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PubMed1985

Tear diluents in the treatment of keratoconjunctivitis sicca.

To determine the optimum solution concentration for lowering elevated tear film osmolarity in keratoconjunctivitis sicca (KCS), tear osmolarity was measured in four KCS patients before and after instillation of either an isotonic saline solution or one of four hypotonic saline solutions (range, 75-225 mOsm/L). Average tear osmolarity one minute after instillation was significantly lower with the hypotonic solutions than with the isotonic saline (mean +/- SEM, 290 +/- 3 mOsm/L vs. 317 +/- 1 mOsm/L, P less than 0.0005). Solutions 150 mOsm/L or less were most effective in lowering osmolarity; the 75 mOsm/L solution was occasionally associated with irritation. In 16 KCS patients, we then compared the therapeutic efficacy of the 150 mOsm/L solution with that of an otherwise identical isotonic solution in a two-week, double-masked, crossover study. The 150 mOsm/L solution was superior for symptom relief by nearly 2:1 (P = 0.01).

Double-Blind Method↗
PubMed1987

Evaluation of diagnostic tools for adult chlamydial keratoconjunctivitis.

Conjunctival smears and serum specimens of 150 patients with presumed chlamydial keratoconjunctivitis were evaluated over a period of 16 months and compared to age- and sex-matched healthy controls. Sensitivity, specificity, and predictive values of fluorescent monoclonal antibody (FMAb) direct tests, IgG single antigen tests for the detection of serum antibody (IgG-IFT), and IgA and IgG immunoperoxidase tests (IgA-IPAs and IgG-IPAs) for serum antibody were compared to McCoy cell culture techniques in a nonoptimized clinical setting. Thus, FMAb sensitivity was 100%, specificity was 52%, and predictive value was 30%. IgG-IFT sensitivity was 94%, specificity was 67%, and predictive value was 37%. IgA-IPA sensitivity was 100%, specificity was 70%, and predictive value was 40%. The IgG-IPA was sensitive but nonspecific. With respect to the current epidemiologic situation in our area, FMAb and IgA-IPA in addition to McCoy cell culture techniques may represent valuable diagnostic tools for the detection of chlamydial disease.

Adult↗
PubMed1988

Epidemic keratoconjunctivitis and lacrimal excretory system obstruction.

Epiphora is a common symptom associated with the acute phase of epidemic keratoconjunctivitis (EKC). Reflex lacrimal secretion occurs secondary to conjunctival or corneal inflammation. Acquired obstruction of the lacrimal excretory system may account for persistence of tearing after resolution of the acute inflammatory phase of the viral infection. Three cases of lacrimal excretory system obstruction after EKC are reported. Multifocal obstruction of the canaliculi and nasolacrimal duct is characteristic. Dacryocystorhinostomy (DCR) was required to relieve obstruction in all cases. Probing and corticosteroid irrigation may avoid the need for silicone intubation or conjunctivodacryocystorhinostomy in the management of canalicular obstruction. Persistent epiphora after EKC should raise clinical suspicion of acquired dacryostenosis. Early recognition may allow for optimal management.

Adult↗
PubMed1992

An electrolyte-based solution that increases corneal glycogen and conjunctival goblet-cell density in a rabbit model for keratoconjunctivitis sicca.

Thirty-two rabbits with monocular surgically induced keratoconjunctivitis sicca (KCS) underwent masked treatment for 12 weeks with 1 of 4 artificial tear solutions. Disease in each group of treated rabbits was compared with disease in untreated KCS controls. One of the solutions tested was a unique electrolyte-based formulation shown previously to preserve normal goblet-cell density after extended exposure in normal rabbits. Only the electrolyte-based solution decreased elevated tear osmolarity and sodium after 9 weeks of treatment (P less than 0.05). At 20 weeks, mean corneal glycogen and conjunctival goblet-cell density in eyes treated with the electrolyte-based solution increased significantly relative to untreated KCS controls (P less than 0.01). With the other three solutions, mean glycogen levels and goblet-cell densities were either decreased relative to untreated KCS controls (P less than 0.05) or were unchanged. The electrolyte-based solution is the first treatment to increase corneal glycogen and conjunctival goblet cells in a rabbit model of KCS.

