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PubMed2006

Persistent conjunctivitis associated with drinking arsenic-contaminated water.

PURPOSE: The aim of this study was to report on 2 cases of bilateral chronic conjunctivitis that were associated with the drinking of arsenic-contaminated underground water for a long time. DESIGN: Interventional case reports comprised the study. METHODS: This study was a review of clinical data and laboratory investigations. RESULTS: Papillary conjunctivitis developed in 2 members of a family who has been drinking underground water for 15 years. There were severe dermatological changes, including hyperkeratosis, on palms and soles, hypo- and hyperpigmented lesions (rain-drop) on the abdomen, chest, and back. Arsenic levels estimated in the nails and hair of both patients were very high. The arsenic level of the drinking water was above the permissible limit. Histopathological examination of conjunctival tissue confirmed the inflammatory response of a papillary type; however, an arsenic estimation in conjunctival tissue was not possible. There were no inclusions of bodies in conjunctival smears stained with hematoxylin and eosin (H&E) stain. There was no response to the usual treatment for papillary conjunctivitis, which only subsided, along with a regression of dermatological changes, when patients were treated with the chelating agent, dimercaprol, and multivitamin preparations, as well as no longer drinking the contaminated water. CONCLUSIONS: This is a rare association and, to the best of our knowledge, the first report of successful treatment with dimercarpol. The source of arsenic was contaminated underground drinking water (from a deep tube-well). The pathophysiology is thought to be the result of an inflammatory response caused by accumulated arsenic in local tissues. Papillary conjunctivitis and dermatological changes can be successfully managed with dimercaprol and multivitamins. Further studies are required to find out the possible link between the papillary response of conjunctiva and arsenic accumulation within the body.

Adolescent↗
PubMed1979

Pseudogonococcal ophthalmia neonatorum. Branhamella (Neisseria) catarrhalis conjunctivitis.

A culture from conjunctivitis occurring in a neonate in association with a recurrent fever yielded a nearly pure growth of Branhamella (Neisseria) catarrhalis. The conjunctivitis was not appreciated and effectively treated until a second hospitalization in the fourth week of life. Partial suppression of symptoms had followed short-term parenteral antibiotic therapy during the first admission. Resolution quickly occurred in response to instillation of sodium sulfacetamide ophthalmic solution. Although B. catarrhalis is considered a non-pathogen, the literature reviewed included a number of diverse infections, but no previous instance of conjunctivitis. The organism's close similarities to Neisseria gonorrhoeae necessitate isolation and correct biochemical differentiation. Misdiagnosis of gonococcal conjunctivitis carries obvious social, psychological and medical impact.

Conjunctivitis↗
PubMed1986

Acute hemorrhagic conjunctivitis epidemic in Colon, Republic of Panama.

Acute hemorrhagic conjunctivitis has caused numerous outbreaks throughout Africa and Asia since it was first recognized in 1969 but did not involve the New World until 1981. This unprecedented outbreak reached Colon, Panama during August 1981 and by October 8,401 cases had been reported (14% of Colon's population). In October the Gorgas Memorial Laboratory and Ministry of Health conducted a survey in Colon to collect descriptive data on household living units, epidemiologic and clinical data from residents, and venous blood from all residents one year or older. The survey sampled 127 households and interviewed 608 people (1% of Colon's homes and 1% of the population). Overall 336 (55%) study subjects recalled having conjunctivitis. Disease rates differed according to residence; poor sectors of the city had 67% attack rates, lower class 52%, middle class 34%, and upper class 13%. Within each sector adults were more likely than children to be index cases, and communal bathrooms and household crowding were the most important risk factors for acute hemorrhagic conjunctivitis. Between 4-20% of people denying acute conjunctivitis had antibody to enterovirus 70 and may represent asymptomatic cases.

Adolescent↗
PubMed1988

Outbreak of acute hemorrhagic conjunctivitis due to coxsackie A24 variant--Taiwan.

