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PubMed2001

Short term oral cefixime therapy for treatment of bacterial conjunctivitis.

BACKGROUND: There have been few controlled studies evaluating treatment of bacterial conjunctivitis beyond the newborn period. Topical therapy of bacterial conjunctivitis achieves a clinical cure but does not prevent acute otitis media (AOM). OBJECTIVES: The aim of this study was to compare systemic antibiotic therapy (cefixime) with topical therapy with polymyxin-bacitracin for treatment of acute bacterial conjunctivitis with regard to clinical and bacteriologic cure and prevention of AOM. METHODS: This study was a randomized, double blind, placebo-controlled trial of polymyxin-bacitracin ointment and oral placebo vs. topical placebo and oral cefixime in children with presumed acute bacterial conjunctivitis. Topical therapy was administered for 7 days; oral therapy was administered for 3 days. Bacterial cultures were obtained at entry and on Day 3 of treatment. Children were examined on Days 3 and 10 or if they worsened within 15 days of entry. RESULTS: Eighty children were enrolled in the study. Bacterial cultures of the conjunctiva were positive in 70% of children: Haemophilus influenzae (53.7%); Streptococcus pneumoniae (13.8%); H. influenzae and S. pneumoniae (1.2%); and Moraxella catarrhalis (1.3%). There were 7 (17.5%) bacteriologic failures among children receiving topical antibiotic and oral placebo and 15 (37.5%) bacteriologic failures among children receiving topical placebo and oral cefixime (P = 0.07 with Yates correction). There was no difference between study groups with regard to either clinical cure or the development of AOM. Nine children (11%), 5 who received active topical therapy and 4 who received active oral drug, developed AOM either during or within 15 days of study entry. CONCLUSION: Cefixime was not more effective than topical polymyxin-bacitracin in either the eradication of conjunctival colonization with respiratory pathogens or the prevention of AOM in children with acute bacterial conjunctivitis.

Acute Disease↗
PubMedDate not supplied

Acquired ptosis secondary to vernal conjunctivitis in young adults.

PURPOSE: To establish a relation between prolonged severe vernal conjunctivitis and upper eyelid ptosis. METHODS: The study consisted of 12 patients between the ages of 19 and 32 years with acquired ptosis who presented in our clinic between September 2001 and February 2005. Potential factors responsible for acquired ptosis were investigated in all patients, with specific attention to the history and severity of vernal conjunctivitis. RESULTS: We found vernal conjunctivitis to be the identifiable cause in 8 men and 4 women with acquired ptosis. There was neither contact lens usage nor trauma or ocular surgery history in their medical records. The blepharoptosis was caused by levator disinsertion and recession of the aponeurosis. The pathology improved in each case after reattachment of the aponeurosis to the superior tarsal border. CONCLUSIONS: These findings suggest that prolonged severe vernal conjunctivitis may induce a lower position of the upper eyelid and eventually lead to ptosis through levator disinsertion that is similar to involutional ptosis. We believe that chronic inflammation of the upper eyelid with giant papillary conjunctivitis and persistent rubbing of the eyelids may be responsible for the development of this pathology.

Adult↗
PubMed1996

Occupational conjunctivitis associated with type IV allergy to methacrylates.

On rare occasions, exposure to methacrylates (MAs) may induce mucosal symptoms. Three patients, two dental laboratory workers and one hearing aid laboratory worker, are presented. All three had allergic contact dermatitis from MAs which disappeared after avoidance of contact with uncured MA compounds. Two of the patients, the dental laboratory assistant and the hearing aid worker, had also developed symptoms of conjunctivitis. Both were exposed to chemically curable and light-curable MAs. The association between their conjunctivitis and type IV allergy to MAs was supported by the following observations: 1) sensitization to several MAs including methylMA, 2-hydroxyethylMA, ethyleneglycol diMA, triethyleneglycoldiMA, tetrahydrofurfuryldiMA, and 1,4-butanedioldiMA, as well as to pentaerythritol triacrylate; 2) simultaneous appearance of their eye symptoms and allergic contact dermatitis; 3) high exposure to MAs because of disturbances of ventilation; 4) disappearance of the eye symptoms during holidays; and 5) opthalmologist's findings of follicular conjunctivitis with some papillae, eosinophilia, and lymphocytosis in conjunctival scrapings corresponding to allergic contact conjunctivitis. In addition, the activation of eosinophils in the conjunctival scrapings was demonstrated with the monoclonal antibody technique, and an elevated level of eosinophilic cationic protein was found in the tear fluid. Our cases suggest that conjunctivitis may be caused by type IV allergy to MAs, although type I allergy (even though prick tests were negative), other hypersensitivity mechanisms, or irritation cannot be excluded. 4H-Gloves seem to give adequate hand protection even to allergic patients. More attention should be paid to ventilation systems if MA exposure occurs. In some cases, patients with eye symptoms need to be patch tested.

