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PubMed1990

Association of giant papillary conjunctivitis with seasonal allergies.

Giant papillary conjunctivitis (GPC) is largely a soft contact lens-related syndrome, characterized by the formation of giant papillae on the upper tarsal conjunctiva, itching, excess mucus, erythema, and contact lens intolerance. In response to the suggestion that GPC occurs more frequently in atopic individuals, a retrospective study was designed in order to determine the months in which patients were diagnosed with GPC during 1987 and 1988. Personal histories of allergy were also recorded for these patients, and compared to an age- and sex-matched control group. Significant peaks in the number of patients diagnosed with GPC occurred in the spring, and especially in late summer/early fall of both years. In addition, the GPC patients reported significantly more overall allergies than did the control group. However, a breakdown of the individual allergy data revealed that only allergies to contact lens solutions, specifically thimerosal, were significantly higher in the GPC group. Reported allergies to medications and pollen were also elevated in the GPC patients, but not significantly. The seasonal onset of GPC diagnoses in 1987 and 1988, and the increase in reported allergies within the GPC group, suggests a strong association between atopy and the development of GPC.

Adult↗

PubMed1988

Comparison of three topical antimicrobials for acute bacterial conjunctivitis.

One hundred fifty-eight patients, 21 years of age or less, presenting with culture-positive (Haemophilus influenzae or Streptococcus pneumoniae) conjunctivitis were treated with trimethoprim-polymyxin B (TP), gentamicin sulfate (GS) or sodium sulfacetamide (SS) ophthalmic solution for 10 days. Clinical response at 3 to 6 days after start of therapy was similar for all test agents: 26 of 55 (47%) patients cured, 25 of 55 (45%) improved for TP; 28 of 57 (49%) cured, 26 of 57 (46%) improved for GS; and 19 of 46 (41%) cured, 22 of 46 (48%) improved for SS. Clinical response at 2 to 7 days after completion of therapy was also similar: 46 of 55 (84%) patients cured, 5 of 55 (9%) improved for TP; 50 of 57 (88%) cured, 5 of 57 (9%) improved for GS; and 41 of 46 (89%) cured, 2 of 46 (4%) improved for SS. Bacteriologic response at 2 to 7 days after completion of therapy was similar for all antimicrobials: 44 of 55 (83%) patients for TP; 39 of 57 (68%) for GS; and 33 of 46 (72%) for SS.

Administration, Topical↗

PubMed1995

Use of eyepatches in phototherapy: effects on conjunctival bacterial pathogens and conjunctivitis.

We conducted a randomized controlled trial to determine the effects of eye occlusion on the risk of eye infection in full term newborn infants receiving phototherapy. Among 102 infants whose eyes were occluded with eyepatches, pathogens were isolated from 50 eyes of 33 infants. The positive isolation rate was significantly higher than that of a group of control infants (n = 101) whose eyes were protected by a headbox made of light-proof plastics. Among the latter group pathogens were detected in 22 eyes of 14 infants. In addition significantly more infants in the eyepatches group had purulent eye discharge (23 of 102 vs. 9 of 101, P = 0.013) and clinical conjunctivitis (13 of 102 vs. 2 of 101, P = 0.004) than the controls. Proper eye care is imperative when eyepatches are used on infants receiving phototherapy, and alternative methods of eye protection should be considered.

Bacteria↗

PubMedDate not supplied

Gonococcal conjunctivitis in a four-month-old infant.

Classic neonatal gonococcal ophthalmia usually manifests during the first week of life with a purulent ocular discharge accompanied by periorbital edema and erythema. This case report describes a 4-month-old child with chronic but minimal ocular discharge and intermittent mild conjunctival infection who proved to be infected with Neisseria gonorrhoeae. This experience emphasizes the need for the physician to evaluate for gonococcal infection any child with conjunctivitis.

Conjunctivitis↗

PubMedDate not supplied

Immunity to reinfection and immunization of male guinea pigs against urethral infection with the agent of guinea pig inclusion conjunctivitis.

