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PubMed2006

Clinical and microbiological profile of microsporidial keratoconjunctivitis in southern India.

PURPOSE: To report the clinical and microbiological profile of microsporidial keratoconjunctivitis in immunocompetent individuals in southern India. DESIGN: Retrospective noncomparative case series. PARTICIPANTS: Nineteen cases of microsporidial keratoconjunctivitis diagnosed between January 2002 and December 2004 were studied. METHODS: All medical and laboratory records of patients with infectious keratitis during the study period were reviewed. In all cases, after relevant history recording and slit-lamp examination, corneal/conjunctival scrapings were collected. Multiple scrapings were taken from the lesions and examined by fluorescence or light microscopy after staining with potassium hydroxide and calcofluor white (KOH + CFW), Gram's stain, Kinyoun's, and Giemsa stain. In some cases, the serum was tested for human immunodeficiency virus antibody by enzyme-linked immunosorbent assay. MAIN OUTCOME MEASURES: Clinical course, demographic features, predisposing factors, microbiological profile, treatment, and final outcome. RESULTS: Of 4822 cases of suspected microbial keratitis seen during the period, 19 (0.4%) were identified as microbiologically proven microsporidial keratitis. All patients were apparently healthy; 8 had a history of ocular trauma, and 3 mentioned bathing in unclean river water. All but 2 had unilateral involvement. The mean age of the patients was 38.4+/-13.7 years (range, 23-73). The duration of symptoms ranged from 1 day to 2 years, with 11 of 19 (58%) presenting within a week of onset of symptoms. Slit-lamp examination revealed multifocal, coarse, punctate, raised epithelial lesions in all patients. A mild to moderate nonpurulent conjunctivitis was present in all cases, with papillary and/or follicular reaction in 14. Corneal/conjunctival scrapings demonstrated microsporidial spores by KOH + CFW in 16 of 17 cases tested, whereas the diagnosis was made by Giemsa stain in 2 cases and by Gram's stain in one. Kinyoun's (1% acid fast) stain was confirmatory in all cases. In all patients, treatment was started after debridement and included oral and/or topical antimicrobial agents. At last follow-up, 15 of 19 achieved a visual acuity of 20/20. CONCLUSIONS: Microsporidial keratoconjunctivitis should be considered in the differential diagnosis of atypical punctate epithelial keratitis associated with conjunctivitis and can be diagnosed by routine microbiological methods. The disease can occur in healthy individuals, and the outcome of treatment is often satisfactory.

Adult↗
PubMed2002

Adenovirus detected by polymerase chain reaction in multidose eyedrop bottles used by patients with adenoviral keratoconjunctivitis.

PURPOSE: We investigated the potential of a multidose eyedrop bottle used by patients with adenoviral keratoconjunctivitis as a source for spreading infection. DESIGN: Prospective consecutive case series. METHODS: The contents of multidose eyedrop bottles given to patients with adenoviral conjunctivitis and in use for 1 week were analyzed by polymerase chain reaction for adenovirus after as long as 9 weeks of preservation at room temperature. RESULTS: Of 26 patients with adenoviral keratoconjunctivitis, the eyedrop bottles of 19 patients (73%) were positive for adenovirus. The maximum detection interval was 9 weeks. Significantly higher prevalences of intrafamilial infection (P =.0098) and of corneal subepithelial opacity (P =.046) were observed among cases with adenoviral contamination than among cases without contamination. CONCLUSIONS: Multidose bottles used by patients with adenoviral keratoconjunctivitis are a possible vector for viral transmission for as long as 9 weeks.

Adenovirus Infections, Human↗
PubMed1996

Possible consequences of shaking hands with your patients with epidemic keratoconjunctivitis.

PURPOSE: We evaluated patients' hands as a possible vector for the spread of epidemic kerato-conjunctivitis. METHODS: The hands and conjunctivitis of 26 patients with epidemic keratoconjunctivitis and the hands of 26 uninfected control patients were cultured for infectious adenovirus. RESULTS: In 12 (46%) of 26 patients with epidemic keratoconjunctivitis, cultures from the hands were positive for adenovirus, whereas cultures from the hands of all uninfected control patients were negative. CONCLUSIONS: Simultaneous coinfection of patients' hands and eyes with adenovirus may contribute to office epidemics. Ophthalmologists and coworkers should not shake the hands of patients suspected of having epidemic keratoconjunctivitis unless properly gloved.