Conjunctivitis, Allergic↗
PubMed2006

Diabetes and risk of acute infectious conjunctivitis--a population-based case-control study.

AIMS: To examine whether diabetes mellitus is associated with an increased risk of acute infectious conjunctivitis (AIC) in adults, as measured by treatment with topical ocular antibiotics. METHODS: A population-based, case-control study in North Jutland County, Denmark. Incident cases of AIC were defined as persons aged more than 15 years redeeming a first-time prescription for a topical ocular antibiotic during 1999 in the County Prescription Database. Five gender- and age-matched population control subjects per case were selected using a unique personal identifier, the Civil Registry Number. Diabetes prior to the ocular antibiotic prescription was determined by record-linkage with the Prescription Database and Hospital Discharge Registry in the county. Odds ratios (ORs) for acute infectious conjunctivitis among diabetic individuals and control subjects were estimated, adjusting for a range of potential risk factors. RESULTS: Among 16 193 adults treated with topical ocular antibiotics, 3.1% had diabetes as compared with 2.5% of the control subjects. The overall adjusted OR for acute infectious conjunctivitis in patients with diabetes was 1.24 [95% confidence interval (CI): 1.13-1.38]. Risk estimates of acute infectious conjunctivitis in individuals with diabetes were consistently increased for both women and men, for all age groups, and for different types of ocular antibiotics prescribed. CONCLUSIONS: This study suggests that diabetes is a risk factor for acute infectious conjunctivitis.

Acute Disease↗
PubMed1990

Identification of a conjunctivitis-associated gene locus from the virulence plasmid of Yersinia enterocolitica.

The virulence plasmid (pYV) of Yersinia enterocolitica is necessary for production of conjunctivitis in guinea pigs and for mouse lethality. To identify the genes responsible for production of conjunctivitis in guinea pigs, we subcloned the BamHI and SalI restriction fragments of the virulence plasmid of Y. enterocolitica A2635 (serotype O:8) into derivatives of the broad-host-range plasmid pRK290 and introduced the constructions into plasmid-negative Y. enterocolitica strains. A mild, transient conjunctivitis was evident 24 h after inoculation with strains containing a 2.8-kilobase (kb) BamHI fragment of pYV. These strains were cytotoxic to HEp-2 cells but did not cause death in iron-loaded adult mice. When the 2.8- and adjacent 0.5-kb BamHI fragments were deleted from the virulence plasmid of a fully virulent Y. enterocolitica isolate, the resultant strain did not cause conjunctivitis in guinea pigs and was not cytotoxic to HEp-2 cells. However, the strain with the deletion appeared to be more virulent for mice, with more rapid dissemination after orogastric inoculation, compared with that of the parent strain. When the deletion was complemented by introduction of a plasmid containing the 2.8-kb BamHI fragment, the strain again caused conjunctivitis but had decreased virulence for mice.

Animals↗
PubMed1997

Treatment of chlamydial conjunctivitis.

Adult inclusion conjunctivitis and neonatal inclusion conjunctivitis are important infectious diseases commonly encountered by ophthalmologists in industrialized countries. Patients with inclusion conjunctivitis are frequently complicated by genitourinary and epipharyngeal chlamydial infections. Thus, treatment of chlamydial conjunctivitis must include systemic antibiotics and not be limited to topical application of antibiotics to the eye. Effective anti-chlamydial agents include tetracyclines, macrolides, and some of the fluoroquinolones. Prolonged and frequent application of ophthalmic agents is vital for successful treatment of conjunctivitis.

