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PubMed1986

Acute anterior uveitis and conjunctivitis following Yersinia infection in children.

We studied characteristics of ocular inflammation associated with yersinia infection in six children, three boys and three girls, ranging in age between 4 and 14 years. Four patients developed acute anterior uveitis with aqueous flare and cells, small keratic precipitates, cells in the vitreous, and occasionally with fibrinous exudates, posterior synechiae and macular edema. The uveitis was unilateral in two patients and bilateral in two. In three 10- to 14-year-old patients the uveitis resolved during corticosteroid treatment in 3 to 8 (mean 6) weeks. In a 4-year-old girl with positive antinuclear antibody titers bilateral uveitis lasted for 17 weeks. Two uveitis patients had recurrent episodes. Two patients had mucopurulent bilateral mild conjunctivitis which resolved in 3 to 5 days. All patients had symptoms of reactive arthritis and one had sacroiliitis. All tested patients were HLA-B27 positive. Our results indicate that in HLA-B27 positive children, especially after the age of 10 years, yersinia infection may occasionally trigger reactive iritis or conjunctivitis which often occur together with other HLA-B27 associated rheumatic diseases.

Acute Disease↗
PubMed1992

Twice daily 4% Sodium Cromoglycate vs. 2% Sodium Cromoglycate used four times daily in seasonal (grass pollen) allergic conjunctivitis.

It is well established that 2% Sodium Cromoglycate is an effective treatment for a number of allergic eye diseases. It has been shown to be non-toxic. It can be used longterm and in serious allergic problems it is a useful adjunctive therapy to steroids. The main problem with Sodium Cromoglycate is that the recommended dosage is a four times daily application and patient non-compliance is common. One of the main objectives of any therapy is to reduce the frequency of dosage and the current study has been designed to investigate the efficacy of a 4% solution of Sodium Cromoglycate, used twice daily, versus a 2% solution used four times daily in seasonal allergic conjunctivitis. A multicentre study, therefore, was carried out to assess the efficacy of both drugs and to assess any possibility of side effects. In addition, a unit dose was used, thus eliminating preservatives and it was used specifically in seasonal allergic conjunctivitis in the pollen season. This study showed that 4% Sodium Cromoglycate used twice daily was at least as affective as 2% Sodium Cromoglycate used four times daily.

Adolescent↗
PubMed1975

[Clinical, electron-microscopic, and histochemical investigations of conjunctivitis lignosa (author's transl)].

A case is briefly described in which a typical conjunctivitis lignosa appeared after the eye had suffered lime burns. In order to help clarify the morphological connection between mucopolysaccharide production and fiber development in the tumor tissue which occurred after the burn, samples were examined histologically, histochemically and with the use of the electron microscope. The tumor had a cartilage like consistency. Its structure could be devided into three regions. Region A is the pseudo-membrane. It has root like extensions which anchor it to the underlying tissue, and which morphologically appear partially homogeneous and partially fibrous. Blood cells and cell remnants are included in the tissue of the pseudomembrane. The histochemical examination of the pseudomembrane did not present a uniform picture. Along with small amounts of dermatan-sulfate and chondroitin-sulfate B the membrane probably contained a rather large amount of hyaluronic acid. The pseudomembrane borders on a granular tissue (Region B) which is distinguished by the wide metachromatic sheathes of the blood vessels found in it and the particularly large number of active fibroblasts along its edges. The silver impregnation method and the electron-microscopic examination showed that the vascular sheathes consist of bundles of reticular fibers which constitute a three-dimensional network. A similar sort of sheath was observed around the fibroblasts. Chondroitin-sulfate makes up the largest fraction of the mucopoly-saccharides near the fibers and appears particularly concentrated at the intersections of the fibers, although it is also diffusely distributed as well. Dermatan-sulfate (or heparan-sulfate) is found only in the mucopolysaccharide sheath of the fibers themselves. The deep region of the tumor (Region C) consists almost exclusively of blood vessels, their sprouts and the fibroblasts which, with their wide fibrous sheathes, almost fill the spaces between the blood vessels. The reticular fibers and their mucopolysaccharide sheathes have the same structure as that observed in Region B, The fact that the mucopolysaccharides did not appear in plaques but rather as bound primarily to the fibers is grounds for suggesting that a fiber development disorder, probably stemming from the pericytes and fibroblasts rich in ergastoplasm and fibrilles, could play the principle role in conjunctivitis lignosa. The cartilagen like consistency of the tumor could be a result of the arrangement of the fibers and their mucopolysaccharide sheathes. Brief remarks are included concerning the therapeutic consequences of the study.

