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Emphysema is a lung condition that causes shortness of breath.

What is emphysema?

Emphysema is a lung condition that causes shortness of breath. In people with this condition, the air sacs in the lungs (alveoli) are damaged. Over time, the inner walls of the air sacs weaken and rupture creating larger air spaces instead of many small ones. This reduces the surface area of the lungs and, in turn, the amount of oxygen that reaches your bloodstream.

When you exhale, the damaged alveoli don’t work properly and old air becomes trapped, leaving no room for fresh, oxygen-rich air to enter. Most people with emphysema also have chronic bronchitis. Chronic bronchitis is inflammation of the tubes that carry air to your lungs (bronchial tubes), which leads to a persistent cough. Emphysema and chronic bronchitis are two conditions that make up chronic obstructive pulmonary disease (COPD). Smoking is the leading cause of COPD. Treatment may slow the progression of COPD, but it can’t reverse the damage.

Types of Emphysema

Emphysema is a type of COPD, and there are different types of emphysema, depending on which part of the lungs it affects.

These are:

paraseptal emphysema

centrilobular emphysema, which affects mainly the upper lobes and is most common in people who smoke

panlobular emphysema, which affects both the paraseptal and centrilobular areas of the lungs

During diagnosis, a CT scan can show which type of emphysema is present. The type does not affect the outlook and treatment.

Pathophysiology

Emphysema is a pathologic diagnosis defined by permanent enlargement of airspaces distal to the terminal bronchioles. This leads to a dramatic decline in the alveolar surface area available for gas exchange. Furthermore, loss of alveoli leads to airflow limitation by 2 mechanisms. First, loss of the alveolar walls results in a decrease in elastic recoil, which leads to airflow limitation. Second, loss of the alveolar supporting structure leads to airway narrowing, which further limits airflow.

It has 3 morphologic patterns:

Centriacinar

Panacinar

Distal acinar, or paraseptal

Centriacinar emphysema is characterized by focal destruction limited to the respiratory bronchioles and the central portions of the acini. This form of emphysema is associated with cigarette smoking and is typically most severe in the upper lobes.

Panacinar emphysema involves the entire alveolus distal to the terminal bronchiole. The panacinar type is typically most severe in the lower lung zones and generally develops in patients with homozygous alpha1-antitrypsin (AAT) deficiency.

Distal acinar emphysema, or paraseptal emphysema, is the least common form and involves distal airway structures, alveolar ducts, and sacs. This form of emphysema is localized to fibrous septa or to the pleura and leads to formation of bullae (as seen in the images below). The apical bullae may cause pneumothorax. Paraseptal emphysema is not associated with airflow obstruction.

The gradual destruction of alveolar septae (shown in the image below) and of the pulmonary capillary bed in emphysema leads to a decreased ability to oxygenate blood. The body compensates with lowered cardiac output and hyperventilation. This V/Q mismatch results in relatively limited blood flow through a fairly well oxygenated lung with normal blood gases and pressures in the lung, in contrast to the situation in chronic bronchitis. Because of low cardiac output, the rest of the body also suffers from tissue hypoxia and pulmonary cachexia. Eventually, these patients develop muscle wasting and weight loss and are identified as “pink puffers.”

Causes

The main cause is exposure to airborne irritants, which include tobacco smoke, marijuana smoke, air pollutants, and manufacturing smoke.

Very rarely, emphysema is caused by heredity, wherein a person has a shortage of a protein that guards the elastic structure in the lungs, known as alpha-1 antitrypsin deficiency.

Close relatives of people with emphysema are more likely to develop the disease themselves. This is probably because the tissue sensitivity or response to smoke and other irritants may be inherited. The role of genetics in the development of emphysema, however, remains unclear.

Abnormal airway reactivity, such as bronchial asthma, has been shown to be a risk factor for the development of emphysema.

Who is at risk for emphysema?

The risk factors include

This the main risk factor. Up to 75 percent of people who have emphysema smoke or used to smoke.

Long-term exposure to other lung irritants, such as secondhand smoke, air pollution, and chemical fumes and dusts from the environment or workplace.

Most people who have emphysema are at least 40 years old when their symptoms begin.

This includes alpha-1 antitrypsin deficiency, which is a genetic condition. Also, smokers who get emphysema are more likely to get it if they have a family history of COPD.

Symptoms of emphysema

The symptoms include:

Breathlessness with exertion, and eventually breathlessness most of the time in advanced disease

Susceptibility to chest infections

Cough with phlegm production

Fatigue

Barrel-shaped chest (from expansion of the ribcage in order to accommodate enlarged lungs)

Cyanosis (a blue tinge to the skin) due to lack of oxygen.

Complications of Emphysema

People who have emphysema are also more likely to develop:

Collapsed lung (pneumothorax). A collapsed lung can be life-threatening in people who have severe emphysema, because the function of their lungs is already so compromised. This is uncommon but serious when it occurs.

Heart problems. Emphysema can increase the pressure in the arteries that connect the heart and lungs. This can cause a condition called cor pulmonale, in which a section of the heart expands and weakens.

Large holes in the lungs (bullae). Some people with emphysema develop empty spaces in the lungs called bullae. They can be as large as half the lung. In addition to reducing the amount of space available for the lung to expand, giant bullae can increase your risk of pneumothorax.

How do doctors diagnose Emphysema?

Your chest feels tight, you’re out of breath much of the time, and you have a cough that won’t go away. Do you have emphysema? You can’t go on symptoms alone. See your doctor. They’ll do the following tests to find out for sure:

Medical History

Your doctor will talk to you about your health and any recent changes you might have noticed. If you have emphysema, you’ll probably have had shortness of breath, often over a period of months or years. You may also experience wheezing. You might have a cough that won’t go away, too.

Physical Exam

Your doctor will check your weight and blood pressure. They’ll listen to your heartbeat and keep an eye out for anything that seems strange or unusual.

If you have advanced emphysema, your doctor may notice that you have any of the following:

You have a “barrel chest” caused by larger-than-normal lungs.

You’re wheezing, having a hard time getting air out of your lungs.

Your fingertips are rounded. Doctors call this “clubbing.”

You purse your lips when you breathe, like you’re blowing a kiss.

The oxygen levels in your blood are low (hypoxemia).

The carbon dioxide levels in your blood are high (hypercarbia), because emphysema makes it hard to exhale properly.

Your lips have a blue tinge (cyanosis), another sign of low oxygen in your blood.

Malnutrition causes muscles to slowly waste away in advanced emphysema.

Pulmonary Function Tests (PFTs)

For this exam, you may sit inside an enclosed booth and breathe into a tube. This will allow your doctor to measure:

How much air your lungs can hold

How fast you can blow air out of your lungs

How much air stays trapped in your lungs after you exhale

Whether you’re able to breathe better after using medicines you inhale, such as albuterol

If you have normal lungs, you’ll likely be able to empty most of the air from them in 1 second. If you have emphysema, it’ll probably take longer.

Chest X-ray and CT scan

If you have advanced emphysema, your lungs will appear to be much larger than they should be. In early stages of the disease, your chest X-ray may look normal. Your doctor can’t diagnose emphysema with an X-ray alone.

A CT scan of your chest will show if the air sacs (alveoli) in your lungs have been destroyed. These make it hard for you to breathe out like normal.

Arterial blood gas

This test measures the amount of oxygen and carbon dioxide in blood from an artery. It is a test often used as emphysema worsens. It is especially helpful in determining if a patient needs extra oxygen.

Pulse oximetry

This test is also known as an oxygen saturation test. Pulse oximetry is used to measure the oxygen content of the blood. This is done by attaching the monitor to a person’s finger, forehead, or earlobe.

Electrocardiogram (ECG)

ECGs check heart function and are used to rule out heart disease as a cause of shortness of breath.

How is emphysema treated?

There is no cure for emphysema. Treatment aims to reduce symptoms and slow the progression of the disease with medications, therapies, or surgeries.

If you are a smoker, the first step in treating this condition is to quit smoking, either with medications or cold turkey.

Medications

Bronchodilator Medications

Inhaled as aerosol sprays or taken orally, bronchodilator medications may help to relieve symptoms of emphysema by relaxing and opening the air passages in the lungs.

Steroids

Inhaled as an aerosol spray, steroids can help relieve symptoms of emphysema associated with asthma and bronchitis. Over time, however, inhaled steroids can cause side effects, such as weakened bones, high blood pressure, diabetes and cataracts. It is important to discuss these side effects with your doctor before using steroids.

Antibiotics

Antibiotics may be used to help fight respiratory infections common in people with emphysema, such as acute bronchitis, pneumonia and the flu.

Vaccines

Patients with emphysema should receive a flu shot annually and pneumonia shot every five to seven years to prevent infections.

Oxygen Therapy

As a patient’s disease progresses, they may find it increasingly difficult to breathe on their own and may require supplemental oxygen. Oxygen comes in various forms and may be delivered with different devices, including those you can use at home.

Surgery or Lung Transplant

Lung transplantation may be an option for some patients with emphysema. For others, lung volume reduction surgery, during which small wedges of damaged lung tissue are removed, may be recommended.