Outbreaks of acute hemorrhagic conjunctivitis caused by enterovirus 70 and several serotypes of adenovirus have occurred in Taiwan since 1971. In 1980-1981, there was a pandemic of acute hemorrhagic conjunctivitis in southeast Asia caused by coxsackie A24 variant (CA24v); however, this virus did not affect Taiwan. In October 1985, CA24v was isolated for the first time from patients with acute hemorrhagic conjunctivitis in southern Taiwan. The following summer, a large epidemic of acute hemorrhagic conjunctivitis due to CA24v occurred. An epidemiologic investigation of patients seen at one ophthalmology clinic in Taipei City revealed that school-age children were the most likely group to introduce illness into households (p less than 0.001) and that males were more often household index cases than were females (p less than 0.01). Multiple case households tended to be more crowded (3.0 vs. 2.5 persons per bathroom; p less than 0.05) and had illness introduced by younger family members (median age of index case = 10 vs. 17 years; p less than 0.01). It is unknown whether this outbreak is an isolated occurrence or represents another resurgence of CA24v in the area.

Adolescent↗
PubMed2001

Bilateral conjunctival mucosa-associated lymphoid tissue lymphoma misdiagnosed as allergic conjunctivitis.

PURPOSE: This report aimed to discuss two nearly identical cases of primary conjunctival mucosa-associated lymphoid tissue (MALT) lymphoma mimicking allergic conjunctivitis. METHODS: Two patients were referred for intractability to conventional treatment of initial diagnoses of allergic conjunctivitis. On ocular examination, normally pigmented, giant papilla-like lesions were found bilaterally in the upper conjunctiva. Excisional biopsies were performed. RESULTS: Histopathologic and immunohistochemical examination of the conjunctival biopsies indicated MALT lymphoma in both patients. The patients subsequently received radiation therapy and achieved complete remission with no evidence of recurrence during follow-up periods of 13 and 11 months. CONCLUSION: Conjunctival low-grade lymphoma may share similar clinical features with allergic conjunctivitis. Ophthalmologists should be concerned that primary conjunctival low-grade malignant lymphoma can be misdiagnosed as allergic conjunctivitis

Adult↗
PubMed1996

Tear tryptase levels and allergic conjunctivitis.

We measured tryptase, a neutral protease stored in the secretory granules of mast cells, by solid-phase radioimmunoassay in tears of 12 subjects with vernal keratoconjunctivitis (VKC) during remission phases, nine subjects with seasonal or perennial allergic conjunctivitis, and eight healthy controls. Mean values of tear tryptase levels were significantly (P < 0.02) increased in VKC patients (14.5 +/- 13 micrograms/l) when compared to those measured in patients with seasonal or perennial allergic conjunctivitis (0.6 +/- 0.1 microgram/l) and in controls (3.3 +/- 3.2 micrograms/l). In subjects with allergic conjunctivitis, the levels of tryptase, almost undetectable before allergen conjunctival challenge, showed a significant increase in the challenged eye 20 min-but not 6 h-after provocation in 5/9 cases. Our results indicate that VKC a severe ocular disease characterized by an increased number and abnormal distribution of mast cells in the conjunctiva, also shows elevated levels of tryptase in tears even during remission phases. Evidence of mast-cell activation, as revealed by a significant increase of tryptase levels in tears, in documented during the early-phase reaction, but not during the late-phase reaction, of allergic conjunctivitis patients challenged topically by specific allergen.

Adolescent↗
PubMed1999

A current appreciation of sites for pharmacological intervention in allergic conjunctivitis: effects of new topical ocular drugs.

