Giant papillary conjunctivitis.
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Conjunctivitis↗
Biomedical subjects
M R Allansmith
Publications and source records attributed to M R Allansmith.
Ocular anaphylaxis: induction by local injection of antigen.
A model of local ocular anaphylaxis has been developed in the rat. Erythema, oedema, and enhanced retention of radioiodinated rat serum albumin ([125I]-RSA) were noted in ocular adnexal tissues of immunized rats within 5 min of injection of antigen; these changes reached a maximum 15 min after antigen injection. Erythema, oedema, and retention of [125I]-RSA subsided to baseline levels 1--6 hr after challenge. A significant increase in weight of ocular adnexal tissues was seen within 15 min after challenge. The weight increase reached a maximum at 45 min and persisted through 6 hr. Weight approached baseline values by 24 hr. Although antigen was injected into the ocular adnexa and not directly into the globe, the globes of the antigen-injected eyes of immunized rats underwent anaphylaxis, possibly because of absorption of antigen through the sclera. In addition, the adnexa and globes of the contralateral eyes, which did not receive antigen, also underwent anaphylactic changes. These changes were not as marked as those observed in the antigen-injected tissues, but followed the same time-course of development. We conclude that anaphylaxis can be locally induced in ocular tissues, that the onset of anaphylaxis is within minutes, and the effects last for at least 24 hr.
Anaphylaxis↗
Evolution of soft contact lens coatings.
To investigate further the reported possibility that surface deposits on soft contact lenses contribute to giant papillary conjunctivitis, we performed scanning electron microscopy on 22 lenses worn for varying durations by a group including persons who had never worn contact lenses and asymptomatic persons who had, and on five never-worn lenses. Thirty minutes' wear resulted in covering of about 50% of the anterior surface with scattered cell-membrane-like and mucus-like material, with mucus-like material on top of cells in places. Eight hours' wear produced about 90% covering with more complex coatings. Routinely worn and cleaned lenses had still more complex coatings on more than 90% of the surface. Deposits were found on routinely worn lenses even after professional cleaning. We conclude that all worn soft contact lenses have coatings that become more complex with time and may never be removed completely.
Cell Membrane↗
Effects of ocular decongestants.
Eight widely used commercially available ocular decongestants were compared on the basis of vasoconstrictive effectiveness. The ability of these preparations to counteract histamine-induced erythema and to block its recurrence when rechallenged after one hour was evaluated in six human subjects in seven sessions. All vasoconstrictors tested were effective. No preparation was statistically different from 0.02% naphazoline hydrochloride in vasoconstrictive effect. In fact, this intermediate concentration of naphazoline (0.02%) was found to be significantly better that the other nonprescription decongestant preparations tested as a group and not significantly different from a group of higher concentrations of naphazoline.
Antipyrine↗
The surface of the continuously worn contact lens.
The anterior surfaces of continuously worn therapeutic contact lenses and routinely cleaned cosmetic lenses were compared by scanning electron microscopy. The continuously worn lenses were uniformly and completely coated with material thicker and smoother that that on the incompletely coated cosmetic lenses. It is concluded that continuously worn lenses build up coatings steadily, whereas routinely cleaned lenses have at least part of the coating removed with each cleaning.
Conjunctivitis↗
Branching of microvilli in the human conjunctival epithelium.
Biopsy specimens were obtained from the upper tarsal and limbal conjunctivae of ten normal persons and from the upper tarsal conjunctivae of five asymptomatic contact lens wearers and five patients with giant papillary conjunctivitis (GPC) associated with contact lens wear. The microvillar surface of the conjunctival epithelium was studied by transmission and scanning electron microscopy. Branches often stemmed from the side of a straight tubular microvillus and formed an acute angle with the main process. Branches sprouted at various distances from the origin of the microvillus. The most common branching pattern was the bifurcated (bifid) form. Occasionally, both primary and secondary bifurcations were primary and secondary bifurcations were observed on the same microvillus. Some microvilli were branched in the normal conjunctivae, but the conjunctivae of asymptomatic contact lens wearers and patients with GPC had more branched microvilli and greater polymorphism, which correlated with the degree of alteration. This report demonstrates the presence of branched microvilli and describes the types seen in normal conjunctivae and compares the frequency with which branched microvilli are seen in altered conjunctival surfaces.
Cell Membrane↗
Mucus secretory vesicles in conjunctival epithelial cells of wearers of contact lenses.
