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Na(+)-dependent L-arginine transport in the pigmented rabbit conjunctiva.

The objective of this study was to characterize Na(+)-coupled L-arginine (L-Arg) transport in the pigmented rabbit conjunctiva. The excised pigmented rabbit conjunctiva was mounted in the modified Ussing chamber for measurement of short-circuit current (Isc), 3H-L-arginine (3H-L-Arg) flux, and 22Na flux. L-Arg when added to the mucosal side led to 0.32-2.65 microA cm-2 increases in the Isc at 37 degrees C, but not at 4 degrees C or in a Na(+)-free solution. L-Arg at 1 mM stimulated net Na+ absorption by 0.12 microEq cm-2 h-1. The evidence for carrier-mediated transport of L-Arg includes: (1) temperature dependence and saturability over 0.01-10 mM, (2) Na+ dependence and ouabain sensitivity, (3) 84 +/- 2% reduction in the apparent permeability coefficient (Papp) of 3H-L-Arg in the presence of excess unlabeled L-Arg (1 mM), and (4) 16-fold difference in L-Arg transport (at 0.1 mM) between the mucosal-to-serosal and the serosal-to-mucosal direction. Moreover, L-Arg transport was inhibited by basic amino acids, large neutral amino acids, and nitric oxide synthase inhibitors, but not by acidic and small neutral amino acids. Kinetic analysis revealed the possible existence of both high and low affinity processes for L-Arg transport. A half maximal concentration (Km) and maximal L-Arg flux (Jmax) values of the low and high affinity processes were 5.90 and 0.07 mM, and 1,248 and 111 pmol cm-2 min-1, respectively. Hill analysis of L-Arg transport at 0.1 mM in the presence of varying Na+ concentrations in the mucosal bathing fluid yielded a Hill coefficient of 0.93, suggesting a 1:1 coupling between Na+ and L-Arg. In conclusion, Na(+)-coupled transport process(es) for L-Arg in accordance with a 1:1 stoichiometry appear to be present on the mucosal side of the pigmented rabbit conjunctiva. The pattern of inhibition by basic and large neutral amino acids and Na+ dependency are suggestive of system B0,(+)-mediated L-Arg transport.

Amino Acids↗

Regulation of ocular mucin secretion by P2Y2 nucleotide receptors in rabbit and human conjunctiva.

The effects of adenine analogues on secretion of high molecular weight, mucin-like glycoproteins (mucins) by conjunctival goblet cells were investigated using isolated rabbit and human conjunctiva. Mucin secretion was assayed using a quantitative dot-blot assay of Helix pomatia agglutinin-horseradish peroxidase binding to mucins absorbed to nitrocellulose filters. In rabbit conjunctiva, exogenous ATP (10(-7)-10(-3) m) induced a concentration-dependent, four-fold increase in mucin secretion that reached a plateau 15 min after drug addition. The rank order of potency of agonists was UTP>=ATPgammaS>ATP>ITP>ADP>>AMP. Adenosine, alpha,beta-methylene- ATP and beta,gamma-methylene-ATP were ineffective in stimulating mucin release. The response to ATP was unmodified by the putative P2 purinergic antagonists suramin or reactive blue (5x10(-5) m). In human conjunctiva, ATP and UTP were nearly equipotent in stimulating mucin secretion with an EC50 congruent with5x10(-6) m. These findings demonstrate that rabbit and human conjunctival cells contain functional P2Y2 (formerly designated as P2U) nucleotide receptors that govern mucin secretion. These receptors may provide useful pharmacological targets for therapeutic modulation of tear film mucins in dry-eye disorders and/or corneal wound healing.

Adenosine Diphosphate↗

Cytokines in the conjunctiva of acute and chronic mucous membrane pemphigoid: an immunohistochemical analysis.