Protein Therapy

Patients with emphysema caused by an alpha-1 antitrypsin (AAT) deficiency may be given infusions of AAT to help slow the progression of lung damage.

Pulmonary Rehabilitation

An important part of emphysema treatment is pulmonary rehabilitation, which includes education, nutrition counseling, learning special breathing techniques, help with quitting smoking and starting an exercise regimen. Because people with it are often physically limited, they may avoid any kind of physical activity. However, regular physical activity can actually improve a patient’s health and wellbeing.

Lifestyle changes

Quitting smoking if you are a smoker. This is the most important step you can take to treat this condition.

Avoiding secondhand smoke and places where you might breathe in other lung irritants

Ask your health care provider for an eating plan that will meet your nutritional needs. Also ask about how much physical activity you can do. Physical activity can strengthen the muscles that help you breathe and improve your overall wellness.

Prevention of Emphysema

To prevent emphysema:

If you smoke, talk to your doctor about how to quit

Avoid exposure to secondhand smoke

Avoid exposure to air pollution or irritants

Wear protective gear if you are around irritants or toxins on the job

Priapism is a persistent, usually painful, erection that lasts for more than four hours and occurs without sexual stimulation.

Overview

Priapism is a persistent, usually painful, erection that lasts for more than four hours and occurs without sexual stimulation. The condition develops when blood in the penis becomes trapped and is unable to drain. If the condition is not treated immediately, it can lead to scarring and permanent erectile dysfunction. It can occur in all age groups, including newborns. However, it usually affects men in two different age groups: between the ages of 5 and 10, and 20 and 50.

Types

There are two main types:

Low-flow or ischemic priapism: This type happens when blood gets trapped in the erection chambers. Most of the time, there’s no clear cause, but it may affect men with sickle-cell disease, leukemia (cancer of the blood), or malaria. If you don’t get treatment right away, it can lead to scarring and permanent erectile dysfunction (ED).

High-flow or non-ischemic priapism: This type is more rare than low-flow and is usually less painful. It often happens when an injury to the penis or the area between the scrotum and anus, called the perineum, ruptures an artery, which prevents blood in the penis from moving normally.

Pathophysiology

The penis has 3 corporeal bodies: 2 corpora cavernosa and 1 corpus spongiosum. Erection is the result of smooth-muscle relaxation and increased arterial flow into the corpora cavernosa, causing engorgement and rigidity (see image below). In priapism, the corpus spongiosum and glans penis are typically not engorged.

Engorgement of the corpora cavernosa compresses the venous outflow tracts (ie, subtunical venules), trapping blood within the corpora cavernosa. The major neurotransmitter that controls erection is nitric oxide, which is secreted by the endothelium that lines the corpora cavernosa (see image below). These events occur in both normal and pathologic erections.

Pathophysiologically, priapism can be of either a low-flow (ischemic) or a high-flow (nonischemic) type. Low-flow priapism, which is by far the most common type, results from failure of venous outflow, whereas high-flow priapism results from uncontrolled arterial inflow. Clinically, differentiation of low-flow from high-flow priapism is critical, because treatment for each is different.

Low-flow priapism may be due to any of the following:

An excessive release of neurotransmitters

Blockage of draining venules (eg, mechanical interference in sickle cell crisis, leukemia, or excessive use of intravenous parenteral lipids)

Paralysis of the intrinsic detumescence mechanism

Prolonged relaxation of the intracavernous smooth muscles (most often caused by the use of exogenous smooth-muscle relaxants such as injectable intracavernosal prostaglandin E1)

Prolonged low-flow priapism leads to a painful ischemic state, which can cause fibrosis of the corporeal smooth muscle and cavernosal artery thrombosis. The degree of ischemia is a function of the number of emissary veins involved and the duration of occlusion. Light-microscopy studies conducted early on demonstrated that corporeal tissue becomes thickened, edematous, and fibrotic after days of priapism.

What are the causes and risk factors of priapism?

A normal erection occurs in response to sexual stimulation. It occurs in several conditions that interfere with the blood flow to the penis or blood drainage from the penis. This condition is unrelated to sexual stimulation and can last for several hours. Below are some of the causes of it.

Medical conditions that can cause priapism:

Sickle cell disease (most common reason for priapism)

Leukemia

History of malignancy (cancer)

Trauma as a cause of priapism:

  • Direct trauma to the penis, pelvis, or perineum
  • Spinal cord injuries

Medications (several drugs have priapism as a side effect):

Antidepressants

Antipsychotics

Blood thinners (warfarin [Coumadin] and heparin)

Medications to help with erectile dysfunction (Viagra, Cialis, Levitra, Caverject)

Illegal drugs (cocaine, ecstasy, methamphetamine, crystal meth, cannabis)

Symptoms

Symptoms vary depending on the type of priapism. The two main types of priapism are ischemic and nonischemic priapism.

Ischemic priapism

It’s the more common type. Signs and symptoms include:

Unwanted erection lasting a lot more than four hours

Unwanted erection on / off for several hours (stuttering priapism)

Rigorous penile shaft, but typically soft tip of male member (glans)

Usually painful or tender penis

Nonischemic priapism

Nonischemic priapism is usually less painful than ischemic priapism. Signs and symptoms include:

Erection lasting more than four hours or unrelated to sexual interest or stimulation

Erect but not fully rigid penile shaft

Complications

Ischemic priapism can cause serious complications.

Due to the lack of oxygen, there can be significant damage if it lasts for more than four hours.

When an erection lasts for too long, this oxygen-poor blood can begin to damage or destroy tissues in the penis.

The complications include erectile dysfunction as well as disfigurement of the penis.

How can a doctor diagnose priapism?

Even though both types of priapism have similar symptoms, your doctor has to run diagnostic tests to determine whether you have low-flow or high-flow priapism. The treatment options differ depending on the exact type of the condition.

Sometimes, doctors can diagnose it based on symptoms and a physical examination of the genital area. Tests used to determine the type of priapism may include:

Blood gas measurement

This procedure involves inserting a needle into your penis and collecting a blood sample. If the sample reveals that blood in your penis is deprived of oxygen, you have low-flow priapism. But if the sample reveals bright red blood, you have high-flow priapism.

Blood tests

Since it can be caused by other diseases and blood disorders, your doctor may also collect a blood sample to check your level of red blood cells and platelets. This can help your doctor diagnose blood disorders, cancers, and sickle cell anemia.

Toxicology test

It is also associated with drug abuse, so your doctor may collect a urine sample to look for drugs in your system.

Ultrasound

Doctors use an ultrasound to measure blood flow in the penis. This test also helps your doctor determine whether trauma or injury is the underlying cause of this disorder.

How is priapism treated?

The goal of all treatment is to make the erection go away and preserve the ability to have erections in the future. If a person receives treatment within four to six hours, the erection can almost always be reduced with medication. If the erection has lasted less than four hours, decongestant medications, which may decrease blood flow to the penis, may be very helpful. Other treatment options include:

Ice packs: Ice applied to the penis and perineum may reduce swelling.

Surgical ligation: Used in some cases where an artery has been ruptured, the doctor will ligate (tie off) the artery that is causing it in order to restore normal blood flow.

Intracavernous injection: This treatment is used for low-flow priapism. Drugs known as alpha-agonists are injected into the penis. They cause the arteries to narrow, reducing blood flow to the penis and causing the swelling to decrease.

Surgical shunt: Also used for low-flow priapism, a shunt is a passageway that is surgically inserted into the penis to divert the blood flow and allow circulation to return to normal.

Aspiration: After numbing the penis, doctors will insert a needle and drain blood from the penis to reduce pressure and swelling.

If you think that you are experiencing it, you should not attempt to treat it yourself. Instead, get emergency help as soon as possible.

What are the home remedies for priapism?

The home remedies are-

Urination – in a priapism attack, you should go to urination when you feel desire. Do not wait till you are full as urination can relax the erection to some extent.

Drinking Water – in such a situation, you should drink as much as water as you can it should be more than what you intake. Drinking lots of water can assist in oxygen-rich blood supply to the penis.

Warm Showers – you should take warm showers when your penis is stuck in erection, it helps a lot to control priapism.

Urination Before Sleep – morning erections is a normal phenomenon and it is closely related to a full bladder. You should evacuate your bladder at night before sleep. It has been reported that early morning erections can lead to a priapism attack.

Exercises – exercising during an attack can resolve an erection. You can perform squats, jogging, cycling, running up and down a stair, gentle walk or running on the spot for this condition.

Sexual Activities – scientific studies state that having sex or masturbation during a priapism has no effect on the erection. On the other hand, it can lengthen the erection.

Stress – stress can be more dangerous for priapism as it can worsen a priapism attack. You should opt for counseling and other support groups for stress relieving.

Medicines – you may take painkillers to relieve your pain. But you should not take other medicines such as antidepressants, antipsychotics, etc. without the consent of your physician.

What are the ways to prevent priapism?

Depending on the cause, certain steps can be taken to prevent it from occurring. These steps are:

Prompt treatment of the disease that may cause this condition

If medication is found to be the cause of Priapism then changing the medication

Abstaining from alcohol and drugs

Injection of phenylephrine in order to stop sustained erections

Chilblains (CHILL-blayns) are the painful inflammation of small blood vessels in your skin.