Biopsy specimens from the upper tarsal conjunctivae of ten patients with clinically evident contact-lens-associated giant papillary conjunctivitis (GPC) and eight asymptomatic contact lens wearers without clinically evident conjunctival changes were compared by light and transmission electron microscopy to determine the contribution of nongoblet epithelial cells to increased mucus. A control group consisted of five subjects who had never worn contact lenses. The apical cytoplasm of superficial nongoblet epithelial cells in specimens from all groups showed single-membrane-limited vesicular inclusions that stained metachromatically with toluidine blue and were positive with PAS staining, which indicated muco-protein content. Some vesicles appeared to discharge their contents into the conjunctival sac. More vesicles were found in the GPC subjects and the asymptomatic contact lens wearers than in the normal subjects. These observations, coupled with the sign of increased or excessive mucus discharge in GPC subjects and in asymptomatic lens wearers, support the premise that the superficial layers of non-goblet conjunctival epithelial cells can contribute to an increase in mucus production.
Adult↗
Secretory component in human ocular tissues.
Lacrimal tissue and accessory lacrimal tissue from seven autopsy cases, lacrimal tissue from three patients undergoing orbital exploration, and biopsy specimens from conjunctiva of 14 subjects were examined for the presence and distribution of secretory component by three anti-secretory-component antisera. Secretory component was present in all lacrimal and accessory lacrimal tissues but in no other ocular tissues. Over 60% of acinar cells stained for secretory component; about 5% of acinar cells stained brightly; about 30% of tubular cells stained brightly. Main and accessory lacrimal tissues appeared identical in their staining patterns. We concluded that the main sites of synthesis of secretory IgA in human ocular tissues are the lacrimal and accessory lacrimal tissues.
Adult↗
Histologic and immunohistologic comparison of main and accessory lacrimal tissue.
Main and accessory lacrimal tissues from autopsy and biopsy specimens were compared histologically and immunohistologically. Formaldehyde-fixed, paraffin-embedded specimens were studied by light microscopy with hematoxylinand-eosin and PAS staining. Glutaraldehyde-fixed, Epon-embedded specimens were sectioned at 1 micron, stained with alkaline Giemsa, and studied by light microscopy. Specimens fixed in a solution of alcohol and acetic acid were stained by immunofluorescence techniques for lactoferrin, lysozyme, secretory component, and the immunoglobulins IgG, IgA, IgM, IgD, and IgE. The main and the accessory lacrimal tissues were identical histologically and had identical distributions of secretory products and immunoglobulin-containing plasma cells. The finding of myoepithelial cells in 1-micron sections of accessory lacrimal tissue indicates autonomic innervation in that tissue. This finding, in conjunction with the identical immunohistology, indicates a common source for unstimulated and stimulated tears.
Aged↗
Effects of topically applied occular decongestant and antihistamine.
In two independent studies including 25 subjects each, naphazoline caused significant whitening (but did not prevent itching) in the histamine-induced red, itchy eye. Antazoline inhibited itching (but not redness) to a significant degree in the same model. The combination of naphazoline and antazoline produced significant whitening and inhibition of itching in all eyes challenged by histamine. The combination of the two drugs was more effective than either component alone in preventing redness. The antihistamine and combination of antihistamine/vasoconstrictor were equally effective in arresting itching.
Antazoline↗
Prevalence of conjunctival changes in wearers of hard contact lenses.
The prevalence of elevated papillae more than 0.3 mm in diameter was 10.5% in the conjunctivae of 200 subjects who had successfully worn polymethylmethacrylate hard contact lenses for eight hours or more daily for more than five years. Only three of 500 (0.6%) control subjects who had never worn contact lenses had these papillary changes. The prevalence of papillary changes for those with the so-called normal symptoms of mucus, itching, or both associated with wearing of hard contact lenses was 53% (16 of 21 subjects). The prevalence of these symptoms was 76% among subjects with polymethylmethacrylate contact lenses who had papillary changes and 8% among subjects with polymethylmethacrylate contact lenses who did not have papillary changes. We conclude that changes in the upper tarsal conjunctiva are associated with the wearing of hard contact lenses, occur in a significant percentage of patients wearing hard contact lenses for prolonged periods, and include a spectrum of papillary changes.
Conjunctival Diseases↗
Lactoferrin in human ocular tissues.
The main lacrimal gland and accessory lacrimal tissue from seven autopsy cases, lacrimal biopsy specimens from three patients, and conjunctival biopsy specimens from ten patients were examined for lactoferrin by an immunohistologic technique. Lactoferrin was identified and localized to acinar epithelial cells of both main and accessory lacrimal tissue. Lactoferrin was not found in conjunctival tissue except within conjunctival neutrophils. Other possible sources of human tear lactoferrin were considered, but we concluded from our data that the primary source of lactoferrin in normal human tears is the acinar epithelium of the main and accessory lacrimal glands.
Adult↗
Technical aspects of histamine determination in human tears.