BACKGROUND AND OBJECTIVES: There is little information available on immunity of males to chlamydial infection after recovering from a primary urethral infection or after immunization with chlamydial antigen. The guinea pig model of genital infection using the chlamydial agent of guinea pig inclusion conjunctivitis was utilized to evaluate the protective immune response in these circumstances. GOAL: To determine whether immunity to reinfection develops after a primary urethral infection and whether immunity develops as a result of immunization with inactivated chlamydiae. STUDY DESIGN: Groups of five male guinea pigs each in two separate experiments were infected in the urethra with chlamydiae and challenged with a fresh inoculum at either 30, 75, or 150 days after infection. The course of the challenge infection was then determined. Similarly, guinea pigs were immunized subcutaneously with ultraviolet-inactivated chlamydial elementary bodies and the course of urethral infection was determined when inoculated 2 weeks after immunization. RESULTS: Male guinea pigs were highly resistant to reinfection after a primary urethral infection. Animals that were immunized with inactivated chlamydiae generally became infected upon challenge, but the intensity of the infection was markedly reduced. CONCLUSIONS: Male guinea pigs possess protective mechanisms that make them more resistant to repeat chlamydial genital infection for a longer period of time than is seen in female guinea pigs. In addition, immunization of males with inactivated chlamydial antigen by a parenteral route is able to elicit a protective response to urethral infection with chlamydiae.

Animals↗

PubMed1987

Branhamella catarrhalis conjunctivitis.

Eleven cases of Branhamella catarrhalis conjunctivitis have been reported. In four recent studies that examine the microbial etiology of ophthalmia neonatorum, B catarrhalis was identified only twice in 1,299 cases. However, diagnosis by Gram stain in some and previous antibiotic therapy in others may have resulted in underdiagnosis of B catarrhalis and inaccurate diagnosis as gonococcal ophthalmia.

Conjunctivitis, Bacterial↗

PubMed1993

Atopic disease, rhinitis and conjunctivitis, upper respiratory tract infections, and insect stings and snake bites.

In this section we review four broad topics in pediatrics: atopic disease, rhinitis and conjunctivitis, upper respiratory tract infections, and insect stings and snake bites. The first three topics comprise three of the most commonly encountered problems in pediatric practice. Although the fourth topic accounts for a relatively small number of office visits, it generates a great deal of concern among our patients and their parents. There have been significant contributions to the pediatric literature in each of these areas over the past year and we review those of particular interest.

Bites and Stings↗

PubMed1994

Atopic disease, rhinitis and conjunctivitis, upper respiratory tract infections, and insect stings and snake bites.

Adolescent↗

PubMed1995

Atopic disease, rhinitis and conjunctivitis, and upper respiratory infections.

In this section, we review three broad topics in pediatrics: atopic disease, rhinitis and conjunctivitis, and upper respiratory tract infections. These topics comprise three of the most commonly encountered problems in pediatric practice. There have been significant contributions to the pediatric literature in each of these areas over the past year, and we review those of particular interest here. The papers that we have chosen to review were selected for both their scientific significance and practicality. Both review articles and original research are included, but all should be relevant to the care of your patients.

Asthma↗

PubMed1989

An outbreak of infectious conjunctivitis spread by microscopes.

Among the potential occupational hazards of microscope use is the transmission of infectious agents among employees. We report a large (145 cases) and costly (+647,000) epidemic of viral conjunctivitis in a microelectronics factory. Spread of the illness appeared to be through sharing of microscopes among employees. Routine handwashing instructions and safety glasses failed to prevent spread of the epidemic. Mandatory screening prior to work and temporary plant shut-down were finally successful. We discuss efforts to control this outbreak and make recommendations to prevent similar epidemics in other workplaces.

Conjunctivitis, Viral↗

PubMed1998

The current and future therapy of allergic conjunctivitis.

A wealth of antiallergic drugs is available for ocular allergy, and many new drugs will soon be approved. Pharmaceutical companies frequently seek approval of anti-inflammatory drugs for allergic indications, because it is relatively easy to perform clinical trials for ocular allergy. Extremely safe drugs for mild to moderate degrees of allergic conjunctivitis include antihistamines, mast cell stabilizers, and nonsteroidal anti-inflammatory agents. Topical corticosteroids, preferably those with reduced side effects, are available for more severe forms of ocular allergy. The choice of an antiallergic drug may be guided by the indication for which the drug was approved. The ultimate selection will be made based on the patient's symptoms, the drug's availability, and its cost.

Anti-Allergic Agents↗

PubMed2003

Contact lens chemistry and giant papillary conjunctivitis.

OBJECTIVE: To review the relationship between contact lens chemistry and the occurrence of giant papillary conjunctivitis (GPC). DESIGN: A review of the literature. RESULTS: GPC can occur with any type of contact lenses. The coating on the lens and the contact lens trauma to the conjunctiva are probable factors. Changing the polymer of the contact lens that a patient with GPC wears can decrease the chance of the condition recurring. Also, replacing a soft contact lens at intervals of less than 3 weeks, rather than 4 or more weeks, significantly reduces the chance of developing GPC. GPC can occur with high Dk silicone contact lenses. Two forms of GPC have been reported: a generalized form similar to that seen with conventional soft contact lenses and a localized form in which the papillae are confined to one or two areas of the tarsal conjunctiva, near the lid margin. CONCLUSION: Contact lens chemistry plays a role in the development of GPC; however, other factors such as edge design, surface properties, fitting characteristics, and replacement cycle are also important variables in the pathophysiology of GPC.