Two important realizations about pathophysiological mechanisms involved in allergic conjunctivitis have led to novel drug discovery efforts and new topical ocular medications for prevention and treatment of this prevent allergic disease. The first of these, interspecies and intraspecies mast cell heterogeneity, was established in the mid-1980's by investigators working in the field of asthma. It is now appreciated that secretory responses as well as effects of pharmacological agents differ depending upon the mast cell population studied. Two types of human mast cells, the tryptase containing (T) and the tryptase/chymase containing (TC) mast cells, have been characterized in a variety of tissues. Significantly, Irani et al. (1) demonstrated by immunohistochemical staining that the mast cells present in conjunctival tissues from patients with allergic conjunctivitis were 100% TC. Functional responses of human conjunctival mast cells to a variety of secretagogues (2) were consistent with their classification as TC or connective tissue type mast cells. Importantly, the studies by Miller et al. mentioned above allowed the harvesting and preparation of human conjunctival mast cells for use in drug screening studies. Utilization of these cells has led to the identification of Patanol, the most effective human conjunctival mast cell stabilizer available for topical use in allergic conjunctivitis (3). These same studies demonstrated the lack of mast cell stabilizing activity for cromolyn and nedocromil in these connective tissue type, TC containing, human conjunctival mast cells. Similar lack of effect was noted with these drugs on human skin mast cell degranulation (4). The second important discovery in the area of allergic conjunctivitis has been the demonstration that conjunctival epithelial cells may contribute to the perpetuation of the allergic response. A report from Gamache et al. (5) identified cytokines produced by human conjunctival epithelial cells following treatment with a number of stimuli. Significantly, Sharif et al. (6) subsequently identified functional histamine H1 receptors on these same cell types. Recently, Weimer et al. (7) have shown that exposure of human conjunctival epithelial cells to histamine leads to the production of pro-inflammatory cytokines IL-6 and IL-8. Importantly, treatment of the epithelial cells with drugs that possess histamine H1 antagonist properties prevents cytokine production. It is noteworthy that first generation anti-histamines antazoline and pheniramine are not potent inhibitors of histamine-stimulated cytokine synthesis in intact epithelial cells, while newer anti-histamines Emadine and levocabastine are more potent. Surprisingly, Patanol was more potent as an inhibitor of histamine-stimulated cytokine production by the epithelial cells than would be predicted from its histamine H1 antagonist affinity. These inhibitory effects on conjunctival epithelial cell production of pro-inflammatory cytokines may contribute to enhanced clinical activity noted with these recently approved drugs.

Anti-Allergic Agents↗
PubMed1988

Neonatal chlamydial conjunctivitis. A long term follow-up study.

Chlamydia trachomatis (Ct) was isolated from eyes of 33 out of 160 infants with neonatal conjunctivitis. In nineteen (58%) of the infants with chlamydial conjunctivitis Ct could also be isolated from the nasopharynx. All infants were treated with oral erythromycin ethylsuccinate 25 mg/kg every 12 hours for 14 days combined with lid hygiene. All were clinically cured, and none had a relapse of clinical Ct conjunctivitis during an observation period of one year. However, one infant had persistent asymptomatic chlamydial eye infection, two displayed a persistent infection of the nasopharynx, and one infant's vagina was infected despite therapy. Serum IgG antibodies to Ct were significantly more often detected in clinical cases (90%) than in controls (33%) (p less than 0.01). Infants with conjunctivitis developed detectable IgM antibodies to Ct in 43% as compared to 7% in controls (p less than 0.01).

Conjunctivitis, Inclusion↗
PubMed1991

Immune response in chlamydial conjunctivitis among neonates and adults with special reference to tear IgA.

