Figure 3 - uploaded by Henrik Myhre Ihler
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A workflow with iTandem. After setting initial goals, the service user logs data, which are assessed during sessions. After monitoring sleep for 4 weeks, the service user and the clinician choose to change modules as they want to focus more on activities and medication.
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Background
Shared decision-making between clinicians and service users is crucial in mental health care. One significant barrier to achieving this goal is the lack of user-centered services. Integrating digital tools into mental health services holds promise for addressing some of these challenges. However, the implementation of digital tools, such...
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Context 1
... could also undermine the overall goal of helping to focus sessions on issues considered particularly relevant to the patient. The patients used the app for 6 weeks ( Figure 3). After setting initial goals, the service user logs data, which are assessed during sessions. ...
Citations
... Screen time should be minimized, and proper lighting must be ensured to reduce digital eye strain and dryness. [153] Encouraging treatment adherence: The importance of adherence to prescribed medications, such as artificial tears, anti-inflammatory agents, and antihistamines, should be emphasized. Nonadherence must be explained as a risk for worsening symptoms or complications, including scarring and vision loss. ...
The conjunctiva is a transparent, thin mucous membrane covering the sclera. This structure extends from the limbus, or the perimeter of the cornea, and covers both the sclera, where it is termed the "bulbar conjunctiva," and the posterior eyelid surfaces, where it is called the "palpebral conjunctiva." Keratoconjunctivitis is an inflammatory condition that affects both the superficial cornea and the conjunctiva. The term is derived from the words "keratitis," which refers to superficial corneal inflammation, and "conjunctivitis," which denotes conjunctival involvement. This ocular condition can arise from an expansive list of etiologies, including viral, bacterial, autoimmune, toxic, or allergic causes.
Keratoconjunctivitis often results in significant discomfort and potential vision impairment. Viruses, particularly adenoviruses, are among the most common culprits, followed by bacterial and fungal pathogens in certain cases. Allergic keratoconjunctivitis, often associated with environmental allergens, as well as dry eye-related forms linked to tear film dysfunction, also contributes significantly to the condition. Autoimmune diseases such as Sjögren syndrome can further complicate the clinical spectrum of this disease by disrupting the ocular surface.
Epidemiologically, keratoconjunctivitis is widespread, with varying prevalence depending on the subtype and geographic location. Viral keratoconjunctivitis, for instance, tends to occur in outbreaks, especially in crowded environments like schools or workplaces. Conversely, dry eye-related keratoconjunctivitis predominantly affects older populations, particularly postmenopausal women, due to hormonal changes affecting tear production.
Patients with keratoconjunctivitis often present with a constellation of symptoms, including redness, photophobia, blurred vision, excessive tearing or dryness, and a gritty or foreign body sensation in the eye. In more severe cases, patients may report sharp pain, mucopurulent discharge, or difficulty keeping the eye open due to irritation. On examination, clinicians may note conjunctival hyperemia, corneal epithelial defects, lid swelling, or papillary reactions on the tarsal conjunctiva. These signs, combined with the patient's history, aid in differentiating the various subtypes of keratoconjunctivitis.
A thorough investigation is essential to establish a definitive diagnosis. Evaluation typically includes a detailed clinical history, slit-lamp biomicroscopy, and, where indicated, laboratory tests such as viral cultures, polymerase chain reaction (PCR) testing for adenoviruses, or conjunctival scrapings for cytology and bacterial cultures. Tear film assessments, including the Schirmer test and tear break-up time (TBUT), are valuable in diagnosing dry eye-associated keratoconjunctivitis. Advanced imaging techniques, such as anterior segment optical coherence tomography (AS-OCT) and confocal microscopy, can provide further insights into the structural integrity of the cornea and conjunctiva.
Management of keratoconjunctivitis highly depends on the underlying etiology. Viral keratoconjunctivitis typically requires supportive care, including artificial tears and cold compresses, as antiviral medications are rarely indicated. In contrast, bacterial keratoconjunctivitis demands prompt antibiotic therapy to prevent complications, such as corneal ulcers. Allergic keratoconjunctivitis often responds well to antihistamines, mast cell stabilizers, and allergen avoidance strategies. For dry eye-related cases, artificial tears, punctal plugs, and, in severe cases, immunomodulatory agents like cyclosporine can provide significant relief. Corticosteroids may be cautiously used in autoimmune-related keratoconjunctivitis, but their prolonged use must be carefully monitored due to the risk of cataracts and glaucoma.
Looking to the future, advancements in the understanding of ocular surface inflammation and tear film dynamics are paving the way for more targeted therapies. Emerging treatments, such as biologic agents targeting specific inflammatory pathways, alongside gene therapies, hold promise in addressing refractory cases. Additionally, innovations in diagnostic tools, including point-of-care tests for tear biomarkers and artificial intelligence-driven imaging technologies, are expected to enhance early detection and personalized management of keratoconjunctivitis.
Overall, keratoconjunctivitis is a complex and multifaceted condition requiring a nuanced approach to diagnosis and management. By integrating current evidence-based practices with emerging therapeutic and diagnostic advancements, healthcare providers can significantly improve outcomes for individuals affected by this debilitating condition. This activity will focus on more well-known entities causing combined keratoconjunctivitis. Specifically, this activity will discuss the entities known as epidemic keratoconjunctivitis (EKC), vernal keratoconjunctivitis (VKC), superior limbic keratoconjunctivitis (SLK), and keratoconjunctivitis sicca.
