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In cases of conjunctivitis associated with the use of soft lenses, delayed hypersensitivity to disinfecting components of the used soft lens liquids has to be considered. In 7/15 patients, positive patch test reactions to merthiolate, chlorhexidine or the soaking solutions were observed. The significance of these findings is discussed.
Gingival hyperplasia may be genetic, may be acquired as a consequence of exposure to drugs and other agents or may appear as part of a more widespread disorder. Five patients who acquired gingival hyperplasia due to amyloidaceous deposits staining only for fibrin are presented. This appears to be a new entity related to ligneous conjunctivitis.
On the basis of a questionnaire sent to the ophthalmology departments of hospitals throughout Germany, 10 patients with ligneous conjunctivitis or pseudomembranous disease, ranging in age from 1 to 71 years were identified. All 10 patients had severely reduced plasminogen levels. Genetic analysis revealed homozygous type I plasminogen deficiency (which had not previously been described in humans) in 7 patients and compound heterozygous plasminogen deficiency in 1 patient. Clear differentiation was not possible in 2 patients. Most of the parents had heterozygous plasminogen deficiency. None of the patients had experienced any episodes of thrombosis. Additionally, the following observations were made: 1) Levels of polymorphonuclear (PMN)-elastase protein were markedly elevated in 6 of 6 patients and 10 of 11 parents tested, and levels were higher in homozygotes than in heterozygotes. 2) Hereditary factor XII deficiency was found in 3 of 6 patients tested. 3) C1-inhibitor was elevated in 2 of 4 patients, prekallikrein was elevated in 1 of 4 patients, and plasminogen activator inhibitor type 1 was elevated in 1 of 4 patients. Infusions of lys-plasminogen concentrate induced pronounced fibrinolytic activity as indicated by high levels of D-dimer, increases in plasmin-antiplasmin complex and decreases in polymorphonuclear elastase. C1-inhibitor, prekallikrein and PAI-1 normalized after repeated infusions of lys-plasminogen. In contrast to dysplasminogenemia, severe type I plasminogen deficiency might be seen as a problem of extravascular space, in particular of the mucous membranes, possibly triggered by mechanically induced or inflammatory lesions of the vessels supplying the tissue.
Nictitans plasmacytic conjunctivitis, commonly referred to as plasma cell infiltrate of the nictitans or plasmoma, was diagnosed in 12 dogs (23 eyes) on the basis of clinical signs and nictitans conjunctival biopsy specimens. These dogs underwent a clinical therapeutic trial with twice daily 0.2 per cent cyclosporin ophthalmic ointment. Response to therapy was monitored over a six-week period and repeat biopsy specimens were then taken. Significant (P < 0.05) reductions between pre- and post trial scores were recorded for: mucopurulent ocular discharge quantity; degree of bulbar conjunctival hyperaemia; areas of nictitans hyperaemia, thickening and depigmentation. Schirmer tear test values significantly increased between the start and end of treatment. Biopsy specimens were subjected to selective detection procedures for plasma cells (methyl green-pyronin staining) and T lymphocytes (CD3 antigen labelling). Mean cell counts showed a significant reduction in plasma cell numbers, but the trend towards reduced T lymphocyte numbers was not significant.
Vital staining with a tetrazolium - alcian blue mixture gave a characteristic punctate red staining of the superior or the inferior tarsus in 69% of all examined patients with chronic simple conjuctivitis (69 patients subjected to 168 examinations). The superior tarsus was more frequently stained than the inferior (61% against 33%). The staining was most often concentrated centrally or in the middle anterior part of the superior tarsus. If located on the inferior tarsus, it was most often found medially, anteriorly. No corresponding staining was seen in normal eyes. The differential diagnosis involving keratoconjunctivitis sicca and pemphigoid is mentioned. The staining is due to enzymatic reduction of tetrazolium in the cytoplasm of the tarsal epithelial cells. The positive vital staining finding is consistent with a diagnosis of chronic simple conjunctivitis.
