Patients with the Hermansky-Pudlak syndrome (HPS) have a triad of clinical findings including: oculocutaneous albinism; a bleeding diathesis; and systemic complications associated with ceroid deposition in several tissues. The syndrome is inherited as an autosomal recessive trait. Several genetic mutations have been reported that cause patients to the various HPS phenotypes. Ophthalmic surgery remains a challenge in patients with the syndrome due to bleeding tendency. Further, pulmonary fibrosis associated to ceroid deposition may lead to decreased pulmonary function in patients with some HPS types. These are important medical issues that every ophthalmic surgeon needs to consider prior to surgery in patients with the syndrome. Co-management in patients with the HPS is of utmost importance in the pre-operative and post-operative periods. Resumen Los pacientes con el síndrome de Hermansky-Pudlak (HPS) tienen una triada de hallazgos clínicos que incluyen: el albinismo oculocutáneo, una tendencia a sangrado y varias complicaciones sistémicas debidas a la deposición de ceroide en varios tejidos del cuerpo. El síndrome se hereda de forma autosómica recesiva. Ahora bien, varias mutaciones genéticas que producen el síndrome han sido reportadas. Esto ha llevado a concluir que hay varios tipos del síndrome. La tendencia al sangrado de los pacientes con HPS hace que la cirugía oftálmica en ellos siga siendo un reto para el oftalmólogo, pues la deposición de ceroide puede conducir a fibrosis pulmonar, la función de los pulmones puede estar disminuida en algunos pacientes con este grupo de enfermedades. El oftalmólogo debe tener presentes estas consideraciones antes de recomendar la cirugía al paciente y escoger el tipo de anestesia a utilizarse. El co-manejo de estos pacientes con el síndrome de Hermansky-Pudlak es de vital importancia en los periodos pre y postoperatorios.

Recent studies such as the Beijing Eye Study, strengthened the clinical impression of post-menopausal women's increased vulnerability to dry eye symptoms. This review article addresses the published literature addressing the impact of hormonal changes, particularly estrogen, on pre-menopausal and post-menopausal women. The impact of the menstrual cycle and hormone replacement therapy have on dry eye symptoms are reviewed. Evidence suggests that the cornea is thinnest at the beginning of the menstrual cycle and thickest by the end of the cycle, when estrogen levels are highest. Interestingly, studies suggest that estrogen may promote dry eye in post-menopausal women, while having protective effects in younger women. Further studies investigating the role of the menstrual cycle, oral contraceptives, and hormone replacement therapy (HRT) on the eye is warranted, particularly to address symptoms, physiological changes, and refractive surgery outcomes. Resumen Estudios recientes, como el “Beijing Eye Study”, han fortalecido la impresión clínica de mujeres posmenopáusicas de una mayor vulnerabilidad a síntomas de ojo seco. Este artículo de revisión aborda la literatura publicada sobre el impacto de los cambios hormonales, especialmente los estrógenos, el anterior a la menopausia y las mujeres posmenopáusicas. El impacto del ciclo menstrual y terapia de reemplazo hormonal en síntomas de ojo seco son revisados. Las evidencias sugieren que la córnea es más fina al principio del ciclo menstrual y más gruesa por el final del ciclo, cuando los niveles de estrógeno son más altos. Curiosamente, los estudios sugieren que el estrógeno puede promover ojo seco en mujeres posmenopáusicas y tener efectos protectores en las mujeres jóvenes. Más estudios que investigan el papel del ciclo menstrual, los anticonceptivos orales y terapia de reemplazo hormonal en el ojo se justifica, en particular para tratar los síntomas, los cambios fisiológicos y los resultados de la cirugía refractiva.

Purpose: To review the epidemiology, clinical features, diagnosis, and management of patients with fungal keratitis. Methods: Review of the literature and summary of personal experience. Results: Fungi may be part of the normal external ocular flora but are found with greater frequency in diseased eyes. Trauma is the most frequent risk factor and often occurs outdoors and involves plant matter. The Gram and Giemsa stains are the most common stains used for the rapid identification of fungi. The only commercially available topical antifungal in the United States is natamycin 5% and it is therefore the first line treatment in most cases. The length of time required for topical treatment is on average 4 to 6 weeks but must be titrated based on clinical response. The most common surgical approach to fungal keratitis is daily debridement with a spatula or blade. Approximately one-third of fungal infections need additional surgical intervention, most commonly in the form of a therapeutic penetrating keratoplasty. The prognosis of fungal keratitis depends on the depth and size of the lesion; small superficial infections respond well to topical therapy. Deep stromal infections and infections with concomitant scleral or intraocular involvement are much more difficult to eradicate. Conclusions: The diagnosis of fungal keratitis can be quite challenging, and treatment requires prolonged antifungal therapy often combined with surgical intervention in the form of penetrating keratoplasty, conjunctival flap, or cryotherapy.