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PubMed1996

Tear hyperosmolarity in renal dialysis patients asymptomatic for dry eye.

Renal dialysis patients have hyperosmolar bodily fluids due to high urea levels, and accordingly their tears should be hyperosmolar. Tear hyperosmolarity is a sensitive and specific test for dry eye. The purpose of this study was to determine whether renal dialysis patients have hyperosmolar tears and dry eye. Ten renal dialysis patients completed the McMonnies and Ho dry eye questionnaire and underwent tear osmolarity testing before dialysis. Serum osmolarity was calculated from serum sodium, potassium, and blood urea nitrogen levels. Half of the subjects also participated in tear osmolarity testing after dialysis and underwent an eye examination that included rose bengal and fluorescein staining, Schirmer's testing, and tear break-up time testing. All of the subjects had both hyperosmolar serum and tears, and tear osmolarities were positive for dry eye in all subjects. However, none of the subjects tested positively for dry eye with the questionnaire. The subjects had some physical findings consistent with dry eye, and Schirmer's testing showed decreased tear production. Renal dialysis patients are a population that have hyperosmolar tears yet remain asymptomatic for dry eye. Urea has been used for years as a dermatologic treatment for dry skin. The high levels of urea in the tears of dialysis patients may protect them from developing dry eye. Tear hyperosmolarity due specifically to ionized solutes such as sodium and potassium is probably more pathogenic in causing dry eye than is hyperosmolarity in general. Nevertheless, tear osmolarity testing should not be used as a dry eye monitor in renal failure patients.

Adult↗
PubMed2004

Anti-Ro/SSA and anti-La/SSB autoantibodies in the tear fluid of patients with Sjögren's syndrome.

PURPOSE: To investigate the presence of anti-Ro/SSA and anti-La/SSB antibodies in the tear fluid and serum of patients with Sjögren's syndrome and to evaluate the association of these autoantibodies with the severity of keratoconjunctivitis sicca. METHODS: Tear fluid and serum were obtained from 28 patients with Sjögren's syndrome and 17 age matched normal control subjects. Evaluation of tear fluid and sera anti-Ro/SSA and anti-La/SSB levels was done by using a quantitative enzyme linked immunosorbent assay kit designed for the quantitative measurement of IgG class autoantibodies directed against highly purified SSA and SSB antigens. Tear function and ocular surface were evaluated by Schirmer I test, tear break up time, and rose bengal staining. Dry eye symptom scores were recorded. RESULTS: Increased levels of anti-Ro/SSA and anti-La/SSB antibodies were detected in sera of 57.1% and 50% of SS patients, respectively. Six patients had increased levels of anti-Ro/SSA in the tear fluid, in one case anti-Ro/SSA being detected in tear fluid when it was negative in serum. Ten patients had positive anti-La/SSB titres in tear fluid and in four of these patients, anti-La/SSB titres were not elevated in serum. A positive correlation was observed between serum and tear fluid titres of anti-Ro/SSA (r = 0.43, p = 0.02), but not of anti-La/SSB. Serum anti-Ro/SSA and anti-La/SSB concentrations correlated positively with dry eye symptom scores (r = 0.42, p = 0.02 and r = 0.48, p = 0.01, respectively) and negatively correlated with Schirmer I test scores (r = -0.39, p = 0.04 and r = -0.40, p = 0.03, respectively). Significant correlations were found between tear anti-La/SSB concentrations and dry eye symptom score (r = 0.56, p = 0.02) and also rose bengal staining scores of the ocular surface (r = 0.44, p = 0.02). CONCLUSION: This study shows that autoantibodies against Ro/SSA and La/SSB antigens are present in the tear fluid of some patients with SS and their presence in serum or tear fluid is associated with the severity of keratoconjunctivitis sicca. Additional measurement of tear fluid levels of anti-Ro/SSA and anti-La/SSB may serve as a valuable diagnostic indicator of SS.

Adult↗
PubMed1985

Human tears inhibit the coating of proteins to solid phase surfaces.

