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PubMed2005

Radial meniscal tears: significance, incidence, and MR appearance.

OBJECTIVE: The purpose of this study was to assess the prevalence of radial meniscal tears at arthroscopy and the ability of MRI to detect radial tears preoperatively. In addition, the ability of four radiologic signs to detect radial tears was assessed. Those signs are the truncated triangle, cleft, marching cleft, and ghost meniscus signs. MATERIALS AND METHODS: Arthroscopy of the knee was performed by a single orthopedic surgeon on 196 consecutive patients. The surgeon noted each radial tear he encountered. The MR images that were obtained at our institution were reviewed, whereas those patients who were imaged elsewhere were excluded. The preoperative MRI reports were reviewed to assess the ability to prospectively identify radial meniscal tears. In addition, a retrospective analysis of the MRI studies was performed by two radiologists in which four radiologic signs were applied to detect radial tears. RESULTS: Twenty-nine patients (15%) had radial tears at arthroscopy. Eighteen of the 29 patients had their imaging performed at our institution and were selected for review. There were 19 radial tears found at surgery. Seven (37%) of the 19 tears were identified as radial prospectively. Retrospectively, using the four signs for radial tears, reviewers identified 17 (89%) of 19 radial tears. CONCLUSION: A more accurate preoperative diagnosis may be rendered using the four described signs to detect radial tears, thus allowing informative preoperative counseling and consideration of new therapies that are available for radial meniscal repair.

Adult↗

PubMed1993

Diagnosis of meniscal tears of the knee with MR imaging: effect of observer variation and sample size on sensitivity and specificity.

OBJECTIVE: A wide range in the efficacy of MR imaging for the diagnosis of meniscal tears of the knee has been reported. To evaluate two possible causes for this variation, we studied how sensitivity and specificity are affected when different observers and sample sizes are used. MATERIALS AND METHODS: Two hundred MR examinations of the knee in patients for whom the results of arthroscopy were available were used for the study. One hundred eight medial meniscal tears and 58 lateral meniscal tears were found at arthroscopy. The sensitivity and specificity for detection of meniscal tears were determined for the original interpretations and retrospective evaluations by three observers. Comparisons were also made between sample sizes of 25 and 100. chi 2 analysis was used for unmatched data sets and McNemar's statistic was used for matched sets. RESULTS: For the 200 examinations, the sensitivity was 0.89-0.93 for medial meniscal tears and 0.79-0.83 for lateral meniscal tears. The specificity was 0.86 for medial meniscal tears and 0.90-0.92 for lateral meniscal tears. Sensitivity and specificity varied widely among different observers and different sample sizes. However, we found no significant difference between any of the comparisons at the p < .05 level. The largest interobserver variation occurred in the detection of lateral meniscal tears, with a sensitivity of 0.71 for one observer and 0.88 for another observer (p = .16). The largest variation between sets of 100 examinations was a change in sensitivity for detection of lateral meniscal tears from 0.74 to 0.88 for the original interpretations (p = .10). For the sample sets of 25 cases, the variation was even larger, with the sensitivity for detection of lateral meniscal tears varying from 0.5 for one set to 1.0 for another. CONCLUSION: We conclude that chance variation related to sample size can cause large but not statistically significant variations in sensitivity and specificity in this setting. These variations are of sufficient magnitude to explain many of the differences in reported sensitivity and specificity for MR imaging in the diagnosis of meniscal tears. We found no significant difference in observer performance.

Adolescent↗

PubMed2000

Sonographic differences in the appearance of acute and chronic full-thickness rotator cuff tears.

This study was undertaken to identify differences in the sonographic appearance of acute and chronic full-thickness rotator cuff tears. The ultrasonograms of 24 patients with an acute rotator cuff tear and 20 with a chronic tear were reviewed for tear size (width), location, and the presence and distribution of fluid. Among these 24 patients, 75% with a midsubstance tear location had an acute tear; 64% of patients with joint or bursal fluid had an acute tear; 80% of patients with a nonvisualized rotator cuff due to a massive tear had a chronic tear; and 73% of patients with no sonographic evidence of bursal or joint fluid had a chronic tear. In conclusion, a midsubstance location and the presence of joint or bursal fluid were more commonly associated with an acute tear. A nonvisualized cuff and the absence of joint and bursal fluid were more commonly observed with a chronic tear.

