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PubMed1993

The role of contact lenses, trauma, and Langerhans cells in a Chinese hamster model of Acanthamoeba keratitis.

PURPOSE: To determine the role of contact lenses, corneal trauma, and Langerhans cells in the development of keratitis caused by Acanthamoeba organisms in Chinese hamsters. METHODS: Various methods were used to induce corneal infections in Chinese hamsters, including application of parasite-laden contact lenses. The role of corneal epithelial defects in promoting parasite binding was examined in vitro in a microscopic binding assay. The role of corneal abrasion in the development of Acanthamoeba keratitis was also examined in Chinese hamsters exposed to parasite-laden contact lenses. Other experiments evaluated the effect of infiltrating Langerhans cells on the incidence and severity of Acanthamoeba keratitis. RESULTS: Corneal epithelial defects promoted extensive parasite binding to abraded corneas compared to intact, nonabraded counterparts. Corneal abrasion was absolutely necessary for the induction of Acanthamoeba keratitis in hamsters infected with contaminated contact lenses. Infection was never detected unless the corneas were abraded before exposure to parasite-laden contact lenses. The presence of Langerhans cells in corneas prevented the development of Acanthamoeba keratitis. CONCLUSIONS: The highest incidence of Acanthamoeba keratitis occurs in corneas expressing epithelial defects and exposed to parasite-laden contact lenses. The presence of Langerhans cells in corneas exposed to parasite-laden contact lenses prevents the development of Acanthamoeba keratitis.

Acanthamoeba↗
PubMed1998

Detection of feline herpesvirus 1 DNA in corneas of cats with eosinophilic keratitis or corneal sequestration.

OBJECTIVE: To determine whether feline herpesvirus 1 (FHV-1) DNA is in the corneas of clinically normal cats and cats with eosinophilic keratitis or corneal sequestration. SAMPLE POPULATION: Corneal biopsy specimens obtained from cats referred for treatment of corneal sequestration or eosinophilic keratitis. PROCEDURE: Corneal scraping or keratectomy specimens collected from clinically normal cats, cats with eosinophilic keratitis, and cats with corneal sequestration were evaluated for FHV-1 DNA by use of polymerase chain reaction (PCR). DNA was extracted from the tissue, and 1 microgram was assayed for FHV-1 by use of a single-round (40 cycles) PCR assay with primers directed at a 322-bp region of the thymidine kinase gene. Polymerase chain reaction positivity for clinically normal and affected cats of various breeds was compared by chi 2 analysis at alpha = 0.05. RESULTS: The FHV-1 DNA was detected in 5.9% (1/17) of corneas from clinically normal cats, in 55.1% (86/156) of corneal sequestra, and in 76.3% (45/59) of scraping specimens from cats with eosinophilic keratitis. Prevalence was significantly (P < 0.001) greater for cats with corneal sequestration or eosinophilic keratitis than for clinically normal cats. For cats with corneal sequestration, prevalence of FHV-1 DNA was significantly lower in Persian and Himalayan, compared with domestic shorthair and longhair breeds. CONCLUSION: Data strongly imply involvement of FHV-1 in the pathogenesis of eosinophilic keratitis and corneal sequestration. In Persian and Himalayan breeds, however, other nonviral factors also appear to be involved. CLINICAL RELEVANCE: Feline herpesvirus 1 must be considered when treating cats with corneal sequestration or eosinophilic keratitis.

Animals↗
PubMed1994

The impact of overnight wear on the risk of contact lens-associated ulcerative keratitis.