Tear and serum samples from 128 neonates and 122 adults with conjunctivitis were examined for antibodies to Chlamydia trachomatis with a micro-immunofluorescence (MIF) technique and the results compared to antigen detection by culture, enzyme immunoassay (EIA) (Chlamydiazyme, Abbott) and direct immunofluorescence (IF) (MicroTrak, Syva and Chlamyset, Orion) tests. From the 52 culture-positive adults, chlamydial IgA (titre greater than or equal to 1:8) antibodies were detected in 81% of the tear and in 62% of the serum samples, while 88% had such serum IgG antibodies (titre greater than or equal to 1:32). The persistence of chlamydial IgA in tears and sera was related to the duration of symptoms of conjunctivitis and the antibody titres declined after institution of antibiotic treatment. In the adults, the sensitivity of the MIF tear IgA antibody test (81%) was higher than that of the EIA (71%) and the IF (MicroTrak 71% and Chlamyset 62%) tests. The specificity for the MIF test was 79%, while it was 100% for the EIA and the two IF tests. Of the 67 chlamydia-infected neonates, 36% had chlamydial tear IgA antibodies, while such antibodies were only found in 15% of the sera. No neonates with chlamydia-negative conjunctivitis had chlamydial IgA antibodies. The MIF test may be used as a diagnostic method complementary to culture, EIA and IF tests in the diagnosis of chlamydial conjunctivitis in adults, but is not applicable in neonates.

Adolescent↗
PubMed1980

Clinical trial of the topical use of disodium cromoglycate in vernal, allergic and chronic conjunctivitis.

Thirty-three patients were treated with disodium cromoglycate (DSCG). Of these 5 had vernal conjunctivitis, 18 had allergic conjunctivitis and 10 had mild chronic conjunctivitis in which the exact aetiology could not be determined. 70% of patients with DSCG as the only medication achieved at least some beneficial effect being almost exclusively in the groups of either vernal or allergic conjunctivitis. The basic trend seemed to indicate a reduction in severity during the treatment with DSCG in allergic diseases.

Chronic Disease↗
PubMed1983

A study of inclusion conjunctivitis in newborn and young adults. Clinical picture, culture, conjunctival scrapings and cytology of the tear fluid in 12 cases.

Chlamydia trachomatis were cultured from the conjunctiva of 8 newborn babies and 4 young adults' (age 20-30 years) affected with acute or therapy-resistant chronic conjunctivitis. The newborn had acute purulent conjunctivitis noticed 4 to 12 days after birth. Five of them had been treated with topical chloramphenicol without effect before the diagnosis was made. They responded well to topical tetracycline ointment, but 3 relapsed. Two developed chronic conjunctivitis and respiratory tract infection, one under long time topical chloramphenicol treatment. The adults had a chronic, in 3 unilateral, conjunctivitis with pronounced follicularly (3) or papillary (1) conjunctival hypertrophy. Different degrees of pseudoptosis, micropannus and corneal infiltrates (in 3) were noticed. In the tear fluid, the quantitative pipette method revealed inflammation shown by neutrophilic granulocytes and lymphocytes with an appreciable predominance of the former in the newborn, while less so in the adults. In the newborn the diagnosis was easily made by culture and by demonstrating inclusions bodies in Giemsa-stained conjunctival scrapings. In the adults the methods were less sensitive. A negative response to one culture does not preclude chlamydial infection.

Adolescent↗
PubMed1988

Atopic conjunctivitis. A cytologic examination.

Tarsal conjunctival scrapings of the lower and upper eyelids of 21 atopic, pollen allergic patients with conjunctivitis were examined three times; during a symptom-free period, during a challenge test and during the pollen season. Eosinophils were also counted from the conjunctival fluid of 17 patients, but only of 12 patients during the challenge. The controls were 10 atopic patients without conjunctivitis (K0), 31 normal persons (K1), who were examined routinely in the course of a spectacle prescription and 45 patients with acute conjunctivitis (K2) of other than allergic origin. A statistically significant difference in the occurrence of eosinophils in the scrapings was found between the pollen allergic patients and the normal control patients but not between patients with atopic or non-atopic conjunctivitis. During the challenge test, the occurrence of eosinophils in the scrapings increased for at least an hour after the challenge had become positive. In the pollen allergic patients eosinophils were equally abundant during the symptom-free and pollen seasons. It is concluded that the occurrence of eosinophils in the conjunctival scraping is not a reliable clinical indicator of allergy.

