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PubMedDate not supplied

A clinical comparison of two formulations of tobramycin 0.3% eyedrops in the treatment of acute bacterial conjunctivitis.

PURPOSE: To compare the safety and efficacy of a new enhanced viscosity ophthalmic formulation of tobramycin, given twice daily (BID), with the existing four times daily (QID) treatment regimen in patients with acute bacterial conjunctivitis. METHODS: This was a 12-day, multicenter, observer-masked, randomized, parallel group study. Patients received one drop of tobramycin 0.3% (3 mg/mL) enhanced viscosity ophthalmic solution BID or tobramycin 0.3% (3 mg/mL) ophthalmic solution QID in the affected eyes for 7 days. The primary efficacy variable was the percentage of patients with sustained cure/presumed bacterial eradication based on clinical judgment at the test-of-cure visit (Day 12). Pretherapy bacterial isolates were obtained and tested for susceptibility to tobramycin by determination of minimum inhibitory concentrations (MIC). RESULTS: A total of 276 patients were enrolled in the study and 203 of these were culture positive and attended all follow-up examinations. In this group, 98% of those treated with tobramycin enhanced viscosity ophthalmic solution and 99% of those treated with tobramycin 0.3% ophthalmic solution were categorized as having sustained cure/presumed eradication at the test-of-cure visit (p = 0.6037). Reported adverse events were not serious, mild to moderate in severity, and generally did not prevent continuation in the study. Several pre treatment pathogens demonstrated tobramycin resistance (MIC > 4 mg/mL). However, therapy with both treatments was effective in the majority of the cases. CONCLUSIONS: Tobramycin enhanced viscosity ophthalmic solution is well tolerated and has equivalent efficacy to the established treatment regimen with a simplified posology. The formulation provides an alternative therapy for acute bacterial conjunctivitis that should improve patient compliance and satisfaction.

Acute Disease↗
PubMed2005

Topical antibiotics for acute bacterial conjunctivitis: Cochrane systematic review and meta-analysis update.

BACKGROUND: Uncertainty remains about the extent to which findings from our previously published systematic review and meta-analysis of double-blind, randomised controlled trials of topical antibiotics compared with placebo in the management of patients with acute bacterial conjunctivitis treated in secondary care outpatient settings are generalisable to the management of the condition in primary care settings. We updated our review, undertaking searches, methodological assessment, data extraction and analysis according to a pre-defined protocol. In addition to the previous three included studies, we identified two additional double-blind primary care trials, one which compares fusidic acid gel with placebo gel and one which compares chloramphenicol eye drops with placebo eye drops in children. Meta-analyses of clinical and microbiological remission data reveal that topical antibiotics are of benefit in improving early (days 2-5) clinical (relative risk [RR] = 1.24, 95% confidence interval [CI] = 1.05 to 1.45) and microbiological (RR = 1.77, 95% CI = 1.23 to 2.54) remission rates; later (days 6-10) data reveal that these early advantages in clinical (RR = 1.11, 95% CI = 1.02 to 1.21) and microbiological cure rates are reduced (RR 1.56, 95% CI = 1.17 to 2.09), but persist. Most cases of acute bacterial conjunctivitis resolve spontaneously. While topical antibiotics are associated with significantly improved rates of early (days 2-5) clinical remission, this benefit is marginal for later remission (days 6-10).

Acute Disease↗
PubMed2006

[Tear eosinophil cationic protein measurement in patients with seasonal allergic conjunctivitis].

PURPOSE: In the patients with seasonal allergy conjunctivitis (SAC), we investigated the concentration of tear eosinophil cationic protein (ECP) levels, the diagnosis of SAC and the usefulness of studying the disease states. SUBJECTS AND METHODS: The subjects were patients suffering from conjunctivitis seasonal allergy caused by cedar pollen and a healthy control group, and the study period was three years from 2001 to 2003. We divided the allergy group into 27 eyes of 27 patients that we measured before the pollen season and 44 SAC eyes of 44 patients that we measured during the pollen season. The healthy control group was 23 eyes of 23 healthy adults. Tears were collected by the schirmer I method. The ECP value of specimens was measured by enzyme-linked immunosorbent assay (ELISA) using samples which we eluted in buffer (0.5 M NaCl + 0.5% tris buffer saline with Tween 20) from Schirmer test paper. RESULTS: The measurement range of ELISA was 3.6-180 microg/l. The mean ECP value above the lower limit of ELISA in tears was 5.06 +/- 3.39 microg/l (n = 7) (mean +/- standard deviation) for the healthy control group, 9.32 +/- 6 .68 (n = 11) for the preseason group, and 54.90 +/- 117.74 (n = 29) for the pollen season group. The difference between the healthy group and the seasonal group was highly significant (p < 0.005), but there was no significant difference between the healthy group and the preseason group. We set the cut-off point at the 95th percentile (11.1 microg/l) of the healthy group and considered any value above cut-off as positive. The ECP value was positive in 2.5% (3 eyes out of 27) in the preseason group and 40.9% (18 of 44) in the seasonal group, and there was a significant difference (p < 0.01) between the seasonal group and the healthy group. When the seasonal group was divided into patients who had started treatment before the pollen season and those who began treatment during the season, we found a small ECP difference, but it was not statistically significant. CONCLUSION: Measurement of the ECP value in seasonal pollen allergy sufferers may be useful for pathological ascertainment, but it dose not provide adequate diagnosis because of the large number of false negative cases.