Adenovirus Infections, Human↗
PubMed1996

Microsporidial keratoconjunctivitis caused by Septata intestinalis in a patient with acquired immunodeficiency syndrome.

PURPOSE: To examine and treat a patient with acquired immunodeficiency syndrome (AIDS) who had mildly hyperemic conjunctiva and epithelial keratopathy in both eyes. METHODS: The patient underwent conjunctival biopsy. The specimen was examined by transmission electron microscopy. RESULTS: Septata intestinalis was demonstrated to be the cause of keratoconjunctivitis in the patient. The keratoconjunctivitis resolved after three weeks of therapy with topical fumagillin. No organisms were seen on repeat conjunctival biopsy. CONCLUSIONS: Microsporidial keratoconjunctivitis in patients with AIDS can be caused by S. intestinalis. This condition appears to respond to topical fumagillin.

AIDS-Related Opportunistic Infections↗
PubMed1997

Lacrimal punctal occlusion for the treatment of superior limbic keratoconjunctivitis.

PURPOSE: To test the hypothesis that superior limbic keratoconjunctivitis is caused by insufficient tear supply to the superior keratoconjunctiva. METHODS: We used cautery and sutures to permanently occlude the lacrimal puncta of 11 patients (22 eyes) with superior limbic keratoconjunctivitis for whom topical treatment was ineffective. RESULTS: All 11 patients (22 eyes) responded favorably to lacrimal punctal occlusion. After lacrimal punctal occlusion, rose bengal and fluorescein staining (both on a scale of 0 [no staining] to 9 [complete staining]) were reduced (mean +/- SD, 2.7 +/- 1.6 to 1.1 +/- 1.8 and 1.4 +/- 1.2 to 0.4 +/- 0.8, respectively). Impression cytology disclosed improvement of squamous metaplasia in the superior conjunctiva as well as increased goblet cells in nine of 13 eyes (69%) examined. Subjective symptoms improved in all 22 eyes (100%). CONCLUSIONS: Improvement of local tear deficiency to the superior limbic portion by punctal occlusion was an effective treatment in this small series. Superior limbic keratoconjunctivitis might be caused by the insufficient local tear supply.

Adult↗
PubMed1995

Lodoxamide tromethamine treatment for superior limbic keratoconjunctivitis.

PURPOSE: We studied the efficacy of topically applied lodoxamide tromethamine 0.1% in the treatment of superior limbic keratoconjunctivitis. METHODS: Three patients with clinical findings of bilateral superior limbic keratoconjunctivitis. were treated with topical lodoxamide tromethamine four times daily in both eyes. RESULTS: While the patients were taking lodoxamide tromethamine, symptoms and objective findings resolved. CONCLUSIONS: Topically applied lodoxamide tromethamine 0.1% is useful in the treatment of superior limbic keratoconjunctivitis. There may be a role for mast cell stabilizers in the treatment of this disorder.

Administration, Topical↗
PubMed2003

Microsporidial keratoconjunctivitis in healthy individuals: a case series.

