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Safety and efficacy of loteprednol etabonate for treatment of papillae in contact lens-associated giant papillary conjunctivitis.

Loteprednol etabonate (LE) is a new corticosteroid based on the "soft drug" concept. Contact lens-associated giant papillary conjunctivitis (GPC) was studied as a model for the anti-inflammatory effect of LE. Patients with bilateral GPC were enrolled in a multicenter, randomized, double-masked, placebo-controlled, parallel group comparison of loteprednol etabonate 0.5% ophthalmic suspension and the LE vehicle (placebo). Patients were instructed to instill 1 drop of the test medication into each eye 4 times daily for 4 weeks, and follow-up examinations occurred on Days 2 or 3, 7, 14, 21, and 28 of masked therapy. Of 113 patients enrolled, 110 patients (LE = 55; placebo = 55) completed the study as planned. Patients receiving LE demonstrated significant reduction in the primary ocular signs of GPC (papillae, p < 0.001) and were rated better in the Investigator's Global Assessment (p = 0.017). LE did not elevate intraocular pressure during the study, and ratings for bulbar conjunctival injection and the Patient Opinion Assessment demonstrated statistical trends that favored treatment with LE. LE was well tolerated and was clinically effective for the treatment of GPC.

Adolescent↗

Dental restorative materials and the prevalence of eczema, allergic rhino-conjunctivitis, and asthma in schoolchildren. Dental amalgam and allergy in schoolchildren.

OBJECTIVE: To study the association between allergic diseases (eczema, allergic rhino-conjunctivitis, and asthma) and different types of dental restorative materials (amalgam, composite, and glass ionomer) in Swedish schoolchildren. DESIGN: Cross-sectional survey with a questionnaire asking for symptoms of allergic disease during the previous year. This information was combined with current dental status (number and type of filled tooth surfaces). SETTING: Primary care and a school in the centre of a middle-sized Swedish town (approx. 80,000 inhabitants). PARTICIPANTS: 348 pupils of both sexes 13-15 years old. OUTCOME MEASURES: The occurrence of allergic disease in pupils with and without dental fillings of different types. The mean number and type of filled tooth surfaces in diseased and healthy pupils. RESULTS: 44% of the pupils had no amalgam fillings. This group of children reported significantly more often asthmatic symptoms than the group with amalgam (P = 0.02). The asthmatic children had a lower mean number of amalgam surfaces than the other pupils (P = 0.002) and also a lower mean number of filled tooth surfaces of all types. CONCLUSION: The results of this study do not support the theory that amalgam fillings increase the prevalence of allergic diseases or allergic reactivity as such in schoolchildren. Neither do composite and glass ionomer seem to cause such complications.

Adolescent↗

Acute hemorrhagic conjunctivitis caused by coxsackievirus A24 variant, South Korea, 2002.

In summer 2002, a nationwide outbreak of acute hemorrhagic conjunctivitis occurred in South Korea. The etiologic agent was confirmed as coxsackievirus A24 variant (CA24v) by virus isolation and sequencing of a part of the VP1 gene. Phylogentic analysis, based on the protease 3C sequences, showed that the Korean isolates were clustered into a lineage distinct from the CA24v isolates reported in previous outbreaks in Asia.

Communicable Diseases, Emerging↗

Adjuvant therapy of aspirin and cromoglycate 2% eye drops in vernal conjunctivitis.

Thirty patients of vernal conjunctivitis were divided into two groups as 'A' and 'B'. A group received the aspirin and cromoglycate 2% eye drops and the B group received cromoglycate eye drops. The results attained the group who received the aspirin and cromoglycate shown encouraging results and the details discussed in the full text.

Adolescent↗

Vernal conjunctivitis in Nigerian children.

Vernal conjunctivitis in 92 Nigerian children are reported. Males are more affected than females. Majority of the patients are in the first decade of life. The disease is usually chronic and palpebral form is twice as common as the limbal. More patients are seen in the early wet season and only in about 10 percent is a history of atopic diseases obtained. The variations of this disease in this series may be due to geographical rather than racial factors.

Adolescent↗

Effect of silver nitrate application on the conjunctival flora of the newborn: and the occurrence of clostridial conjunctivitis.

Newborn conjunctival cultures were obtained from 35 babies prior to silver nitrate application and 48 hours later. On initial culture, 46 facultative bacteria and 27 anaerobes were recovered; 48 facultative and 18 anaerobes were recovered after 48 hours. Haemophilus vaginalis, Bacteroides species and anaerobic cocci decreased in numbers, whereas S. epidermidis, Micrococcus and Propionibacterium acnes increased during this time interval. Clostridial species were isolated from two cases who developed conjunctivitis, along with Peptostreptococcus in one of the cases. In vitro experiments demonstrated lack of killing of C. perfringens in silver nitrate concentrations of 0.1 percent, even after 24 hours exposure.

