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Most cases of conjunctivitis are either viral in origin, which makes them extremely contagious and usually self-limited, or bacterial, which usually requires topical antibiotic therapy. Prolonged follicular conjunctivitis should be considered chlamydial in origin and requires systematic antibiotic therapy.
The prescript requiring application of silver nitrate eye drops (0.66% AgNO3) to the conjunctivae of the newborn within two hours after delivery was revoked in March 1985. The present study comprises a prospective investigation of the occurrence of microorganisms in specimens of eye secretion from neonates received during the period February-April 1986, and a review of findings of Neisseria species and B. catarrhalis in 3,485 specimens of ocular secretions and of C. trachomatis in 1,240 conjunctival scrapes received at the Neisseria Department 1986-1988. The numbers of cases of conjunctivitis neonatalis caused by the following microorganisms were: N. gonorrhoeae 8, N. cinerea 6, other Neisseria species 8, B. catarrhalis 49 and C. trachomatis 92. During the period 1984-1988, the total number of neonates with gonococcal conjunctivitis neonatalis was 18. The gonococcal infection was diagnosed within the first week of life in 50% of the cases but could occur as late as in the fourth week of life. Similarly, infection with B. catarrhalis was most common in neonates less than one week old (49%), whereas chlamydial infection was most common in the second week of life (39%). It is concluded that the eyes of neonates should be carefully observed for at least four weeks and that microbiological examinations for gonococci and chlamydia are indicated if signs of infection appear.
A patient with chronic conjunctivitis was found to have a parasitic nematode infection of the conjunctiva. The parasite was found within the cul-de-sac of the conjunctiva, entirely motile. The treatment of the conjunctivitis was simple removal of the organism, and periodic follow up.
The development of techniques for the continuous administration of drugs to the eye raises the question of whether a conjunctivitis can be controlled by continuous low rates of steroid release, or whether large, intermittent doses of steroid, as provided by eyedrops, are necessary. Efficacy of the two modes of drug administration was evaluated in a conjunctivitis model produced in immunized rabbits by daily topical ocular challenge with antigen. The acetates of hydrocortisone and prednisolone were released from a drug delivery system inserted in the cul-de-sac of the eye or were provided in eyedrops. The model was sufficiently sensitive to differentiate between the effectiveness of hydrocortisone and prednisolone. The continuous delivery of either steroid from the drug delivery system was as efficacious, or more so, than the corresponding steroid dose given as eyedrops.
One hundred forty-three patients (207 eyes) with conjunctivitis or blepharoconjunctivitis were studied. Attempts were made to establish an etiologic diagnosis by clinical and laboratory methods. The etiologic diagnosis that was made on the basis of the initial clinical examination correlated poorly with the results of standard laboratory tests. Conversely, the standard laboratory evaluation failed to establish a definitive diagnosis in the majority of cases. These findings suggest that the diagnostic dogmatism prevalent in conjunctivitis is unwarranted. Morphologic signs and routine laboratory tests leave us without a verified etiologic diagnosis in a substantial number of cases.¿
A new adenovirus of intermediate type involved in conjunctivitis has been isolated. The virus is related to adenovirus types 13 and 30 by neutralization and to types 10 and 19 by hemagglutination inhibition. Since 1976 the agent has been causing sporadic cases of conjunctivitis in different parts of The Netherlands. Twenty-three cases have been established by virus isolation from the affected eyes. The symptoms of the disease range from epidemic keratoconjunctivitis to pharyngoconjunctival fever. Also, adenovirus type 13-30/10-19 has been isolated from the cervix uteri of four women in a series of 1,477 women with cervicitis.
Aerobic and anaerobic cultures and clinical data were obtained from 126 pediatric patients with acute conjunctivitis. Similar cultures were obtained from 66 persons who did not have a conjunctival inflammation. Anaerobes were isolated from 47 patients (37.3%). In 26 cases (20.6%), they were in mixed cultures with aerobes, and in 21 cases (16.7%), they were the only isolates. Aerobes alone were recovered in 72 patients (57.1%). No bacterial growth was noted in seven patients (5.6%). The organisms recovered from eyes with conjunctivitis in statistically significant numbers were Staphylococcus aureus, Streptococcus pneumoniae, Haemophilus influenzae, and anaerobic Gram-postive cocci.
Five patients with symptomatic giant papillary conjunctivitis were treated with topical cromolyn sodium eyedrops. All patients responded favorably with relief of symptoms. Four of the patients who were subsequently examined while receiving cromolyn therapy had less prominent giant papillae on the upper tarsal conjunctivae. Thus far, the treatment of giant papillary conjunctivitis has been poorly defined and is not always practical. Topical cromolyn eyedrops seem to be helpful in the treatment of this disorder.