PURPOSE: To present a series of 6 cases of microsporidial keratoconjunctivitis in healthy, nonimmunocompromised individuals. DESIGN: Retrospective, noncomparative case series. PARTICIPANTS: Six individuals with unilateral keratoconjunctivitis. METHODS: Cornea epithelial scrapings were taken and evaluated by modified trichome staining. Blood was taken for human immunodeficiency virus (HIV) enzyme-linked immunosorbent assay in all cases and for CD4 and CD8 T-lymphocyte counts in 5 cases. MAIN OUTCOME MEASURES: The individuals were evaluated based on symptoms, visual acuity, slit-lamp biomicroscopy, and pathologic examination of the corneal scrapings. RESULTS: All cases occurred in men whose ages ranged from 16 to 37 years. Initial symptoms included unilateral pain and redness. All experienced subsequent worsening of symptoms and blurring of vision after using topical steroids prescribed by general practitioners. Slit-lamp biomicroscopy revealed coarse, multifocal, punctate epithelial keratitis in all 6 cases, anterior stromal infiltrates in 2 cases, with accompanying conjunctivitis in all cases. Modified trichrome staining of corneal epithelial scrapes revealed pinkish to red spores characteristic of microsporidia in all cases. Results of an HIV enzyme-linked immunosorbent assay were negative in all cases, and CD4 and CD8 T-lymphocyte counts and ratios were normal in all 5 tested cases. On diagnosis, topical steroid therapy was stopped in all cases. Treatment with topical Fumidil B (bicyclohexylammonium fumagillin; Leiter's Park Ave Pharmacy, San Jose, CA) together with oral albendazole was given in 3 cases, oral albendazole alone in a single case, and broad-spectrum antibiotic treatment with topical norfloxacin or chloramphenicol in two cases. Two cases had keratic precipitates with mild cellular activity in the anterior chamber and one such case was restarted subsequently on topical steroids. All six cases showed resolution of epithelial keratitis but with residual visually inconsequential subepithelial scars by the end of 1 month of treatment. CONCLUSIONS: Microsporidial keratoconjunctivitis can occur more commonly than expected in healthy, nonimmunocompromised individuals. Topical steroids seem to contribute to the persistence of this infection and may be a predisposing factor in these cases by creating a localized immunocompromised state. The clinical course is variable and may be self-limiting with cessation of topical steroid use.

Adolescent↗
PubMed1983

Superior limbic keratoconjunctivitis in contact lens wearers.

Forty patients with daily wear, cosmetic contact lenses (CL) presented with symptoms of ocular irritation and a keratoconjunctivitis clinically resembling superior limbic keratoconjunctivitis (SLK). Typically the patients were either successful hard CL wearers who changed to soft lenses and used a chemical aseptisizing solution or preserved saline solution, or successful soft CL wearers using salt tablets who switched to a preservative-containing system. In all cases, exposure to thimerosal-preserved solutions was documented. Upon discontinuation of lens wear, all signs and symptoms slowly resolved without permanent sequelae. Positive skin and ocular sensitivity reactions to thimerosal were present in one-third (5/15) of patients tested. Light and transmission electron microscopic examination of conjunctival specimens disclosed intercellular epithelial edema, pseudoepitheliomatous hyperplasia, acute and chronic inflammation, and decreased numbers of goblet cells. Exposure to thimerosal is implicated in the etiology of contact lens-superior limbic keratoconjunctivitis (CL-SLK).

Adolescent↗
PubMed1993

Effective treatment of phlyctenular keratoconjunctivitis with oral tetracycline.

PURPOSE: To determine the clinical characteristics, possible etiologic agents, and response to oral antibiotic therapy in patients with phlyctenular keratoconjunctivitis. METHODS: The authors reviewed the medical records of the 17 patients with phlyctenular keratoconjunctivitis who were seen and treated at the Bascom Palmer Eye Institute between 1981 and 1991. RESULTS: All 17 patients were younger than 18 years of age at the onset of their disease. Girls (n = 14) outnumbered boys (n = 3) 4:1. Significant incapacitating symptoms and ocular morbidity occurred frequently, including three perforated corneas. Five of ten patients who were tested for Chlamydia infection had positive test results and five patients possibly had early rosacea dermatitis. All patients experienced long-term remission of their ocular disease after a course of oral tetracycline or erythromycin. Two patients demonstrated unique linear (fascicular) corneal phlyctenules. CONCLUSION: Oral tetracycline or erythromycin treatment produces long-lasting remission of phlyctenular keratoconjunctivitis in affected children.

Administration, Oral↗
PubMed2002

Cataract surgery combined with ocular surface reconstruction in patients with severe cicatricial keratoconjunctivitis.