Overview – Chilblains

Chilblains (CHILL-blayns) are the painful inflammation of small blood vessels in your skin that occur in response to repeated exposure to cold but not freezing air. Also known as pernio, chilblains can cause itching, red patches, swelling and blistering on your hands and feet.

Chilblains usually clear up within one to three weeks, especially if the weather gets warmer. You may have recurrences seasonally for years. Treatment involves protecting yourself from the cold and using lotions to ease the symptoms. Chilblains don’t usually result in permanent injury. But the condition can lead to infection, which may cause severe damage if left untreated. The best approach to chilblains is to avoid developing them by limiting your exposure to cold, dressing warmly and covering exposed skin.

Pathophysiology

The pathophysiology and pathogenesis of pernio remain still largely unknown due to the rarity of the condition. However, the thinking is that there is some association with vasospasm as the primary pathophysiologic finding, particularly when the patient becomes exposed to cold, damp conditions for a prolonged period. In a small study by the Mayo Clinic, researchers exposed five patients with known pernio to ice-water immersions and analyzed the patients’ vascular response. They found that all of the patients demonstrated vasospasm when exposed to the ice water bath, potentially discovering a target for pharmacologic therapy in patients with pernio.

What causes chilblains?

Chilblains are the result of an abnormal reaction to the cold. They’re common in the UK because damp, cold weather is usually in the winter.

Some people develop chilblains that last for several months every winter.

When the skin is cold, blood vessels near its surface get narrower. If the skin is then exposed to heat, the blood vessels become wider.

If this happens too quickly, blood vessels near the surface of the skin can’t always handle the increased blood flow.

This can cause blood to leak into the surrounding tissue, which may cause the swelling and itchiness associated with chilblains.

Risk factors of Chilblains

Some people are more at risk of chilblains than others.

This includes people with:

Poor circulation

A family history of chilblains

Regular exposure to cold, damp or draughty conditions

A poor diet or low body weight

Lupus – a long-term condition that causes swelling in the body’s tissues

Raynaud’s phenomenon – a common condition that affects the blood supply to certain parts of the body, usually the fingers and toes

People who smoke are more at risk of chilblains as nicotine constricts blood vessels.

Chilblains can also occur on areas of the feet exposed to pressure, such as a bunion or a toe that’s squeezed by tight shoes.

What are the symptoms of chilblains?

Chilblains occur several hours after being exposed to the cold. You may get just one chilblain but often several develop. They may join together to form a larger swollen, red area of skin.

Chilblains are very itchy. A burning sensation is also typical. They are usually red at first but may become purple. Pain and tenderness over the chilblains often develop.

Common places for chilblains to develop are:

Fingers

Toes

Ear lobes

Nose

Cheeks

Heels

Shins

Thighs

Hips

Typically, each chilblain lasts for about seven days and then, gradually, goes away over a week or so. Some people have repeated bouts of chilblains each winter.

Complications of chilblains

If you have severe or recurring chilblains, there’s a small risk of further problems developing, such as:

Infection from blistered or scratched skin

Ulcers forming on the skin

Permanent discolouration of the skin

Scarring of the skin

It’s often possible to avoid these complications by:

Not scratching or rubbing the affected areas of skin

Not directly overheating the chilblains (by using hot water, for example)

You can also help reduce your risk of infection by cleaning any breaks in your skin with antiseptic and covering the area with an antiseptic dressing. The dressing should be changed every other day until the skin heals.

If the skin does become infected, antibiotics may be prescribed to treat the infection.

Differential Diagnosis

The primary disorder that merits consideration when diagnosing pernio is chilblain lupus erythematosus (CHLE). CHLE is a rare dermatology condition often confused with other forms of pernio or vasculitic processes. Due to the implications of familial genetic inheritance and the possible association with systemic lupus erythematosus, a specific diagnosis of chilblains lupus becomes a priority when a patient presents with pernio-like symptoms. CHLE is largely idiopathic, but familial variants are associated with several different genetic mutations, including TREX1, SAMHD1, and STING.

Treatment is often symptomatic with steroids, but literature has shown the possibility for systemic medications such as JAK inhibitors as effective treatments.  While the progression to systemic lupus erythematosus (SLE) is low in CHLE, further workup is the recommended course due to the implications of long-term undiagnosed SLE.

Other conditions, particularly vasospastic conditions, that the clinician should consider in the differential include:

Raynaud phenomenon

Acrocyanosis

Cryoglobulinemia

Cold panniculitis

Treatment and medication

The first line of treatment for chilblains generally includes measures to keep hands and feet warm and dry, such as keeping your indoor environment warm and dry, using gloves and socks, and changing damp gloves and socks when needed.

If your chilblains don’t clear up with these home remedies, your doctor may recommend medication, including:

Nifedipine (Procardia). This type of blood pressure medication treats chilblains by helping to open up blood vessels and improve circulation. Side effects may include flushing, nausea, dizziness and swelling in the hands or feet.

A topical corticosteroid. Applying a corticosteroid cream to chilblains may help the lesions go away.

Lifestyle and home remedies

Chilblains usually clear up in one to three weeks after cold exposure. In the meantime, you can take steps to ease your signs and symptoms, including:

Rewarming affected skin gently, without massaging, rubbing or applying direct heat

Avoiding cold exposure whenever possible

Keeping your affected skin dry and warm, but away from sources of heat

Applying lotion to alleviate itching

Making sure the affected skin is cleaned with an antiseptic and gently bandaged to prevent infection

Avoiding scratching

Quitting smoking, as smoking can constrict your blood vessels and slow wound healing

Preventing chilblains

The following advice may help prevent chilblains:

Stop smoking. Nicotine causes the blood vessels to constrict (get narrower), which can make chilblains worse.

Avoid medicines that may constrict blood vessels, such as caffeine and decongestants.

Keep active. This helps improve your circulation.

Wear warm clothes and insulate your hands, feet, and legs. Wearing long johns, long boots, tights, leg warmers or long socks will help. If you get cold feet in bed, wear a pair of clean socks.

Avoid tight shoes and boots as these can restrict the circulation to toes and feet.

Moisturize your feet regularly. This stops them from drying out and the skin cracking.

In cold weather, eat at least one hot meal during the day. This will help warm your whole body.

Warm your shoes on the radiator before you put them on. Make sure damp shoes are dry before wearing them.

Warm your hands before going outdoors by soaking them in warm water for several minutes and drying them thoroughly. Wear cotton-lined waterproof gloves if necessary.

Turn up the central heating. Try to keep one room in the house warm and avoid drafts.

If you are diabetic, give yourself regular foot checks (or ask someone else to do this). Diabetics may not be able to feel their feet and could have septic chilblains without realising.

Compulsive sexual behavior is sometimes called hypersexuality.

Overview

Compulsive sexual behavior is sometimes called hypersexuality, hypersexuality disorder or sexual addiction. It’s an excessive preoccupation with sexual fantasies, urges or behaviors that is difficult to control, causes you distress, or negatively affects your health, job, relationships or other parts of your life.

It may involve a variety of commonly enjoyable sexual experiences. Examples include masturbation, cybersex, multiple sexual partners, and use of pornography or paying for sex. When these sexual behaviors become a major focus in your life, are difficult to control, and are disruptive or harmful to you or others, they may be considered compulsive sexual behavior.

No matter what it’s called or the exact nature of the behavior, untreated hypersexuality disorder can damage your self-esteem, relationships, career, health and other people. But with treatment and self-help, you can learn to manage compulsive sexual behavior.

Causes

Although the causes of hypersexuality disorder are unclear, they may include:

An imbalance of natural brain chemicals. Certain chemicals in your brain (neurotransmitters) such as serotonin, dopamine and norepinephrine help regulate your mood. High levels may be related to compulsive sexual behavior.

Changes in brain pathways. It may be an addiction that, over time, might cause changes in the brain’s neural circuits, especially in the reinforcement centers of the brain. Like other addictions, more-intensive sexual content and stimulation are typically required over time in order to gain satisfaction or relief.

Conditions that affect the brain. Certain diseases or health problems, such as epilepsy and dementia, may cause damage to parts of the brain that affect sexual behavior. In addition, treatment of Parkinson’s disease with some dopamine agonist medications may cause hypersexuality disorder.

Risk factors

Compulsive sexual behavior can occur in both men and women, though it may be more common in men. It can also affect anyone, regardless of sexual orientation. Factors that may increase risk of compulsive sexual behavior include:

Ease of access to sexual content. Advances in technology and social media allow access to increasingly intensive sexual imagery and information.

Secrecy and privacy of compulsive sexual activities tend to allow these problems to worsen over time.