The presence of surfactants in human tear samples was studied using methods employed in ELISA technology. Initial experiments whereby diluted tear samples were incubated with special polyacrylate ELISA microcuvettes showed no binding of tear-lactoferrin to the cuvettes whereas a marked binding of purified lactoferrin could be observed. In subsequent experiments it was shown that incubation of purified lactoferrin with increasing amounts of human tears resulted in a dose dependent inhibition of the binding of lactoferrin to the microcuvettes. Partial characterisation of the "coating inhibitory activity" in human tears was investigated by studying the effect of tears or isolated tear fractions on the non-specific binding of a peroxidase conjugated antibody onto the microcuvettes. Preincubation of microcuvettes with tears followed by a wash with phosphate buffered saline resulted in a marked inhibition of the adhesion of the peroxidase conjugate, suggesting that the coating inhibitory activity is caused by a binding of a factor in human tears to the solid phase. The findings reported here resemble earlier observations concerning lacrimal surfactants. The method described in this paper can be performed using a small quantity of human tears or isolated tear proteins and is therefore quite suitable for further biochemical analysis of tear surfactant activity as well as for clinical studies in patients with various tear film disorders.

Animals↗
PubMed1991

Cystatins in human tear fluid.

The activities of cysteine proteinases which include several lysosomal cathepsins are controlled by naturally occurring inhibitory proteins termed cystatins. Cystatins occur both intracellularly and extracellularly in various tissue fluids including tears. Tears were collected by the Schirmer paper strip method from healthy volunteers who had no history or signs of external ocular disease. The tear components were extracted from the filter papers, and used to determine the apparent free cystatin activity and cystatin levels of tears, and for immunoblots. Tears were also collected using capillary tubes for the measurements of cystatins. By titrating papain, a cysteine proteinase, of known specific activity with tear fluid, relatively high levels of apparent free cystatin activity were demonstrated in tears: 28.8 +/- 3.47 (S.E.M.) pmols papain inhibited per mg tear protein (n = 9). The concentrations of cystatins in tear samples were measured by an indirect enzyme-linked immunosorbent assay (ELISA) using antibodies against human salivary cystatin S and purified cystatin S as standard. The ELISAS revealed that tears contain high levels of cystatin-like immunoreactive material, amounting to about 10% of tear proteins. In microgram cystatin S/mg protein the values were: right eye: 94.7 +/- 9.9; left eye: 115.5 +/- 14.8; n = 12. Cystatin levels of tears collected using capillary tubes were comparable: 120.7 +/- 19 micrograms/mg protein (n = 10). Immunoblots of tear fluids revealed a protein of about 14,000 molecular weight which reacted with antihuman cystatin SN monoclonal antibodies. Protein(s) of similar molecular weight were visualized using antibodies against human cystatins S and C. Less abundant additional cystatin-like immuno-reactive proteins were detected by using the two latter antibodies.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1998

HPLC analysis of closed, open, and reflex eye tear proteins.

Changes in the closed, open and reflex eye tear proteins of normal subjects were compared and analysed. Tear proteins were resolved by high-performance liquid chromatography (HPLC) utilising both gel filtration (P-300 SW) and reverse-phase (C-18) columns and the HPLC fractions were further analysed by sodium dodecyl sulphate-polyacrylamide gel electrophoresis (SDS-PAGE) under reducing and non-reducing conditions. The protein composition of the closed-eye tear was significantly different from that of the open and reflex-eye tear. Secretory IgA (sIgA) was the predominant protein in closed eye tears constituting 49% of the total protein compared to 11% in reflex tears, whereas lysozyme was the predominant protein (53%) in reflex tears. Levels of lactoferrin, lipocalin and lysozyme were relatively constant in both open and reflex tears. HPLC profiles of the closed-eye tears, upon continuous stimulation of lacrimal glands indicated that sIgA was significantly reduced whereas lactoferrin, lipocalin, and lysozyme were significantly increased. These results indicate that the tear composition upon waking attains that of the open eye within 4 to 5 minutes, and upon continuous stimulation this reflects the reflex-eye tear composition. It also indicates that mechanisms responsible for changes in concentration of constitutive and regulated tear protein with stimulus can be studied successfully using non-invasive methods to collect human tears.

Adult↗
PubMed2006

Characterisation of human tear proteins using high-resolution mass spectrometry.