PURPOSE: To present the technique and outcome of cataract surgery combined with ocular surface reconstruction in patients with severe cicatricial keratoconjunctivitis. SETTING: Department of Ophthalmology, Tokyo Dental College, Chiba, Japan. METHODS: Phacoemulsification with transplantation of a limbal allograft and an amniotic membrane was performed in 4 eyes of 3 patients with cataract and end-stage cicatricial keratoconjunctivitis. The surgical technique and the improvements in visual acuity were reviewed. The follow-up ranged from 13 to 27 months. RESULTS: Phacoemulsification and intraocular lens implantation were performed in all cases without intraoperative complications. In 3 of the 4 eyes, the best corrected visual acuity improved from hand motions to 20/100, hand motions to 20/30, and counting fingers to 20/50. The visual acuity recovered to 20/60 postoperatively in 1 eye in which the preoperative visual acuity was light perception; at 1 year, the visual acuity decreased to hand motions because of recurrent fibrous tissue over the cornea. CONCLUSION: Small-incision phacoemulsification was performed safely in combination with ocular surface reconstruction in patients with cataract and end-stage cicatricial keratoconjunctivitis.

Cataract↗
PubMed1984

A large outbreak of keratoconjunctivitis due to adenovirus type 8.

A large nosocomial outbreak of keratoconjunctivitis due to adenovirus type 8 is described. Two hundred cases were identified, 123 by isolation of the virus and 77 by detecting HI antibodies in convalescent sera. Infection usually presented as a severe keratoconjunctivitis, and 107 (54%) of infected patients developed sub-epithelial corneal opacities. The majority (66%) of infections were acquired at the accident and emergency department attached to a large urban eye hospital when patients attended for other reasons; trauma to the eye, especially corneal foreign bodies, was the most frequent cause for the initial attendance. Transmission of virus within the family occurred in 13% of cases, but there was little spread outside family or hospital environments. The outbreak lasted from May to September, 1982, but it was not confirmed by isolation of the virus until the end of June when control measures were instituted. Delay in applying control measures was probably the major factor accounting for this large, prolonged outbreak of epidemic keratoconjunctivitis.

Adenoviridae Infections↗
PubMed2004

Subepithelial infiltrates associated to viral keratoconjunctivitis following photorefractive keratectomy.

PURPOSE: To report three cases of adenoviral keratoconjunctivitis in patients who have undergone photorefractive keratectomy and that just developed subepithelial infiltrates. METHODS: Description of patients that developed postoperative adenoviral keratoconjunctivitis after photorefractive keratectomy without influence in the final visual outcome. RESULTS: All patients presented adenoviral keratoconjunctivitis 2-3 months after refractive surgery. They developed multiple pinpoint subepithelial infiltrates in six eyes, without haze development. The final uncorrected visual acuity was better or equal to 20/30. CONCLUSION: Although patients undergoing photorefractive keratectomy might develop severe corneal scarring following ocular infections, such events may follow their natural evolution.

Adenovirus Infections, Human↗
PubMed1999

Metalloproteinases in canine experimental traumatic keratoconjunctivitis.

Matrix metalloproteinases (MMPs) are thought to be involved in eye disease and may be present in tears. MMP activity was measured by gelatine zymography. Active gelatinase levels were determined by a gelatine degradation ELISA. Potential MMP-9 (gelatinase-B) monomer enzyme activity was elevated (P < 0.001) in keratoconjunctivitis in comparison to normal tears. MMP-9, dimer form, enzyme activity was elevated (P < 0.001) in fluids from keratoconjunctivitis cases in comparison to fluids from normal eyes. Significant increases in gelatinase bioactivities were seen in tears from keratoconjunctivitis disease cases (P < 0.01). Enzymes in dogs with eye disease were biologically active indicating that both the active forms of the enzyme were present. Hence, they could be an important indicator in deterioration of the cornea during eye disease.

Animals↗
PubMed1997

[Keratoconjunctivitis sicca in patients with lipoprotein (a) elevation].