Animals↗
PubMed1998

Transplantation of the autologous submandibular gland for most severe cases of keratoconjunctivitis sicca.

OBJECTIVE: This study aimed to examine the long-term qualitative and quantitative function of the secretion of transplanted autologous submandibular glands in patients with most severe keratoconjunctivitis sicca. DESIGN: The study design was clinical. PARTICIPANTS: The authors performed 26 operation in 22 patients. A complete ophthalmologic examination was performed in 16 eyes of 13 patients 1 week and 3 months and in 8 eyes of 8 patients 1 year after surgery. INTERVENTION: The submandibular gland was moved from its natural site into the temporal fossa. The glands supplying vessels were connected to the temporal artery and vein, and its secretory duct was implanted into the conjunctival fornix. MAIN OUTCOME MEASURES: Scintigraphy with Tc 99m Pertechnetate was used to document the graft vitality. Subjective symptoms and application frequency of artificial tears were recorded. Baseline as well as stimulated secretion and breakup time were measured and rose bengal staining and ocular ferning test were performed. In selected cases, the secretory product could be sampled for the detection of electrolytes, amylase, and secretory immunoglobulin A (SIgA). RESULTS: Scintigraphy showed vital gland tissue in 14 of 16 grafts at 3 months and 6 of 8 grafts at 1 year after surgery. Two of the 16 transplants were lost completely during the first 3 postoperative months, 1 because of an underlying autoimmunopolyendokrinopathy and the other because of an insufficient vascular anastomoses. In eyes with a vital transplant, baseline secretion and breakup time were increased significantly at 3 months and 1 year after surgery. Patients with a vital transplant reported a strong relief of symptoms and were able to stop taking artificial tear substitution at 1 year. Electrolytes showed a fluctuating concentration. A year after transplantation, the SIgA and amylase concentrations were more than ten times increased compared to normal tear values. CONCLUSION: Microvascular transferral of an autologous, paralytic submandibular gland results in a significant relief of subjective symptoms, a reduction of artificial tear applications, and an increase of baseline secretion over the first postoperative year. The composition and volume of the secretory product fluctuate, but high values of SIgA and amylase show an actively secreting graft. Although the authors' long-term experience still is limited, they believe that the procedure is a promising alternative approach for desperate dry eye conditions.

Amylases↗
PubMed1985

Clinical experience with povidone-iodine eye drops in patients with conjunctivitis and keratoconjunctivitis.

In 40 patients with conjunctivitis or keratoconjunctivitis povidone-iodine eye drops were either administered alone or in combination with a cortisone preparation. The antimicrobial activity in the concentration administered was adequate for the elimination of the causative organisms from the conjunctival sac in the majority of patients, and the preparation was well tolerated.

Adult↗
PubMed2001

Treatment of keratoconjunctivitis sicca with topical androgen.

OBJECTIVE: Androgens have been reported to influence lipid production of sebaceous glands and even many ocular tissues. The effect of topical androgen therapy on a 54-year-old patient with keratoconjunctivitis sicca (KCS) and decreased lipid phase of the tear film is reported. METHODS: For assessment of the lipid phase of the tear film, break up time (BUT) and lipid layer thickness (LLT) were monitored during 6 months before treatment as well as 3 months while using a daily topical androgen therapy. RESULTS: During the topical androgen therapy the pathological lipid phase of the tear film was completely restored indicated by the normalisation of the values of BUT and LLT. CONCLUSION: These findings are consistent with animal experiments indicating that topical administered androgen can restore the decreased lipid phase of the tear film. This may open up new therapeutic strategies for KCS.

Administration, Topical↗
PubMed2002

Vernal keratoconjunctivitis: pathogenesis and treatment.