INTRODUCTION: The proteins found in tears play an important role in maintaining the ocular surface and changes in tear protein components may reflect changes in the health of the ocular surface. Proteomics provides a comprehensive approach for cataloguing all the proteins of the tear proteome, which will help to elucidate disease pathogenesis, make clinical diagnoses and evaluate the influence of medications on the structure, composition and secretion of tear proteins. In this study, an alternative proteomic strategy was investigated to explore the human tear proteome. MATERIALS AND METHODS: Tear samples were obtained from patients who had pterygium and were collected on the first day and third day after pterygium surgery. Tears pooled from 6 patients were used in the analysis. Reverse-phase high-pressure liquid chromatograph (RPHPLC) was used as the first step to separate intact proteins into 21 peaks. Each fraction was then tryptic-digested and analysed by nanoLC-nano-ESI-MS/MS to characterise the protein components in each fraction. RESULTS: In total, 60 tear proteins were identified with high confidence, including well-known abundant tear proteins, and tear-specific proteins such as lacritin and proline-rich proteins. Among them, proline-rich protein 5 was found for the first time in tear fluid. A large number of plasma proteins were also observed in tear fluid. CONCLUSIONS: The results showed that the proteomic strategy used in this study was successfully applied to analyse tear proteome.

Eye Proteins↗
PubMed1985

Tear analysis in contact lens wearers.

Tear analysis in contact lens wearers was compared with tear analysis in aphakics without contact lens wear and normal phakic patients. Subjects were divided into five groups: group 1, aphakic without contact lens; group 2, phakic with daily-wear hard contact lens; group 3, phakic with daily-wear soft contact lens; group 4, phakic with extended-wear soft contact lens; and group 5, aphakic with extended-wear soft contact lens. The experimental groups were compared with age- and sex-matched control groups for statistical analysis of tear variables by means of the Student's t-test. The variables measured were tear osmolarity, tear albumin, and lysozyme and lactoferrin concentrations in basal and reflex tears. Highly significant elevations of tear osmolarity were found in aphakic subjects without contact lenses. Less significant differences in tear osmolarity were found in phakic subjects with hard daily-wear lenses or with extended-wear soft lenses. Tear albumin, lysozyme, and lactoferrin in basal and reflex tears were not significantly different in the different groups of contact lens wearers or in the group of aphakic subjects without contact lenses compared with their control groups. Individual variations in tear albumin, lysozyme, and lactoferrin appeared to be responsible for the inability to demonstrate significant differences in tear composition in association with the wearing of different types of contact lenses. Older and aphakic patients demonstrated a tendency to have increased concentrations of proteins in the tears compared with younger, phakic contact lens wearers and normal controls without contact lenses.

Adolescent↗
PubMed2001

Surgical repair of chronic rotator cuff tears. A prospective long-term study.

BACKGROUND: Rotator cuff disease or injury is one of the most frequently seen orthopaedic conditions, and surgical repair of rotator cuff tears is a common procedure. A prospective analysis of the operation, with consistent assessment of patient characteristics, variables associated with the rotator cuff tear and repair techniques, and outcome factors, was performed. METHODS: One hundred and five shoulders with a chronic rotator cuff tear underwent open surgical repair and acromioplasty between 1975 and 1983. The patients were followed for an average of 13.4 years (range, two to twenty-two years). There were sixteen small tears, forty medium tears, thirty-eight large tears, and eleven massive tears. The tears were repaired directly (seventy-two tears), by V-Y plasty (twelve), by tendon transposition (twenty), or by reinforcement with a fascia lata graft (one). The long head of the biceps had been previously torn in eleven shoulders and was tenodesed in three other shoulders. In fifty-six shoulders, the distal part of the clavicle was excised for treatment of degenerative arthritic changes, often associated with osteophyte formation. RESULTS: Satisfactory pain relief was obtained in ninety-six shoulders (p < 0.0001). There was significant improvement in active abduction (p < 0.001) and external rotation (p < 0.007) as well as in strength in these directions of movement (p < 0.03 and p < 0.002, respectively). At the latest follow-up evaluation, the result was rated as excellent for sixty-eight shoulders, satisfactory for sixteen, and unsatisfactory for twenty-one. Tear size was the most important determinant of outcome with regard to active motion, strength, rating of the result, patient satisfaction, and need for a reoperation. Older age, less preoperative active motion, preoperative weakness, distal clavicular excision, and a transposition repair technique were all associated with larger tear size. There were eight reoperations; five were for rerepair of a persistent or recurrent rotator cuff tear. CONCLUSIONS: Standard tendon repair techniques combined with anterior acromioplasty, postoperative limb protection, and monitored physiotherapy can produce consistent and lasting pain relief and improvement in range of motion. Improving the results of this procedure will depend upon the development of new techniques to address the active motion and strength deficiencies following repair of massive rotator cuff tears.