OBJECTIVE: To assess the relative risk of contact lens-associated ulcerative keratitis by lens type and related lens-wearing behavior. DESIGN: Case-control study. SETTING/PARTICIPANTS: Forty practice-based case patients with contact lens-associated ulcerative keratitis and 180 control patients matched to the case patients' dispensing practitioner and date of contact lens prescription. RESULTS: Compared with users of daily-wear soft lenses, users of disposable soft contact lenses had a 13.33-fold (95% confidence interval [CI], 5.35 to 33.20) excess risk of ulcerative keratitis. However, after adjusting for overnight wear, the excess risk associated with disposable contact lenses is reduced to 3.21 (95% CI, 1.22 to 14.36). Overall, overnight wear of contact lenses conferred an 8.25-fold excess risk (95% CI, 3.33 to 25.58) of ulcerative keratitis after controlling for lens type. No protective effect of standard compared with substandard lens hygiene was found. The risk of ulcerative keratitis attributable to overnight wear was estimated at 49% for users of daily-wear lenses and 74% for users of lenses approved for overnight wear. CONCLUSION: Overnight wear of contact lenses is the overwhelming risk factor for ulcerative keratitis among contact lens users. We estimate that 49% to 74% of cases of contact lens-associated ulcerative keratitis could be prevented by eliminating overnight wear.

Adolescent↗
PubMed2000

Shifting trends in bacterial keratitis in south Florida and emerging resistance to fluoroquinolones.

OBJECTIVE: To study the distribution, current trends, and patterns of resistance to antimicrobial agents of bacterial keratitis isolates in South Florida. DESIGN: Retrospective, observational, case series. PARTICIPANTS: The microbiology records of all patients with bacterial keratitis seeking treatment at the Bascom Palmer Eye Institute from January 1, 1990 through December 31, 1998 were reviewed. MAIN OUTCOME MEASURES: In vitro laboratory minimum inhibitory concentration testing of the corneal isolates to the fluoroquinolones (ofloxacin and ciprofloxacin) and to the aminoglycosides (tobramycin and gentamicin) was performed using the Vitek (Automatic Microbial System Biomerieux Vitek, Inc., Hazelwood, Missouri) method. RESULTS: During this 9-year period, 2920 consecutive corneal cultures were obtained, and a pathogen was recovered in 1468 cultures (50%). The number of corneal ulcers scraped, positive cultures, recovered bacterial isolates, and ratio of gram-positive to gram-negative isolates per year remained approximately equal throughout the study period. Staphylococcus aureus and Pseudomonas aeruginosa represented 19.4% and 25.7%, respectively, of the total bacterial isolates during this period. However, we documented a gradual increase in the number of S. aureus keratitis isolates (29% of gram-positive organisms in 1990 versus 48% in 1998, P = 0.01) coupled with a decrease in the number of P. aeruginosa isolates (54% of gram-negative organisms in 1990 versus 46% in 1998). A decrease in the incidence of contact lens-associated keratitis and P. aeruginosa isolates in this group of patients was documented. Serratia marcescens and P. aeruginosa were most commonly isolated in contact lens-associated keratitis (18% each). There was increasing laboratory resistance of S. aureus keratitis isolates to the fluoroquinolones (11% in 1990 to 28% in 1998), but resistance patterns to the aminoglycosides remained unchanged. There was a three-fold increase in the percentage of resistant S. aureus isolates to fluoroquinolones between 1990 and 1994 and between 1995 and 1998. Both fluoroquinolones and aminoglycosides exhibited low in vitro effectiveness against P. aeruginosa throughout the study period. CONCLUSIONS: The increased recovery of S. aureus keratitis isolates and decreased laboratory effectiveness against fluoroquinolones to these pathogens present an important therapeutic challenge.

Anti-Bacterial Agents↗
PubMed1990

Ulcerative keratitis in contact lens wearers. Incidence and risk factors.