Also, an increased risk of it may occur in people who have:

Alcohol or drug abuse problems

Another mental health condition, such as a mood disorder (such as depression or anxiety), or a gambling addiction

Family conflicts or family members with problems such as addiction

A history of physical or sexual abuse

Symptoms

How do you know if what you – or someone you love – is struggling with compulsive sexual behavior? While they vary in severity as well as type, here are some common symptoms:

Escape – Using compulsive sexual behavior as an escape from problems such as anxiety, stress, loneliness, or depression

Difficulty with closeness – An inability or difficulty establishing or maintaining closeness in a relationship – even if you are married or otherwise committed to a partner

Continued sexual behavior despite consequences – Continuing to engage in risky sexual behaviors despite serious negative consequences, such as losing a job, trouble at work, legal problems, jeopardizing an important relationship, the potential to give someone a sexually transmitted disease

No satisfaction in the behavior – Continuing the sexual behavior that you feel driven to do despite the fact that you derive no satisfaction from the activity

Loss of control – Sexual thoughts and impulses intensify to the point where you feel you no longer have any control

Complications

Compulsive sexual behavior can have many negative consequences that affect both you and others. You may:

Struggle with feelings of guilt, shame and low self-esteem

Develop other mental health conditions, such as depression, suicide, severe distress and anxiety

Neglect or lie to your partner and family, harming or destroying meaningful relationships

Lose your focus or engage in sexual activity or search internet pornography at work, risking your job

Accumulate financial debts buying pornography and sexual services

Contract HIV, hepatitis or another sexually transmitted infection or pass a sexually transmitted infection to someone else

Engage in unhealthy substance use, such as using recreational drugs or drinking excessive alcohol

Be arrested for sexual offenses

Diagnosis of compulsive sexual behavior

Your doctor or other mental health professional can do a psychological evaluation, which may involve answering questions about your:

Physical and mental health, as well as your overall emotional well-being

Sexual thoughts, behaviors and compulsions that are hard to control

Use of recreational drugs and alcohol

Family, relationships and social situation

Problems caused by your sexual behavior

With your permission, your mental health professional may also request input from family and friends.

Determining a diagnosis

There’s an ongoing debate in the psychiatric community about exactly how to define compulsive sexual behavior because it’s not always easy to determine when sexual behavior becomes problematic.

Many mental health professionals use the Diagnostic and Statistical Manual of Mental Disorders (DSM-5), published by the American Psychiatric Association, as a guide for diagnosing mental health problems. Because compulsive sexual behavior doesn’t have its own diagnostic category in the DSM-5, it may be diagnosed as a subcategory of another mental health condition, such as an impulse control disorder or a behavioral addiction.

Some mental health professionals consider compulsive sexual behaviors as sexual activities taken to an extreme with significant and negative consequences. Although more research is needed to clarify and classify all the criteria, diagnosis and treatment by a mental health professional who has expertise in addictions and compulsive sexual behaviors will likely yield the best results.

Treatment for Compulsive Sexual Behavior

Treatment for compulsive sexual behavior or hypersexual disorder usually involves medications, psychotherapy and self-assist groups. The main goal of medication for compulsive sexual behavior or hypersexual disorder is to assist you control desires and lessen excessive performances while upholding healthy sexual activities.

Psychotherapy

Certain types of psychotherapy, moreover called talk treatment, may assist you study how to control your hypersexual disorder. These comprise of:

Psychodynamic psychotherapy for compulsive sexual behavior or hypersexual disorder focuses on intensifies your knowledge of unconscious feelings and behaviors, increasing new impending into your inspirations, and resolving conflicts.

Cognitive behavioral therapy or CBT for compulsive sexual behavior or hypersexual disorder helps you recognize unhealthy, pessimistic beliefs and performances and restore them with strong, positive ones.

Medicines of compulsive sexual behavior

Medicines to treat hypersexual disorder is frequently prescribed mainly for other illnesses like depression, OCD or anxiety. They include:

Antidepressants. These are SSRIs – selective serotonin & reuptake inhibitors. These comprise of paroxetine (Paxil), sertraline (Zoloft), fluoxetine (Prozac) and others.

Mood stabilizers. These treatments are normally used to treat bipolar disorder, previously named manic depression, however may reduce wild sexual desires. E.g. lithium (Lithobid).

Naltrexone for compulsive sexual behavior or hypersexual disorder is a naltrexone (Vivitrol, Revia) is normally used to doctor alcoholism plus obstruct the section of your brain which feels enjoyment with certain compulsive behaviors.

Anti-androgens for compulsive sexual behavior or hypersexual disorder help in decreasing the natural consequences of sex hormones (or androgens) in men.

Luteinizing hormone or releasing hormone for compulsive sexual behavior or hypersexual disorder is a treatment which reduces compulsive sexual feelings by reducing the development of testosterone in men.

Self-Help Groups

Support groups or self-help groups could be beneficial for individuals with hypersexual disorder and in favor of handling with all the problems it can trigger. Many groups are formed following a 12-step plan of AA or Alcoholics Anonymous.

Additionally to assisting you make transforms exactly; these special aid units can help you:

Discover about your disorder.

Find assist and accepting of your condition.

Identify supplementary treatment options and materials.

These self-help groups possibly will be based on Internet or comprise in local person get-togethers, or both.

Prevention of compulsive sexual behavior

Because the cause isn’t known, it’s not clear how it might be prevented, but a few things may help keep this type of behavior in check:

Get help early for problems with sexual behavior. Identifying and treating early symptoms may help prevent compulsive sexual behavior from getting worse over time or escalating into a downward spiral of shame, relationship problems and harmful acts.

Seek treatment early for mental health disorders. Compulsive sexual behavior may be worsened by depression or anxiety.

Identify and seek help for alcohol and drug abuse problems. Substance abuse can cause a loss of control and unhappiness that can lead to poor judgment and may push you toward unhealthy sexual behaviors.

Avoid risky situations. Don’t jeopardize your health or that of others by putting yourself into situations where you’ll be tempted to engage in risky sexual practices.

Ectopic pregnancy (Ectopic means out of place) is when an embryo grows in the wrong place outside the womb.

Definition

Ectopic pregnancy (Ectopic means “out of place”) is when an embryo grows in the wrong place outside the womb. An embryo is a fertilized egg that results when an egg and sperm combine.

Once an egg is fertilized, it usually travels down a fallopian tube and attaches to the lining of your uterus (also called the womb). Fallopian tubes are the tubes between your ovaries (where your eggs are stored) and the uterus. The uterus is the place inside you where your baby grows.

In most ectopic pregnancies, the fertilized egg attaches to a fallopian tube before it reaches the uterus. Less often, it attaches to an ovary, the cervix or your abdomen (belly). The cervix is the opening to the uterus that sits at the top of the vagina. These areas don’t have enough space or the right tissue for a baby to grow.

Without treatment, an ectopic pregnancy can cause the place where it’s attached to bleed heavily or burst. This can lead to serious bleeding and even death in pregnant women. An ectopic pregnancy always ends in pregnancy loss. About 1 in 50 pregnancies (2 percent) in the United States is ectopic.

Types of ectopic pregnancy

Tubal pregnancy

A tubal pregnancy occurs when the egg has implanted in the fallopian tube. This is the most common type of ectopic pregnancy and the majority of ectopic pregnancies are tubal pregnancies. The type of tubal pregnancy can be further classified according to where inside the fallopian tube the pregnancy becomes established.

Non-tubal ectopic pregnancy

Nearly two percent of all ectopic pregnancies become established in other areas including the ovary, the cervix or the intra-abdominal region.

Heterotopic pregnancy

In some rare cases, one fertilized egg implants inside the uterus and another implant outside of the structure. The ectopic pregnancy is often discovered before the intrauterine pregnancy, mainly due to the painful nature of ectopic pregnancy. If human chorionic gonadotropin levels continue to rise after the ectopic pregnancy has been removed, the pregnancy inside the womb may still be viable.

Causes 

An ectopic pregnancy is often caused by damage to the fallopian tubes. A fertilized egg may have trouble passing through a damaged tube, causing the egg to implant and grow in the tube.

Things that make you more likely to have fallopian tube damage and an ectopic pregnancy include:

Smoking: The more you smoke, the higher your risk of an ectopic pregnancy.

Pelvic inflammatory disease (PID): This is often the result of an infection such as chlamydia or gonorrhea.

Endometriosis, which can cause scar tissue in or around the fallopian tubes.

Being exposed to the chemical DES before you were born.

Some medical treatments can increase your risk of ectopic pregnancy. These include:

Surgery on the fallopian tubes or in the pelvic area.

Fertility treatments such as in vitro fertilization.

Symptoms of Ectopic Pregnancy

An ectopic pregnancy doesn’t always cause symptoms and may only be detected during a routine pregnancy scan.

If you do have symptoms, they tend to develop between the 4th and 12th week of pregnancy.

Symptoms can include a combination of:

A missed period and other signs of pregnancy

Tummy pain low down on 1 side

Vaginal bleeding or a brown watery discharge

Pain in the tip of your shoulder

Discomfort when peeing or pooing

But these symptoms aren’t necessarily a sign of a serious problem. They can sometimes be caused by other problems, such as a stomach bug.

Risk Factors

The risk factors include the following:

Previous ectopic pregnancy

Prior fallopian tube surgery

Previous pelvic or abdominal surgery

Certain sexually transmitted infections (STIs)

Pelvic inflammatory disease

Endometriosis

Other factors that may increase a woman’s risk of ectopic pregnancy include

Cigarette smoking

Age older than 35 years

History of infertility

Use of assisted reproductive technology, such as in vitro fertilization (IVF)

About one-half of all women who have an ectopic pregnancy do not have known risk factors. Sexually active women should be alert to changes in their bodies, especially if they experience symptoms of an ectopic pregnancy.