Adult↗
PubMed1975

Characterization of a virus associated with epidemic conjunctivitis in Thailand.

A strain of virus, named the A-E strain, was isolated from a patient suffering from acute haemorrhagic conjunctivitis during an epidemic of the disease in Bangkok in 1972. The virus had the characteristics of an enterovirus but was not neutralized by any known enterovirus antiserum. Cross neutralization tests indicated that the isolate was closely related to the J670-71 virus isolated in Japan. The virus produced conjunctivitis in rabbits and monkeys following conjunctival inoculation.

Adolescent↗
PubMedDate not supplied

[The etiopathogenetic aspects in ligneous conjunctivitis].

In a 55-year-old patient with Lyell syndrome, a ligneous conjunctivitis is present at the right eye. The histological examination of the hyperplasic conjunctiva shows a pluri-stratified epithelium made up of several rows of cells with a marked intra- and intercellular oedema. The connective subepithelial tissue shows an important inflammatory infiltration with numerous hyaline plates characteristic of the disease. The vessels are dilated, with thin walls, permitting the passage of fibrin to the surface. The ligneous conjunctivitis is interpreted as a post-membranous granuloma of the palpebral conjunctivae [correction of conjunctivita]. Its presence in a patient with Lyell syndrome shows its immunoallergic nature.

Chronic Disease↗
PubMed1991

Accumulation of Th-2-like helper T cells in the conjunctiva of patients with vernal conjunctivitis.

A total number of 132 T cell clones (TCC) were obtained by PHA-stimulation of single T cells from mononuclear cell suspensions of conjunctival flogistic infiltrates of three patients with vernal conjunctivitis (VC). The phenotype and functional properties of these TCC were compared with those of 122 TCC contemporarily established from PB mononuclear cell suspensions of the same patients, 120 TCC established from lymph nodes of three patients with nonspecific hyperplastic lymphoadenitis and 159 TCC established from thyroid lymphocyte infiltrates of three patients with Graves' disease. The great majority of conjunctival TCC displayed the CD4+ CD8- phenotype (CD4/CD8 ratios ranging from 6.1 to 7.0), whereas the mean CD4/CD8 ratios for control TCC ranged from 0.9 to 2.4. After stimulation with either PHA or PMA plus anti-CD3 mAb, conjunctival TCC differed from control TCC for their ability to produce cytokines. In particular, a large number of conjunctival TCC produced IL-4, but no, or limited amounts of, IFN-gamma, whereas no difference was observed between conjunctival and control TCC with regard to the production of IL-2. The failure of IFN-gamma production by conjunctival TCC was apparently not caused by delay or block in cytokine production, but actually reflected the lack of IFN-gamma transcription. Virtually all conjunctival TCC able to produce IL-4, but not IFN-gamma, as well as most of those producing both cytokines, provided helper function for IgE synthesis in allogeneic normal B cells. The accumulation in the conjunctiva of patients with vernal conjunctivitis of CD4+ T cells that, apart from the production of IL-2, resembles murine Th2 cells for their profile of cytokine production and helper function suggests a possible role for these cells in the pathogenesis of the disease.

Adult↗
PubMed1991

Neutrophil chemotactic factors in the tears of giant papillary conjunctivitis patients.

This study was designed to determine the presence of neutrophil chemotactic factors in the tears of patients with giant papillary conjunctivitis (BPC) secondary to contact lenses. Chemotactic activity was measured using modified Boyden chambers and the chemoattractant formylmethionyl-leucyl-phenylalanine (f-MLP) for 100 percent response. Elevated levels of chemotactic activity were found in the tears of symptomatic patients (80.8 +/- 6.4, % f-MLP) compared with control tears of asymptomatic contact lens wearers (15.7 +/- 3.3%) and non-contact lens wearers (5.6 +/- 1.2%). Using radioimmunoassay, C5a (serum-derived chemoattractant), leukotriene-B4, and interleukin-1 (immune cell-derived chemoattractants) were not detected in the tears of symptomatic patients. The authors determined whether injured conjunctival cells participate in this process by releasing neutrophil chemotactic factors. Isolated rabbit bulbar conjunctiva incubated with culture medium for 4 and 6 hr released high levels of neutrophil chemotactic factors. The release of these factors from injured conjunctiva support the premise that physical trauma of conjunctival cells induced by contact lenses may be an important component of the pathophysiology of giant papillary conjunctivitis.