Vernal keratoconjunctivitis (VKC) is a recurrent or chronic ocular allergic disease that affects mostly children and young adults living in warm climates worldwide. Understanding and treating VKC has been a challenge for ophthalmologists since the pathogenesis is unclear and anti-allergic therapy often unsuccessful. In this paper, the culmination of 11 years of research into the immunological characteristics of this disease in a group of 221 VKC patients will be presented. Cytological, biohumoral, immunohistological and molecular biological studies indicate that VKC is a Th2 lymphocyte-mediated disease. Mast cells, eosinophils and their mediators play major roles in the clinical manifestation of VKC. In addition to typical Th2-derived cytokines, IL-4, IL-5 and IL-13, other cytokines, chemokines, growth factors and enzymes are over-expressed in the conjunctiva of VKC patients. Furthermore, structural cells, such as epithelial cells and fibroblasts, are involved both in the inflammatory process and in the tissue remodeling phase, ultimately resulting in the formation of giant papillae. Interactions between specific (IgE- and Th2-mediated) and non-specific triggers and mechanisms may account for treatment failure. New insights into the pathogenesis of VKC should generate the means to better design the strategies for this complex disease.

Humans↗
PubMed2003

A comparison of methods for detecting adenovirus type 8 keratoconjunctivitis during a nosocomial outbreak in a Neonatal Intensive Care Unit.

BACKGROUND: An outbreak of epidemic keratoconjunctivitis (EKC) due to adenovirus (Ad) type 8 and involving 14 members of the hospital staff and 33 neonates admitted to the Neonatal Intensive Care Unit of the local University Hospital occurred between September and December 2000 in Pavia, Italy. The outbreak was preceded by an outbreak of EKC within the community. OBJECTIVE: To compare the performance of conventional virus isolation on cell cultures, direct detection of Ad antigens in conjunctival cells by a direct fluorescent assay (DFA) and Ad DNA detection in conjunctival swabs by polymerase chain reaction (PCR) for diagnosis of adenoviral conjunctivitis. STUDY DESIGN: Of conjunctival swabs collected from 47 patients, all were tested by virus isolation, 43 by direct Ad antigen detection, and 37 by Ad DNA detection. Direct Ad antigen detection was carried out by DFA using a group-specific monoclonal antibody. Detection and subgrouping of Ad DNA by nested PCR was performed using two sets of primers complementary to hexon and fiber genes, respectively. RESULTS: Ad was detected in 24/47 (51.1%), 21/43 (48.8%), and 23/37 (62.1%) samples by virus isolation, direct antigen detection and PCR, respectively. Overall, 30/47 (63.8%) samples were Ad-positive. Of 37 specimens tested in parallel by all three methods, Ad was detected by at least one of the three techniques in 26/37 (70.3%). All Ad isolates were identified as serotype 8 by neutralization, while all PCR-positive samples were identified as belonging to subgroup D. No other virus was isolated from any conjunctival swab. Time required for test completion was 9.6 (4-20) days for virus isolation, 1-2 h for DFA and 24 h for PCR. CONCLUSIONS: DFA was a sensitive and rapid assay but results depend on the quality of sample and the expertise of the observer. PCR was the most sensitive assay, although it takes longer to perform and requires dedicated facilities; thus, it could be restricted to DFA-negative samples. Virus isolation is still useful from an epidemiological point of view.

Adenovirus Infections, Human↗
PubMed1974

Epidemic keratoconjunctivitis in the West of Scotland, 1967-72.

Outbreaks of epidemic keratoconjunctivitis have occurred among workers in shipyards and other industrial concerns in the West of Scotland in 1956, 1967 and 1971-72. In the most recent episode 220 persons were known to be affected and those mainly involved were shipyard personnel working on the open decks of ships under construction; only a few non-industrial workers were affected. As in previous outbreaks adenovirus type 8 was shown to be the causal organism. It is likely that spread of the virus was probably facilitated in some of the patients by such procedures as first aid measures to remove foreign bodies from the eye. A survey of the family contacts of those affected in 1971-72 revealed that only 2% were secondarily infected. This was probably due to propaganda measures to discourage the use of communal face towels, etc.Despite close virological surveillance over a period of 6 years of patients attending opthalmic clinics in the West of Scotland, there is as yet no clue to the whereabouts of adenovirus type 8 during interepidemic periods. It is suggested that travellers might be responsible for the introduction of the infection into an area.

Adenoviridae↗
PubMed1986

Adenovirus type 8 keratoconjunctivitis--an outbreak and its treatment with topical human fibroblast interferon.