Anti-Bacterial Agents↗
PubMed1999

Conjunctivitis caused by a swine Chlamydia trachomatis-like organism in gnotobiotic pigs.

The objective of this study was to determine whether a chlamydial strain recovered from growing and finishing swine with conjunctivitis or keratoconjunctivitis could cause the same infections in gnotobiotic pigs. The strain shares biological characteristics with Chlamydia trachomatis. After propagation in Vero cells and preparation of the inoculum (10(7) inclusion-forming units/ml), chlamydial strain H7 was instilled into the ventral conjunctival sac (0.15 ml/sac) of 12 anesthetized 3-day-old gnotobiotic piglets. Four age-matched gnotobiotic piglets were anesthetized and sham infected with uninfected cell culture lysates. None of the principal piglets developed clinical symptoms of conjunctivitis or keratoconjunctivitis. Principal piglets necropsied 7 days postinfection (DPI) had histologic lesions of mild or moderate conjunctivitis; immunohistochemical evaluation revealed chlamydial antigen in conjunctival epithelium. A majority of principal piglets necropsied at 14-28 DPI had histologic lesions of mild conjunctivitis, but chlamydial antigen was not detected by immunohistochemistry. The results indicated that chlamydial strain H7 can cause mild or occasionally moderate conjunctivitis in gnotobiotic pigs, but the conjunctival infection is asymptomatic.

Animals↗
PubMed2000

Experimental allergic conjunctivitis in guinea pigs induced by Japanese cedar pollen.

We report a new experimental allergic conjunctivitis with Japanese cedar pollen as antigen in guinea pigs, and the immunological characteristics of this model were also elucidated. Allergic conjunctivitis was developed by immunization in guinea pigs with a mixture containing Japanese cedar pollen and killed Bordetella pertussis. When local application of Japanese cedar pollen suspension 14 d after systemic immunization was performed every 3d, remarkable conjunctivitis was observed from 20 to 35 d. Increase in vascular permeability and decrease in histamine contents of the conjunctiva were also observed after local application of antigen. Passive cutaneous anaphylactic (PCA) reactions revealed that both IgG- and IgE-rich antibodies were produced in this model. Chlorpheniramine, ketotifen and levocabastine were effective in inhibiting cedar pollen-induced conjunctivitis. Although a high concentration was needed, tranilast and amlexanox also showed significant inhibition of conjunctivitis induced by cedar pollen.

Animals↗
PubMed2004

Apafant, a potent platelet-activating factor antagonist, blocks eosinophil activation and is effective in the chronic phase of experimental allergic conjunctivitis in guinea pigs.

Platelet-activating factor (PAF) plays important roles in allergic reactions. In particular, there are many concerns about PAF, eosinophils, and the chronicity of allergic diseases. The purpose of the present studies is to elucidate the role of PAF in eosinophil activation at conjunctiva and to confirm the efficacy of Apafant (a potent PAF antagonist) ophthalmic solution in chronic experimental allergic conjunctivitis. Guinea pigs were actively immunized and allergic conjunctivitis was induced by repetitive instillation of 2.5% ovalbumin. PAF solution was topically applied and eosinophil activation was assessed by measuring the eosinophil peroxidase (EPO) activity in the tear fluid. Itch-scratching episodes and clinical symptoms scores were evaluated in the repetitive challenge conjunctivitis. From the instillation of PAF solution into guinea pig eyes, which were in a state of chronic allergic conjunctivitis, a significant increase in EPO activity was observed, and this increase was inhibited by pre-treatment with Apafant. In the repetitive challenge model, the animals treated with Apafant ophthalmic solution showed a significant reduction of clinical symptoms and the itch-scratch response in both the first and the second challenges. PAF has an activity, that induces mediator release from eosinophils in the conjunctival tissues and may be involved in the chronic phase of allergic conjunctivitis.

Administration, Topical↗
PubMed1996

[Effect of fenitrothion on experimental allergic conjunctivitis].