Bacteria↗

The control of allergic conjunctivitis by suppressor of cytokine signaling (SOCS)3 and SOCS5 in a murine model.

Allergic conjunctivitis (AC) is a common allergic eye disease characterized by clinical symptoms such as itchiness, conjunctival congestion, elevated Ag-specific IgE, mast cell activation, and local eosinophil infiltration. In this study we established a murine model for Ag-induced AC to understand the pathogenesis of the disease. Cell transfer experiments indicated that AC can be divided into early and late phase responses (EPR and LPR). EPR was associated with IgE responses, leading to itchiness, whereas LPR was characterized by local eosinophil infiltration. Both EPR and LPR were significantly inhibited in STAT6-deficient mice, and adoptive transfer of Th2 cells reconstituted LPR. Furthermore, SOCS3 was highly expressed at the disease site, and T cell-specific expression of SOCS3 deteriorated clinical and pathological features of AC, indicating that Th2-mediated SOCS3 expression controls the development and persistence of AC. Reduction of the expression level in SOCS3 heterozygous mice or inhibition of function in dominant-negative SOCS3 transgenic mice clearly reduced the severity of AC. In contrast, constitutive expression of SOCS5, a specific inhibitor of IL-4 signaling, resulted in reduced eosinophil infiltration. These results suggest that negative regulation of the Th2-mediated response by dominant-negative SOCS3 and SOCS5 could be a target for therapeutic intervention in allergic disease.

Adoptive Transfer↗

Acute hemorrhagic conjunctivitis caused by enterovirus type 70: an epidemic in American Samoa.

From December 1981 to February 1982, an estimated 22,000 cases of acute hemorrhagic conjunctivitis (AHC) caused by enterovirus type 70 (EV 70) occurred among Samoan and non-Samoan residents of American Samoa. The overall attack rate was estimated to be 68%. Samoans of all ages resident in traditional housing and of large family size were at greatest risk of acquiring AHC, while non-Samoan adults resident in western style housing were at lowest risk. Epidemiologic aspects of AHC acquisition were also different for the Samoan and non-Samoan communities; index cases in Samoan households were frequently young adults, whereas index cases in non-Samoan households were commonly school age children, suggesting a role for school transmission in non-Samoans only. In this outbreak, subclinical AHC was rare; of 50 asymptomatic members of affected households, only 3 had neutralizing antibody to EV 70 (all with titers of 1:10). Investigation documented the highly contagious nature of AHC caused by EV 70, and the ease with which epidemic transmission may develop under conditions of crowding and frequent interpersonal contact.

Acute Disease↗

Prevalence of atopic diseases in Nigerian children with vernal kerato-conjunctivitis.

A descriptive study of 117 cases of vernal kerato-conjunctivitis (VKC), in children below the age of 18 years, newly presenting to 2 hospitals in Ibadan, Nigeria. All the children had a structured questionnaire administered to them which inquired about demographic and clinical, especially history or presence of other atopic diseases amongst other things. Specifically inquired about were asthma, eczema, allergic rhinitis or hay fever, allergic skin rash e.g. scabies, reaction to drugs and others. The children were also examined to confirm or detect the presence of these atopic diseases. The overall prevalence of atopic conditions was 19.8% amongst cases of VKC. These comprised of 6% asthma, 5% allergic rhinitis and 4.3% eczema. (Total 15.5%). Other forms of atopic conditions like other non-specific allergic skin reactions (0.9%), reaction to certain drugs e.g. chloroguine (0.9%) and other unknown allergic conditions (2.6%). It is suggested that children with VKC should be subjecteed to detailed enquiry and examination with regards to the presence of other atopic conditions. This will go a long way in understanding the type(s) of allergic response involved and perhaps of management of VKC.

Adolescent↗

Ligneous conjunctivitis in four Doberman pinschers.

Ligneous conjunctivitis (LC) was diagnosed in four unrelated Doberman pinschers. Thick, opaque membranes of the palpebral conjunctivae and nictitating membranes were present bilaterally. Three dogs had concurrent signs of multisystemic disease. A thick, amorphous, eosinophilic, hyaline-like material in the substantia propria of the conjunctiva--containing a moderate, mononuclear cell infiltrate--was evident on histological examination. A predominance of T lymphocytes, few macrophages, and weak positive staining for immunoglobulin G (IgG) and immunoglobulin A (IgA) were evident by immunohistochemical staining. The clinical and histological appearance of LC in Doberman pinschers and humans is similar.