Adolescent↗
PubMed1990

Comparison of two enzyme immunoassays to culture for the diagnosis of chlamydial conjunctivitis and respiratory infections in infants.

Data are limited for the performance of enzyme immunoassays for the detection of Chlamydia trachomatis in conjunctival and nasopharyngeal specimens from infants. The only available data are for one assay, Chlamydiazyme (Abbott Diagnostics). The purpose of this study was to compare a new enzyme immunoassay, Pathfinder (Kallestad Diagnostics), with Chlamydiazyme and culture for the diagnosis of chlamydial conjunctivitis and pneumonia in infants. Pathfinder differs from Chlamydiazyme in that it uses a monoclonal antibody directed against the chlamydial lipopolysaccharide in addition to a polyclonal antichlamydial antibody. Triplicate conjunctival and nasopharyngeal specimens were obtained from 97 infants with conjunctivitis, and additional nasopharyngeal specimens were obtained from 14 infants with suspected chlamydial pneumonia (total, 111 nasopharyngeal specimens). Twenty-nine (30%) of the conjunctival specimens from infants with conjunctivitis and four (28.6%) of the nasopharyngeal specimens from the infants with pneumonia were positive for C. trachomatis by cell culture. The sensitivities, specificities, and positive and negative predictive values for Pathfinder for conjunctival specimens were 96.6, 98.5, 96.6, and 98.5%, respectively. The results for Chlamydiazyme were 96.6, 100, 100, and 98.6%, respectively. For nasopharyngeal specimens, the results for Pathfinder were 77.8, 94.6, 73.7, and 95.7%, respectively. The results for Chlamydiazyme were 66.7, 95.7, 75, and 93%, respectively. Pathfinder and Chlamydiazyme appeared to perform equivalently for the detection of C. trachomatis in both eye and nasopharyngeal specimens from infants with chlamydial conjunctivitis and pneumonia.

Antibodies, Monoclonal↗
PubMed1999

Genetic relatedness among nontypeable pneumococci implicated in sporadic cases of conjunctivitis.

Nontypeable Streptococcus pneumoniae is a common cause of epidemic conjunctivitis. A previous molecular fingerprinting study identified a clone of nontypeable pneumococcus that was responsible for a recent outbreak of conjunctivitis. In the present study, we examined the extent to which pneumococci that cause sporadic cases of conjunctivitis are related to this epidemic strain. Using arbitrarily primed BOX-PCR, we have determined that, of 10 nontypeable pneumococci causing sporadic conjunctivitis, 5 were clonal and closely related to a previous outbreak strain, whereas 5 others were genetically diverse.

Adult↗
PubMed1986

Neonatal chlamydial conjunctivitis.

Maternal chlamydial antibodies were determined in cord sera of 41 infants who developed neonatal chlamydial conjunctivitis and compared with the antibody profile of infants who had been exposed to Chlamydia trachomatis at birth by their isolation positive mothers but in whom conjunctivitis did not develop. No protective effect could be attributed to maternal antibodies transferred to the infants. Paired sera samples were collected from 18 infants with chlamydial conjunctivitis. Chlamydial IgM antibodies were detected in four of these 18 cases at the time diagnosis was established by isolation. An additional eight cases had developed chlamydial IgM at the time the convalescent sera samples were taken, on average on day 40. At that time symptoms had disappeared after systemic treatment had been given. Thus chlamydial IgM antibodies were eventually shown in two thirds of infants with chlamydial conjunctivitis who were all systemically treated and clinically healed. These data suggest a cautious assessment of chlamydial IgM in the diagnosis of chlamydial pneumonia.

Adult↗
PubMed2006

Interleukin 10 and transforming growth factor beta contribute to the development of experimentally induced allergic conjunctivitis in mice during the effector phase.