Adult↗
PubMed1990

Evolutionary study on the Coxsackievirus A 24 variant causing acute hemorrhagic conjunctivitis by oligonucleotide mapping analysis of RNA genome.

The evolution of the variant of Coxsackievirus A 24 (CA 24 v) which causes acute hemorrhagic conjunctivitis was explored. Using 15 isolates obtained from Southeast Asia during the period 1970-1986, the genetic distance between isolates was estimated from pairwise comparison of nucleotide changes deduced from common spots on oligonucleotide maps of the isolates. From regression analysis of the genetic distance and the time of isolation of the isolates, the evolutionary rate of CA 24 v was estimated to be 3.44 x 10(-4)/nucleotide/month. The phylogenetic relationship of these isolates was explored using the neighbor-joining method and the modified unweighted pair group method using arithmetic averages (UPGMA). The phylogenetic tree constructed indicates that CA 24 v appeared from one focal place in July 1968 +/- 25 months, very close to the time of the first world epidemic of, then newly recognized, acute hemorrhagic conjunctivitis.

Asia, Southeastern↗
PubMed1987

Topical human fibroblast interferon for acute adenoviral conjunctivitis.

We conducted a prospective, randomized, double-blind, placebo-controlled clinical trial investigating the use of topical human fibroblast interferon (HuIFN-beta) 7.5 x 10(5) IU/ml, one drop 5 times daily, in the treatment of acute epidemic conjunctivitis. Of 50 patients who were initially enrolled, tear-film cultures for adenovirus were positive from 26% for type 8, 12, or 19. Based upon a quantifiable conjunctivitis severity score of 37 patients evaluated after approximately 1 week of therapy, analysis of covariance showed a statistically significant greater improvement with topical HuIFN-beta compared with placebo for affected left eyes (P = 0.02) but not for right eyes (P = 0.5), an effect that could not be adequately explained. We suggest that a higher dosage of topical HuIFN-beta may prove useful in the control of more severely affected cases. This trial provides guidelines for future investigations of interferon in the treatment and prophylaxis of adenoviral keratoconjunctivitis.

Adenoviridae Infections↗
PubMedDate not supplied

Nedocromil sodium ophthalmic solution 2% twice daily in patients with allergic conjunctivitis.

In a multicenter, open-label evaluation, 1098 patients with ocular itching and a history of perennial or seasonal allergic conjunctivitis instilled one drop of nedocromil sodium 2% twice daily in each eye. Ocular symptoms, signs, and global improvement were assessed at baseline and 1 month; satisfaction scores, quality-of-life variables, and adverse events were also recorded. Significant improvements from baseline (P<.012) occurred in mean severity scores for itching, burning, stinging, watering, swelling, tired eyes, dryness, gritty sensation, eye pain, foreign-body sensation, and light sensitivity. Physicians reported significant reductions (P<.0001) in bulbar conjunctival redness and swelling. Two thirds of patients (634/954) and three fourths of physicians (710/954) reported at least 75% improvement in overall condition after 1 month. The most common adverse events were burning (2.7%) and unpleasant taste (1.4%); headache (1.2%) and adverse events leading to discontinuation (1.3%) were rare. Patients reported significant improvement (P<.001) in their ability to perform daily activities; 65% were more satisfied with nedocromil than with their typical medication. Physicians would prescribe nedocromil again to 80% of the patients. Nedocromil sodium 2% twice daily was effective and safe for the treatment of symptoms of allergic conjunctivitis, significantly improving quality of life and producing high rates of user and physician satisfaction.

Activities of Daily Living↗
PubMedDate not supplied

Efficacy and acceptability of nedocromil sodium 2% and olopatadine hydrochloride 0.1% in perennial allergic conjunctivitis.