An outbreak of keratoconjunctivitis is described which involved at least 186 people; adenovirus type 8 was identified in 50 of the cases. Topical human fibroblast interferon was assessed in a double-blind, placebo-controlled study in which 34 patients participated. Seventeen of the 34 trial patients yielded adenovirus type 8; three were infected with adenovirus type 7. The outbreak was curtailed by control of infection measures: principally careful hand-washing by medical personnel between cases and by discouraging attendance of new cases at the Eye Infirmary. Consequently the trial numbers are small. In addition there was a wide interpatient variation in the severity of infection. Therefore it was not possible to make any statistically valid conclusions concerning the recovery rate of patients receiving interferon or placebo.

Adenoviridae Infections↗
PubMed1999

Efficacy of supratarsal dexamethasone versus triamcinolone injection in recalcitrant vernal keratoconjunctivitis.

PURPOSE: To compare the efficacy of supratarsal injection of short acting dexamethasone sodium phosphate versus intermediate acting triamcinolone acetonide as a new therapeutic modality for treating eyes with recalcitrant vernal keratoconjunctivitis (VKC). METHODS: The study was a prospective, randomized, double blind, case controlled trial, including 38 eyes of 19 patients with recalcitrant VKC. Except for two initial patients who received supratarsal injection of triamcinolone acetonide in both the eyes, one eye of each patient was randomly assigned to receive either 2 mg of dexamethasone sodium phosphate or 20 mg of triamcinolone acetonide. RESULTS: Both the drugs were equally effective with no statistically significant difference in the mean time of resolution of cobblestone papillae, limbal edema, shield ulcer, SPK and relief of symptoms. The recurrence rate of disease was, however, lower following triamcinolone acetonide injection. CONCLUSIONS: Supratarsal injection of corticosteroid is a cheap, effective and safe modality of treatment for managing eyes with recalcitrant VKC. Both short acting dexamethasone and intermediate acting triamcinolone acetonide are equally effective.

Adolescent↗
PubMed1999

Vernal keratoconjunctivitis in a Stockholm ophthalmic centre--epidemiological, functional, and immunologic investigations.

PURPOSE: To classify a cohort of 62 patients with vernal keratoconjunctivitis (VKC) in immunologic, functional, and epidemiological terms. METHODS: A retrospective chart review was conducted to establish the patients' ethnic origin and to ascertain the results of standard in vitro and in vivo testing for atopic allergy. The latter data were compared with tear Phadiatop, an allergy screening test, in 31 subjects. Further subgroup analyses included methacholine bronchial provocations, serum screening for chlamydial antibodies and epidemiological calculations of the observed prevalence of VKC in the Stockholm area in 1994. RESULTS: Thirty-seven subjects (59.7%) were sensitised to common allergens. No additional allergic subjects were diagnosed with the tear Phadiatop test. The serology for ocular chlamydial disease was negative. Only 6 out of 17 subjects displayed bronchial reactivity to methacholine of whom 4 had a history of asthma. VKC was clearly more common in individuals with an Asian and African origin. CONCLUSIONS: Sensitivity to allergens is a strong determinant for the disease but in a large proportion of the subjects this immunologic abnormality is absent. The varying prevalence of the condition in different ethnic groups indicates a genetic predisposing factor.

Adolescent↗
PubMed1989

Thiomersal keratoconjunctivitis, frequency, clinical spectrum and diagnosis.

Thiomersal keratoconjunctivitis is a common problem in soft contact lens wearers, accounting for thirty two (10%) of three hundred and twelve consecutive referrals for contact lens related problems to an out patient department. The clinical findings in 55 patients are described, of which 42 show the 'typical' appearance of the condition. This consists of non-specific conjunctival changes, limbal follicles, superficial punctate keratopathy and superior corneal epithelial opacity. Thirteen atypical cases are presented, demonstrating superior limbitis occurring in isolation, coarse punctate keratopathy, severe keratopathy with visual loss, pseudo-dendritic corneal lesions, acute conjunctival hyperaemia without keratopathy. Symptoms were also seen in two patients who were hard lens wearers. In such atypical cases, diagnosis may be difficult but can be aided by the use of topical challenge with thiomersal.

Adult↗
PubMed1991

Mast cell hyperplasia in atopic keratoconjunctivitis. An immunohistochemical study.