Ectopic pregnancy complications

A complication of ectopic pregnancy is more likely if diagnosis or treatment is delayed, or if the condition is never diagnosed.

Internal bleeding: A woman who has an ectopic pregnancy and does not receive a timely diagnosis or treatment is more likely to experience severe internal bleeding. This can lead to shock and serious outcomes.

Damage to fallopian tubes: Delayed treatment can also result in damage to the fallopian tube, significantly increasing the risk of future ectopic pregnancies.

Depression: This can result from grieving over the loss of the pregnancy and worrying about future pregnancies.

It is important to remember that pregnancy remains possible even if a fallopian tube is removed. If both tubes are removed, in-vitro fertilization (IVF) remains an option if a woman wishes to conceive a child.

Diagnosis of ectopic pregnancy

Most ectopic pregnancies are suspected between 6 and 10 weeks of pregnancy. Sometimes the diagnosis is made quickly. However, if you are in the early stages of pregnancy, it can take longer (a week or more) to make a diagnosis of an ectopic pregnancy.

Your diagnosis will be made based on the following:

Consultation and examination

Your doctor will ask about your medical history and symptoms and will examine your abdomen. With your consent, your doctor may also do a vaginal (internal) examination. You should be offered a female chaperone (someone to accompany you) for this. You may also wish to bring someone to support you during your examination.

Urine pregnancy test

If you have not already had a positive pregnancy test, you will be asked for a urine sample so that this can be tested for pregnancy. If the pregnancy test is negative, it is very unlikely that your symptoms are due to an ectopic pregnancy.

Ultrasound scan

A transvaginal scan (where a probe is gently inserted in your vagina) is known to be more accurate in diagnosing an ectopic pregnancy than a scan through the tummy (transabdominal scan). Therefore, you will be offered a transvaginal scan to help identify the exact location of your pregnancy. However, if you are in the early stages of pregnancy, it may be difficult to locate the pregnancy on scanning and you may be offered another scan after a few days.

Blood tests

A test for the level of the pregnancy hormone βhCG (beta-human chorionic gonadotropin) or a test every few days to look for changes in the level of this hormone may help to give a diagnosis. This is usually checked every 48 hours because, with a pregnancy in the uterus, the hormone level rises by 63% every 48 hours (known as the ‘doubling time’) whereas, with ectopic pregnancies, the levels are usually lower and rise more slowly or stay the same.

Laparoscopy

If the diagnosis is still unclear, operation under a general anesthetic called a laparoscopy may be necessary. The doctor uses a small telescope to look at your pelvis by making a tiny cut, usually into the umbilicus (tummy button). This is also called keyhole surgery.

Treatment

Currently, three different treatments available for an ectopic pregnancy.

Your doctor will discuss the most appropriate one for you, however, your doctor may also find it necessary to proceed from one method to another.

Laparoscopic (keyhole) surgery to remove the fertilized egg from fallopian tubes

A telescopic device (the laparoscope) is inserted through a small cut below your navel (belly button). To help identify your organs, carbon dioxide gas is blown into your stomach through a needle.

A couple of small incisions are also made in your lower abdomen to manipulate and if necessary remove the ectopic pregnancy tissue.

The surgery may involve removing your fallopian tube (salpingectomy) or opening your fallopian tube (salpingostomy) to remove the ectopic pregnancy tissue.

Laparotomy to remove the ectopic pregnancy

If the pregnancy is advanced or there has been significantly associated hemorrhaging (bleeding) then your doctor may perform a laparotomy, a type of surgery involving a much larger incision.

Intramuscular injection of the drug methotrexate

A medication called methotrexate is used to dissolve the pregnancy tissue. It is given by injection in the leg or bottom and is suitable for women without pain or those with minimal pain.

This type of treatment was introduced to avoid surgery but needs careful follow-up.

The follow-up requires blood tests after the first week and then once or twice a week until tests show that you are no longer pregnant. The schedule of blood tests will be explained to you by your doctor. The treatment has a 90 percent success rate. If it is not successful, your doctor may have to reconsider medical treatment or surgery.

Recovery after treatment

After laparoscopic surgery or a methotrexate injection, most women recover and are ready to leave the hospital within 24 hours.

After a laparotomy, it is more common to stay in the hospital for 2 to 3 days.

If you had a salpingostomy or methotrexate injection you will need to have regular tests at the hospital to ensure all the pregnancy cells are gone. This usually involves another blood hormone test.

Prevention of Ectopic Pregnancy

There’s no way to prevent an ectopic pregnancy, but here are some ways to decrease your risk:

Limit your number of sexual partners.

Always use a condom during sex to help prevent sexually transmitted infections and reduce your risk of pelvic inflammatory disease.

Don’t smoke. If you do, quit before you try to get pregnant.

Hydrosalpinx or Blocked Fallopian Tubes is the blockage of a woman’s fallopian tube.

Definition

Hydrosalpinx or Blocked Fallopian Tubes is the blockage of a woman’s fallopian tube caused by a fluid buildup and dilation of the tube at its end.

Most often it occurs at the fimbrial end of the tube next to the ovary, but it can also occur at the other end of the tube that attaches to the uterus. The term hydrosalpinx comes from Greek, with hydro meaning water and salpinx meaning tube.

Blocked fallopian tubes are one form of tubal factor infertility. When the fallopian tube is blocked, the cells inside the tube secret fluid that can’t escape, dilating the tube.

This prevents fertilization – and thus pregnancy – by blocking an ovulated egg from moving from the ovary to the fallopian tube for fertilization by the sperm. If an ovulated egg is somehow able to connect with a sperm for fertilization, the hydrosalpinx would still likely block the resulting embryo from traveling to the uterus for implantation and pregnancy.

It can also potentially cause a dangerous ectopic pregnancy, in which the embryo implants outside the uterus, most often inside the fallopian tube, and results in a life-threatening situation.

Types of Blocked Fallopian Tubes

The types of blocked Fallopian tubes are normally categorized depending on the location of the tube affected. They are;

Midsegment tubal obstruction

This occurs in the ampullary and it normally results from tubal ligation damage. Tubal ligation is a surgical procedure to prevent future pregnancies. The procedure has its own risks, but many women who opt for it end up requiring a correction when they change their minds

Proximal Tubal Occlusion

This involves the Isthmus and normally results from infections after an abortion, miscarriage, PID, caesarean section and some birth control procedures can block the tubes

Distal Tubal Occlusion

This type affects the end part near the ovary and hydrosalpinx is the major cause of the blockage.

Risk factors

Damage to fallopian tubes can result in infertility without any obvious signs or symptoms. Your risk for having a hydrosalpinx or blocked tubes increases with each of the following:

Appendicitis

Endometriosis

Previous pelvic surgery

Sexually transmitted disease

Pelvic Adhesions

The diagnosis changes to hydrosalpinges when both tubes are damaged. If you have experienced trouble getting pregnant, or have pelvic pain and unusual vaginal discharge, Dr. Douglas will want to rule out the possibility of hydrosalpinx or hydrosalpinges.

Causes of Blocked Fallopian Tubes

The most common cause of blocked fallopian tubes is a pelvic inflammatory disease (PID). PID is the result of a sexually transmitted disease, but not all pelvic infections are related to STDs. Also, even if PID is no longer present, a history of PID or pelvic infection increases the risk of blocked tubes.

Other potential causes of blocked fallopian tubes include:

Current or history of an STD infection, specifically chlamydia or gonorrhea

History of uterine infection caused by an abortion or miscarriage

History of a ruptured appendix

History of abdominal surgery

Previous ectopic pregnancy

Prior surgery involving the fallopian tubes

Endometriosis

Symptoms of Blocked Fallopian Tubes

Blocked fallopian tubes symptoms are very rare. The symptoms include

Strong to mild abdominal pain

Fever

Painful periods

Strange looking or smelling vaginal discharge

Feeling pain while having sex or passing urine, but because many women ovulate, fallopian tube blockage can go ignored until a woman wants to get pregnant.

Complications

Surgery to open the fallopian tubes carries the same potential complications as any surgery. These include:

Infection

Creation of more scar tissue

Damage to organs

Bleeding

One risk of pregnancy after surgery is an ectopic pregnancy, meaning that a fertilized egg gets stuck outside of the womb, often in a fallopian tube. The egg will not develop, and there can be a risk to a woman’s health.

Diagnosis of Blocked Fallopian Tubes

There really are no outward signs that will let you know if you are suffering from blocked fallopian tubes. If you have ever suffered from the pelvic inflammatory disease, there is a 15% -50% chance that your tubes are blocked.

The primary indicator that there is a blockage is an inability to conceive. Fortunately, there are diagnostic tests that can detect any abnormalities or blockages if there is evidence of some type of blockage to the tubes. Here are details on how blocked fallopian tubes are diagnosed…

Hysterosalpingogram (HSG)

Hysterosalpingogram is an X-ray test, using a contrast dye to view any obstruction in the fallopian tubes. The dye is inserted through a thin tube that is placed up through the vagina, into the uterus. Filling the uterus with this dye will then spill into the fallopian tubes. X-rays are then taken to determine if there is an injury or abnormal shape of the uterus and fallopian tubes, including obstruction in the tubes. This test is the number one test performed to determine if there is a blockage in the fallopian tubes.

