We are the combination of four hospitals: the General Hospital, the Children’s Hospital, the Women’s Hospital and the Traumatology, Rehabilitation and Burns Hospital. We are part of the Vall d’Hebron Barcelona Hospital Campus: a world-leading health park where healthcare plays a crucial role.
Patients are the centre and the core of our system. We are professionals committed to quality care and our organizational structure breaks down the traditional boundaries between departments and professional groups, with an exclusive model of knowledge areas.
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This is an inflammation or infection of the conjunctiva, the transparent membrane that covers the eyelid and the white part of the eyeball. When small blood vessels of the conjunctiva become inflamed, they become more visible, so this layer turns red. The most common cause is a viral or bacterial infection, a reaction to an allergen or an irritant. This is a very common condition in the general population.
The following three types of conjunctivitis may be found:
It can affect any person of any age.
Diagnosis of conjunctivitis is clinical, by means of good medical history and an examination by the primary care doctor and/or, on specific occasions, by the ophthalmologist.
The most common test is a biomicroscopic examination with a slit lamp. On certain occasions a sample of conjunctival exudate can be collected for a culture, especially if the suspicion is of a bacterial conjunctivitis.
For viral conjunctivitis, being a viral infection, the main treatment is waiting, as the body itself is able to combat the infection. Hydrating eye drops can be used frequently to soothe the discomfort, in addition to washing with saline solution if there is an accumulation of secretions, or even sometimes additional anti-inflammatory drops according to the clinical picture.
Bacterial conjunctivitis is usually treated with topical antibiotics, except on certain occasions that may require systemic antibiotic treatment. Hydrating eye drops can also be used to soothe the discomfort in addition to washing with saline solution if there is an accumulation of secretions.
In the case of an allergic conjunctivitis, anti-histamines can normally be used to reduce itching and inflammation, although hydrating drops and washing with cold saline solution can also be useful for soothing symptoms.
As for conjunctivitis due to irritants, hydrating eye drops and washing with saline solution are usually enough, although depending on the origin of the irritation, it can sometimes require an anti-inflammatory or other types of drops.
In the case of viral and bacterial conjunctivitis, prevention could be carried out by means of good hygiene (washing your hands, not touching your eyes if you live with an affected person, changing the pillows and not sharing towels).
In the case of allergic conjunctivitis, prevention is possible, avoiding contact with the allergen if known.
And for conjunctivitis due to irritants, prevention could be done through eye protection (protective glasses), especially in work environments where there may be a risk of contact with chemical substances or risk of foreign bodies entering the eye.
Ophthalmology, General Hospital
Sjögren's Syndrome is a chronic, systemic autoimmune disease, the cause of which is unknown. Its main symptoms are a dry mouth (xerostomia) and dry eyes (xerophthalmia). In this disease, the cells making up our defence system (immune system) attack parts of the body itself, such as the glands that keep the eyes and mouth moist, and glands in other parts of the body, altering their function. Symptoms in other organs, such as the lungs, joints or nervous system, may also occur.
Patients with Sjögren's Syndrome often have other conditions related to anomalous functioning of the immune system, such as systemic lupus erythematosus, scleroderma and rheumatoid arthritis.
Patients with Sjögren's Syndrome mainly have symptoms related to a lack of tear and saliva production, which causes dryness in the mouth and eyes. The main symptoms suffered by patients are a burning, gritty sensation in the eyes, red eyes, blurred vision, the need to drink water frequently, difficulty swallowing dry food and a higher propensity for tooth decay and mouth infections. This dryness may also affect the skin and vaginal area, which causes painful sexual relationships. Other symptoms that Sjögren's Syndrome patients may show are joint or muscle pain and fatigue. Less frequently, other organs, such as the lungs, kidney and nerve endings, may be affected.
Above all, the disease affects women aged between 40 and 60. It is calculated that the incidence is between 0.5% and 3% of the population.
There is no single test enabling diagnosis of Sjögren's Syndrome. Diagnosing Sjögren's Syndrome in a patient referred with dry eyes and mouth is based on tests that confirm the existence of a deficit in tear and saliva production and that prove that the dryness is associated with an imbalance in the immune system.