In a placebo controlled double-blind crossover study, 60 patients with chronic non-infections conjunctivitis were treated for 4 weeks with either sodium cromoglycate eye drops or with placebo followed by 4 weeks on the alternative treatment. The dose was one drop into each eye 4 times daily. The scores for a number of symptoms and signs were significantly lower after 4 weeks sodium cromoglycate treatment than after similar placebo treatment. In both the patients' and clinician's opinion significantly more patients responded to the active treatment than to the placebo treatment. At the end of the trial clinician recorded more preferences for sodium cromoglycate (27) than for placebo (9), and the difference was highly significant (P less than 0.01). No side effects were reported during the trial.
Twenty-three patients with allergic conjunctivitis caused by birch, timothy or mugwort pollen were examined for the presence of total and specific IgE in the tear fluid. In thirteen of the 23 patients IgE could be shown in the tears. Specific IgE antibodies against the causative pollens were present in the tear fluid of 8 of the patients. The relation between serum and tear IgE on one hand and serum and tear albumin on the other hand suggests local production of the specific IgE antibody.
Fucithalmic, which is 1% fusidic acid in a sustained-release eye preparation, was shown to be superior to both chloramphenicol eye drops and framycetin (Soframycin) eye drops in the treatment of bacterial conjunctivitis in Tanzania. The clinical success rate was 77/83 (93%) on fusidic acid compared with 22/46 (48% on chloramphenicol and 26/35 (74%) on framycetin (P less than or equal to 0.02). The better effect of fusidic acid could be ascribed to a much lower rate of in vitro resistance (17%) compared to chloramphenicol (58%) and framycetin (41%). Because of the low resistance rate to fusidic acid among eye pathogens, especially in areas of the world with a high resistance towards other commonly used eye anti-infectives, Fucithalmic given twice daily would seem to be a valuable new eye anti-infective.
Fusidic acid 1% and chloramphenicol 0.5% eye drops were in a randomized, single-blind manner given as a one-week treatment to out-patients with acute, purulent conjunctivitis. A clinical success was recorded in 84% (102/121) of patients receiving fusidic acid and in 81% (104/129) of patients receiving chloramphenicol. More patients (14%) receiving chloramphenicol complained of trivial side effects such as stinging and local discomfort, compared with fusidic acid (5%). No serious side effects were recorded. It is concluded that fusidic acid dispensed in a carbomer eye vehicle represents an effective and well tolerated new topical eye preparation with the advantage of being administered twice daily.
Serum beta-2 microglobulin and C-reactive protein levels were measured in 52 patients with acute adenovirus conjunctivitis and 58 healthy subjects, by ELISA technique. Serum beta-2 microglobulin levels were found to be significantly increased while there was no change in C-reactive protein levels. Serum beta-2 microglobulin levels closely paralleled the severity of the disease. The increased beta-2 microglobulin level in serum showed a significant fall to normal level on clinical improvement. There was no difference in the serum beta-2 microglobulin levels in virus-isolation positive and negative patients.
A multicentre, group comparative open study was carried out on 68 patients to compare the effects of 2% sodium cromoglycate eyedrops and an oral antihistamine, terfenadine, on acute symptoms of seasonal allergic conjunctivitis. The study was continued for one week after the onset of acute symptoms. Both medications were equally efficient in reducing symptoms during the first hour of observation. During the one-week follow-up both medications reduced symptoms to a low level, and both medications were equally effective for allergic symptoms, except that terfenadine was more effective in reducing the watering of eyes.
Fucidic acid viscous eye drops 1% given twice daily was compared with chloramphenicol eye drops 0.5% given 6 times daily in patients with acute conjunctivitis. Patients were recruited from 38 general practitioners in Norway. The mean duration of treatment was 6.6 days for Fucidic acid, 6.2 days for chloramphenicol. There was no major differences between the two groups in the bacteriological findings, and there was no significant difference in response to treatment. The use of fusidic acid in a carbomer vehicle as in Fucithalmic, has proved to give a long-lasting antibiotic concentration in the tear fluid, which allows the preferable twice daily application.