Adolescent↗
PubMed1991

Double-blind trial of pentigetide ophthalmic solution, 0.5%, compared with cromolyn sodium, 4%, ophthalmic solution for allergic conjunctivitis.

Fifty patients (25 per group) with the signs and symptoms of allergic conjunctivitis confirmed by positive skin test enrolled in this randomized, double-blind, parallel group, 2-week comparison of pentigetide, 0.5%, ophthalmic solution (Pentyde) and cromolyn sodium, 4%, USP ophthalmic solution (Opticrom). The physician and the patient rated the patient's overall ocular condition on days 3, 8, and 15. On day 15 both the physician and the patients rated the pentigetide group as significantly (Chi-square, P less than .05) more improved than the cromolyn sodium group. The physician rated independently conjunctival symptoms and ocular signs at days 1, 3, 8, and 15. Improvement in signs and symptoms favored pentigetide in the majority of comparisons to cromolyn sodium (14 of 18). The pentigetide group showed significantly (ANOVA, P less than .05) greater improvement in hyperemia, edema, lacrimation, and blurred vision/photophobia. Patients completed daily diaries for seven symptoms. At the end of the study, comparisons to baseline between groups favored the pentigetide group for six of the seven symptoms; for itching, improvement favored significantly (ANOVA, P less than .05) the pentigetide group. The mean severity of all symptoms decreased by 64% in the pentigetide group as compared with a decrease of 46% in the cromolyn sodium group. Adverse experiences were minor and comparable in both groups. No clinically abnormal changes were noted for visual acuity, intraocular pressure, or common laboratory tests. This double-blind, active-controlled trial demonstrates that pentigetide, 0.5%, ophthalmic solution is safe and effective in the treatment of allergic conjunctivitis.

Adolescent↗
PubMed1991

Current therapy for bacterial keratitis and bacterial conjunctivitis.

Therapy of bacterial keratitis and conjunctivitis requires that antibiotics be administered to eliminate viable bacteria. Only a limited number of ophthalmic antibiotics are commercially available. Although generally adequate for the treatment of bacterial conjunctivitis, the commercial preparations are believed to contain too low a concentration of antibiotic for the treatment of bacterial keratitis. Using products designed for parenteral administration, the ophthalmologist or the pharmacist formulates so-called fortified preparations containing much higher antibiotic concentrations. Because of their limited spectrum of action, two fortified preparations generally are administered concurrently. Topical application is the most effective route of antibiotic administration for treatment of bacterial keratitis. Antibiotics may also be injected periocularly, a method with risk, or intravenously, a method of uncertain efficacy.

Administration, Topical↗
PubMed1991

A review of bacterial keratitis and bacterial conjunctivitis.

Bacterial keratitis is an opportunistic infection of the avascular corneal stroma, initiated by a breakdown of the epithelial barrier. Corneal abrasion with infected material, extended-wear contact lenses, eyelid disease, and disorders of the ocular surface are predominant contributing factors. Acute bacterial conjunctivitis occurs when sufficient bacteria are introduced into the fornices to overwhelm normal bacteriostatic and flushing mechanisms. Chronic conjunctivitis is associated with a constant adnexal source of bacteria and resolves when the source is successfully treated. Rapid diagnosis and treatment of bacterial keratitis are essential to limit stromal scarring and minimize visual loss.

Acute Disease↗
PubMed1977

Acute haemorrhagic conjunctivitis in Hong Kong 1971-1975.

Acute haemorrhagic conjunctivitis occurred in epidemic in Hong Kong in 1971 and 1975 respectively. Two picornaviruses, the Enterovirus type 70 and an antigenic variant of Coxsackie virus type A24, were isolated during the 1971 outbreak, while only the latter virus was detected in the 1975 outbreak. In 1972 and 1974, sporadic cases of conjunctivitis associated with Enterovirus type 70 were observed. Serological survey in late 1975 showed a high proportion of the population might still be susceptible to both viruses. Recrudescence of the disease is conceivable when environmental condition is favourable for the spread of these viruses.

Adenoviruses, Human↗
PubMed1990

Epidemic acute haemorrhagic conjunctivitis due to Coxsackie virus A24 variant in Ghana.