Treatment of Sjögren's Syndrome is essentially based on measures that alleviate the feeling of dryness shown by the patient. The treatment includes the use of artificial tears, eye gels, eye drops, nebulisers and tablets to stimulate saliva production. Particular patients may be given treatment to stimulate glandular secretion. In serious cases, where there are symptoms in organs other than the glands (lungs and peripheral nerves, etc) it may be necessary to administer medication that acts to decrease immune system activity (immunosuppressant drugs).
Patients with Sjögren's Syndrome must undergo a series of eye tests, blood and urine tests and, on certain occasions, it is necessary to do a small biopsy of lip mucous to confirm the existence of inflammation in the glands producing saliva.
Sindrome-Sjogren
Sociedad Española de Medicina Interna
American College of Rheumatology: Síndrome de Sjögren
Spondyloarthritis is the name of a group of diseases whose common element is inflammation of the axial skeleton (especially the spine), although it can also affect the peripheral joints (hands, feet, knees, etc.). The following diseases are included in this group: axial spondyloarthritis (or ankylosing spondylitis, in its more advanced stage), psoriatic arthritis, arthritis related to inflammatory intestinal disease, reactive arthritis, and a subgroup of juvenile idiopathic arthritis.
The most common symptom is pain in the lower back or buttocks (inflammatory lumbar pain). This pain is characterised by worsening with rest and improving with exercise. It is associated with prolonged morning stiffness, can wake patients up in the night, and it improves with anti-inflammatory medications. It can also affect the peripheral joints; this is most common in psoriatic arthritis, which can manifest as pain and inflammation in the knuckles, wrists, feet, and other joints.
Spondyloarthritis also affects what we call the enthesis, where a tendon inserts into a bone. The most commonly affected entheses are the Achilles tendon and the epicondyles (elbows), although any tendon insertion can be affected.
Finally, these diseases also present with manifestations outside the joints, and these may be the only visible presentation of the illness. These include inflammation of the eye (uveitis), inflammatory intestinal disease (ulcerative colitis or Crohn's disease), or inflammation of the skin (psoriasis). In fact, 30% of patients with psoriasis have psoriatic arthritis and the skin lesions tend to predict the joint disease.
Spondyloarthritis can affect anyone, although it usually presents between adolescence and 50 years of age. Axial spondyloarthritis usually manifests before the age of 40, while psoriatic arthritis can start later (between 30 and 50 years of age). These affect women and men equally, even though axial spondyloarthritis is slightly more prevalent in men.
It is quite common for people who have one of these illnesses to have family members with the same disease or another spondyloarthritic condition. That is why it was decided these be grouped together, thinking that they share a common aetiology. Thus, genetics is the main cause of these diseases, with several genes identified; the most prominent is HLA-B27, which can be detected in the laboratory, making diagnosis easier. Other causes, like infectious aetiologies, have been investigated, since in many cases the disease is preceded by an infection that acts as a trigger.
The diagnosis of the disease is done in a comprehensive way, considering the symptoms the patient complains of, the physical examination, the analytical results, and the imaging (X-ray, ultrasound, MRI) results. It's important to consider that there is no one analysis or other test that can diagnose these diseases by itself; it will always require a specialist in rheumatology to perform a medical evaluation of the situation as a whole.
Since the symptoms they present can be confused with very common conditions (lower back pain) and there is no specific test that can diagnose them unequivocally, it's common for a diagnosis to take up to 10 years. It is routine for patients to visit multiple professionals and specialists (traumatologists, physical therapists, osteopaths, primary care physicians, etc.) before receiving a diagnosis.
One of the treatment pillars for spondyloarthritis is exercise and physical therapy that targets the joints. The main pharmacological options are anti-inflammatory agents, and in case these do not control the illness, the so-called disease modifying drugs (DMDs) will then be used. Within the DMDs, we use conventional DMDs, like methotrexate and sulfasalazine, and more recently we have begun using biological and synthetic DMDs, which represent an important advance in the treatment of these diseases.