A case-control study of ulcerative keratitis in soft contact lens (CL) users compared three groups of daily wear or extended wear patients: (a) 86 patients with ulcerative keratitis, (b) 61 hospital-based controls, and (c) 410 population-based controls. Overnight lens use, whether regularly with extended wear lenses or occasionally with daily wear lenses, emerged as the preeminent risk factor for ulcerative keratitis. It increased risk by 10 to 15 times in users of extended wear lenses and by 9 times in users of daily wear lenses when these groups were compared with subjects engaged in strict daily wear of daily wear lenses. Even when actual overnight wear was not taken into account, the relative risk was four times greater in users of extended wear lenses than in users of daily wear lenses. The study found a marginal association (p = 0.056) between lens care frequency in general and ulcerative keratitis in comparing ulcerative keratitis cases with population controls. Of the individual hygiene-related measures, evidence of a protective effect was strongest for cleaning the lens case. Smokers showed a threefold greater risk than nonsmokers, regardless of the type of lens worn. An incidence study found the rate of ulcerative keratitis to be approximately 1 in 2,500 daily wear lens users and 1 in 500 extended wear lens users per year. This finding was statistically consistent with the risk ratio noted in the case-control study. Extrapolations suggest that 4,000 of the 9 million U.S. users of daily wear soft lenses develop ulcerative keratitis annually. Among the 4 million U.S. extended wear soft lens users, 8,000 may do so per year.

Adult↗
PubMed1998

Platinum spatula versus Mini-tip Culturette in culturing bacterial keratitis.

PURPOSE: To compare the traditional method of culturing bacterial keratitis (platinum spatula) with the use of a commercially available Mini-tip Culturette (Becton-Dickinson, Cockeysville, MD, U.S.A.). METHODS: An experimental model of bacterial keratitis was created in rabbit corneas by intrastromal injection of bacteria. Cultures were taken of rabbit corneas with both the Mini-tip Culturette and the platinum spatula. Culture results were compared with corneal colony counts. Humans with community-acquired presumed bacterial keratitis were cultured with both the Mini-tip Culturette and the platinum spatula. The sensitivity and specificity of the Mini-tip Culturette method was determined and compared with the platinum-spatula technique. RESULTS: Rabbit keratitis model: 100% of corneas had established infections by colony count. Each ulcer was culture positive with platinum spatula, moist Mini-tip Culturette, and dry Mini-tip Culturette. Human keratitis: Seven patients had culture-negative keratitis with both the Mini-tip Culturette and the platinum spatula. Five patients were culture positive with both the Mini-tip Culturette and the platinum spatula. One of the positive cultures had growth of multiple organisms by using the platinum spatula but not with the Mini-tip Culturette. The sensitivity of the Mini-tip Culturette was 83.3%. The specificity of the Mini-tip Culturette was 100%. Detected organisms included group A beta-hemolytic Streptococcus, S. aureus, coagulase-negative Staphylococcus, Serratia marcescens, and Pseudomonas aeruginosa. CONCLUSION: The Mini-tip Culturette is a highly specific and moderately sensitive method for culturing bacterial keratitis.

Animals↗
PubMed2006

Microbial keratitis at extremes of age.

PURPOSE: To study the risk factors, clinical presentation, response to treatment and outcome of microbial keratitis occurring in patients at extremes of age (ie, children and the elderly) and to compare them with microbial keratitis affecting the general adult population. METHODS: In this prospective, nonrandomized, analytical clinical study, all patients presenting with microbial keratitis and undergoing microbiological workup over a 1-year period were evaluated using a dedicated corneal ulcer protocol. Patients were divided into 3 groups based on age: (1) pediatric group if the age was 16 years or younger, (2) elderly group if the age was 65 years or older, and (3) control group if the age was between 17 and 64 years. Features studied included microbiological profile, predisposing factors, clinical presentation, response to treatment, and final visual outcome. RESULTS: A total of 269 eyes of 269 patients were studied (26 in the pediatric group, 55 in the elderly group, and 188 in the control group). Culture positivity rates were similar in all the groups. The elderly and control groups had a similar incidence of fungal and bacterial keratitis, but the pediatric group had a significantly lower incidence of fungal keratitis (P = 0.001). Trauma was the most common predisposing factor in all groups. Elderly patients tended to present with a higher incidence of central ulcers (P = 0.04), severe ulcers (P = 0.04), and poor visual acuity (P = 0.003) as compared with the control group. The percentage of ulcers healing with medical treatment alone was significantly more in the pediatric group (P = 0.004), while the incidence of poor visual outcome was greater in the elderly group (P = 0.006) as compared with the control group. CONCLUSIONS: Microbial keratitis in pediatric patients is more likely to be of bacterial etiology, and nonsevere ulcers in this age group have a better chance of resolution with medical therapy alone when compared with that in the general adult population. Conversely, elderly patients with microbial keratitis tend to present with severe, central ulcers with a significant risk of having a poor visual outcome.