Acute Disease↗

PubMed1994

Pathology and pathogenesis of the intratendinous tearing of the rotator cuff viewed from en bloc histologic sections.

Histologic sections from 17 en bloc surgical specimens were studied to clarify the pathogenesis of intratendinous tears of the rotator cuff. The specimens consisted of the bony insertion, the partially torn area, and the musculotendinous junction of the supraspinatus tendon. An intratendinous tear alone was present in two patients, and was associated with bursal side cuff tears in seven patients and joint side cuff tears in eight. There were 13 men and 4 women, whose average age was 49.8 years. Trauma was noted in all intratendinous tears and combined intratendinous and joint side cuff tears and in two of the seven patients who had intratendinous plus bursal side tears. All patients exhibited clinical evidence of subacromial impingement. Histologic sections were stained with azan and hematoxylin and eosin. Microscopically, the sections demonstrated several abnormalities in addition to degeneration. The intratendinous tears was located in the midlayer of the tendon in 15 specimens and eccentrically in two, the axis of which were parallel to tendon fibers in all. The intratendinous tears continued to local disruptions of the enthesis in 11 cases. The inner surface of the tear appeared smooth in 16 specimens. Despite the presence of granulation tissue and vessel proliferation near the intratendinous tears, there was no evidence of closure of the defect in any specimen. Intratendinous tears develop between superficial and deep layers of the degenerated rotator cuff. Shear within the tendon appears to be responsible in pathogenesis. Concomitant subacromial bursitis is very common.

Adult↗

PubMed1998

A comparison of MRI findings in patients with acute and chronic ACL tears.

This retrospective study compared the magnetic resonance imaging (MRI) findings in 87 patients with acute and chronic anterior cruciate ligament (ACL) tears. Sixty patients had acute tears and 27 had chronic tears. The appearance of the torn ligament was examined on MRI, and associated meniscal and osteochondral injuries were described. All findings were verified at arthroscopy. Acute ACL tears (MRI examination was performed within 6 weeks of injury) were typified by the presence of diffuse (58%) or focal (42%) increased signal within the ligament, whereas chronic ACL tears (MRI examination was performed more than 6 months after injury) usually appeared as either a fragmented ligament (44%) or an intact band of low signal with abnormal orientation (30%). Patients with chronic ACL tears had a higher prevalence of medial meniscal tears (78% versus 40%), articular chondromalacia, and an increased posterior cruciate bow ratio (0.47 versus 0.37) in association with chronic ACL tears. A bone bruise was seen in 68% of acute ACL tears but in no case of chronic ACL tear. On MRI, there are salient differences between acute and chronic ACL tears. Chronic ACL tears are associated with a greater prevalence of meniscal and osteochondral injuries. These findings may have implications for future treatment recommendations.

Acute Disease↗

PubMed1980

Proteins in tears from healthy and diseased eyes.

The levels of total protein in tears from healthy donors, conjunctivitis vernalis patients, and conjunctivitis follicularis patients, were 625, 1370 and 1160 mg% respectively. Serum albumin accounted for 3.3%, 43% and 67% of the total protein of tears from these groups, and the level of proteins probably synthesized by the lacrimal gland, was in tears from conjunctivitis follicularis patients only half the level in normal tears. By crossed immunoelectrophoresis with intermediate gel, 10 antigenic species could be recognized in normal tears, and of these the following were identified: Lysozyme, IgA, lactoferrin and serum albumin. In tears from patients with conjunctivitis vernalis three more immunoprecipitates were observed, of which one was due to IgG. No lysozyme could be demonstrated in tears from a case of conjunctivitis sicca by immunoelectrophoresis. In tears from healthy donors the mean level of IgA was 20 mg%, of IgG 3 mg%, and IgM could not be demonstrated. Rabbit anti-tear immunoglobulin did not precipitate a standard of human IgM in double immunodiffusion. In cases of conjunctivitis vernalis and follicularis the mean levels were increased to 80 and 114 mg% IgG, and 11 and 14 mg% IgM, but IgA was increased only to 32 and 41 mg%. It is assumed that the level of IgA in normal tears is almost entirely due to local synthesis, while serum albumin and other immunoglobulins may have escaped from the circulation by molecular sieving. The increased levels of immunoglobulins in inflammatory diseases is probably due to transudation. However, in blepharoconjunctivitis patients several tear samples with a high IgM and a low or zero level of IgG could be demonstrated. Possible explanations for this phenomenon are discussed.