Chromotubation

This test is similar to hysterosalpingogram because chromotubation includes dye being passed into the uterus and fallopian tubes as well. This test is performed during laparoscopy so that doctors can see the dye spilling from the fallopian tube. The dye used for this procedure cannot be seen on an X-ray, it is blue in color. This test is considered the most reliable way to determine fallopian tube blockage but does require surgery. It is not the initial test performed unless there is another reason to perform surgery such as chronic pelvic pain.

Sonohysterography

This is a non-invasive procedure where ultrasound imaging is used to determine if there are any abnormalities of the reproductive organs. This type of test is not always a reliable way to determine fallopian tube blockage since the tubes are so small and spillage of the fluid cannot always be seen on ultrasound. This test may help to determine hydrosalpinx or other issues such as uterine fibroids.

Treatment of Blocked Fallopian Tubes

For Single Tubal Blockage: This is not difficult to cure. It does not include complex process. Fertility specialists normally recommend powerful fertility drugs to patients to improve their probabilities of ovulating on whichever side the tube is open without blockage.

For Both Tubes Blockage: Here generally the fertility drugs are not satisfactory when both tubes are blocked. Here, laparoscopic surgery is the greatest desirable choice to overcome the problem. The chances of success depend on the age of the women if younger then better. Laparoscopic surgery either clears the blockage or splits out tissue that is affecting the issues.

Common laparoscopic procedures include:

Tubal ligation reversal involves surgically reopening, untying or reconnecting a woman’s fallopian tubes that have been intentionally tied off or closed from a tubal ligation. Tubal ligation reversal can enable a woman to become pregnant again and is generally performed through minimally invasive robotic surgery.

Salpingectomy is a surgery to address hydrosalpinx (a buildup of fluid in the fallopian tubes) by removing scar tissue around the tube or removing the damaged part of the tube that is causing the fluid buildup.

Tubal removal may also be the best option to treat infertility. Although removing a fallopian tube sounds drastic, the inflammation from a damaged tube is a constant irritation in the pelvic cavity that can interfere with fertility. By removing the damaged tube causing inflammation, there is a better chance of getting pregnant through the remaining healthy fallopian tube.

Adhesiolysis is the simultaneous use of laparoscopy and hysteroscopy to remove adhesions or blockages from the origin of the fallopian tube, where it exits the uterus. A fertility surgeon inserts imaging die into the woman’s fallopian tubes to visualize the blockage and then taps the blockage away from the end of the tube using a wire guide through a slender tube.

IVF: IVF is the most effective modality treatment for blocked fallopian tubes and frequently the last option for patients who wish to get over this sickness and become pregnant

Prevention of Blocked Fallopian Tubes

Preventive measures that you could take:

Avoid drinking and smoking.

Practice some meditation. This can help lower your stress levels.

Sign up for yoga classes, or do it at home. A few poses that can help boost the health of your reproductive organs are the butterfly pose and bridge pose.

Avoid excessive consumption of junk foods. Include foods like fresh fruits, green leafy vegetables, and coconut oils. These are rich in antioxidants. Citrus foods, eggs, mangoes, zucchini, and spinach are rich in carotenoids, which help your enzymes and circulation as well.

Increase your intake of Vitamin C – it helps ease out inflammation.

Use herbal tampons. These contain herbs like goldenseal and Dong Quai, which can help clear out your fallopian tubes.

Blepharitis is a very common inflammatory disorder of the edge of the eyelids where the eyelashes are located.

Definition

Blepharitis is a very common inflammatory disorder of the edge of the eyelids where the eyelashes are located. Bacteria, which normally exist on our skin, are drawn to crusts around the base of the eyelashes and produce chemical substances which irritate the eyes resulting in itching, irritation and burning of the eyes. The ducts of special glands, called meibomian glands, which are located in the eyelids just behind the eyelashes, become blocked.

These glands are important in helping to prevent the film of tears which covers the very sensitive cornea (the clear window of the eye) from evaporating too rapidly in between blinks, as they produce the mucus layer of the tear film.

It results in:

Tear film instability which in turns results in irritation, a foreign body sensation, burning, itching and redness of the eyes (dry eye symptoms)

Tearing of the eyes due to an overproduction and overflow of tears as a reflex reaction to eye irritation

Red inflamed eyelid margins

Cyst formation in the eyelid (chalazion or meibomian cyst – see photograph below)

Loss of eyelashes

Inturning of the eyelid margins (entropion) resulting in painful rubbing of the eyelashes against the cornea

Corneal ulcer (marginal ulcer or marginal keratitis)

Prevalence

It is one of the most common ocular disorders encountered by eye care practitioners. In the United States, blepharitis is estimated to affect more than 180 million people. In a United States survey of ophthalmologists and optometrists, it was estimated that 37% and 47% of the patients presented with certain form of blepharitis in clinical practice, respectively.

Blepharitis

Types of Blepharitis

Anterior blepharitis

Anterior blepharitis is the name given to the condition when the inflammation affects the skin around the base of the eyelashes.

Anterior blepharitis is usually caused by one of two things.

Seborrhoeic dermatitis. This complaint causes the skin to become oily or flaky, blocking the Meibomian glands in the eyelid.

A reaction to Staphylococcus bacteria, which is usually present but harmless on our skin.

Posterior blepharitis

In patients with posterior blepharitis, the inflammation usually affects the Meibomian glands which are behind the base of the eyelashes. Posterior blepharitis is normally caused by issues with the Meibomian glands, such as when they become blocked by flakes of skin, debris or bacteria. Occasionally, people who suffer from the skin condition known as Rosacea, will also find they are prone to posterior blepharitis.

Mixed blepharitis

Unsurprisingly, mixed blepharitis is a combination of both anterior and posterior types of the condition.

Risk factors

A risk factor is something that increases your chance of getting a disease or condition. Risk factors for blepharitis include:

Seborrheic dermatitis

Acne rosacea

Contact allergies

Diabetes

Chemical irritants

Poor hygiene

Cosmetic makeup

Advanced age

Causes of Blepharitis

There are a number of possible causes of blepharitis.

They include:

An inflammatory reaction to bacteria that normally live on eyelids

Seborrheic dermatitis or rosacea

Parasites: Demodex eyelash mites

Infection with the herpes simplex virus (HSV)

People who have dandruff are more likely to develop blepharitis. Keeping the dandruff under control can help reduce the symptoms.

Another possible cause is dysfunction of the Meibomian glands on the rim of the eyelids. These glands produce an oily substance that prevents the eye’s film of tears from evaporating.

Some doctors believe that blepharitis is a precursor of Meibomian gland dysfunction, rather than the gland dysfunction causing blepharitis.

Blepharitis symptoms

Blepharitis causes varying degrees of discomfort depending on the severity of the case. Common signs and symptoms include:

Itchy, flaky eyelid margins

Red/blood-shot eyes

Foreign body sensation

Excessive or frothy tears

Crusty or sticky lashes

Sensitivity to light

Rough, scaly eyelids

Excessive blinking

It is a good idea to make an appointment with your optometrist or ophthalmologist as soon you experience any of the above symptoms.

Symptoms of Blepharitis

Complications of Blepharitis

It is unusual for blepharitis to cause serious medical problems. However, blepharitis can lead to the following changes in eye health.

Sty: A sty (sometimes spelled stye) or hordeolum is a bacterial infection in one of the oil glands whose opening is clogged. The result is a painful lump on the edge or inside of the eyelid.

Chalazion: A chalazion or conjunctival granuloma occurs when blockage in one or more of the oil glands causes it/them to become enlarged and scarred. Multiple chalazia can also develop, either on the same eyelid or on different lids.

Chronic pinkeye: Blepharitis can lead to recurrent bouts of pinkeye (conjunctivitis).

Ulceration of the cornea: Constant irritation from inflamed eyelids or misdirected eyelashes may cause a sore (ulcer) to develop on the cornea. It does not affect vision generally, although disturbances of the tear film may intermittently blur vision, causing varying amounts of fluctuating vision during the day.

Diagnosis and test

Blepharitis can be diagnosed through a comprehensive eye examination. Testing, with special emphasis on the eyelids and front surface of the eyeball, may include:

Patient history to determine any symptoms the patient is experiencing and any general health problems that may be contributing to the eye problem.

External examination of the eye, including lid structure, skin texture and eyelash appearance.

Evaluation of the lid margins, base of the eyelashes and meibomian gland openings using bright light and magnification.

Evaluation of the quantity and quality of tears to check for any abnormalities.

An optometrist can determine the type of blepharitis based on the appearance of the eyelid margins. The different types and symptoms are as follows:

Staphyloccal blepharitis patients frequently exhibit mildly sticking eyelids, thickened lid margins, and missing and misdirected eyelashes.

Seborrheic blepharitis patients have greasy flakes or scales around the base of eyelashes and a mild redness of the eyelids.

Ulcerative blepharitis patients have matted hard crusts around the eyelashes. Removing the crusts leaves small sores that ooze and bleed. These patients may also experience eyelash loss, distortion of the front edges of the eyelids and chronic tearing. In severe cases, the cornea (the transparent front covering of the eyeball) becomes inflamed.