The aim of this study was to evaluate the potential role of certain soluble factors in conjunctival scar tissue formation of pemphigoid patients. Epibulbar conjunctival biopsy specimens were taken from patients with acute ulcerative (n = 4), subacute (n = 8) and chronic (n = 8) mucous membrane pemphigoid and from twelve age-matched healthy individuals. The tissues were embedded in glycol methacrylate and analysed by immunohistochemical methods. Interleukin-2 (IL-2), interferon-gamma, transforming growth factor-beta (TGF-beta), platelet-derived growth factor (PDGF), basic fibroblast growth factor (bFGF), tumour necrosis factor-alpha and proliferating cells (as identified with the antibody Ki-67) were found in both pemphigoid patients and normal controls. Interleukin-4 was not found with this method in either normal or diseased conjunctiva. Significant differences between normal and diseased conjunctiva were found for TGF-beta and for proliferating cells, which were both increased in the acute disease group. More intense staining was found in the subacute disease group for IL-2, bFGF and PDGF. Our findings showed that a variety of cytokines were present in normal and diseased bulbar conjunctiva. Acute conjunctival disease in mucous membrane pemphigoid may indicate active scar tissue formation, implied by an increase in TGF-beta and the presence of proliferating fibroblasts.

Acute Disease↗

Characterization of epithelial primary cultures from human conjunctiva.

Primary cultures of human epithelial cells from normal conjunctiva were developed and characterized to determine whether they retained epithelial characteristics. Conjunctival explants were obtained from the upper fornix of healthy donors and cultured in supplemented DMEM/F-12 medium for 5 days. The epithelial outgrowth was maintained for an additional 10 days. Primary cultures were then processed for light microscopy, transmission and scanning electron microscopy (TEM, SEM), and immunocytochemistry. They exhibited typical features of conjunctival epithelium on light microscopy (polygonal morphology, intimate cohesion, production of mucins), TEM (abundant desmosomes, keratin bundles, granules, microvilli), SEM (polygonal shape, microvilli, intimate cohesion), and immunocytochemistry (positivity for the receptor of epidermal growth factor, desmosomal proteins, and cytokeratins). In conclusion, primary cultures developed from normal human conjunctiva maintained the epithelial characteristics in vitro. Because the conjunctiva is a major component of the anterior ocular surface, we propose this in vitro system as suitable for physiopathologic and toxicologic studies.

Antibodies, Monoclonal↗

Alpha/beta- and gamma/delta-T-cell-receptor-positive lymphocytes in healthy and inflamed human conjunctiva.

BACKGROUND: The possible existence and distribution patterns of alpha/beta- and gamma/delta-TCR+ cells, which are important constituents of immune surveillance and act via the CD3+ cell complex have not yet been elucidated in the healthy and inflamed conjunctiva. MATERIALS AND METHODS: Paraffin-embedded conjunctival specimens included 18 from 18 patients with ocular cicatricial pemphigoid (OCP), 20 from 20 healthy controls, 6 from 6 patients with lye burns, and 6 from 2 patients with Stevens-Johnson syndrome; all were worked up by histology and immunohistochemistry. RESULTS: alpha/beta-TCR+ cells were visualized in the conjunctival epithelium and stroma of healthy persons, OCP, lye burns and Stevens-Johnson syndrome. alpha/ beta-TCR+ cells and a small number of gamma/delta-TCR+ cells were observed in the corneal epithelium and stroma of patients who have failing corneal grafts. After ileal mucosa transplantation to the epibulbar conjunctiva, membrane staining changes to nuclear and cytoplasmic staining. Treatment with systemic cytotoxic drugs abolishes all alpha/beta-TCR+ and gamma/delta-TCR+ cells. CONCLUSIONS: alpha/beta-TCR+ cells can be found in the non-infected epithelium and stroma of the healthy and inflamed (OCP, lye burns, and Stevens-Johnson syndrome) conjunctiva, as well as in the corneal epithelium and stroma of failing corneal grafts, whereas gamma/delta-TCR+ cells are absent. A small number of gamma/delta-TCR+ cells are present in the corneal stroma and adjacent conjunctival epithelium of patients with chronic corneal graft rejection or after transplantation of gut tissue. Further investigations may establish the role, if any, of these T-cell subsets in immune surveillance of the non-infected outer eye and in corneal graft rejection.