In this 2-week, randomized, crossover study, ophthalmic solutions of nedocromil sodium 2% and olopatadine hydrochloride 0.1% were compared for effectiveness and acceptability in 28 patients with perennial allergic conjunctivitis and previous olopatadine experience. Patients received nedocromil twice daily or olopatadine twice daily for 1 week, then were crossed over to the alternate medication for 1 week. Outcome measures were patient satisfaction (questionnaire), severity of ocular symptoms (daily diary scores), clinical signs (physician assessments), quality of life (questionnaire), and global assessments of effectiveness. Both medications were well accepted. Of the 28 patients, 16 (57.1%) would request a nedocromil prescription, 10 (35.7%) an olopatadine prescription (P = .157); 22 patients (78.6%) would recommend nedocromil to other allergy sufferers, while 18 (64.3%) would recommend olopatadine (P = .480). Light sensitivity scores were significantly lower with nedocromil (P = .0125); other symptom scores were comparable between medications. Both drugs significantly (P < .01) and comparably decreased erythema, conjunctival injection, and overall conjunctival signs from baseline. Comparable improvement also occurred in quality-of-life scores. Both physicians and patients judged nedocromil and olopatadine to be similarly effective in preventing signs and symptoms. Nedocromil sodium 2% is an effective treatment for perennial allergic conjunctivitis. Patients receiving olopatadine can be switched to nedocromil with no loss in efficacy or satisfaction, but with a reduction in cost.

Adolescent↗
PubMedDate not supplied

Nedocromil sodium in golfers with seasonal allergic conjunctivitis.

To evaluate nedocromil sodium 2% ophthalmic solution for the treatment of seasonal allergic conjunctivitis, 24 golfers with documented ragweed-pollen allergy instilled eyedrops twice daily for 4 days prior to golf-course intervention and 15 minutes before playing a round of golf during peak ragweed season. Ocular symptoms were scored at baseline (7 days before golfing), prior to instillation on the day of golf, and 30 minutes, and 1, 4, 8, and 12 hours after tee-off. Physician assessment was performed prior to tee-off, before tee-off on the ninth hole, and at the end of the 18th hole. Itching, burning, grittiness, tearing, redness, and light sensitivity were significantly decreased after nedocromil administration, as were erythema, edema, conjunctival hyperemia, and overall findings in the conjunctiva. Symptom severity scores fell approximately 30 minutes after instillation, with improvements persisting 8 and 12 hours after treatment. Most patients (92%) rated the treatment moderately or completely effective, and 83% were willing to continue its use. Physician assessments of effectiveness agreed with those of the patients. In this open-label study, nedocromil sodium eyedrops relieved the ocular symptoms of seasonal allergic conjunctivitis for up to 12 hours, well beyond a usual round of golf.

Adolescent↗
PubMedDate not supplied

Efficacy and safety of ketorolac tromethamine 0.5% and levocabastine 0.05%: a multicenter comparison in patients with seasonal allergic conjunctivitis.

This multicenter, double-masked, randomized, parallel-group study compared the efficacy and safety of ketorolac tromethamine 0.5% ophthalmic solution with levocabastine 0.05% and ketorolac tromethamine vehicle in patients with seasonal allergic conjunctivitis. One drop of ketorolac, levocabastine, or vehicle was instilled in each eye four times daily for 6 weeks. In the majority of efficacy variables, ketorolac produced the greatest improvements, followed by levocabastine and vehicle. Ketorolac was significantly more effective (P < .05) than vehicle in reducing mean itching scores, palpebral hyperemia, bulbar hyperemia, and edema. Patients treated with ketorolac reported significant improvements (P < .05) in their ability to sleep and to concentrate on work, compared with those who received vehicle. No significant differences were noted among the treatment groups in safety or tolerability. Ketorolac tromethamine 0.5% ophthalmic solution instilled four times daily is effective and safe in reducing the signs and symptoms of seasonal allergic conjunctivitis.

Adolescent↗
PubMed2002

The effect of BCG-PSN on T-cell subsets and cytokines in vernal conjunctivitis.

The effects of BCG-PSN on T-cell subsets and cytokines in vernal conjunctivitis were observed. The level of total IgE was quantitatively determined before and after treatment with BCG-PSN by allergen diagnostic instrument in vitro. The content of T-cell subsets of peripheral blood and cytokine were determined by using indirect immune fluorescence method, and IL-4 and INF-gamma were quantified by ELISA. The results showed that the level of total IgE was substantially reduced (P < 0.01) after treatment in the BCG-PSN group. Meanwhile, CD8+ was decreased, CD4+ and CD4+/CD8+ ratio elevated with significant differences (P < 0.05) as compared with pre-treatment results. The changes in total IgE, CD8+, CD4+ and CD4+/CD8+ ratio after treatment also presented significant differences (P < 0.05) between BCG-PSN group and routine treatment group. The level of IL-4 in serum declined (P < 0.05) after treatment in the BCG-PSN group, and INF-gamma went up (P < 0.05). IL-4 and INF-gamma in serum showed significant differences (P < 0.05) between two groups after treatment. It is concluded that BCG-PSN has a bi-directional immunoregulating effect. It can bring CD4+ and CD8+ into homeostasis, thereby preventing the occurrence of anaphylaxis. At the same time, BCG-PSN can restrain Th2, decrease the synthesis of IL-4, switch the balance of Th1/Th2 to Th1 side, boost up the predominance of Th1 relatively, which is propitious to perennial stabilization and recovery of vernal conjunctivitis.