Meibomian blepharitis patients have a blockage of the oil glands in the eyelids, poor quality of tears and redness of the lining of the eyelids.

Treatment and medications

Blepharitis cannot be totally cured, but it is possible to make your eyes more comfortable:

Warm compresses- These will help to unblock glands and loosen the crusts on the eyelid so that they are easier to remove. You can buy reusable warming packs which you heat up in the microwave, or you can use a flannel, cotton-wool ball or something similar, which you can soak in hot, but not boiling, water. Place the compress on the edge of your closed eyelids for five minutes, rocking it gently. This will loosen the crusts. Use a use a separate clean compress for each eye.

Lid cleaning- After applying the compress you should clean your lids. Your optometrist will be able to advise you of the different options available.

Lubricants- These are available from your optometrist or pharmacist and can help if your eyes feel gritty and dry.

Antibiotics- If warm compresses and cleaning your eye lids do not work, your doctor or prescribing optometrist may prescribe you antibiotic ointment or tablets. You may need to take these for several weeks or months and the benefits may last for some months after you finish the treatment.

If you have blepharitis, avoid smoky atmospheres and wearing eye makeup, particularly eyeliner and mascara.

Prevention

Strict eye hygiene helps prevent blepharitis. Using clean towels and making sure your hands are clean before touching your eyes and eye area are important steps in prevention. If you wear makeup, it is important to thoroughly remove any traces of it before going to bed.

In cases of posterior blepharitis where the oil glands are not producing enough oil, nutritional supplements of Omega-3 fatty acids may be recommended by your doctor. Flaxseed oil is a common fatty acid supplement.

Darier disease or Keratosis Follicularis is an autosomal disorder.

Definition

Darier disease (DAR Darier disease Dyskeratosis Follicularis Darier White disease/ Keratosis follicularis) is a rare, often chronic, genetic disorder characterized primarily by non-contagious skin changes.

Darier disease or Keratosis Follicularis is an autosomal disorder, meaning that a single gene inherited from one parent causes this disease. Like Hailey-Hailey disease, Darier Disease is also grouped as a hereditary acantholytic dermatosis. Skin changes commonly start in adolescence.

Flare-ups of Darier Disease or Keratosis Follicularis are triggered by tight-fitting clothes, humidity, stress and sun exposure. Darier disease affects both men and women equally and is not contagious.

Majority of the patients develop symptoms of Darier Disease or Keratosis Follicularis before the age of 30. Many patients can also have this disease in a mild form of which they are not aware of. Individuals with severe Darier Disease have chronic relapsing-remitting symptoms. In some patients, the symptoms may resolve spontaneously. The rashes or lesions of Darier Disease or Keratosis Follicularis worsen upon exposure to sun and sometimes by corticosteroid use. Patients with Darier Disease or Keratosis Follicularis can have flare ups of this condition with bacterial infections. Patient’s overall health commonly will be good irrespective of the severity of this condition.

Pathophysiology

Mutations in the gene ATP2A2 on chromosome 12q23-24, which codes for sarco-endoplasmic reticulum Ca2+ ATPase, leads to both acantholysis and apoptosis. Defects in Ca2+ sequestration from the cytosol into the lumen of ER damages the normal processing of junctional-adhesion proteins such as impaired synthesis, maturation, or function of the desmosomes in epithelial cells.

The mechanisms by which specific ATP2A2 mutations impact the function of the ATP2A2 protein have been investigated using an in vitro model. The investigators found that the resultant transfected cells showed defects in ATP2A2 protein expression, ATP hydrolysis, calcium transport and calcium binding. Thus diverse biochemical mechanisms are responsible for altered protein function.

Causes of Darier disease

Darier disease is caused by mutations in the ATP2A2 gene. This gene gives the body instructions to make an enzyme known as SERCA2. This enzyme helps control the level of calcium ions inside cells. Calcium ions act as signals for many cell functions needed for normal development.

Mutations in the ATP2A2 gene affect the amount or function of the SERCA2 enzyme. This enzyme is expressed throughout the body, and it is unclear why mutations in this gene affect only the skin.

The linear form of Darier disease is also caused by ATP2A2 gene mutations, but these mutations are acquired and arise in only some body cells after conception (somatic mutations).

Darier disease symptoms

Darier disease is a skin condition characterised by wart like blemishes on the body. These are usually coloured (yellow-brown or brown), hard to the touch, mildly greasy and can emit a strong odour.

Common sites for blemishes are the scalp, forehead, upper arms, chest, back, knees, elbows, and behind the ear. Pits (depressions in the skin) may be present in the palms of the hands and soles of the feet. The mucous membranes may also be affected including the mouth (palate), inside the cheeks, gums, and throat, the vulva and rectum.

Red and white streaks in the nails, with irregular texture, can occur.

The symptoms usually appear in late childhood to early adulthood.  A person with the condition may have ‘flare-ups’ where more symptoms are present and periods with fewer blemishes.

Other characteristics may include:

Mild intellectual disability

Epilepsy

Depression

Learning and behavioural difficulties.

Another form of Darier disease is the linear or segmental form which has blemishes on localised areas of the skin; these blemishes are not as widespread as typical Darier disease and may only occur on one side of the body.

Typical sign of Darier’s disease in lower back area

Complications

Most affected patients develop signs before the age of 20 years.

Many have mild and unnoticed Darier disease.

More severe disease may have a chronic relapsing-remitting pattern.

The signs may clear up altogether.

Flare-ups may be caused by any of the following factors.

Exposure to sunlight or heat.

Topical steroid use

Bacterial infection, usually Staphylococcus aureus

Herpes simplex infection – including severe Kaposi varicelliform eruption (see eczema herpeticum).

In most patients, general health remains good regardless of the severity of the disease. However, it can have a major impact on psychosocial functioning.

Darier’s disease in nail

Diagnosis and test

The doctor will ask about your symptoms and health history. A physical exam will be done. It will focus on the skin. This is often enough to make the diagnosis.

The skin may also be tested. This can be done with a biopsy. A small sample of skin will be removed. It will be sent to a lab for testing.

blood test may also be done to look for signs of the faulty gene.

Treatment and medications

Oral retinoids have been reported to be effective treatments. However, prolonged use of oral retinoids can cause significant side effects and individuals using these drugs need to be monitored closely by their physicians. Symptoms of the disease will return if the retinoid therapy is stopped.

Topical retinoids such as tazarotene, isotretinoin, and adapalene have been shown to be effective in some individuals. Tacrolimus ointment, a calcineurin inhibitor, has been helpful in moderating symptoms in some patients.

Surgical treatments, including dermabrasion, carbon dioxide laser, and erbium YAG laser, may be effective in treating localized areas.

Antibacterial washes, antiseptic creams, and oral antibiotics may help with odor and skin infections.

Using high factor sunscreen, avoiding sun exposure, and wearing cotton clothing may help reduce flare-ups of the disease.

Other useful treatments:

Laser treatment or resurfacing of very thick areas has been reported to be successful and may be offered by some dermatology departments. Surgical excision or Dermabrasion (removing surface layers) of very thick areas has been used occasionally.

Photodynamic therapy, a type of photochemotherapy delivered in dermatology departments, that is used to treat other skin conditions (e.g. Actinic Keratosis) has been used effectively in some cases of Darier disease. Botulinum toxin injections has been reported in a small number of patients and may be helpful for severe Darier disease. This can be helpful in reducing sweating and can be discussed with your dermatologist.

Prevention of Darier disease

The avoidance of triggers is paramount in preventing exacerbations of Darier disease.

Triggers can include sunlight, heat, occlusive clothing, and friction. Patients should avoid sun exposure, wear loose clothing, use sunscreen, and employ proper hygiene practices.

Cleaning with antiseptic solutions can prevent infections.

As Darier disease is inherited in an autosomal dominant fashion, patients should be offered genetic counseling

Meniere’s disease (also called idiopathic endolymphatic hydrops).

Definition

Meniere’s disease (also called idiopathic endolymphatic hydrops) is one of the most common causes of dizziness originating in the inner ear.

In most cases, only one ear (unilateral) is involved, but both ears (bilateral) may be affected. Ménière’s disease typically affects people between the ages of 40- and 60-years-old and can impact anyone. Occasional symptoms include vertigo (attacks of a spinning sensation), hearing loss, tinnitus (a roaring, buzzing, or ringing sound in the ear), and a sensation of fullness in the affected ear.

These episodes typically last from 20 minutes up to eight to 12 hours.

Hearing loss is often intermittent, occurring mainly at the time of the attacks of vertigo. Loud sounds may seem distorted and cause discomfort. Usually, the hearing loss involves mainly the lower frequencies, but over time this often affects higher tones as well. While hearing loss initially fluctuates, it often becomes more permanent as the disease progresses.

Meniere’s disease pathophysiology

Although the etiology of Meniere’s disease is not well understood, it appears to be the result of the abnormal volume or composition of fluid in the inner ear. The inner ear consists of a system of connected tubes and cavities called a labyrinth. The outer ear consists of bone and is known as the bony labyrinth. A membranous labyrinth, made up of a soft structure of the membrane, is located inside the bony labyrinth and is similar in shape.

