and protecting layer that bathes the ocular surface. It is continuously replenished through cycles of production and elimination via evaporation, absorption and drainage. These processes are often referred to as tear film dynamics. Osmolality is an objective clinical measurement that provides insight into the balance of these complex tear film dynamics. Balanced tear production and elimination is vital for tear film integrity, stability and normal osmolality. Imbalances cause alterations of the tear film structure and composition, ultimately leading to tear film instability and measurable tear film hyperosmolality. Elevated tear film osmolality is considered a core mechanism in dry eye, forming the basis of dry eye symptoms and leading to ocular surface damage. Despite its immense potential in the diagnosis of dry eye, tear film osmolality is not commonly assessed. This review will focus on the current knowledge of tear film dynamics and tear film osmolality.     

Additional feeding assistance improves the energy and protein intakes of hospitalised elderly patients. A health services evaluation

Malnutrition is a serious issue that is prevalent in elderly hospitalised patients. Traditionally the role of feeding was designated to the nurse; however competing tasks mean that additional support for feeding assistance is needed. A program that utilises volunteers during weekday lunchtimes to assist, feed and socialise with patients at a Sydney hospital began during 2005. Twenty-three patients (mean age: 83.2±8.9years) participated in this study. Observations and weighed plate waste were recorded for each patient for all meals on two weekdays (when volunteers present) and two weekend days (when volunteers not present). Grip strength, Mini-Nutritional Assessments and interviews were conducted with patients, and surveys with volunteers and staff. Lunchtime energy and protein intakes increased significantly (396kJ and 4.3g respectively) when volunteers were present. Volunteers spent an average of 12.3min with each patient at lunchtime, compared to 4.7min for nurses. Nurses indicated time barriers to feeding patients but were positive about the value of the program. Volunteers were commonly observed feeding, setting up meals and providing encouragement to patients. Additional feeding assistance is one effective strategy to increase the energy and protein intakes and combat malnutrition in elderly inpatients.