Unfortunately, there is no particular action we know of that can prevent the appearance of spondyloarthritis.Nevertheless, tobacco use is one of the most important factors involved in these diseases and their progression, so avoiding tobacco is recommended. In the case of psoriatic arthritis, the fact that the skin disease often precedes the joint disease offers us a window of opportunity to identify it early and avoid its progression. Biomarkers to be able to identify it before it appears are being researched.
Minority diseases, also called rare diseases, are those that affect between 5% and 7% of the population. They are very varied, affecting different parts of the body with a wide range of symptoms that change both between diseases and within the same disease. It is estimated that some 30 million people in the EU, 3 million in Spain, and around 350,000 in Catalonia suffer from one.
The complexity of most rare diseases requires multidisciplinary care with professionals from different medical specialities, case management for nursing, psychological support and also social work.
The Vall d'Hebron Barcelona Hospital Campus is home to more than 100 specialist professionals dedicated to the care of more than 2,000 rare diseases. Apart from treating the most rare diseases of any centre in Spain, it is one of the leading hospitals in Europe in this field. In fact, Vall d'Hebron is part of 20 European reference networks, known as ERN. This makes this hospital a highly specialised centre for rare diseases, from birth to adulthood, through a networked system that allows sharing of resources and knowledge with other world-class hospitals.
Adult and child
Pediatric
This concentration of patients with rare diseases at Vall d'Hebron improves knowledge and promotes research. Research in this field focuses above all on improving diagnostic capacity for diseases that are often difficult to diagnose and on developing new treatments for those diseases. In the case of diseases with few patients, publicly funded research is often the main avenue for the discovery of new drugs, and public health is the framework that provides the public with access to high medication complexity.
For more information, contact the Rare Disease Team at the following email address: minoritaries@vallhebron.cat
Patients have very serious damage to the ocular surface (the cornea, conjunctiva and eyelids) generally caused by chemical burns or an inflammatory disease of the ocular surface such as cicatricial pemphigoid or Lyell’s syndrome.
These disorders of the ocular surface may result in very low visual acuity, irritation and pain. They are conditions significantly affecting the cornea, the conjunctiva and the eyelids; organs essential to maintaining a healthy ocular surface and therefore good vision.
Loss of vision, pain, severe dry eye syndrome, corneal damage and ulcers, infections, and even loss of the eyeball.
Diagnosis is essentially clinical. Changes in the ocular surface may present as corneal ulcers, corneal vascularization or conjunctivalization (normally the cornea tissue has no blood vessels) or due to symblepharon, which are scars that form between the conjunctiva and the eyelids.
Treatments are multiple and spread out, depending on how severely the ocular surface is affected. Natural tear substitutes are used, such as autologous serum or plasma rich in platelets. Surgical options that may be carried out are amniotic membrane grafts, corneal transplants, limbal stem cell transplant (autologous or heterogeneous), eyelid transplant, and in very severe cases, keratoprosthesis.
There is no way to prevent this serious condition of the ocular surface, but early diagnosis and treatment can limit the damage it causes.
There are multiple reasons why a cornea might be damaged. When this happens, a cornea transplant is performed which involves changing that part of the affected eye for another healthy one from a donor.
The main pathologies that can lead to a cornea transplant are: keratocon, scars and ulcers, corneal dystrophies (especially Fuchs’ dystrophy) and decompensation from previous surgeries and treatments.
The main symptoms that are detected when a cornea is damaged are:
Clinical diagnosis is essential, but there are also different tests to see if a corneal transplant should be carried out, and in particular, what kind is required. The tests are:
The type of transplant varies depending on the affected part of the cornea.
Oculoplastic and orbital surgery is a sub-specialism that treats the pathology related to the eye attachments, with four main fields of interest: orbital pathology, tear duct anomalies, anophthalmic cavity pathology and eyelid disorders.
The main characteristic of this field is its multi-disciplinary nature, due to the diversity of systemic diseases that may be involved. It is also an area that touches on other specialisms, including maxillofacial surgery, ear, nose and throat, plastic surgery and neurosurgery.
Treatment in this field often involves inter-relation with other medical specialisms, including endocrinology, internal medicine, radiology and oncology. We also provide medical and surgical care for oculoplastic pathology at the Children’s and Women’s Hospital.
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