An outbreak of acute haemorrhagic conjunctivitis (AHC) occurred in Accra, Ghana, reaching a peak in July 1987. Individuals ranging from infants to adults over 50 years were infected, with those between 20 and 30 years being the most affected group. There was a female preponderance. Clinical features included conjunctivitis, subconjunctival haemorrhage and ocular pain. Some patients reported of blurred vision due to mild keratitis. Isolation of virus from clinical specimens of AHC patients was successful only in cells of human origin such as HeLa and FL. Coxsackie virus A24 variant (CA 24v) was identified as the aetiologic agent. This is the first report to associate CA 24v with an epidemic of AHC in Africa, south of the Sahara, which is outside the endemic area of Southeast Asia and the Caribbeans. This finding suggests that earlier outbreaks of AHC in Ghana and Africa may have been due to CA 24v but went undetected. The results of various tests performed during this study suggest that, at least, two antigenically different viruses of CA 24v circulated during the course of this epidemic.

Conjunctivitis, Acute Hemorrhagic↗
PubMed1977

Spontaneous cytomegalovirus mononucleosis with conjunctivitis.

Cytomegalovirus (CMV) was isolated from the conjunctiva of a patient with mild unilateral catarrhal conjunctivitis associated with the typical clinical features of CMV mononucleosis syndrome in a previously healthy adult. The diagnosis was confirmed by a marked rise in the complement fixation antibody titers. Prospective studies are needed to determine the frequency of conjunctival involvement in CMV mononucleosis and the relation, if any, to sporadic cases of conjunctivitis.

Adult↗
PubMed1990

Lacrimal conjunctivitis.

In the course of an acute phase of pneumococcal conjunctivitis, a serpiginous corneal ulcer has never been reported to develop. However, if there is a pneumococcal chronic dacryocystitis and a resultant lacrimal conjunctivitis, the association with pneumococcal serpiginous ulcers is significant. This is most likely due to the fact that those serological types that are particularly virulent for the cornea have an affinity to colonize and infect the lacrimal sac.

Conjunctivitis↗
PubMed1990

[Randomized study of cefatrizine versus cefaclor in conjunctivitis otitis syndrome].

The association conjunctivitis-otitis is highly suggestive of Haemophilus influenzae infection. This conjunctivitis otitis syndrome could be a good model to assess the efficacy of different antibiotic regimen in the treatment of acute otitis media due to HI without tympanocentesis. This prospective randomized trial compared the efficacy of two orally cephalosporins which demonstrate in vitro an activity against HI. This study was conducted from 4.20.1988 to 3.15.1989 and involved 73 children with COS examined in an outpatient clinic. The mean age was 17.7 months. Before treatment culture were taken from the lower palpebral conjunctivae. 81 strains was found: HI 61 (beta-lactamase-producing 15), Streptococcus pneumoniae 16, Branhamella Catarrhalis 4. The 73 patients were treated with 40 to 50 mg/kg/day of the test drug for ten days, 25 with Cefaclor in 3 divided dose (group 1), 24 with Cefatrizine in 3 divided dose (group 2), 24 with Cefatrizine in 2 divided dose (group 3). The recoveries was obtained in 17/25 in the group 1, 18/24 in the group 2, 15/24 in the group 3. There was no significant difference between the 3 groups.

Acute Disease↗
PubMed1990

[Nystatin in the treatment of candidal conjunctivitis].

The author presents the case-history of a 19-year-old female patient with subacute bilateral conjunctivitis, where based on repeated cultivation form the conjunctival sac Candida albicans was proved as the aetiological agent. After the application of Nystatin (Fungicidin Spofa ointment, dragée) marked immediate improvement of the clinical finding was recorded and gradual regression of follicles and tarsal squamous hyperplasia. The author discusses possible types of mycotic conjunctivitis with regard to the character of the inflammation, the aetiological agent and treatment.

Adult↗
PubMed1989

An outbreak of acute haemorrhagic conjunctivitis caused by enterovirus 70 in Jeddah during 1985.

Seventy-five cases of acute haemorrhagic conjunctivitis (A.H.C.) were subjected to full ophthalmic, bacteriological, virological, serological as well as cytological examinations. The majority of cases presented with bilateral conjunctivitis (70 out of 75). Although follicular reaction was the earliest sign, yet subconjunctival haemorrhages were the most constant findings in all the cases. Enterovirus 70 was isolated in 57 cases from conjunctival swabs and in 43 cases from serum samples. Complement flaxation test was positive for enterovirus 70 in 42 cases but negative for coxsackie and adenoviruses. No primary role has been found for bacteria in the pathogenesis of A.H.C. in this outbreak. Cytological examination of conjunctival scrappings showed the characteristics cytopathic effect (CPE) of enteroviruses.

Adolescent↗