The floppy eyelid syndrome represents a chronic conjunctivitis characterized by a triad of (1) a loose upper lid that readily everts on elevating the lid, (2) a soft rubbery tarsus that can be folded on itself, and (3) a diffuse papillary conjunctivitis. Seven cases of this condition are reported, all involving men, and four involving obese patients.
We report the association of ligneous conjunctivitis with middle-ear and tympanic membrane involvement in two children. Eye and ear specimens revealed histopathologic and ultrastructural findings consistent with ligneous conjunctivitis, characterized by an amorphous, eosinophilic material with acute and chronic nongranulomatous inflammation. Ear specimens demonstrated granulation tissue along with the above features. Conjunctival and ear lesions from these patients were studied histochemically, immunohistochemically, and ultrastructurally. Our studies demonstrate fibrin and albumin deposition as a common feature in all lesions. Deposition of other components, such as mucopolysaccharides, amyloid, immunoglobulins, and mast cells, were, however, variable. The diversified nature of these lesions, together with the association of eye and ear disease, substantiates the existence of an underlying systemic disorder of unknown cause.
In an attempt to reduce chemical conjunctivitis after silver nitrate prophylaxis, three different ophthalmic solutions (sodium chloride, sterile water, and a boric acid-sodium borate solution) were used to irrigate the eyes immediately after prophylaxis in 450 neonates. Sterile water significantly reduced (P less than .02) the prevalence of chemical conjunctivitis when compared to the conventional sodium chloride rinse. A significantly greater prevalence of chemical irritation in low-birth-weight infants was also noted (P less than .02).
Results of oral and topical erythromycin therapy in 41 infants under 4 months of age with chlamydial conjunctivitis were evaluated in randomized clinical trial. After three weeks of treatment, relapse or reinfection of the eye occurred in four of 19 patients (21%) in the topical therapy group and in three of 22 patients (13.6%) in the oral therapy group (p less than .69). In the topical therapy group, chlamydiae were isolated from nasopharyngeal cultures of eight patients (42%) during or after therapy. Chlamydiae were eradicated from the nasopharynx of the six colonized patients treated with oral erythromycin. All relapses responded to a course of oral erythromycin therapy. We conclude that both modes of therapy are comparable for treatment of chlamydial conjunctivitis, but that oral therapy has the advantage of eradicating nasopharyngeal colonization.
Four prepubertal children had confirmed gonococcal conjunctivitis. All were febrile and had hyperpurulent conjunctival discharge with periorbital inflammation. Cultures of pharyngeal, rectal, and genital specimens on selective media excluded infection at other sites. Detailed social evaluation revealed no evidence or suspicion of sexual abuse. Isolated gonococcal conjunctivitis occurs in prepubertal children. Unlike gonococcal infections at other locations, a nonsexual mode of transmission may exist. However, a careful physical examination and detailed social evaluation, looking for signs of sexual abuse, must be obtained in any prepubertal child with a gonococcal infection.
Seasonal allergic conjunctivitis is one of the most common manifestations of allergic disease, affecting 15 % population in the United States annually. Short ragweed (RW) is a major cause of seasonal allergies. Immunostimulatory DNA sequences (ISS or CpG motifs) can inhibit an on-going Th2/allergic response and induce a de novo Th1 response. In this study, we investigated the ability of these ISS to modulate allergic responses in a RW-induced mouse model of seasonal allergic conjunctivitis. Systemic or mucosal administration of ISS oligonucleotide (ISS-ODN) after RW sensitization inhibited both the immediate hypersensitivity response and the late-phase cellular infiltration and induced a RW-specific Th1 response. ISS-ODN administration suppressed the rise of RW-specific IgE titers after repeated allergen challenge. Furthermore, ISS administration was more effective than dexamethasone in inhibiting the allergic response. Mechanistically, the ISS-induced immunomodulatory effects were abolished when mice were treated with anti-IL-12 neutralizing antibodies, suggesting a pivotal role for type 1 cytokines in the inhibition of both the immediate hypersensitivity and the late-phase cellular infiltration. Thus, ISS-ODN is a novel anti-inflammatory and immunomodulatory agent that significantly inhibits the allergic response and may provide an alternative to the current standard care of ocular allergy.