Immunohistochemical staining of conjunctival biopsies from four normal subjects and five patients with atopic keratoconjunctivitis (AKC) was performed, using a monoclonal antibody to human mast cell tryptase. A massive hyperplasia of mast cells in the patients with AKC was demonstrated. The mean mast cell density in the normal patients was 55.6/mm2 and in the patients with AKC, 172/mm2. The appearance of large numbers of mast cells in the conjunctival epithelium of AKC patients was also demonstrated. The possible pathophysiological significance of these findings is discussed.

Adolescent↗
PubMed1993

Microsporidial keratoconjunctivitis in AIDS.

Microsporidia are rare human opportunistic pathogens that are now increasingly recognised in patients with AIDS, most commonly as an ocular or enteric pathogen. This paper reports a case of microsporidial keratoconjunctivitis in a patient with AIDS which responded to treatment with dibromopropamidine isethionate ointment. The clinical and laboratory features of microsporidial ocular infection are reviewed.

AIDS-Related Opportunistic Infections↗
PubMed2000

Improvement of the ocular surface using hypotonic 0.4% hyaluronic acid drops in keratoconjunctivitis sicca.

BACKGROUND: The ocular surface changes of keratoconjunctivitis sicca (KCS) could be the result of the effect of an altered tear film on the epithelial environment. PURPOSE: To evaluate the possibility of improving the environmental conditions of the ocular surface by lowering tear osmolarity, increasing tear film volume and stabilising the tear film. Also, to study the effect of such an improvement on the epithelial cells of the ocular surface. METHODS: One hundred and thirty-five patients with a diagnosis of KCS were treated on a randomised basis with either unpreserved hypotonic 0.4% hyaluronic acid (HHA) eye drops or 0.3% hydroxypropylmethylcellulose plus 0.1% Dextran 70 (HPMC) eye drops 6 times a day for 60 or 90 days. In all patients a Schirmer I test, break-up time (BUT), ocular surface staining with 1% Bengal Rose, or 2% fluorescein, as well as subjective symptoms, were recorded before and 15, 30 and 60 days after the beginning of the study. Patients were divided into three subgroups and the effect of the treatment was studied using three different techniques: the tear ferning test, conjunctival impression cytology and tear osmolarity measurement. RESULTS: Improvements in BUT, vital staining, Schirmer I and symptoms were recorded in both groups of treatment, with significant differences for patients treated with 0.4% HHA. On day 60, 30 min after installation: tear ferning patterns changed from 100% pathological (types III-IV) to 93% physiological (types I-II) in the 0.4% HHA group and from 100% pathological to 78% physiological in the 0.3% HPMC group (p < 0.01 between groups). Tear osmolarity shifted from 353 +/- 23 to 305 +/- 6 mosmol/l in the 0.4% HHA group and from 346 +/- 15 to 336 +/- 8 mosmol/l in the 0.3% HPMC group (p < 0.001 between groups). On day 90, the impression cytology score improved from 1.2 to 1.9 in the 0.4% HHA group while it did not change in the 0.3% HPMC group (p < 0.05 between groups). CONCLUSION: In KCS appropriate treatment with a hypotonic 0.4% HHA tear substitute can change the tear environment and results in improvement of the epithelial conditions of the ocular surface.

Adjuvants, Immunologic↗
PubMed2003

Corneal surface changes in keratoconjunctivitis sicca. Part II: The mucus component. A non-contact photomicrographic in vivo study in the human cornea.

PURPOSE: Description of mucus on the corneal surface and in the precorneal tear film in keratoconjunctivitis sicca (KCS). METHODS: In all, 24 patients with KCS examined with slit lamp and by non-contact photomicrography. RESULTS: Material interpreted as mucus seemed to exist in three varieties: one optically dense, light reflecting, and with definite forms (fine threads, variously thick and long strands, sheet-like structures); one appearing as small clumps or patches of light-reflecting material adhering to the corneal surface; and one amorphous. All were present either per se, or in various combinations, with or without adherent cell debris. The mucus attached to abnormal (stainable) corneal surface cells. CONCLUSIONS: The formed material strongly resembles formed mucus found in samples from normal conjunctival surface; the light-reflecting clumps or patches adhering to the surface are possibly of the same origin. The nature of the amorphous material is unclear. Adherence of formed mucus to the corneal surface seems to be related to the presence of abnormal (stainable) surface cells.

Adult↗