Burns, Chemical↗

Retrospective study on skin reddenings and petechiae in the eyelids and the conjunctivae in forensic physical examinations.

Skin reddening with or without additional changes such as pinpoint intracutaneous hemorrhages and/or minute superficial scratches was observed in 165 out of 739 physical examinations (reddening with additional changes: n = 81; reddening only: n = 84). The most common site where reddening was observed was the neck region (reddening with additional changes: n = 30; reddening only: n = 34). In over 85% of the cases, the postinfliction interval (Pi) was < or = 1 day, and there were 12 and 10 cases with 1 < Pi < or = 3 days, respectively. Among these 22 cases, there were 5 cases with 2 < Pi < or = 3 days, (reddening with additional changes: n = 4; reddening only: n = 1). The maximum Pis were almost 3 days, and 2 days and 13 h, respectively. These results demonstrate that reddening of the skin with and that without additional changes (in particular petechiae) were detectable up to approximately 3 and 2 days after the event, respectively. Furthermore, in 17 out of 64 cases with reddening in the neck, petechial hemorrhages were seen in the eyelids and/or conjunctivae (reddening with additional changes: n = 10; reddening only: n = 7). The maximum Pi in which petechial hemorrhages were detectable in the eyelids and/or the palpebral conjunctivae was 1 day and 21 h. The present study indicates that physical examinations within 2 or 3 days after the event seem to be more suitable to find skin reddening and/or petechiae in the eye lids and/or the conjunctivae.

Autopsy↗

Alterations in expression of mucin, tenascin-c and syndecan-1 in the conjunctiva following retinal surgery and plaque radiotherapy.

PURPOSE: Disturbances of the ocular tear film layer and dry eye symptoms are common complications following retinal surgery and ocular tumour therapy. Examined were the histopathological changes of the conjunctiva following posterior segment surgery and plaque radiotherapy. METHODS: Biopsy specimens of the superior bulbar conjunctiva were obtained during cataract surgery between 2 weeks and 7 years following vitrectomy (n=92) or plaque radiotherapy for uveal melanoma (n=20) and from control subjects without previous ocular surgery (n=29). These were examined using conventional histology (HE, PAS, Van Gieson) and immunochemistry [APAAP, using antibodies directed against MUC1, MUC5AC, syndecan-1 and tenascin-C (TN-C)]. The histopathological changes were graded and statistical analysis was performed using Wilcoxon and Kruskal-Wallis rank sum tests. RESULTS: Conjunctival specimens of patients following vitrectomy or plaque radiotherapy for uveal melanoma demonstrated increased epithelial stratification, a significant decrease in the number of PAS- and MUC5AC-positive goblet cells, and distributional changes in expression of MUC1, syndecan- and TN-C within conjunctival epithelium or stroma. These alterations - in particular the goblet cell reduction and stromal fibrosis - were most prominent in those patients who had undergone radiotherapy. CONCLUSIONS: Posterior segment surgery can lead to morphological alterations of the conjunctiva and distributional changes in ocular mucins, which may cause dry eye symptoms.

Adult↗

Conjunctiva in asymptomatic contact lens wearers.

Biopsy specimens of the upper tarsal conjunctiva from 11 asymptomatic, biomicroscopically normal contact lens wearers (five hard and six soft) were studied by scanning electron microscopy. The conjunctiva in lens wearers showed areas of normal epithelial cell surfaces interspersed among areas of altered cells. The altered cell surfaces were characterized by centralized clumped microvilli and baring of that portion of plasma membrane around the cell periphery. The degree of centralization of microvilli varied widely, from a mild tendency to centralize accompanied by slight reduction in cell diameter, to an exteme centralization and dramatic diameter reduction. In some cells, the centralized microvillar structure had a unique mucuslike covering. Numerous altered cells were present in all 11 specimens from asymptomatic contact lens wearers. The number of these cells found by conjunctival biopsy of the hard contact lens wearers and the number in the soft contact lens wearers apparently did not differ. The upper tarsal conjunctiva in these asymptomatic contact lens wearers has an altered epithelial surface, different from that observed in normal subjects without contact lens-wearing experience and from subjects with contact lens-associated giant papillary conjunctivitis.