Adolescent↗

PubMed1994

Collection and concentration of tear proteins studied by SDS gel electrophoresis. Presentation of a new method with special reference to dry eye patients.

An obvious obstacle in the analysis of tear film samples from patients with dry eyes is the drastically reduced tear volume. To overcome this problem we have developed a method by which the surface of the eye is flushed with saline, diluting the sparse tear fluid, followed by a concentration of the wash fluid. We compared undiluted tears, diluted tears, tear fluid collected by flushing, reconcentrated diluted tears and reconcentrated flush fluid. Gel electrophoresis of the tear samples obtained showed a representative collection of tear proteins, with bands ranging in molecular weight from about 10 kDa to about 90 kDa. The method may therefore provide a useful alternative to the analysis of undiluted tear fluid in such patients. After storage at -80 degrees C for 1 month, electrophoresis often showed some weakening of band intensities. However, no specific loss of bands was found, and by ultracentrifugation a band profile similar to that of fresh, undiluted tears was obtained. For most purposes, therefore, samples may be kept by this means for later analysis.

Cryopreservation↗

PubMed1982

A polyacrylamide-gel electrophoretic study of human tear proteins.

The protein composition of normal and pathological tears was studied by polyacrylamide-gel (disc) electrophoresis. Polyacrylamide-gel electrophoresis was shown to detect at least 14 fractions in 2-10 microliters of native tears. A comparison was made between the protein composition of normal tears and serum. The most characteristic bands in the tear-protein pattern were identified by parallel electrophoresis of tears, serum, human milk and purified egg-white lysozyme. The identified fractions were specific tear prealbumin, serum albumin, transferrin, lactoferrin and lysozyme. An unidentified major tear-protein component was also described. The tear-protein pattern was divided into six zones: (1) prealbumin zone; (2) post-albumin zone; (3) post-transferrin zone; (4) macroglobulin zone; (5) basic globulin zone; (6) prelactoferrin zone. A significant rise in the level of serum albumin and transferrin was demonstrated in tears from cases of acute catarrhal conjunctivitis. The optimal circumstances were discussed under which major and minor tear components and basic and acidic tear proteins can be determined simultaneously. Polyacrylamide-gel electrophoresis is recommended as a useful method to study the various diseases of the anterior segment of the eye.

Electrophoresis, Polyacrylamide Gel↗

PubMed1983

IgG specific antibodies to rye grass and ragweed pollen antigens in the tear secretions of patients with vernal conjunctivitis.

We studied the tears of 30 patients (25 males and five females, ranging in age from 8 to 34 years) with vernal conjunctivitis for pollen-specific IgG antibodies to rye grass and ragweed antigen E by an enzyme-linked immunosorbent assay (ELISA). Eighteen of 30 (60%) and 20 of 30 (67%) patients with vernal conjunctivitis had significant levels (more than 2 S.D. from the mean of control tears) of IgG antibodies in their tear secretions to rye grass (geometric mean = 68.7 ELISA units) and ragweed antigen E (geometric mean = 50 ELISA units), respectively. In contrast, the control groups (eight atopic individuals, four with seasonal rhinitis, and 12 with allergic conjunctivitis) had low amounts of specific IgG antibodies to these two pollen antigens in their tears. Total IgG and IgM were also increased in the tears of patients with vernal conjunctivitis. To evaluate whether these immunoglobulins and specific IgG antibodies were locally produced by the conjunctival tissues, we used transferrin as a marker for the leakage of plasma proteins into tears. We found that the specific IgG antibodies to rye grass or ragweed antigen E, or both, in the tears were locally produced by the conjunctival tissues. The local production ranged from 20% to 99.9%. Of 17 patients with vernal conjunctivitis and undetectable pollen-specific IgE antibodies in their tears, 14 (82.4%) had tear specific IgG antibodies to rye grass or ragweed antigen E or both, whereas of those with measurable tear IgE antibodies, only nine of 13 (69%) had tear IgG antibodies to rye grass or antigen E or both. These results suggested that both IgE- and IgG-mediated immune mechanisms may be important in the pathogenesis of vernal conjunctivitis.

Adolescent↗

PubMed1990

Sialic acid in human tear fluid.