Acromion↗
PubMed2006

Tibialis anterior tendon and extensor retinaculum: imaging in cadavers and patients with tendon tear.

OBJECTIVE: Under the hypothesis that the anatomic relationship of the tibialis anterior tendon and extensor retinaculum of the foot and ankle is relevant to the clinical aspects of a tear in that tendon, we assessed the anatomic details of these structures using MRI in cadavers and evaluated MRI in patients with a tibialis anterior tendon tear. MATERIALS AND METHODS: Seven cadaveric feet underwent detailed MRI using standard and oblique coronal planes with respect to the course of the tibialis anterior tendon and extensor retinaculum. Cadaveric sections subsequently provided an anatomic correlation. MR images of seven patients with tibialis anterior tendon tear were analyzed by consensus of two musculoskeletal radiologists. RESULTS: Imaging-anatomic correlations allowed identification of the tibialis anterior tendon and extensor retinaculum. The tendon passed through three tunnels formed by the superior extensor retinaculum, oblique superomedial, and oblique inferomedial limbs of the inferior extensor retinaculum. Of seven patients with the tendon tear, three patients had complete tears and four patients had partial tears. In all partial tears, the level of the tear was at the ankle joint, corresponding to the approximate level of the oblique superomedial limb. In all complete tears, the proximal ends of torn tendons were retracted to a level below the oblique superomedial limb. In all tears, the oblique superomedial limb surrounding the torn tendon was seen with thickening in four patients and enhancement after IV gadolinium injection in two patients. Other findings included a bulbous appearance or swelling of the torn tendon in two complete and two partial tears and fluid collections within the tendon sheath and in an area confined by the extensor retinaculum in four patients. CONCLUSION: The relationship of the tibialis anterior tendon and extensor retinaculum is well depicted on MRI, even in patients with a tibialis anterior tendon tear, and is clinically relevant to the tear of this tendon.

Adult↗
PubMed2007

Peripheral tear of the triangular fibrocartilage: depiction with MR arthrography of the distal radioulnar joint.

OBJECTIVE: Although central tears of the triangular fibrocartilage are easily seen on imaging, peripheral tears of the ulnar attachment are frequently missed. The aim of this study was to evaluate the accuracy of MR arthrography of the distal radioulnar joint in depiction of peripheral tears of the triangular fibrocartilage. MATERIALS AND METHODS: Forty-one patients (18 women, 23 men; mean age, 38 years; age range, 18-60 years) underwent MR arthrography and wrist arthroscopy. For MR arthrography, iopamidol (300 mg I/mL) and gadopentetate dimeglumine (4 mmol/L) were injected into the distal radioulnar joint. Consensus review of both MR arthrograms and conventional arthrograms was performed by two experienced musculoskeletal radiologists. Presence or absence of communicating and noncommunicating tears of the ulnar attachment of the triangular fibrocartilage was recorded. Arthroscopy was used as the standard of reference for determining sensitivity, specificity, and accuracy in detection of tears of the ulnar attachment. RESULTS: At MR arthrography, communicating tear of the ulnar attachment was diagnosed in three patients, noncommunicating tear in 19 patients, and normal attachment in 19 patients. Arthroscopy revealed peripheral tear of the triangular fibrocartilage in all three patients with communicating tear, in 14 of 19 patients with noncommunicating tear, and in three of 19 patients with normal attachment. The sensitivity was 85% (17/20), specificity was 76% (16/21), and accuracy was 80% (33/41). CONCLUSION: MR arthrography of the distal radioulnar joint is accurate in depiction of peripheral tears of the ulnar attachment of the triangular fibrocartilage. These tears often appear as noncommunicating tears extending from the distal radioulnar joint into the triangular fibrocartilage.

Adolescent↗
PubMed2002

Partial and complete tear of the anterior cruciate ligament.