Adult↗

Inverted papilloma of the conjunctiva.

We encountered inverted papilloma of the conjunctiva in three cases. To the best of our knowledge, this tumor, which typically involves the nose, paranasal sinuses, and lacrimal sac, has not been described previously in the conjunctiva. Two of the tumors occurred as purely inverted lesions of the inner canthal region )caruncle and plica) and the third as a mixed inverted-exophytic papilloma over the tarsus. Melanotic pigmentation in one of the lesions was clinically confused with malignant melanoma. Because of the high incidence of recurrence of these tumors in the sinuses and lacrimal sac, and their unknown biologic behavior in the conjunctiva, inverted papillomas should be removed completely and the patients carefully observed.

Aged↗

Fixation techniques for secretory component in human lacrimal gland and conjunctiva.

We compared biopsy specimens of human lacrimal gland and conjunctiva preserved by alcohol-acetic acid with the same tissues preserved by freezing to find secretory component. Secretory component was found in lacrimal gland preserved both by alcohol-acetic acid and by freezing. The structure of the tissue was better preserved with the alcohol-acetic acid fixation. Three of eight conjunctival specimens preserved by alcohol-acetic acid showed weak staining for secretory component in a few superficial epithelial cells. We found nonspecific staining of the conjunctiva with the control antiserum, rhodamine-labeled goat antibovine serum. Two specimens preserved by freezing were unreadable; four of the remaining six stained nonspecifically with the remaining two specimens stained with neither the control nor the experimental antiserum; the second may have had more staining with the experimental antiserum than with the control. We found no evidence for including the conjunctiva in the secretory IgA immune system.

Conjunctiva↗

Expression of vascular endothelial growth factor receptor-3 (VEGFR-3) on monocytic bone marrow-derived cells in the conjunctiva.

Vascular endothelial growth factor-3 (VEGFR-3), also known as Fms-like tyrosine kinase receptor 4 (FLT-4), was thought to be expressed exclusively on the lymphatic endothelium, high endothelial venules, and rarely on vascular endothelium. It plays a critical role in the development of lymphatics and cancer metastasis. Very recently, however, VEGFR-3 expression has been identified on dendritic cells (DCs) in the inflamed cornea, and related to the trafficking of these cells to lymphoid organs. The current study was performed to evaluate the expression of VEGFR-3 in the conjunctiva. The conjunctiva and limbus of normal and inflamed murine eyes were excised and stained for VEGFR-3. Immunofluorescence double staining for CD11b, CD11c, CD31, CD45, GR-1, CD3, CD80, LYVE-1 and class II major histocompatibility complex (MHC) antigen expression, using confocal microscopy, was performed to further phenotype the VEGFR-3+ cells. VEGFR-3 and LYVE-1 expression was observed on lymphatic, but not blood vessel, endothelium. In addition, we also detected expression of VEGFR-3 on non-endothelial CD45+ bone marrow-derived cells in the conjunctiva of normal and, in an increased number, in inflamed eyes. These cells were uniformly CD11b+, CD3-, and Gr-1-, suggesting a monocytic origin, similar to the VEGFR-3+ cells in the cornea. Nearly half of the VEGFR-3+ cells were also positive for MHC class II expression, and none were positive for CD80 (B7-1), indicating their relative immature status. In contrast to the recently described VEGFR3+ corneal cells, however, VEGFR-3+ conjunctival cells did not express the DC marker CD11c. We conclude that in addition to its known role in lymphangiogenesis, VEGFR-3 is also expressed by a conjunctival monocyte/macrophage lineage, implicating a potential relationship between lymphangiogenesis and leukocyte trafficking in the ocular surface.