A simple assay for the determination of sialic acid (N-acetylneuraminic acid) in human tear fluid was evaluated. Sialic acid, terminally bound on carbohydrate side-chains of glycoproteins, was released after treatment with neuraminidase and measured by an enzymatic colorimetric test. Tear fluid samples were collected from ten healthy adults, using glass capillaries and cellulose sponges. Sialic acid levels in tears collected with sponges (0.8-1.8 mmol l-1) did not differ significantly from those found in capillary tears (0.9-1.8 mmol l-1). Sialic acid, expressed as mmol g-1 protein, was significantly lower in tears collected with sponges (0.18-0.32 mmol g-1) than with capillaries (0.19-0.42 mmol g-1). Recovery of sialic acid and protein after incubation of cellulose sponges with tears was more than 99%. Sialic acid levels in human tears, which had been centrifuged to remove insoluble material, remained unchanged. Furthermore, tear sialic acid activity did not pass a filter with a molecular weight cut-off point of 10,000. Our data indicate that with the assay used in this report, sialic acid in tears is not due to secretory immunoglobulin A (sIgA), lactoferrin and lysozyme. The fact that the major tear proteins do not contribute to the sialic acid levels detected in tears suggests that other as yet unknown soluble glycoproteins are involved.

Adult↗

PubMed2005

Human tear viscosity: an interactive role for proteins and lipids.

Human tear viscosity is poorly understood. Tears need to remain on the ocular surface for lubrication without causing damage to the surface epithelia due to drag when blinking. Whole tears are shear-thinning (non-Newtonian), which cannot be explained by the amount of mucin present, nor by individual proteins. Whole tears minus lipids become Newtonian. Though no free lipids had previously been found in collected tears, tear lipocalin (TL), a major tear protein, is known to bind lipids. In this study, we aimed to confirm whether there are any free lipids in collected tears, and to clarify the combined contribution of tear proteins to viscosity, including experiments on recombinant TL, both without (apo-TL) and with (holo-TL) bound lipid. We also investigated possible oligomer formation by holo- and apo-TL as a mechanism for viscosity using SDS-PAGE and analytical ultracentrifugation (AU). For comparison, we have included results for beta-lactoglobulin, a well-characterised lipocalin protein. No free lipids were detected in whole tears. Rheology showed that any protein combination that included lysozyme or lactoferrin was shear-thinning, as was apo-TL, though holo-TL was Newtonian (linear). Results from SDS-PAGE and AU showed apo-TL to be entirely monomeric, but holo-TL showed some dimerization. Both apo- and holo-beta-lactoglobulin exhibited a monomer-dimer equilibrium. We conclude that hetero-protein interactions, possibly electrostatic, involving lipid-binding-induced structural changes to TL, significantly contribute to the viscosity of human tears.

Carrier Proteins↗

PubMed2004

Functional aspects of the tear film lipid layer.

The lipid layer is an essential component of the tear film, providing a smooth optical surface for the cornea and retarding evaporation from the eye. The meibomian lipids which compose it are well adapted for this purpose. They form a thin, smooth film whose thickness, and probably composition, influences the rate of evaporation. Their melting range ensures sufficient fluidity for delivery to the tear film from the lid margin reservoirs, while the film itself may exhibit a higher viscosity at the cooler temperature of the ocular surface. The factors governing lipid film formation during the blink are not fully understood, but one view is that the polar lipids, interacting with the aqueous sub-phase of the tear film, spread in advance of the non-polar components, which form the bulk of the film. The meibomian lipids stabilise the tear film by lowering its free energy; they carry water into the film during its formation and interact with lipid-binding proteins in the aqueous phase, such as tear lipocalin. The lipocalins, complexed with other tear components, may also contribute to the high, non-Newtonian viscosity of the tear film and its low surface tension, features which are essential for tear film stability. Formation of the lipid film is a complex process. Lipid is delivered to the tear film in the up-phase of the blink, more from the lower than the upper reservoir. The lipid layer comes to a stop well after completion of the blink and remains relatively immobile until it is compressed in the down-phase of the blink that follows. Then, it either retains its structure in a series of subsequent blinks, or is completely re-constituted after mixing with the reservoir lipids. Delivery of meibomian lipid to the marginal reservoirs is mainly the result of continuous secretion, under neural and hormonal control, supplemented by lid action. The reservoirs provide a hydrophobic barrier to tear overspill and to contamination by skin lipids which might destabilise the tear film. They probably also provide the chief route for meibomian lipid excretion.