AIMS: To find out the prevalence of ocular injury and infection among dental personnel in Riyadh, Saudi Arabia. PARTICIPANTS: Two hundred and four dental personnel. METHOD: A questionnaire completed by researchers and observation during practice. RESULTS: The response rate was 81%. Dentists and dental technicians had a similar prevalence (42.3%) of foreign bodies in their eyes during the period of one month. Almost 50.5% of dentists rarely had foreign bodies in their eyes, while only 22.2% of dental technicians claimed the same. The majority of dental surgery assistants (73.6%) never experienced foreign bodies in their eyes. Only 27.0% of female personnel had foreign bodies in their eyes as compared to 73.0% of male personnel, while only 28.5% of females had conjunctivitis as compared to 71.4% among male personnel. 75% of regular eye protector wearers (EPW) never had foreign bodies while 67.2% EPW never had conjunctivitis. Dental technicians were more prone to ocular injury, 13.8% as compared to 4.4% of dentists. Only 30% of the regular eye protector wearers suffered ocular injury. CONCLUSIONS: Protection of the eyes should be emphasised and practised at undergraduate level. The awareness of eye protection should be highlighted at all clinical and research symposia. Further studies should be conducted to assess the financial implications of ocular injuries and infections in dental institutions and practices. Recommendations are made for universal precautions and the observation of safety at work guidelines by all dental team members.
A variant of coxsackievirus A24 (CA24v) is one of the agents causing acute hemorrhagic conjunctivitis. There was an epidemic of acute hemorrhagic conjunctivitis caused by CA24v in Korea from 2002 to 2003. Seventy-one strains of CA24v were isolated from 159 conjunctival specimens (45%). Most of the patients were school children under the age of 20. The epidemic began in the first week of August in 2002, and spread extensively, with a peak in the third week of September. CA24v strains were also isolated from conjunctival specimens in 2003. Reverse transcription polymerase chain reaction (RT-PCR) was performed and sequencing of the 340 bp fragment of the VP1 region of the viruses. Sequencing data were multiple-aligned using CLUSTAL W (version 1.81). Phylogenetic trees were plotted using TreeView (version 1.6.6). Homologies ranged from 97.7%-100%, depending on geographical regions: from 99.4%-100% in 2002 and 98.4%-100% in 2003. A phylogenetic tree based on the nucleotide sequence homologies formed clusters depending on years rather than on geographical regions. Identities (98%-100%) were found among the Korean CA24v strains, and there was 85%-90% homology between these and the prototype strain.
Sol-to-gel systems of ciprofloxacin hydrochloride were prepared utilizing the phase transition properties of hydroxy propyl methyl cellulose K 15 M grade (HPMC) and carbopol 934. The sol-to-gel systems were sterilized by gamma radiation and/or filtration. The sol-to-gel systems were evaluated for rheological characteristics, in vitro release behavior, microbial efficacy, in vivo release behavior, and efficacy against induced bacterial conjunctivitis in rabbits' eyes. Concentration in aqueous humor was determined and stability studies were carried out as per the ICH guidelines. The system passed the test for sterility. The sol-to-gel system exhibited a zero-order drug release pattern over 24 h in in vitro release studies. The drug was active against selected microorganisms in microbial efficacy studies. Better improvement in artificially induced bacterial conjunctivitis in rabbits' eyes was observed in animals treated with the sol-to-gel system compared with marketed eye drops. Drug concentration in aqueous humor was greater than the minimum inhibitory concentration (MIC 90) against selected microorganisms. The shelf-life of the product was >2 years.
The role of nitric oxide in allergic conjunctivitis was studied in a guinea pig model. The eyes of sensitized guinea pigs were challenged with ovalbumin (20 micrograms per eye) or histamine (20 micrograms per eye). Synthesis of nitric oxide (NO) was inhibited using L-NAME (200 micrograms per eye) or aminoguanidine (200 micrograms per eye). The formation of conjunctival edema was graded and levels of nitrite, a breakdown product of nitric oxide were measured in lavage fluid. Conjunctival vasopermeability was determined by measuring the albumin concentration in the fluid on the surface of the eye (lavage fluid). Animals were treated with sodium nitroprusside (SNP) or phenylephrine after which histamine induced conjunctival vasopermeability changes were measured. Drugs were administered topically with the other eye serving as a control. Both ovalbumin and histamine produced a marked inflammatory response including hyperaemia and edema. At the top of the inflammatory response occurring 30 min after challenge, increased levels of nitrite, a breakdown product of NO, were measured in lavage fluid. Prophylactic treatment with L-NAME or aminoguanidine resulted in a significant inhibition of the NO synthesis. Both L-NAME and aminoguanidine decreased conjunctival vascular permeability and edema formation significantly. Administration of SNP resulted in a marked dilatation of conjunctival blood vessels and produced a dose-dependent increase of vascular permeability. Addition of SNP to histamine significantly enhanced conjunctival edema and potentiated vascular permeability. These results indicate that NO is produced in the acute phase of allergic conjunctivitis and mediates vasodilatation after topical provocation with ovalbumin or histamine in sensitized guinea pigs. The resulting increase of the conjunctival blood flow subsequently increases the vascular permeability and enhances conjunctival edema formation. Inhibition of NO synthesis leads to a reduction of conjunctival hyperaemia and subsequently reduces the formation of edema.