Animals↗

Expression of Toll-like receptors in healthy and allergic conjunctiva.

PURPOSE: To investigate the expression of toll-like receptors (TLRs) in healthy and active vernal keratoconjunctivitis (VKC) conjunctiva. DESIGN: Comparative nonrandomized interventional study. PARTICIPANTS: Nine patients with vernal keratoconjunctivitis and 10 healthy subjects. METHODS: Normal and VKC conjunctiva were evaluated for TLR-2, TLR-4, and TLR-9 mRNA and proteins by relative real-time polymerase chain reaction and immunohistochemistry. Colocalization of TLRs was further evaluated by confocal microscopy and double-labeled immunofluorescence in T cells (CD4), mast cells (AA1), and eosinophils (EG2). MAIN OUTCOME MEASURES: Identification of TLRs at molecular and biochemical levels and identification of inflammatory cells that coexpress these receptors. RESULTS: Toll-like receptor 2, TLR-4, and TLR-9 were expressed in normal and VKC conjunctival epithelium and stroma, both with a more intense immunoreactivity in the stroma. In VKC tissues, TLR-4 was upregulated, TLR-9 was downregulated, and TLR-2 was slightly decreased relative to normal tissues. Toll-like receptor 4 was localized on CD4+ lymphocytes, eosinophils, and mast cells, whereas lymphocytes and eosinophils, but not mast cells, expressed TLR-9. CONCLUSIONS: Toll-like receptors are expressed in healthy and allergic conjunctiva. The upregulation or downregulation of these receptors and their presence on inflammatory cells suggest a role of TLRs in VKC.

Adolescent↗

Role of structural cells of the cornea and conjunctiva in the pathogenesis of vernal keratoconjunctivitis.

Vernal keratoconjunctivitis (VKC) is a severe type of allergic conjunctival disease characterized by the presence both of various corneal epithelial and stromal lesions as well as of conjunctival proliferative changes such as giant papillae of the upper tarsal conjunctiva and limbal lesions. These clinical findings as well as various pathophysiological characteristics of VKC are distinct from those of other types of ocular allergy and allergic diseases of other organs. The outer eye possesses specific allergological characteristics, one of which is communication between the cornea and conjunctiva through a thin layer of tear fluid. Fibroblasts of the cornea and the conjunctiva are activated by proinflammatory and T helper 2 (Th2) cell-derived cytokines. Corneal fibroblasts enhance ocular allergic reactions as a result of their activation-induced expression both of chemokines such as eotaxin and TARC as well as of adhesion molecules such as ICAM-1 and VCAM-1, all of which together promote the activation and infiltration of eosinophils and Th2 lymphocytes. In contrast, corneal epithelial cells suppress such reactions by physically separating corneal fibroblasts from bioactive substances in tear fluid. Exaggerated proliferation of and deposition of extracellular matrix by conjunctival fibroblasts likely exacerbate conjunctival inflammation. Restoration of an intact corneal epithelium and inhibition of the activities of corneal and conjunctival fibroblasts may provide a basis for the development of new treatments for severe ocular allergic diseases such as VKC.

Animals↗

Number of inflammatory cells in the normal conjunctiva.

We counted inflammatory cells per cubic millimeter in both the epithelium and the substantia propria of samples from upper tarsal conjunctiva of 15 normal subjects and from lower forniceal conjunctiva of ten normal subjects. The upper limit of normal for number of cells was nearly 500,000/mm3. Lymphocytes accounted for about 70% of the inflammatory cells. Neutrophils and lymphocytes were almost always present in both the epithelium and the substantia propria. Plasma cells and mast cells were present in the substantia propria of all subjects, but never in the epithelium. Neither eosinophils nor basophils were found in any specimen. We concluded that conjunctiva of the white and quiet eye usually contains heavy infiltrates of inflammatory cells.