Chemical Phenomena↗

PubMed2006

Tear film lipid layer alterations in allergic conjunctivitis.

PURPOSE: To assess the alterations of the tear film lipid layer and tear functions in patients with seasonal allergic conjunctivitis (SAC) and to compare the results with healthy control subjects. METHODS: Seventy-eight eyes of 39 consecutive patients diagnosed as SAC (mean age 32.6 years; 11 male, 28 female) as well as 20 eyes of 10 healthy control subjects (mean age 32.5 years; 6 male, 4 female) underwent slit-lamp examinations, tear film breakup time measurements (BUT), corneal fluorescein stain scoring, Schirmer test, and tear film lipid layer interferometry. The 2 groups were then compared for the examined parameters. RAST and serum IgE level evaluations were also carried out in the patients to confirm the diagnosis of allergy. RESULTS: The mean BUT was 3.4 +/- 1.5 seconds in patients with SAC compared with the mean value of 12.4 +/- 2.4 seconds in the controls (P < 0.05). There were no significant differences in relation to Schirmer test values between the 2 groups; 78% of the patients with SAC had grade 3 or above dry eye change in tear film lipid layer interferometry, whereas none of the controls had an interferometry grade greater than 3 (grade 1-2 normal; grade 3-4 dry eye; grade 5 severe dry eye). Eyes with SAC had significantly higher tear film lipid layer thickness ranges compared with the control eyes (P < 0.05). CONCLUSION: SAC was associated with advanced tear instability and thickening of the tear film lipid layer. Evaluation of the tear film lipid layer thickness might be useful in the assessment of the extent of dry eye disease and the treatment outcomes in patients with allergy.

Adult↗

PubMed2005

Prostaglandin D2 induces chemotaxis in eosinophils via its receptor CRTH2 and eosinophils may cause severe ocular inflammation in patients with allergic conjunctivitis.

PURPOSE: Eosinophils are known to have important roles in the pathogenesis of allergic conjunctivitis. Prostaglandin (PG) D2, which has been implicated as a factor in allergic diseases, is known to have chemotactic activity for eosinophils. Its receptor, chemoattractant receptor homologous molecule expressed on TH2 (CRTH2), serves as a receptor for PGD2 and has been reported to mediate PGD2-dependent migration of eosinophils. In the present study, both eosinophil toxic activity for corneal epithelial cells and chemotaxis induced by PGD2 in normal volunteers were investigated. Expression of CRTH2 in normal subjects was also measured. METHODS: Primary cultured corneal epithelial cells and eosinophils in serum from normal volunteers were used and a human corneal epithelial cell line was established. Studies were performed with/without amniotic membrane. CRTH2 expression on eosinophils was assessed by flow cytometry. Chemotaxis experiments were performed using a modified Boyden chamber technique. RESULTS: Corneal epithelial cells cultured with eosinophils showed higher floating epithelial cells and epithelial defect than those cultured in the absence of eosinophils. Flow cytometry analysis revealed that eosinophils expressed CRTH2. PGD2 induced chemotaxis of eosinophils. CONCLUSIONS: Corneal epithelial damage might be caused by eosinophils, which are recruited by PGD2 secretion via CRTH2 expressed on eosinophils.

Cell Line↗

PubMed2006

In vivo confocal microscopy of normal conjunctiva and conjunctivitis.

PURPOSE: To analyze the appearance of normal conjunctiva and conjunctival inflammation by in vivo confocal microscopy. METHODS: Conjunctiva of 15 normal patients and 21 patients with conjunctivitis including bacterial, papillary, follicular, granulomatous, and cicatrizing disease were analyzed by the Heidelberg retina tomograph (HRTII)/Rostock cornea modul (RCM). RESULTS: Scans of normal bulbar and tarsal conjunctiva corresponded well to the established anatomy except for a prominent, thickened epithelial basement membrane observed by in vivo microscopy. Presumed goblet cells were visible throughout the conjunctival epithelium. Adenoid structures and hair follicles were discernible in the tarsal conjunctiva in vivo. Conjunctival perfusion could be observed directly. Acute and chronic inflammatory cells, conjunctival papillary, and follicular reactions, as well as conjunctival cicatrization, could be discriminated. In a patient with conjunctival granuloma, in vivo confocal microscopy disclosed suture material inside the lesion. CONCLUSION: Confocal microscopy using near-infrared laser light is a useful new tool in the analysis of conjunctival tissue in vivo. It is a valuable aid in the differential diagnosis of conjunctival inflammation and thus may guide therapeutical decisions.