The effect of fenitrothion on experimental allergic conjunctivitis was studied using guinea pigs. Guinea pigs were passively sensitized with anti-sera against ovalbumin (OVA) or Japanese cedar pollen. Eight days after the sensitization, 6 x 10(-5) mg/kg to 6 mg/kg of fenitrothion were administered subcutaneously. Two days after the injection, OVA or Japanese cedar pollen was given in the conjunctival sac and the allergic conjunctivitis was examined. OVA or Japanese cedar pollen induced the allergic conjunctivitis, depending on the challenge dosage (OVA). However, no adverse effect of fenitrothion was observed on allergic conjunctivitis challenged with OVA or Japanese cedar pollen. An anti-allergic agent, ketotifen, suppressed the allergic intensity. These results indicate that fenitrothion has no adverse effect on the experimental allergic conjunctivitis.

Animals↗
PubMed1994

Respiratory syncytial virus and allergic conjunctivitis.

The pathogenesis of allergic conjunctivitis is largely conjectural. We investigated the possible involvement of respiratory syncytial virus (RSV), a ubiquitous respiratory pathogen, in the development of allergic conjunctivitis through immune mechanisms. Brush cytology technique was used to obtain conjunctival cells from 30 patients with allergic conjunctivitis and 20 controls. Samples were assayed for the presence of RSV sequences with the reverse transcription polymerase chain reaction (RT-PCR) and the nested polymerase chain reaction (nested PCR). In order to further investigate the relation of RSV and allergic conjunctivitis, we performed an animal study. BALB/c mice were either infected with live RSV or sham infected intranasally. The mice were exposed to ovalbumin (OVA) with alum adjuvant. At differing intervals, levels of OVA concentration in serum and IgG-anti-OVA antibody were measured by ELISA and IgE-anti OVA antibody in serum was assessed by passive cutaneous anaphylaxis. RSV sequences were detected in 7 (23%) of 30 patient samples and 1 (5%) of 20 control samples. IgG and IgE antibody responses to OVA in serum were demonstrable only in RSV-infected mice immunized with OVA and alum. Our results proved that PCR could detect RSV sequences in conjunctival samples. RSV may be a significant pathogenic factor in allergic conjunctivitis.

Acute Disease↗
PubMed1998

Risk factors associated with mycoplasmal conjunctivitis in house finches.

Observations from a citizen-based survey were used to identify potential risk factors associated with mycoplasmal conjunctivitis (Mycoplasma gallisepticum) in eastern house finches (Carpodacus mexicanus). Between November 1994 and October 1996, 778 volunteers provided 7,224 monthly observations at residential bird feeding sites across an eight state region in the eastern USA. Information collected by questionnaires included health status of house finches and four sympatric passerine species, types and number of bird feeders maintained, neighborhood housing locale and altitude of the observation site. Bivariate analyses revealed that house finches were 14 to 72 times as likely to be observed with conjunctivitis than the sympatric species studied. Year of the study, season, and the presence of platform, hopper, and tube type feeders were significantly associated with conjunctivitis in house finches. Multivariate analysis using a logistic regression model suggests that increased risk of conjunctivitis in house finches was associated with the second year of the study (the third year of the outbreak), the cooler non-breeding periods from September through March, and the presence of tube style feeders. In addition, the presence of raised platform type feeders may have been protective against conjunctivitis in house finches. Prevention of spread of this disease may include modifying bird feeding activities based on season and type of feeder.

Animals↗
PubMed1976

A coxsackievirus type A24 epidemic conjunctivitis in Brunei.

The paper reports on a coxsackievirus type A24 epidemic of acute conjunctivitis in Brunei. The role of the Singapore Epidemic Conjunctivitis 1970 (coxsackievirus type A24) virus in the new disease syndrome variously known as the "Epidemic Haemorrhagic Conjunctivitis", "Picornavirus Epidemic Conjunctivitis" and "Acute Haemorrhagic Conjunctivitis" is again established.

Brunei↗
PubMedDate not supplied

Treatment of acute bacterial conjunctivitis with topical lomefloxacin 0.3% compared to topical ofloxacin 0.3%.