Adolescent↗

Histological study of conjunctiva-associated lymphoid tissue in mouse.

PURPOSE: To investigate conjunctiva-associated lymphoid tissue (CALT) in the mouse conjunctiva by histological methods. METHODS: The presumed follicular tissue in the conjunctiva of normal mice, age ranging from 4 to 6 weeks, was histologically investigated by the hematoxylin-eosin staining method. Next, we treated the mice with topical instillation of a combined solution of ovalbumin and cholera toxin B to investigate the morphological changes of conjunctival follicles to antigen challenge. The treated mice underwent sequential clinical examinations, and the conjunctival follicular tissue was examined by an immunohistochemical method using anti-CD4 antibody, anti-CD8 antibody, and anti-S-100 antibody. RESULTS: Follicular tissue was present on the mouse nictitating membrane. Both size and number of follicular tissue areas increased with topical ovalbumin treatment. Immunohistochemical study revealed CD4, CD8, and S-100 positive cells in the follicular tissue. The epithelial layer, corresponding to follicular tissue, demonstrated intra-epithelial pocket and the presence of CD4-positive cells in the intra-epithelial pocket. CONCLUSION: Follicular tissue at the nictitating membrane is CALT in the mouse.

Animals↗

Pseudoadenomatous hyperplasia of the conjunctiva.

PURPOSE: To describe the clinical and pathologic features of three patients with pseudoadenomatous hyperplasia of the conjunctiva. DESIGN: Observational case series with clinicopathologic correlation. METHODS: Case reports and clinical histories and examination of three biopsy specimens. MAIN OUTCOME MEASURES AND RESULTS: Pseudoglandular hyperplasia of the conjunctiva was associated with chronic inflammation, including eosinophils, in two patients, and squamous epithelial hyperplasia in a third. The pseudoglands are lined by varying proportions of squamous epithelium and goblet cells. CONCLUSIONS: Pseudoglandular hyperplasia of the conjunctiva can mimic a well-differentiated mucoepidermoid carcinoma. Awareness of this entity may help to prevent misdiagnosis and unnecessary surgery.

Administration, Topical↗

Cytological changes of the conjunctiva in immunoglobulin-producing dyscrasias.

The conjunctivae of 15 patients with confirmed immunoglobulin-producing dyscrasias were examined by cytological techniques. Of 13 patients with no gross ocular symptoms, 10 showed distinct epithelial cell changes and/or the presence of periodic acid-Schiff (PAS)-positive cells. Two other patients with gross abnormalities of the conjunctiva revealed the presence of PAS-positive cells, Dutcher bodies, and lymphocytoid-plasma cells. Lymphomatous deposition may develop in the conjunctiva and present as conjunctival nodules or as a diffuse infiltration. It is concluded that the cytological preparation of conjunctival smears may serve as a sensitive indicator of systemic immunoglobulin-producing dyscrasias.

Aged↗

Conjunctiva-Müller's muscle excision to correct anophthalmic ptosis.

We treated 35 eyelids with ptosis and anophthalmos by resecting conjunctiva and Müller's muscle. Before surgical intervention all patients were evaluated by an experienced ocularist who, if necessary, modified or refit the prosthesis. All eyelids had a positive response to 10% phenylephrine hydrochloride. Preoperatively, the margin reflex distance-one (MRD-1) of the ptotic eyelids ranged from -2.0 to +3.5 mm. The amount of conjunctiva-Müller's muscle excision ranged from 7.25 to 9.25 mm. Following surgery, the average change in MRD-1 was 3.33 mm. Thirty-one eyelids (88.6%) achieved a post-operative level within 1 mm of the opposite eyelid. There were two overcorrections and two undercorrections. Postoperatively, no patients had any compromise of the superior fornix, socket dryness, or inability to retain their prosthesis. Resection of conjunctiva and Müller's muscle is a simple and effective method to treat ptosis associated with anophthalmos.

Adolescent↗