BACKGROUND: Elevated Lp(a) levels are known as risk factor for premature coronary artery disease and apoplexy. To our knowledge ophthalmologic alterations have not been described in combination with elevated Lp(a) levels. We examined whether patients with LP (a) elevation had an increased incidence of keratoconjunctivitis sicca. PATIENTS AND METHODS: 27 patients, 16 women and 11 men were examined. The Lp(a) value was in all patients definitively pathological. The following examinations were performed: history, slitlamp examination, Schirmer-test, impressioncytology, fluorescein staining of the cornea, applanation tonometry and examination of the ocular fundus. RESULTS: The results show a pathologic Schirmer-test in 70.3% of the eyes, in 81.5% a pathologic impressioncytology, and in 48.1% a pathologic fluorescein staining. The Schirmer-test is not sufficiently sensitive and specific in diagnosing the dry eye, whereas impression cytology is highly sensitive and specific. CONCLUSIONS: We could show, that in more than 80% of the examined patients at least one sign of keratoconjunctivitis sicca was found; however we did not find a correlation between the height of the Lp(a) level and the degree of pathologic impression cytology. Further examinations are needed to investigate the causal connection between keratoconjunctivitis sicca and Lp(a) elevation.

Adolescent↗
PubMed1985

[Euphorbiae keratoconjunctivitis].

This paper reports on 6 cases of keratoconjunctivitis caused by the latex of Euphorbiaceae, one of them with slight systemic intoxication. Phorbolesters are considered to be responsible for the toxicity of the latex of Euphorbiaceae, e.g., in the case of Euphorbia helioscopia, 12-Desoxyphorbol-13-phenylacetate-2-O-acetate. Since all of the cases of keratoconjunctivitis Euphorbiae described here, as well as the majority of those cited in the literature, have resulted in a restitutio ad integrum, a benign course may be expected, even in cases of keratoconjunctivitis Euphorbiae with initially severe clinical pictures.

Burns, Chemical↗
PubMed1991

Sjogren's syndrome and keratoconjunctivitis sicca.

Keratoconjunctivitis sicca patients diagnosed on the basis of a history, dry-eye symptoms, and definite clinical signs of keratoconjunctivitis sicca, with the associated symptoms of dry mouth and/or arthritis, had measurements of tear osmolarity, Schirmer tear test without anesthetic, stimulated parotid salivary flow, and serum analysis for the presence of autoantibodies associated with Sjogren's Syndrome. In contrast to previous studies, a lower incidence of SS-A or SS-B (1-3%), ANA (41-47%), DNA (11-16%), and RF (9-12%) serum antibodies was detected. Salivary-stimulated parotid flow was abnormally decreased in 59% of the patients. Sjogren's syndrome, as indicated by the presence of serum antibodies, appears to have a lower incidence in keratoconjunctivitis sicca than considered previously.

Adult↗
PubMed1993

Successful treatment of microsporidial keratoconjunctivitis with topical fumagillin in a patient with AIDS.

There recently have been several reports of microsporidial keratoconjunctivitis caused by the organism Encephalitozoon hellem. However, treatment of this infection has been largely ineffective. We report a case of a 35-year-old Hispanic woman with AIDS and E. hellem keratoconjunctivitis confirmed with light, electron, and immunofluorescence microscopy that resolved promptly with topical fumagillin, a crystalline antibiotic with proven efficacy against Encephalitozoon species. No corneal or systemic toxicities were noted using the dosage and preparation employed (10 mg/ml suspension in balanced salt solution). An easily prepared, topical fumagillin suspension appears to be a safe, effective treatment for E. hellem keratoconjunctivitis.

AIDS-Related Opportunistic Infections↗
PubMed1998

Advances in the diagnosis and management of keratoconjunctivitis sicca.

Keratoconjunctivitis sicca is a common ocular surface disease that develops in patients with aqueous tear deficiency. Recent advances have been made in diagnosis, pathogenesis, and therapy of this condition. Advances in diagnosis include improved understanding of the specificity of the tests used for diagnosis, elucidation of the mechanism of the ocular surface rose bengal and fluorescein staining that occurs in this condition, and the expanded use of impression cytology. Advances in pathogenesis include the concept that keratoconjunctivitis sicca is a condition of abnormal growth and differentiation and immune activation of the ocular surface epithelium. These findings indicate that keratoconjunctivitis sicca may represent a chronic wound-healing response to a poorly lubricated and inflamed ocular surface. Advances in therapy include improved nonpreserved artificial tears and therapies targeted at decreasing ocular surface inflammation.

Animals↗