Adolescent↗

PubMed2004

Non-invasive methods of assessing the tear film.

The interaction between the tear film and the ocular surface epithelium is crucial for the maintenance of ocular surface health; interference with this relationship may cause dry eye. Several diagnostic techniques have been developed to assess the tear film and diagnose dry eye but many of these tests are invasive and modify the parameter which they are designed to measure. Non-invasive or minimally invasive tests may overcome this problem and provide more reproducible and objective data. One test of this kind is meniscometry, which is particularly useful in assessing tear volume indirectly by measuring tear meniscus radius. The newly developed video-meniscometer, which enables calculation of the meniscus radius digitally, is useful for the diagnosis of tear-deficient dry eye. Video-meniscometry also has other applications, to the study of tear and eye drop turnover, determining the indication for punctal plugs and in demonstrating dysfunction of the tear meniscus. Interferometry of the tear film lipid layer is useful in screening and evaluating dry eye severity and in selecting dry eye candidates for punctal occlusion. It is also useful for analysing tear lipid layer pathophysiology more clearly, especially in combination with meniscometry. Meibometry is a minimally invasive technique to quantify the amount of meibomian lipid on the lid margin. Lipid is blotted onto a plastic tape and the change in optical density is used to calculate lipid uptake. Laser meibometry has increased the scope of this technique for the assessment of meibomian gland dysfunction; also, the delivery of lipids from the lid reservoir to the preocular tear film can be analysed using interferometry and laser meibometry. The present report reviews the application of these techniques to the study of tear film physiology and dry eye.

Diagnostic Techniques, Ophthalmological↗

PubMed2005

Tear film tests in Parkinson's disease patients.

OBJECTIVE: Parkinson's disease (PD) has both motor and nonmotor features. Parkinson's disease patients are prone to dry eye due to both autonomic dysfunction and motor symptoms affecting blinking. This study was conducted to investigate the changes in tear functions in PD patients. DESIGN: Nonrandomized, prospective, clinical study. PARTICIPANTS: Fifty-six eyes of 56 consecutive patients with PD were studied. Thirty-six eyes of age-matched non-PD patients without pathology affecting tear tests were examined as control subjects. INTERVENTION: Modified Hoehn-Yahr (H-Y) scale, blink rate (BR), and tear tests were examined. MAIN OUTCOME MEASURES: Modified H-Y scale, BR, dry eye assessment questionnaire, meibomian gland evaluation, tear meniscus height, tear breakup time, fluorescein stain, rose bengal stain, Schirmer's test, and phenol red thread test. RESULTS: Overall tear function abnormalities were significantly more common in PD patients (P = 0.001, Mann-Whitney U test). Each test was found to be significantly disturbed in PD patients relative to controls (P<0.05, Mann-Whitney U test). Each PD patient had at least 1 abnormal test. Overall tear function abnormalities as assessed by the total abnormal test count correlated with the H-Y score (P<0.001, Spearman rho correlation). Parkinson's disease patients' mean BR (12.7+/-7.42 per minute) was significantly less than the controls' (21.8+/-7.37) (P<0.01, Student's t test). The abnormality in each tear test, except those for meibomian gland function and tear meniscus height, was significantly related to the H-Y scores (P<0.05, chi2 linear-by-linear association). CONCLUSION: The results of this study indicate that PD is associated with disturbances in tear function. With the exception of meibomian gland disease and tear meniscus height, the tests were found to have a linear association with the H-Y scale, which may be attributed to associated dysfunctions of PD.

Aged↗

PubMed2000

Effect of laser in situ keratomileusis on tear stability.