Adolescent↗
PubMed1999

Meta-analysis of six clinical phase III studies comparing lomefloxacin 0.3% eye drops twice daily to five standard antibiotics in patients with acute bacterial conjunctivitis.

BACKGROUND: Lomefloxacin 0.3% ophthalmic solution twice daily has been compared in patients with bacterial conjunctivitis in six randomized double-blind or investigator-masked phase III studies with either chloramphenicol 0.5% 5x/day, gentamicin 0.3% 4x/day, fusidic acid 1% 2x/day, tobramycin 0.3% 4x/day or norfloxacin 0.3% 4x/day. METHODS: A meta-analysis of all individual data of these six studies was performed. A total of 582 patients with clinically diagnosed bacterial conjunctivitis were evaluated by slit-lamp examination with grading of eight key signs and symptoms and by conjunctival swab cultures at baseline, on day 3-5 and on day 7-9. Success of therapy, local tolerance and safety were evaluated at termination. In vitro sensitivity of the ocular isolates to 6-10 antibiotics was evaluated by disk diffusion tests. RESULTS: Two hundred and ninety patients treated with lomefloxacin 0.3% (LF) and 292 patients treated by one of the control antibiotics (combined control group, CCG) were enrolled in the studies. Two hundred and seventy-eight LF and 283 CCG patients were evaluable for the intent-to-treat (ITT) analysis, while 85 LF and 95 CCG patients had bacteria above the pathological threshold and formed the core subpopulation. The mean cumulative sum score in the LF group was 9. 47 on day 1, and decreased by 5.70 on day 3-5 and by 8.10 on day 7-9. In the CCG it decreased significantly less: it was 9.19 at baseline, decreased by 5.15 on day 3-5 and by 7.33 on day 7-9. Swab counts decreased in the LF and CCG group similarly, with the major decrease observed between day 1 and day 3-5. Most of the organisms considered resistant in vitro were still eradicated with the regimen used. Of the few surviving organisms also isolated on the next follow-up visit, one isolate in the LF group and seven in the CCG showed decreased in vitro sensitivity towards the treatment antibiotic used. Local tolerance was good or excellent, without any significant differences except for burning sensation, which lasted significantly longer in the CCG group than in the LF group. Adverse events were observed in 18 LF and 23 CCG patients; four LF and three CCG patients had to be withdrawn. All adverse events were non-serious. CONCLUSION: Lomefloxacin eye drops used with a loading dosage followed by a twice daily regimen proved as effective, safe and well tolerated as five established standard treatments used at a 2, 4 or 5 times daily regimen, caused less discomfort upon instillation, and showed a lower risk to generate or select new resistant strains.

Acute Disease↗
PubMed2004

Dynamics of PAF-induced conjunctivitis reveals differential expression of PAF receptor by macrophages and eosinophils in the rat.

The action of platelet-activating factor (PAF) toward the PAF receptor (PAF-R) plays an important role in inflammation. We employed immunohistochemistry and quantitative confocal immunofluorescence microscopy to examine the dynamic changes of PAF-R expression in the conjunctiva in response to PAF-induced conjunctivitis in Brown Norway rats within the first 2 h after topical administration of PAF. Instillation of PAF caused an alteration in pattern of recruitment of macrophages and eosinophils into the conjunctiva, as was visualized by immunohistochemical staining for the antigens ED 1 and ED 2 (markers of macrophages) and MBP (a marker of eosinophils). An increase in the number of PAF-R positive cells was alos detected. Quantitative colocalization analysis revealed ther strongest rise in the degree of PAF-R expression by macrophages within the first 6 h, whereas their infiltration increased throughout the period of observation. However, eosinophils showed a high degree of PAF-R expression during all 24 h of the experiment, although they infiltrated strongly only within the first 2 h. Thus, for the first time, the use of quantitative colocalization analysis software developed by us has reveal intrinsic details of the interaction of PAF anf PAF-R in conjunctivitis, findings not otherwise obtainable by using qualitative approaches alone. Our results provide a theoretical basis for a definition of the proper time-frame in which to prevent and control the infiltration of macrophages and eosinophils into the conjunctiva.