AIM: To investigate the involvement of interleukin (IL)10 and transforming growth factor (TGF) beta in the development of experimentally induced allergic conjunctivitis in mice. METHODS: Balb/c mice were actively sensitised with ragweed in alum, and then challenged with ragweed in eye drops after 10 days. 24 h later, the conjunctivas, spleens and blood were collected for histological and cytokine expression analyses, proliferation and cytokine production assays and measurement of immunoglobulin (Ig) levels. Mice developing experimentally induced allergic conjunctivitis were injected intraperitoneally with 200 microg of anti-IL10 or anti-TGF beta antibodies at 0, 2, 4, 6 and 8 days (induction phase treatment) or 500 microg of antibodies 2 h before ragweed challenge (effector phase treatment). Normal rat IgG was used for control injections. RESULTS: Treatment with either anti-IL10 or anti-TGF beta antibodies during the induction phase did not affect eosinophil infiltration into the conjunctiva. By contrast, treatment with either antibody during the effector phase suppressed infiltration. During the effector phase, treatment with anti-TGF beta antibody, but not the anti-IL10 antibody, markedly up regulated proliferation and Th2 cytokine production by splenocytes. IL1alpha levels in the conjunctiva were reduced after treatment with either antibody; in addition, eotaxin and tumour necrosis factor alpha levels were reduced after treatment with antibody to TGF beta. CONCLUSIONS: IL10 and TGF beta do not have immunosuppressive roles in the development of experimentally induced allergic conjunctivitis. Rather, they augment the infiltration of eosinophils into the conjunctiva during the effector phase of experimentally induced allergic conjunctivitis.

Adoptive Transfer↗
PubMed1996

Allergic conjunctivitis and dry eye.

AIMS: Differential diagnosis of allergic conjunctivitis or dry eye is sometimes very difficult to diagnose by symptoms and clinical examination alone, especially in older patients. It was hypothesised that clinically allergic patients who were serum antigen specific IgE negative were candidates for dry eye. METHODS: Sixty patients were studied prospectively who were clinically diagnosed with allergic conjunctivitis by their itchy sensation and papilla formation of conjunctiva. They consisted of 30 serum antigen specific IgE positive and 30 IgE negative patients, with no significant differences in age. Dry eye examination and serum total IgE were performed on these two groups. RESULTS: No significant differences were seen between the two groups with regard to age (p = 0.76) and sex ratio. The antibody negative group had lower Schirmer's test scores (p = 0.002), lower tear clearance (p = 0.0001), lower tear function index (p = 0.0001), and lower serum total IgE (p = 0.04) than the antibody positive group. CONCLUSION: This study suggests that the evaluation of serum antigen specific IgE and tear dynamics are important for the differential diagnosis of patients with allergic conjunctivitis and dry eye. Clinically diagnosed allergic conjunctivitis with negative serum antigen specific and total IgE can be one form of dry eye.

Adolescent↗
PubMed1983

A study of the neurological disorder associated with acute haemorrhagic conjunctivitis due to enterovirus 70.

Ninety cases of the neurological manifestations associated with acute haemorrhagic conjunctivitis caused by Enterovirus 70 (EV 70) are reported. The patients were seen during the widespread epidemics in 1971 and 1981. Male adults were predominantly affected by a "polio-like" paralysis of the limbs and/or cranial nerves. Root pains were often complained of early in the disease. In the absence of a necropsy, clinical and neurophysiological examinations helped to localise the lesions. Significant antibody titres against EV 70 were demonstrated in the serum and more relevantly in the CSF. Though other viruses can cause sporadic and epidemic conjunctivitis and similar paralysis independently, the combination of a haemorrhagic conjunctivitis and a neurological disease mostly simulating poliomyelitis is caused by EV 70 alone. It is therefore suggested that this combination be called "Enterovirus 70 disease". Because of its neurovirulence, it is important to identify this virus at the very beginning of an epidemic of conjunctivitis, so as to limit its spread by strict public health measures.

Adolescent↗