Albumins↗

Bacterial conjunctivitis in Muc1 null mice.

PURPOSE: In contrast to wild-type mice, genetically engineered Mucin1 (Muc1) null animals display a marked propensity for development of blepharitis and conjunctivitis. Molecular approaches confirmed the presence of Muc1 mRNA and protein in the conjunctival tissue of wild-type mice and identified the bacterial species in Muc1 null symptomatic mice. METHODS: Muc1 null animals housed in a conventional facility were examined for visually apparent inflammation of the eye and surrounding tissue. Blood taken from overtly affected animals was assayed for antibodies to common murine viral agents. Swabs of infected eyes and whole eye preparations were used to detect and speciate bacterial pathogens. Frozen sections of whole eye, lid margin, and Harderian gland were immunostained with antibodies to Muc1 and cytokeratin 14, both epithelial cell markers. Northern blot analysis and reverse transcription-polymerase chain reaction (RT-PCR) were performed on RNA isolated from conjunctiva and Harderian gland of wild-type mice to compare relative levels of transcript. RESULTS: Student's unpaired t-test performed on the eye inflammation frequency of Muc1 null mice confirmed a statistical significance (P < 0.01) when compared to wild-type background animals housed in the same room. Analysis of blood samples from affected Muc1 null animals detected no common murine viral pathogens. Bacterial analysis of conjunctival swabs and whole eye preparations demonstrated the presence of coagulase-negative Staphylococcus, Streptococcus type alpha, and Corynebacterium group G2. Muc1 antibody staining of wild-type sections revealed the presence of Muc1 on conjunctival goblet and non-goblet cells and on the epithelium of the Harderian gland. Serial sections stained with cytokeratin 14 antibody confirmed the epithelial nature of cells expressing the Muc1 protein. RNA from conjunctiva and Harderian gland subjected to RT-PCR and northern blot analysis showed an abundance of Muc1 transcript in these tissues. CONCLUSIONS: Muc1 mRNA and protein are present in murine conjunctival and Harderian gland epithelia. Animals lacking Muc1 mRNA and protein are predisposed to developing eye inflammation when compared to wild-type animals with an intact Muc1 gene. Muc1 appears to play a critical protective role at the ocular surface, presumably by acting as a barrier to infection by certain bacterial strains.

Animals↗

[Measurement of total IgE in tears : the adaptation of an immunoenzyme technique and the value of investigating locally produced IgE in the diagnosis of chronic conjunctivitis].

The measurement of total IgE in tears could be useful to confirm the diagnosis of allergic conjunctivitis, particularly in chronic forms when the etiology is difficult to determine solely on clinical criteria and allergologic anamnesis. Since the level of IgE is normally very low in tears, the adaptation of a fluorescent enzyme immunoassay of total IgE (Unicap, Pharmacia-Upjohn) reduces the detection limit from 0.35 to 0.15 kU/l. Satisfactory results are obtained for accuracy, within-run precision (CV < 5%) and between-run precision (CV < or =11%). During allergic reactions, the local synthesis of IgE is evaluated by the ratio between the measured lacrimal IgE and the lacrimal IgE that have been filtered through the hemato-lacrimal barrier. The serum and tear albumin allows to quantify the permeability of the barrier and thus the amount of filtered tear IgE.

Antibody Formation↗

Giant papillary conjunctivitis in frequent replacement contact lens wearers: a retrospective study.

PURPOSE: We conducted a retrospective study of 47 patients who wore frequent replacement contact lenses on a daily-wear basis to determine the incidence of giant papillary conjunctivitis (GPC) and to assess the potential risk factors that may predispose frequent replacement contact lens wearers to develop GPC. METHODS: We reviewed the records of patients with no prior contact lens experience who were fit with frequent replacement contact lenses from September 1993 to February 1997. RESULTS: Forty-seven of 260 patients met the requirements for inclusion in the study. Ten (21.27%) patients had developed GPC. The incidence varied with the frequency of contact lens replacement. The contact lens replacement schedule ranged from 1 day to 12 weeks. In those patients replacing their contact lenses every 4 weeks or at a longer interval, the incidence of GPC was 36%, while for patients who replaced their lenses more frequently, the incidence was 4.5%. Coated contact lenses were also more common among patients who replaced their lenses at 4 weeks or longer (P = 0.23). A significantly greater number of patients in the GPC group incorporated enzymatic cleaning into their contact lens care system (P = .0004). A history of allergy was more prevalent in patients who developed GPC and was statistically significant (P = .012). There was no significant difference found between the groups for age, gender, average daily wearing time, FDA classification of contact lens material, time in contact lenses from fitting to diagnosis or last follow-up period, or the parameters and fitting characteristics of the contact lenses. CONCLUSION: The frequency at which patients replace their contact lenses appears to be an important variable in developing GPC. Although frequent replacement contact lenses do not eliminate GPC, patients on a 1-day to 3-week replacement cycle had a significantly lower risk of developing GPC than patients who replaced their lenses at longer intervals. Lens coating was present less often on contact lenses replaced daily and up to 3 weeks. For patients who are at high risk for GPC, replacing lenses at intervals ranging of one day to two weeks appears to offer a better strategy for avoiding GPC than incorporating enzymatic cleaning into their lens care system.