We evaluated the effect of local specific immunotherapy in 40 patients suffering from seasonal allergic conjunctivitis. Twenty patients received saline solution in both eyes; and 20 others received local specific immunotherapy in both eyes. Sodium cromoglycate drops were instilled in both eyes in all patients. Subjective and objective symptoms, and cytological findings had significantly improved after 1 year in the group treated with local specific immunotherapy plus sodium cromoglycate compared to the group treated with sodium cromoglycate and saline solution.
The surveillance of acute hemorrhagic conjunctivitis (AHC) caused by enterovirus 70 (EV70) is insufficient because of the difficulties of virus isolation using conventional methods. In this study, reverse transcription-polymerase chain reaction (RT-PCR) and stringent microplate hybridization (SMH) methods were assessed for the detection of EV70 in conjunctival swabs collected from the patients of AHC which broke out in Miyazaki Prefecture in 1990 and Okinawa Prefecture in 1994. Furthermore, with the use of the SMH method, we compared the genetic homogeneity of EV70 detected from the samples collected in 1990 and 1994 to the J670/71 strain isolated approximately 25 years ago. A similar investigation was performed between recent coxsackievirus A24 variant (CA24v) and EH24/70 strain, a standard strain of CA24v that was isolated approximately 25 years ago. As a result, RT-PCR products were detected in 26 of 34 conjunctival swabs collected in Miyazaki Prefecture in 1990. Likewise, RT-PCR products were detected in 9 of 10 conjunctival swabs collected in Okinawa Prefecture in 1994, and these RT-PCR products were all identified as EV70 by SMH method. Such a high level of virus recovery from specimen shows the evidence of usefulness of these techniques. Recent EV70 showed a reaction of about 60% to a probe synthesized with J670/71. Likewise, recent CA24v showed a reaction of about 30% to a probe synthesized with EH24/70. These finding are highly suggestive of the progress of viral mutation.
The Mita-, Bour-, and Kami-strains of trachoma and inclusion conjunctivitis agents became adapted to serial passages in HeLa cell cultures after alternating passages between yolk sacs and tissue culture.
A new Moraxella strain was isolated from angular conjunctivitis. It is characterized by the ability to produce acid from several carbohydrates, by its ability to produce indole, and by a lack of catalase activity.
Media for isolation of Haemophilus sp. from the conjuctiva were compared in an oasis in southern Tunisia where severe trachoma and seasonal epidemic purulent conjunctivitis are common. Of 89 children tested, IsoVitaleX-supplemented chocolate agar yielded Haemophilus in 87%, plain chocolate agar in 75%, sheep blood agar with a stab of Staphylococcus epidermidis in 74%, and Fildes medium in 58%. Since other microbial pathogens are easily identified in the modified blood agar, it was the most useful single medium.
Although human infection with adenovirus-associated virus (AAV) has been demonstrated, there is no evidence that disease results from such infections. The proportion of adenovirus infections which are dual infections with AAV is virtually unknown, since special methods are required to demonstrate infection with AAV. To search for AAV, we re-examined a collection of specimens from 40 persons involved in an epidemic of pharyngoconjunctival fever associated with a swimming pool. Virological and serological studies indicated that the etiological agent was adenovirus type 3. When the 91 original eye, throat, and fecal specimens were re-examined, using methods suitable for detection of adenovirus and AAV, 37 strains of adenovirus type 3 and 35 strains of AAV type 3 (AAV3) were isolated. Surprisingly, 19 AAV3 but only 11 adenovirus isolates were found in eye specimens, whereas adenovirus isolates were equally distributed in all types of specimens. Four AAV3 strains were isolated from adults. Significant (fourfold or greater) rises in AAV3 complement-fixing antibody titers were seen in six of 14 persons shedding AAV3, whereas nine of 10 persons shedding adenovirus type 3 showed significant rises in adenovirus complement-fixing antibody. These results raise the question whether AAV persists better in eyes than adenovirus or that a possible association with conjunctivitis might be present. In contrast to the results in the specimens from the swimming pool epidemic, only one of 36 adenovirus strains isolated in other Seattle-based studies yielded AAV. Complement fixation tests on serial sets of sera collected from 60 children not involved in the swimming pool episode revealed nine AAV2 and 12 AAV3 infections during a 4-year period.