PURPOSE: To analyze MR direct and indirect signs for knees with anterior cruciate ligament (ACL) partial or complete tear. MATERIAL AND METHODS: According to documented MR direct and indirect signs for ACL tear, we retrospectively reviewed the incidence of those signs in 15 partial ACL tear and 17 complete ACL tear patients. The findings were also compared with duration of injury (less or more than 6 weeks, as acute or chronic stages). RESULTS: A residual straight and tight ACL fiber in at least one pulse sequence was more frequently detected in partial ACL tears. The empty notch sign, a wavy contour of ACL, bone contusion at lateral compartment and lateral meniscus posterior horn tear were significantly more frequently seen in complete tear cases. The posterior cruciate ligament angle in chronic complete ACL tear cases (109 degrees +/-20 degrees ) had a tendency to be less than in chronic partial ACL tear cases (119+/-18 degrees ). CONCLUSION: The empty notch sign, a wavy ACL, bone contusion, and posterior horn of lateral meniscus tears are suggestive of a complete ACL tear. A residual straight and tight ACL fiber seen in at least one image section is a helpful sign to diagnosis of partial ACL tear. In the acute ACL injury stage, a focal increase of the ACL signal intensity is more suggestive of a partial ACL tear.

Adult↗
PubMed2003

A prospective multipractice investigation of patients with full-thickness rotator cuff tears: the importance of comorbidities, practice, and other covariables on self-assessed shoulder function and health status.

BACKGROUND: Rotator cuff tears are among the most common conditions of the shoulder. One of the major difficulties in studying patients with rotator cuff tears is that the clinical expression of these tears varies widely and different practices may have substantially different patient populations. The goals of the present prospective multipractice study were to use patient self-assessment questionnaires (1) to identify some of the characteristics of patients with rotator cuff tears, other than the size of the cuff tear, that are correlated with shoulder function, and (2) to determine whether there are significant differences in these characteristics among patients from the practices of different surgeons. METHODS: Ten surgeons enrolled a total of 333 patients with a full-thickness tear of the supraspinatus tendon into this prospective study. Each patient completed self-assessment questionnaires that included items regarding demographic characteristics, prior treatment, medical and social comorbidities, general health status, and shoulder function. RESULTS: As expected, patients who had an infraspinatus tendon tear as well as a supraspinatus tendon tear had significantly worse ability to use the arm overhead compared with those who had a supraspinatus tear alone (p < 0.005). However, shoulder function and health status were correlated with patient characteristics other than the size of the rotator cuff tear. The number of shoulder functions that were performable was correlated with the subscales of the Short Form-36 and was inversely associated with medical and social comorbidities. The patients from the ten different surgeon practices showed significant differences in almost every parameter, including age, gender, method of tear documentation, tear size, prior treatment, medical and social comorbidities, general health status, and shoulder function. CONCLUSIONS: Clinical studies on the natural history of rotator cuff tears and the effectiveness of treatment must control for a wide range of variables, many of which do not pertain directly to the shoulder. Patients from the practices of different surgeons cannot be assumed to be similar with respect to these variables. Patient self-assessment questionnaires appear to offer a practical method of uniform assessment across different practices.

Age Factors↗
PubMed2000

Variability of tear protein levels in normal young adults: between-day variation.

BACKGROUND: An adequate knowledge of physiological variation is important for valid comparative studies of tear proteins. The aim of this study was to investigate the between-day variation of the human tear protein levels, including the total protein concentration (TPC) and the levels of major protein fractions. Two sampling methods, the yawn and the eye-flush methods, were used and compared. METHODS: TPC was determined by the Bradford method. The major protein fractions were separated by sodium dodecyl sulfate-polyacrylamide gel electrophoresis (SDS-PAGE) and their levels were determined by scanning densitometry after SDS-PAGE. The tear protein levels were monitored for 3 days. RESULTS: The between-day differences in the levels of TPC and the individual protein fractions were not statistically significant in either sampling method, but the variations of some proteins were large and would be clinically significant. Different variations were observed in different proteins. The variations in serum albumin were large, up to 61% and 113% in the yawn and eye-flush methods respectively. The variations in lactoferrin, tear-specific prealbumin and lysozyme were relatively small in the yawn method. The variations in protein levels obtained by the eye-flush method were generally higher than by the yawn method. CONCLUSION: Although the between-day differences in tear protein levels were not statistically significant, the variations in some proteins would be large in magnitude. The variability of tear protein levels obtained by the eye-flush method was larger than that by the yawn method. Therefore, caution should be taken if the eye-flush method is used for sampling tears for quantitative analysis of tear proteins, although it is easier to collect tear samples using this method. The results will be useful to exclude normal variation in tear protein levels when comparing pre- and post-therapeutic tear protein levels in eyes treated for tear-related abnormalities.