Adolescent↗

Giant papillary conjunctivitis in frequent-replacement contact lens wearers: a retrospective study.

PURPOSE: A retrospective study was done of 47 patients who wore frequent-replacement contact lenses on a daily basis and replaced them every 1 day to 12 weeks. The incidence of giant papillary conjunctivitis (GPC) was determined, and potential risk factors that may predispose frequent-replacement contact lens wearers to develop GPC were assessed. METHODS: The records of patients who were fitted with frequent-replacement contact lenses with no prior contact lens experience (September 1993 to February 1997) were reviewed. RESULTS: Forty-seven of 260 patients met the requirement for inclusion in this study. Ten (21.27%) of the patients developed GPC. The incidence varied according to how often the contact lenses were replaced. Incidence was 36% in patients who replaced their lenses at 4 weeks or longer and 4.5% in patients who replaced their lenses at less than 4 weeks. Lenses were coated more often in patients who replaced their lenses at 4 weeks or longer (pi = .23). A significantly greater number of patients in the GPC group incorporated enzyme into their contact lens care system (pi = .0004). A history of allergy was present, significantly more often in patients who developed GPC (pi = .012). There was no significant difference between the groups for age, sex, average daily wearing time, Food and Drug Administration classification of contact lens material, time in contact lenses from fitting to diagnosis or last follow-up period, or the parameters and fitting characteristics of the contact lenses. CONCLUSION: The frequency of contact lens replacement appears to be an important variable in development of GPC. Although frequent-replacement contact lenses do not eliminate GPC, patients on a 1-day to 3-week replacement cycle had a significantly lower risk of developing GPC than patients who replaced their lenses at longer intervals. Coating was present less often on lenses replaced every 1 day to 3 weeks. In patients who are at high risk for GPC, replacing lenses at intervals of 1 day to 2 weeks appears to offer a better strategy in avoiding GPC than incorporating enzymatic cleaning into their care system.

Adult↗

Genetic characterization of adenovirus strains isolated from patients with acute conjunctivitis in the city of São Paulo, Brazil.

Genome analysis was carried out on adenovirus strains isolated from patients with acute follicular conjunctivitis in the city of São Paulo, Brazil. Eighteen conjunctival scrapings, collected between December 1993 and March 1994, were analyzed by two methods: a combination of polymerase chain reaction with restriction fragment length polymorphism and viral DNA restriction analysis, carried out using 10 restriction endonucleases: BamHI, BglI, BglII, HindIII, KpnI, SacI, SalI, SmaI, XbaI, and XhoI. Among 11 adenovirus detected by cell culture isolation, nine were Ad8, and two were Ad7. By restriction analysis the Ad8 isolates were typed as two new variants-Ad8/D11 (seven of nine samples) and Ad8/D12 (two of nine samples). Ad7 isolates were identified as a subtype of the widespread genome type Ad7b and the virulent type Ad7h, a predominant genome type circulating in Argentina, Chile, and Uruguay but absent in Brazil until 1991.

Acute Disease↗

Investigation of an epidemic of acute haemorrhagic conjunctivitis in Pune, India.

An epidemic of acute haemorrhagic conjunctivitis (AHC) was reported from Pune in August-September, 1996. Conjunctival swabs and scrapings were taken from acute patients attending the OPD of the Ophthalmology department of B. J. Medical College, Pune. Conjunctival swabs were processed in human embryonic lung fibroblasts (HEL) cell line and viral isolates were obtained which were identified as Enterovirus (EV) 70 prime strain using standard in-vitro neutralisation test. Indirect intracellular immunofluorescence test also confirmed the identity of the virus involved in the epidemic.

Conjunctivitis, Acute Hemorrhagic↗