OBJECTIVE: Patients frequently experience dry eye symptoms after laser in situ keratomileusis (LASIK). The mechanisms that lead to these changes are not well understood. The purpose of this study was to investigate the effect of LASIK on tear function. DESIGN: Prospective, comparative, nonrandomized interventional trial. PARTICIPANTS: Fifty-eight consecutive patients (96 eyes) who underwent myopic LASIK treatment. METHODS: The prospective study involved 58 consecutive patients (96 eyes) who underwent sequential or bilateral LASIK for the correction of myopia. Dry eye symptoms, standardized Schirmer test values, basal tear secretion test, and tear break-up time were measured before surgery and 1 day, 1 week, and 1 month after surgery. MAIN OUTCOME MEASURES: Schirmer test value, basal tear secretion value, and tear break-up time. RESULTS: Before surgery, 15.6% of patients (15/96) had dry eye symptoms. After surgery, 94.8% of patients (91/96), 85.4% of patients (82/96), and 59.4% of patients (57/96) experienced dry eye symptoms at 1 day, 1 week, and 1 month, respectively. Schirmer test value (13.32 +/- 10. 67 mm) increased at 1 day (14.48 +/- 10.57 mm; P = 0.25) and subsequently decreased at 1 week (11.18 +/- 9.81 mm; P = 0.05) and at 1 month (10.83 +/- 10.02 mm; P = 0.03). Basal tear secretion test value (8.49 +/- 8.48 mm) decreased at 1 day (6.80 +/- 6.48 mm; P = 0.05), at 1 week (5.97 +/- 6.88 mm; P = 0.005), and at 1 month (5.89 +/- 6.24 mm; P = 0.007). Tear break-up time (5.32 +/- 2.35 seconds) decreased 1 day (4.14 +/- 1.90 seconds; P < 0.001) and 1 week (4.49 +/- 1.70 seconds; P = 0.004) after surgery and recovered by 1 month after surgery (5.09 +/- 3.03 seconds; P = 0.52). Poor preoperative tear functions with a Schirmer test value less than 10 mm was a significant risk factor (72% vs. 46%; relative risk, 1.58 [1.10-2.26]) for experiencing dry eye symptoms at 1 month after surgery. CONCLUSIONS: Dry eye symptoms are common after myopic LASIK surgery. Laser in situ keratomileusis significantly altered the tear break-up time, Schirmer test values, and basal tear secretion. Patients with preexisting tear flow abnormality as demonstrated by Schirmer test values less than 10 mm are especially at risk of experiencing dry eye symptoms.

Adult↗

PubMed1996

Tear flow and evaporation in patients with and without dry eye.

PURPOSE: To evaluate the steady-state tear flow and evaporation from the ocular surface of patients with and without dry eye. METHODS: Two groups of patients, 21 with dry eye and 34 without dry eye, with similar age distributions were selected by criteria based on tear osmolarity, Schirmer test, meibomian gland loss, and dry eye symptoms and were compared for tear flow, tear volume, percent turnover, and surface evaporation. RESULTS: Tear flow averaged 0.10 +/- 0.08 microliters/minute in patients with dry eye versus 0.15 +/- 0.12 microliters/minute in patients without dry eye (P = 0.002). Tear volume averaged 2.13+/- 1.3 microliters in patients with dry eye versus 2.23 +/- 2.5 microliters in patients without dry eye (P = not significant) and tear turnover averaged 5.3 +/- 2.9% in patients with dry eye versus 8.2 +/- 4.3% in patients without dry eye (P = 0.019). Evaporation averaged 25 +/- 35 X 10(-7) g/cm(2)/second in patients with dry eye versus 13 +/- 6 X 10(-7) g/cm(2)/second in patients without dry eye (P = 0.003). CONCLUSIONS: Measured tear flow was significantly lower than previously determined in patients with and without dry eye. Evaporation was increased in patients with dry eye and accounted for the majority of the tear loss in patients with dry eye. Normal tear osmolarity can be maintained, even with low tear flow, if evaporation is kept within the normal range.

Adult↗

PubMed1997

Detection of antichlamydial antibodies in tears: a diagnostic aid?