Adult↗
PubMed1984

The identification of transferrin, an iron-binding protein in rabbit tears.

The iron-binding protein activity in rabbit tears was analysed using immunochemical techniques. Ouchterlony analysis showed that rabbit tears contain the iron-binding protein transferrin and that tear transferrin has complete antigenic identity with serum and milk transferrin. Immunoelectrophoresis showed that tear transferrin had the same electrophoretic mobility as serum transferrin. SDS-PAGE analysis of rabbit tears in the presence of purified milk transferrin was used to identify the tear transferrin band. The amount of transferrin in rabbit tears, quantified by an ELISA technique, ranged from 80 to 464 micrograms ml-1 with a mean of 285 micrograms ml-1. The origin of transferrin in rabbit tears is not yet clear. Immunofluorescence studies showed the presence of transferrin in cells lining the lacrimal ducts. The results presented here show that rabbit tears are markedly different from human tears. Rabbit tears contain transferrin and probably lack lactoferrin, whereas human tears contain large amounts of lactoferrin and hardly any detectable transferrin.

Animals↗
PubMed2004

Sequential changes of lipid tear film after the instillation of a single drop of a new emulsion eye drop in dry eye patients.

PURPOSE: The lipid tear film stabilizes the tears by lowering the surface tension and preventing aqueous tear evaporation and may be analyzed by kinetic analysis of the tear interference images. This study investigated changes in the lipid film after application of a new emulsion-based eye drop of Refresh Endura (Allergan, Irvine, CA) in normal subjects and patients with dry eyes. DESIGN: Comparative, nonrandomized interventional study. PARTICIPANTS: Five normal subjects and 10 aqueous tear deficiency (ATD) patients with or without lipid tear deficiency were enrolled prospectively. METHODS: A complete eye examination was performed, including symptom score, tear break-up time, dye staining, and fluorescein clearance test. One eye received a single dose of emulsion eye drop (EED), whereas the other eye received nonpreserved saline as a control. Kinetic analysis of tear interference images taken by DR-1 (Kowa, Japan) was performed before and at various times after instillation of the drops. MAIN OUTCOME MEASURES: Symptoms, pattern, thickness, and spread time of the tear film. RESULTS: Compared with the control, all eyes receiving EED showed rapid restructuring of the preexisting lipid film. In normal persons, restructuring resulted in a thick lipid band across the cornea and a significant increase of the lipid film thickness. For ATD patients, EED application resulted in either a scant, irregular tear film, which became covered by the lipid film, or a modified lipid film changed without forming a band or irregularities. Emulsion eye drops tended to be more comfortable in patients with more severe ATD. Kinetic analysis showed that the mean spread time improved for all patients after EED when compared with baseline or with controls (P<0.05). CONCLUSIONS: Emulsion eye drop produces significant changes in the tear film of normal and dry eye patients. Further investigation with a prolonged period of treatment is warranted to establish whether EED may help improve the spread and thickness of the lipid tear film in moderate and severe dry eyes.

Adult↗
PubMed1997

Inflammatory cytokines in the tears of patients with ocular rosacea.