PURPOSE: The main purpose of this prospective study was to compare the efficacy, local tolerance, and safety of topical lomefloxacin 0.3% and topical ofloxacin 0.3% in the treatment of acute bacterial conjunctivitis. PATIENTS AND METHODS: Forty patients with acute bacterial conjunctivitis were included in a randomized, prospective, parallel-group study. Twenty patients were assigned to the lomefloxacin group (Okacin, CIBA Vision Ophthalmics) and 20 patients to ofloxacin (Oflox, Allergan). Lomefloxacin 0.3% was given 1 drop every 2 hours during waking hours on the first day then twice daily for one week. Ofloxacin 0.3% eyedrops were given four times daily. All patients underwent eye examination and clinical findings were graded and recorded according to severity of lid hyperemia, lid edema, lid crusting, conjunctival edema and discharge, bulbar conjunctival hyperemia, palpebral conjunctival hyperemia, corneal edema, and ocular discomfort. The score for each clinical sign was recorded before and after treatment. The mean cumulative sum score (CSS) was obtained by adding the scores for signs and symptoms. All conjunctival swabs were cultured and tested for sensitivity. Patients with confirmed bacterial conjunctivitis were included. RESULTS: There were 10 male and 10 female patients in each group. The age range was from 1 to 78 years, and the mean age was 35 years in the lomefloxacin group. In the ofloxacin group the age range was from 1 to 70 years, and the mean age was 26 years. There was no significant difference between the two groups in relation to age or sex. The causative organisms were Staphylococcus epidermidis in 16 cases (36%), alpha-hemolytic Streptococci in 9 (20%), Haemophilus spp. 6 (13%), Staphylococcus aureus 5 (11%), Streptococcus pneumoniae 4 (9%), Pseudomonas aeruginosa 3 (7%), and other 2 (4%). The mean CSS for conjunctivitis was 12.1 before therapy in the lomefloxacin group and 12.7 in the ofloxacin group. On the 7th day of therapy, the mean CSS was 0.7 in the lomefloxacin group, and 1.6 for ofloxacin. All patients showed improvement, but a total of 18 out of 20 (88%) in the lomefloxacin group showed complete resolution compared to 15 (75%) in the ofloxacin group. The difference was not statistically significant (p = 0.08). Tolerance was excellent in both groups, and no side effects were reported. A burning sensation was noted by two patients, one in each group. CONCLUSIONS: Lomefloxacin and ofloxacin were equally effective and safe in the treatment of acute bacterial conjunctivitis.

Administration, Topical↗
PubMed2000

[Prevalence of the Chlamydia trachomatis in neonatal conjunctivitis determination by indirect fluorescence and gene amplification].

BACKGROUND: Chlamydia trachomatis is one of the most common identifiable infectious agents in neonatal conjunctivitis. It also causes pneumonitis, that is preceded by conjunctivitis in one third of cases. AIM: To asses the prevalence of Chlamydia trachomatis in newborns with conjunctivitis. PATIENTS AND METHODS: In 162 newborns, coming from 14 Primary Health Centers from Santiago de Chile, C. trachomatis was detected by indirect fluorescence and two polymerase chain reaction (PCR 1 and 2), which amplified different sequences from the common endogenous plasmid. Those patients with positive indirect fluorescence and PCR 2 were defined as infected: RESULTS: The prevalence of C. trachomatis was 8%, and the distribution of the positive cases was similar in the different Health Centers. Other isolates were: S. aureus (9.8%), S. pneumoniae (8%), S. viridans (6.2%) y H. influenzae (5.5%). CONCLUSIONS: The prevalence of C. trachomatis in neonatal conjunctivitis in Chile is similar to that of developed countries. Therefore, C. trachomatis should be considered in the election of antimicrobials for the treatment of neonatal conjunctivitis, to avoid ocular and respiratory complications.

Chile↗
PubMed2001

Topical antibiotics for acute bacterial conjunctivitis: a systematic review.

There has been uncertainty about whether antibiotic therapy confers significant benefit in the treatment of acute bacterial conjunctivitis. This study aimed to assess the efficacy of antibiotic therapy in the management of acute bacterial conjunctivitis. Using standard Cochrane search methods, we identified double-blind randomised controlled trials in which any form of antibiotic treatment (topical, systemic or combination) had been compared with placebo in the management of acute bacterial conjunctivitis. Data extraction and analysis followed a pre-defined protocol. Meta-analysis was performed to obtain summary measures of relative risk. Six published trials were identified, of which three fulfilled the eligibility criteria for inclusion in this review. The trials were heterogeneous in terms of their inclusion and exclusion criteria, the nature of the intervention, and the outcome measures assessed. Meta-analysis indicates that acute bacterial conjunctivitis is frequently a self-limiting condition, as clinical remission occurred by days 2 to 5 in 64% (95% confidence interval (CI) = 57-71) of those treated with placebo. Treatment with antibiotics was, however, associated with significantly better rates of clinical remission (days 2 to 5: relative risk (RR) = 1.31, 95% CI = 1.11-1.55), with a suggestion that this benefit was maintained for late clinical remission (days 6 to 10: RR = 1.27, 95% CI = 1.00-1.61). Acute bacterial conjunctivitis is frequently a self-limiting condition but the use of antibiotics is associated with significantly improved rates of early clinical remission, and early and late microbiological remission. Since trials to date have been conducted in selected specialist care patient populations, generalisation of these results to a primary care-based population should be undertaken with a degree of caution.