Anatomy of Inner Ear

The membranous labyrinth contains a fluid; hairlike sensors that line the membranous labyrinth respond to the movement of the fluid. This fluid needs to retain a certain volume, pressure, and chemical composition in order for all of the sensors in the inner ear to function properly. The following factors may change the properties of the inner-ear fluid and cause or trigger Meniere’s disease.

Improper fluid drainage due to blockage or anatomical abnormality

Abnormal immune response

Allergies

Viral infection

Genetic predisposition

Head trauma

Migraines

No single cause has yet been identified for Meniere’s disease; it may be caused by a combination of factors.

Types of Meniere’s disease

Meniere’s Disease can be classified in three ways. In the management of Meniere’s disease, the following three primary sub-classifications of Meniere’s disease, to describe the specific signs and symptoms, as noted below.

Classic Meniere’s disease is an inner ear disorder characterized by episodic vertigo attacks (often with nausea and vomiting), sensorineural hearing loss, tinnitus, and pressure or fullness in the involved ear (usually unilateral). Initially, the hearing loss typically involves the low frequencies and the hearing loss fluctuates, generally becoming worse with each attack. Over time, the hearing loss progresses to involve the higher frequencies and the degree of hearing loss can progress to severe-to-profound. It is estimated that 80 percent of all Meniere’s disease patients are unilaterally involved.

In Vestibular Meniere’s disease, vertigo attacks are identical to classic Meniere’s disease (above). However, in Vestibular Meniere’s disease, hearing remains normal, and other aural symptoms (tinnitus, fullness) are absent.

Bilateral Meniere’s disease is characterized by bilateral fluctuating hearing loss and recurrent episodes of vertigo. One ear may initially present and later enter a quiescent period. Years later, a disease in the opposite ear may develop. Approximately 50% of patients destined to develop bilateral Meniere’s disease do so within 2 years, and 75% do so within 5 years. If patients with bilateral Meniere’s disease experienced symptomatic improvement with oral steroids, a diagnosis of autoimmune inner ear disease is made.

Meniere’s disease risk factors

Excess fluid in the inner ear: The inner ear is a group of connected passages and cavities called a labyrinth. The outside of the inner ear is made of bone (bony labyrinth). Inside is a soft structure of membrane (membranous labyrinth). Normally, there is a presence of fluid in the membrane system of the inner ear. This fluid plays a very important role in maintaining the balance of an individual. When there is a defect in the membranes of the inner ear like swelling, scarring, infection, injury, etc. the fluid bursts out of the membrane entering other areas and causing damage, which affects the sense of balance

Autoimmune: There is some evidence that the body’s own immune mechanism may be responsible for the disorder.

Viral Infection: There is a possibility that a virus could be responsible for the disorder.

Allergies: Any kind of allergy to substances like dust, pollen, or food products like wheat, nuts, dairy products, seafood may trigger inner ear symptoms of dizziness, ringing, hearing loss, etc. and aggravate Meniere’s disease.

Heredity: Meniere’s disease could be a result of genetic variation and it could run in families.

Migraine: There is an increased prevalence of migraine in patients with Meniere’s disease. About one-third of patients with Meniere’s also experience migraines.

Dietary: There is some evidence that shows excess salt intake can exacerbate the condition.

Other: Some other probable causes are stress, smoking, and alcohol.

Causes of Meniere’s disease

The exact cause of Ménière’s disease isn’t clear, although it’s thought to be caused by a problem with the pressure in the inner ear.

The inner ear is made up of:

The cochlea – A coiled, spiral tube that contains two fluid-filled chambers and is responsible for hearing

The vestibular apparatus – A complex set of tubes that help to control balance

The fluid inside the inner ear is called endolymph.

If the pressure of the endolymph fluid changes – for example, because there is too much fluid – it can result in symptoms such as vertigo and tinnitus.

It’s thought that this pressure change is responsible for Ménière’s disease, although it hasn’t been proven.

Symptoms

Signs and symptoms of Meniere’s disease include:

Recurring episodes of vertigo: You have a spinning sensation that starts and stops spontaneously. Episodes of vertigo occur without warning and usually last 20 minutes to several hours, but not more than 24 hours. Severe vertigo can cause nausea.

Hearing loss: Hearing loss in Meniere’s disease may come and go, particularly early on. Eventually, most people have some permanent hearing loss.

Ringing in the ear (tinnitus): Tinnitus is the perception of a ringing, buzzing, roaring, whistling or hissing sound in your ear.

Feeling of fullness in the ear: People with Meniere’s disease often feel pressure in an affected ear (aural fullness).

After an episode, signs, and symptoms improve and might disappear entirely for a while. Over time, the frequency of episodes may lessen.

Symptoms of Meniere’s disease

Meniere’s disease complications       

The most disruptive feature of Ménière’s disease is the sudden onset of vertigo attacks.

The individual may have to lie down and miss out on social, leisure, work, or family activities.

Vehicle licensing authorities in many countries state that people with a diagnosis of Ménière’s disease must not drive.

These authorities will not permit the individual to drive until they receive a doctor’s confirmation that their symptoms are under control.

Diagnosis and test

A diagnosis of Meniere’s disease includes vertigo, hearing loss, tinnitus, and a feeling of pressure. Many of the symptoms of Meniere’s disease can also be caused by other conditions, so the diagnosis of the condition often involves first ruling out other medical possibilities.

There is no specific test for Meniere’s disease, but doctors use a range of tests in combination to help diagnose the disorder. These include:

Hearing tests – To test if hearing loss is specific to your inner ear. cator of Meniere’s.

Electronystagmography (ENG) – Measures involuntary eye movement while your balance is put under stress.

Magnetic resonance imaging (MRI) – Can be used to rule out disorders of the central nervous system that may be confused with Meniere’s disease, such as acoustic neuroma, Arnold-Chiari malformation and multiple sclerosis (MS).

Treatment and medications

Ménière’s disease does not have a cure yet, but your doctor might recommend some of the treatments below to help you cope with the condition.

Medications- The most disabling symptom of an attack of Ménière’s disease is dizziness. Prescription drugs such as meclizine, diazepam, glycopyrrolate, and lorazepam can help relieve dizziness and shorten the attack.

Salt restriction and diuretics- Limiting dietary salt and taking diuretics (water pills) help some people control dizziness by reducing the amount of fluid the body retains, which may help lower fluid volume and pressure in the inner ear.

Other dietary and behavioral changes- Some people claim that caffeine, chocolate, and alcohol make their symptoms worse and either avoid or limit them in their diet. Not smoking also may help lessen the symptoms.

Cognitive therapy- Cognitive therapy is a type of talk therapy that helps people focus on how they interpret and react to life experiences. Some people find that cognitive therapy helps them cope better with the unexpected nature of attacks and reduces their anxiety about future attacks.

Injections- Injecting the antibiotic gentamicin into the middle ear helps control vertigo but significantly raises the risk of hearing loss because gentamicin can damage the microscopic hair cells in the inner ear that help us hear. Some doctors inject a corticosteroid instead, which often helps reduce dizziness and has no risk of hearing loss.

Pressure pulse treatment- The U.S. Food and Drug Administration (FDA) recently approved a device for Ménière’s disease that fits into the outer ear and delivers intermittent air pressure pulses to the middle ear. The air pressure pulses appear to act on endolymph fluid to prevent dizziness.

Alternative medicine- Although scientists have studied the use of some alternative medical therapies in Ménière’s disease treatment, there is still no evidence to show the effectiveness of such therapies as acupuncture or acupressure, tai chi, or herbal supplements such as ginkgo Biloba, niacin, or ginger root. Be sure to tell your doctor if you are using alternative therapies since they sometimes can impact the effectiveness or safety of conventional medicines.

Surgery- Surgery may be recommended when all other treatments have failed to relieve dizziness. Some surgical procedures are performed on the endolymphatic sac to decompress it. Another possible surgery is to cut the vestibular nerve, although this occurs less frequently.

Surgical procedures

Endolymphatic Sac Procedure

The endolymphatic sac plays a significant role in controlling fluid levels in the inner ear. The surgical procedure may effectively lessen vertigo by reducing the fluid collected within the inner ear. The procedure, endolymphatic sac decompression consists of removing a small fragment of bone from the endolymphatic sac. Sometimes, a tube is placed in the inner ear to drain excess fluid, to help relieve the pressure from the ear canals.

Vestibular Nerve Section

This procedure involves cutting the vestibular nerve in the inner ear, which is responsible for maintaining balance. This medical procedure relieves issues associated with vertigo spells while attempting to preserve hearing ability in the affected ear. The procedure requires administering general anesthesia and an overnight hospitalization of the patient. The theory behind the surgery is to convert an unstable labyrinth into a stable non-functional labyrinth.

Labyrinthectomy

This procedure best suits the patients who have severe hearing loss. The surgeon removes a section from the affected inner ear that governs balance and hearing ability.

Prevention of Meniere’s disease

There are no current guidelines to prevent Meniere disease. However, to help reduce your risk, avoid:

High-salt diets

Excess alcohol

Stress

Smoking

Avoid medications that can be toxic to the ear