OBJECTIVE: The purpose of the study is to compare tear fluid concentrations of interleukin-1alpha (IL-1alpha), tumor necrosis factor-alpha (TNF-alpha), and epidermal growth factor (EGF) in ocular rosacea with those in control subjects and to examine the relation between tear functions, such as production and clearance rate, and the concentrations of cytokines in tear fluid. PARTICIPANTS AND INTERVENTION: Fourteen patients with severe meibomian gland disease, facial rosacea, and symptoms of ocular irritation were examined for ocular surface disease, tear production, and tear clearance rate (TCR). Twelve control subjects, frequency-matched for age, and 15 ideal normal subjects with no ocular symptoms and normal tear function were assessed using the same parameters. Minimally stimulated tear samples (20 microl) were drawn from each subject and analyzed using a sandwich enzyme-linked immunosorbent assay to detect IL-1alpha, TNF-alpha, and EGF. RESULTS: Tear IL-1alpha concentration was significantly higher in patients with rosacea than in age-matched (P = 0.003) and ideal control subjects (P < 0.001). Tumor necrosis factor-alpha was not detected in patients or control subjects, indicating levels of less than 10 pg/ml. Epidermal growth factor was not significantly higher in patients with rosacea than in age-matched control subjects. Tear turnover LN(TCR) was lower in patients with rosacea than in both age-matched (P = 0.048) and ideal control subjects (P = 0.002). Schirmer I scores were statistically lower in patients with rosacea than in ideal control subjects (P = 0.013), but not age-matched control subjects. Interleukin-1alpha was correlated inversely with LN(TCR) (r= -0.58, P < 0.0001) and Schirmer I (r = -0.39, P = 0.012). CONCLUSIONS: Concentrations of IL-1alpha are present in normal tears but are elevated in ocular rosacea, whereas TNF-alpha is not present in either case. The reduced tear turnover, LN(TCR), its inverse correlation with IL-1alpha, and the absence of TNF-alpha in the tears of these patients suggest that the increased concentration of IL-1alpha observed may be largely because of clearance failure of cytokine normally produced at the ocular surface.

Adult↗
PubMed2003

Group IIA phospholipase A(2) content in tears of patients having photorefractive keratectomy.

PURPOSE: To study the effect of photorefractive keratectomy (PRK) on the concentration of group IIA phospholipase A(2) (GIIAPLA(2)) in tears. SETTING: Departments of Ophthalmology and Pathology, University of Turku, Turku, and Helsinki University Eye Hospital, Helsinki, Finland. METHODS: Tear samples were collected from 25 eyes of 23 patients (mean age 32.3 years +/- 8.6 [SD]) preoperatively and 2 and 7 days after PRK. The GIIAPLA(2) concentration in the tears was measured by time-resolved fluoroimmunoassay. RESULTS: The GIIAPLA(2) concentration was significantly lower and the tear fluid flow rate significantly higher 2 days after PRK than preoperatively. At 7 days, the GIIAPLA(2) concentration and the tear fluid flow-corrected excretion of GIIAPLA(2) were significantly higher than preoperatively and at 2 days. The tear flow rate was also significantly higher than preoperatively. CONCLUSIONS: The GIIAPLA(2) content in tears decreased 2 days after PRK due to dilution of the GIIAPLA(2) content during hypersecretion of reflex tears. Photorefractive keratectomy caused an increase in the tear flow rate, GIIAPLA(2) concentration, and tear fluid flow-corrected excretion of GIIAPLA(2) in tears 7 days after surgery, enhancing the protection of tears against bacterial infections.

Adult↗
PubMed1999

Clinical application of a homogeneous colorimetric assay for tear lysozyme.

PURPOSE: Tear lysozyme and tear lactoferrin are enzymes synthesized by the lacrimal gland. Their concentration in human tears reflects tear gland function. Tear gland dysfunction can lead to ocular surface disease. We developed a colorimetric lysozyme assay. The objective of this study was to determine the diagnostic power and the clinical application of this assay that allows rapid and precise quantification of tear lysozyme. METHODS: Tear specimens of 120 eyes (30 Sjögren's patients and 30 controls) were collected using standardized filter paper discs. Tear lysozyme concentration was determined using p-nitrophenyl penta-N-acetyl-beta-chitopentaoside as substrate in the colorimetric assay. The results were compared to clinical findings and to two commonly used tests, the Micrococcus agar diffusion assay for tear lysozyme and the tear lactoferrin immunodiffusion assay. RESULTS: The colorimetric assay showed a good dose-response relationship. The use of the assay as a method of diagnosing aqueous tear deficiency, using the clinical findings and the medical history as gold standard, demonstrated 85% sensitivity and 92% specificity. The results of the colorimetric assay when compared with the Micrococcus agar diffusion assay showed a linear relationship of r=0.77; when compared with the lactoferrin immunoassay r=0.73. CONCLUSIONS: The colorimetric assay is simple to perform and does not require sophisticated laboratory equipment and personnel. Results can be precisely quantified within one hour after tear collection. The diagnostic power of the test is comparable to previously reported assays for lysozyme and lactoferrin and will be useful in the diagnosis of ocular surface disease.

Adolescent↗