We evaluated various technical aspects of tear collection to assess their influence on the measurement of tear histamine levels. We included several methods of collecting tears, storage of tears with and without freezing, storage for three vs ten days, and removal vs nonremoval of cells before freezing. We assayed tear samples in various groups of people with inflamed eyes. None of the various means of collecting or storing the tear samples influenced the histamine measured. The measuring technique is a stable one that requires minimal treatment of samples before assay. To date, we have found that only patients with vernal conjunctivitis have elevated tear histamine levels. Any increase of tear histamine over 10 ng/ml (geometric mean plus 2 S.D.) or any significant decrease is probably related to the disease itself and not to factors related to the technique used to measure tear histamine.
Biochemistry↗
Tear histamine levels in vernal conjunctivitis and other ocular inflammations.
Histamine levels were measured in tears from normal volunteers (geometric mean, 5 ng/ml), patients with vernal conjunctivitis (16 ng/ml), and patients with a wide variety of external ocular inflammatory disease (3 ng/ml). Histamine levels were significantly higher in patients with vernal conjunctivitis than in normal subjects (P < 0.01) or patients with other types of ocular inflammation (P < 0.001). We postulate that histamine is an important mediator in the expression of the inflammatory response in vernal conjunctivitis, and that its elevation may be caused by abnormalities in the number of mast cells, the stability of the mast cells or in the system that regulates histamine.
Conjunctivitis↗
Participation of ocular tissues in systemic anaphylaxis.
The participation of ocular tissues was examined in two models of systemic anaphylaxis in the rat. Increased retention of radiolabeled rat serum albumin, which accompanies anaphylaxis, was the parameter measured. The production of IgE antibodies to egg albumin or worm antigen was stimulated by immunization with minute amounts of egg albumin and alum or by infection with Nippostrongylus brasiliensis. Intravenous administration of egg albumin or worm extract produced clinical signs of systemic anaphylaxis in the correspondingly immunized rats. Systemic anaphylaxis was accompanied by increased retention of radiolabeled rat serum albumin in the small intestine in both groups of rats. Significantly increased retention occurred in rat lid-conjunctivaorbital tissues of both groups and in globe tissues of the rats immunized with egg albumin. We concluded that the ocular tissues participated in systemic anaphylaxis.
Albumins↗
Degranulation of ocular mast cells in rats undergoing systemic anaphylaxis.
The percentage of degranulated ocular mast cells in five egg albumin--immunized, systemically challenged rats was compared with that in five egg albumin--immunized, saline-challenged controls. For the lid and orbit, at least 100 mast cells per rat were evaluated. For the conjunctiva, tarsus, limbus, and episclera-sclera, at least 20 were evaluated. For the ciliary body and choroid, all mast cells in 15 sections separated by at least 15 micrometer were examined. The morphology of degranulated and intact mast cells was the same in the experimental and control animals, except for the change in granules. There were significantly more degranulated mast cells in most of the ocular tissues of rats undergoing systemic anaphylaxis than in tissues of controls rats; the increase in degranulated cells was especially striking in the choroid. We concluded that degranulation of mast cells is a measure of anaphylaxis, provided that the number of degranulated mast cells, and not simply the presence of such cells, is considered and compared with appropriate controls.
Anaphylaxis↗
Russell bodies in contact-lens-associated giant papillary conjunctivitis.
Biopsy specimens of the upper tarsal conjunctiva in soft contact lens-associated giant papillary conjunctivitis were taken during (1) chronic exacerbation, (2) brief remission, and (3) intentional exacerbation. Inflammatory cells were quantitated and compared with inflammatory cells in normal upper tarsal conjunctivae. Specimens were evaluated by light and electron microscopy. The most remarkable feature was the presence of diamond-shaped Russell bodies in 20% of the plasma cells of the second biopsy specimen. A few round Russell bodies were seen in the first biopsy specimen and none in the third. We concluded that the brief quiescent phase (second biopsy specimen) was characterized by retention of immunoglobulin to produce Russell bodies, and that the active phases of the disease were marked by migration of mast cells into the epithelium and by the presence of eosinophils and basophils in the substantia propria.
Basophils↗
Attachment of bacteria to soft contact lenses.
A total of 25 soft contact lenses from 17 asymptomatic contact lens wearers and eight patients with contact lens-associated giant papillary conjunctivitis were examined by scanning electron microscopy. Structures that resembled bacteria were present on the anterior surface of seven lenses. All lenses showed a coating of granular mucus-like deposits. Some bacteria were seen scattered randomly over the surface, with no apparent attachment to the lens, whereas others were attached to the coated surface by thin, flagella-like foot processes, the distal ends of which were unattached. These attached bacteria were cylindrical in shape. Several bacteria showed a constriction centrally. Some bacteria were covered by the surface coating, while others, which were round to ovoid in shape, appeared partially embedded in the coating itself. Aggregations of bacteria were seen around clumps of mucus-like debris.
Bacteria↗