Administration, Topical↗
PubMed1977

Severe persistent inclusion conjunctivitis in a young child.

A 14-month-old girl had inclusion conjunctivitis although there had been no signs or symptoms that required medical attention in her first year. By 2 1/2 years of age, the child had extensive pannus and corneal scarring that severely reduced vision. The infection was caused by a genital strain of Chlamydia trachomatis, TRIC type E, that was probably acquired at birth. Although genitally transmitted chlamydial strains normally cause a self-limiting inclusion conjunctivitis in areas where trachoma is not endemic, this case illustrates that they may occasionally cause severe trachoma. Possibly local idoxuridine (IDU) treatment (administered to this patient before the correct diagnosis was made) contributed to the severity of this infection.

Child, Preschool↗
PubMed1981

Giant papillary conjunctivitis after keratoplasty.

Giant papillae of the upper tarsal conjunctiva have been found in vernal conjunctivitis and, more recently, in giant papillary conjunctivitis in patients with contact lenses. A similar syndrome occurred in 11 patients who had undergone penetrating keratoplasty with interrupted nylon sutures. Minimal itching, mild mucous discharge, mild blepharoptosis, and giant papillae of the upper tarsal conjunctiva were associated with exposed suture ends. Removal of exposed sutures led to resolution of the condition. Conjunctival scrapings from three of five patients demonstrated eosinophils. Although the syndrome may have an immunologic basis, the findings are also consistent with a mechanical origin related to exposed nylon sutures.

Adolescent↗
PubMed1981

An immunopathologic study of giant papillary conjunctivitis associated with an ocular prosthesis.

A 21-year-old woman, whose left eye had been enucleated when she was 2 years old, developed giant papillary conjunctivitis and experienced ocular discomfort and increased tearing when she wore her prosthesis. Cultures grew normal flora, and topical antibiotics failed to relieve her symptoms. Immunopathologic studies of a conjunctival biopsy specimen disclosed plasma cells of all five classes of immunoglobulins in the substantia propria and many IgE-containing cells. Russell bodies found in some of the plasma cells were of the IgM and IgG types. The patient was treated with a 2% solution of cromolyn sodium, applied four times a day. Within one month, her symptoms had resolved, there was less conjunctival congestion, and the papillae were much less prominent. Our findings suggested that there may be a heterogenous humoral response in giant papillary conjunctivitis along with a strong immediate (Type I) hypersensitivity component.

Adult↗
PubMed1983

Aspirin therapy in vernal conjunctivitis.

Prostaglandin D2 is a secondary mast cell mediator that causes redness, chemosis, mucous discharge, and eosinophil chemotaxis in the eye. It may play an important role in allergic ocular disease. Although histamine is a key mediator of allergic inflammation, antihistamine therapy provides only symptomatic relief. We added aspirin therapy to the treatment regimen of three patients with vernal conjunctivitis. Aspirin acetylates the enzyme cyclooxygenase, thereby preventing the formation of prostaglandin D2. Within two weeks after initiation of aspirin therapy, we noted dramatic improvement in conjunctival and episcleral redness and resolution of keratitis and limbal infiltration. We recommend a trial of oral aspirin as adjunctive therapy for intractable cases of vernal conjunctivitis.

Adolescent↗
PubMed1989

Treatment of gonococcal conjunctivitis with single-dose intramuscular ceftriaxone.

We treated 13 consecutive patients with culture proven Neisseria gonorrhoeae conjunctivitis with single-dose intramuscular injections of ceftriaxone. Pretreatment conjunctival cultures and Gram stains were obtained from all patients. The patients were admitted for antibiotic administration, a single conjunctival saline lavage, and follow-up conjunctival cultures six and 12 hours after treatment. Three of 13 organisms (23%) were penicillinase producing. All patients responded to treatment, and all six- and 12-hour posttreatment cultures were negative for N. gonorrhoeae. These results indicate that a single intramuscular dose of ceftriaxone is curative treatment for non-neonatal gonococcal conjunctivitis.

Adolescent↗