Adult↗

PubMed2006

Site-specific disease potential of individual Streptococcus pneumoniae serotypes in pediatric invasive disease, acute otitis media and acute conjunctivitis.

BACKGROUND: Recent studies have shown that some Streptococcus pneumoniae serotypes possess a higher potential to cause invasive disease than others. However, it is unknown whether disease potential for specific serotypes is similar for mucosal disease. Our objective was to assess the disease potential of individual S. pneumoniae serotypes causing invasive pneumococcal disease (IPD), acute otitis media (AOM) and acute conjunctivitis (AC) in children. METHODS: Serotypes of pneumococcal isolates from children with IPD, AOM and AC were compared with those carried by healthy children aged <3 years. All children resided in the same area and were studied during the same period. Odds ratios for disease were calculated for each diagnosis following multivariate analysis, including gender, age, ethnic group, previous antibiotic treatment and year variability. RESULTS: A total of 5,500 isolates were collected: 189 from blood or cerebrospinal fluid, 3,200 from middle ear fluid, 348 from conjunctiva and 1,763 from nasopharynx of healthy children. A significant positive association with IPD was demonstrated for serotypes 1, 5 and 12F; with AOM for serotypes 1, 3, 5, 12F, 19A and 19F; and with AC for serotype 3 and nontypeable S. pneumoniae. A significant negative association with IPD was demonstrated for nontypeable S. pneumoniae and with AOM for serotypes 6A, 6B, 15A and nontypeable S. pneumoniae. CONCLUSIONS: Our results reflect the importance of the polysaccharide capsule in site-specific disease potential and provide useful information regarding disease potential of nonvaccine serotypes shown to be involved in carriage replacement after vaccination with the 7-valent conjugate vaccine.

Acute Disease↗

PubMed2005

Conjunctival cytology features of giant papillary conjunctivitis associated with ocular prostheses.

PURPOSE: In this study, the conjunctival cytology features of giant papillary conjunctivitis (GPC) associated with ocular prosthesis wear was examined. METHODS: In a prospective study, 12 consecutive patients diagnosed with GPC associated with ocular prosthesis wear were examined. Impression cytology specimens were taken from the upper eyelid tarsal conjunctiva, the bulbar conjunctiva, and the lower eyelid tarsal conjunctiva of each socket, with the contralateral eye serving as a matched control. RESULTS: The randomized impression cytology specimens showed no significant change in goblet cell density or epithelial cell morphology when comparing the GPC and control specimens. The GPC specimens did have a statistically significant increase in conjunctival inflammation and mucous strands on all three sample areas. In addition, the GPC specimens from the upper and lower tarsal conjunctiva had a honeycomb pattern consistent with giant papillae. CONCLUSIONS: This is the first report to describe the honeycomb pattern created by giant papillae on impression cytology and the changes of GPC on the lower tarsal conjunctiva.

Adolescent↗

PubMed2006

Two presentations of contact lens-induced papillary conjunctivitis (CLPC) in hydrogel lens wear: local and general.

PURPOSE: The purpose of this study was to confirm that two distinct clinical presentations of contact lens-induced papillary conjunctivitis (CLPC), local and general, occur in hydrogel lens wear. METHODS: Retrospective analyses of 124 CLPC events were identified. The classification of CLPC was based on location and extent of papillae. CLPC was classified as local if papillae were present in one to two areas of the tarsal conjunctiva and general if papillae occurred in three or more areas. The CLPC events were compared with an asymptomatic control group in prospective clinical trials conducted from 1993 until 2003 at two clinical sites, Australia and India. Two hundred sixteen subjects from Australia and 914 subjects from India wore either high Dk silicone hydrogel or low Dk hydrogel lenses on a 6-night (6N) or 30-night extended-wear (EW) schedule. The physiological responses of the ocular surface, including tarsal conjunctiva redness and roughness, number of papillae present, lens fit and performance, and subjective patient symptoms, were measured during each visit at each site. These variables listed were compared between local CLPC groups and asymptomatic controls and general CLPC groups and asymptomatic controls. RESULTS: Two types of CLPC in hydrogel lens wearers have been confirmed. Of the 124 CLPC events, there were 61 local and 63 general events. Local and general CLPC cases reported significantly greater frequency of symptoms compared with the asymptomatic controls, in particular itching, lens awareness, secretion, and blurred vision (p < 0.1). CONCLUSIONS: The classification of CLPC into two types, local and general, in hydrogel lens wear was confirmed based on presentations at both sites. This distribution of papillae between local and general CLPC may indicate separate etiologies involved in the pathogenesis of the condition.

Adolescent↗