OBJECTIVES: The antibody response in sera and tears of 167 patients with suspected chlamydial conjunctivitis was compared with the antibody response in sera and tears of 45 patients with symptoms of urogenital chlamydial infection to discover whether and which type of antichlamydial antibody detected in tears may be of diagnostic help in chlamydial conjunctivitis. METHODS: Diagnosis was based on chlamydial antigen detection from the conjunctiva and urogenital tract, done by a direct immunofluorescence assay, McCoy cell culture, and polymerase chain reaction. Additionally, antichlamydial immunoglobulin A (IgA) and immunoglobulin G (IgG) were determined in sera and tears of all patients by an immunoperoxidase assay. RESULTS: Two hundred twelve patients were examined--167 with conjunctivitis, 45 with symptoms of urogenital chlamydial infection. Cell culture, direct immunofluorescence assay, and polymerase chain reaction brought identical results. Conjunctival specimens taken from 33 (20%) of the patients with conjunctivitis were Chlamydia antigen positive; specimens taken from 134 (80%) were negative. Antichlamydial antibodies were found in tears of 29 (88%) of the patients with conjunctivitis whose specimens were Chlamydia antigen positive. Fifty-four (40%) of the patients with conjunctivitis whose specimens were Chlamydia antigen negative had antichlamydial antibodies in their tears. Twenty-five patients with urethritis (56%) were Chlamydia antigen positive in urethral swabs; 20 (44%) were negative. Antichlamydial antibodies were found in the tears of eight (32%) of the Chlamydia antigen-positive and two (10%) of the Chlamydia antigen-negative patients with urethritis. In contrast to patients with conjunctivitis, findings for patients with urethritis always were negative for antichlamydial IgG in the tears. CONCLUSION: Antichlamydial antibodies in tears were seen significantly more often in patients with conjunctivitis than in those with urethritis (P < or = 0.05). Antichlamydial IgG was found only in tears of patients with conjunctivitis. Therefore, the authors conclude that the detection of antichlamydial IgG in the tears might be helpful for diagnosis in patients with suspected chlamydial conjunctivitis who have antigen-negative conjunctival swabs.

Adolescent↗

PubMed1999

Correlation of tear fluorescein clearance and Schirmer test scores with ocular irritation symptoms.

OBJECTIVE: To correlate and compare the Schirmer 1 test and a new method of measuring tear fluorescein clearance with the CytoFluor II fluorometer with the severity of ocular irritation symptoms, clinical signs of meibomian gland disease, corneal fluorescein staining scores, and corneal and conjunctival sensitivity. DESIGN: Case-control study. PARTICIPANTS: Forty patients presenting with a chief complaint of ocular irritation, and 40 asymptomatic control subjects of similar age distribution. INTERVENTION: All subjects completed a symptom questionnaire, a baseline ocular examination, fluorescein clearance test (FCT), and Schirmer 1 test. MAIN OUTCOME MEASURES: The FCT was performed with a CytoFluor II fluorophotometer by measuring the fluorescein concentration in minimally stimulated tear samples collected from the inferior tear meniscus 15 minutes after instillation of 5 microl of 2% sodium fluorescein. Severity of ocular irritation was assessed with a symptom questionnaire. Schirmer 1 test, biomicroscopic meibomian gland evaluation, corneal fluorescein staining score, and corneal and conjunctival sensation scores were assessed with the Cachet-Bonnet anesthesiometer in all subjects. RESULTS: Irritation symptoms correlated with higher log tear fluorescein concentration (symptomatic 3.08 +/- 0.62 units/,microl, normal control 1.89 +/- 0.7 units/microl, P < 0.005) and lower Schirmer 1 test scores (symptomatic 12.6 mm, normal control 22.3 mm, P < 0.005). The FCT showed greater predictive value for identifying ocular irritation than the Schirmer 1 test. A fluorescein concentration of 274 units//microl eliminated 80% of the normal subjects (specificity) and identified 85% of the abnormal subjects (sensitivity). Log of tear fluorescein concentration and the Schirmer 1 test correlated with meibomian gland orifice metaplasia (2.81 +/- 0.78 units/microl and 14.47 +/- 9.53 mm in those with metaplasia vs. 1.83 +/- 0.71 units/microl and 23.14 +/- 7.67 mm in those without metaplasia, P < 0.001) and with the percentage of acinar dropout. Both log of tear fluorescein concentration and the Schirmer 1 test correlated with corneal fluorescein staining (Pearson correlation of 0.394 P < 0.0001 for Schirmer 1 test and 0.312 P < 0.005 for log of tear fluorescein). In addition, log of tear fluorescein and Schirmer 1 test scores correlated with corneal and conjunctival sensation scores (Spearman's rho for corneal sensation: log of tear fluorescein -0.38, P < 0.003, Schirmer 1 test -0.39, P < 0.002, and for conjunctival sensation: log of tear fluorescein -0.391, P < 0.001, Schirmer 1 test -0.23, P < 0.061). CONCLUSIONS: The FCT shows a greater predictive value for ocular irritation than the Schirmer 1 test. It correlates better with age, meibomian gland dysfunction, and decreased corneal and conjunctival sensation. Decreased tear clearance was identified as a risk factor for ocular irritation, even in subjects with normal Schirmer scores. This simple technique may provide new clues into the mechanism and therapy of ocular irritation.

Adult↗