Acute Disease↗
PubMed2001

Homozygous and compound-heterozygous type I plasminogen deficiency is a common cause of ligneous conjunctivitis.

Severe type I plasminogen deficiency has been recently linked to ligneous conjunctivitis, a rare and uncommon form of chronic conjunctivitis. In this study, eight unrelated ligneous conjunctivitis patients living in different parts of the world were examined. All affected subjects from which plasma was available displayed absent or markedly reduced plasminogen antigen and plasminogen functional activity. Molecular genetic studies of seven patients identified a Lys19-->Glu mutation in two boys in a homozygous state, and in two girls in a compound-heterozygous state in which the second plasminogen gene carried a missense (Arg134-->Lys) and a nonsense mutation (Cys133--> Stop), respectively. A fifth patient was shown to be homozygous for a frameshift mutation in plasminogen exon 14 (Gly565ins-G). In two unrelated subjects with ligneous conjunctivitis no mutations in the plasminogen gene were identified. Our results suggest that the Lys19-->Glu mutation is the most prevalent mutation in the plasminogen gene of patients with ligneous conjunctivitis.

Adolescent↗
PubMed2001

[Conjunctival provocation test with Dermatophagoides pteronyssinus in the diagnosis of allergic conjunctivitis from house mites].

INTRODUCTION: Perennial conjunctivitis due to house dust mites is the most frequent form of allergic conjunctivitis in urban environments. However, its diagnosis remains difficult for ophthalmologists. In this study, we evaluated a conjunctival provocation test (CPT) using standardized extracts of Dermatophagoides pteronyssinus (Dpt) and compared it to the diagnostic methods commonly performed in allergology: prick tests with dust and house dust mites and specific and IgE assay. MATERIALS AND METHODS: We performed a CPT on 60 volunteer patients, between the ages of 8 and 64 years, corresponding to 30 patients sensitized to house dust mites with the presence of specific IgE and chronic conjunctivitis, 21 patients not sensitized to house dust mites but presenting features of chronic conjunctivitis, and 9 asymptomatic patients. A house dust mite desensitizing treatment was not an exclusion criterion for a number of allergic patients. CPTs were prepared from Dpt allergenic extracts (Laboratoires Stallergènes, Antony, France) with 5 progressive concentrations by dilution in a nonphenolic physiological solution: 1.2 RI, 3.7 RI, 11 RI, 33 RI, and 100 RI. CPTs were performed in only one eye and asymmetry of the ocular response was evaluated by the cumulative clinical score of Abelson Chambers and Smith. The correlation between the 2 diagnostic tests was established by calculating the Cohen correlation coefficient or kappa. We also evaluated the sensitivity and diagnostic specificity for each test. RESULTS: The statistical correlation between specific IgE and the other allergological tests in for allergic conjunctivitis to house dust mites was 0.93 for the CPT, 0.46 for the prick test to Dpt, and 0.33 for the prick test to dust. The diagnostic sensitivities and specificities for each test were 90% and 100% for the CPT, 60% and 70% for the prick test to dust, 70% and 76% for prick test to Dpt, respectively. Beyond an antigenic cut-off value of 11 RI, we also observed greater hypersensitivity reactions for patients with lacrimal IgE or elevated specific IgE levels. CONCLUSION: The results obtained with the CPT confirm its high antigenic quality. It is a particularly useful, rapid, and perfectly safe clinical test. It is the only test able to establish a relationship between ocular manifestations and specific I(8)E.

Adolescent↗