Adolescent↗
PubMed2006

Multistate outbreak of Fusarium keratitis associated with use of a contact lens solution.

CONTEXT: Fusarium keratitis is a serious corneal infection, most commonly associated with corneal injury. Beginning in March 2006, the Centers for Disease Control and Prevention received multiple reports of Fusarium keratitis among contact lens wearers. OBJECTIVE: To define the specific activities, contact lens hygiene practices, or products associated with this outbreak. DESIGN, SETTING, AND PARTICIPANTS: Epidemiological investigation of Fusarium keratitis occurring in the United States. A confirmed case was defined as keratitis with illness onset after June 1, 2005, with no history of recent ocular trauma and a corneal culture growing Fusarium species. Data were obtained by patient and ophthalmologist interviews for case patients and neighborhood-matched controls by trained personnel. Available Fusarium isolates from patients' clinical and environmental specimens were genotyped by multilocus sequence typing. Environmental sampling for Fusarium was conducted at a contact lens solution manufacturing plant. MAIN OUTCOME MEASURES: Keratitis infection with Fusarium species. RESULTS: As of June 30, 2006, we identified 164 confirmed case patients in 33 states and 1 US territory. Median age was 41 years (range, 12-83 years). Corneal transplantation was required or planned in 55 (34%). One hundred fifty-four (94%) of the confirmed case patients wore soft contact lenses. Forty-five case patients and 78 controls were included in the case-control study. Case patients were significantly more likely than controls to report using a specific contact lens solution, ReNu with MoistureLoc (69% vs 15%; odds ratio, 13.3; 95% confidence interval, 3.1-119.5). The prevalence of reported use of ReNu MultiPlus solution was similar between case patients and controls (18% vs 20%; odds ratio, 0.7; 95% confidence interval, 0.2-2.8). Fusarium was not recovered from the factory, warehouse, solution filtrate, or unopened solution bottles; production of implicated lots was not clustered in time. Among 39 isolates tested, at least 10 different Fusarium species were identified, comprising 19 unique multilocus genotypes. CONCLUSIONS: The findings from this investigation indicate that this outbreak of Fusarium keratitis was associated with use of ReNu with MoistureLoc contact lens solution. Contact lens users should not use ReNu with MoistureLoc.

Adult↗
PubMed1997

Newly acquired herpes simplex virus keratitis after penetrating keratoplasty.

BACKGROUND: After penetrating keratoplasty for reasons unrelated to herpes simplex virus (HSV) keratitis, any nonspecific epithelial defect may still be caused by HSV. The purpose of this study is to determine the incidence of newly acquired herpetic keratitis and to assess contributing factors. METHODS: The authors retrospectively studied the results of 2398 penetrating keratoplasties performed between 1980 and 1995. Three typical case histories are discussed. RESULTS: Of 2112 patients in whom the primary diagnosis was not related to HSV keratitis, 18 presented with epithelial herpetic keratitis in their corneal graft. The incidence of newly acquired herpetic keratitis after penetrating keratoplasty was 1.2 per 1000 person-years. In most cases, the infection occurred in the first 2 years after the transplantation. Most often, well-known reactivating stimuli could have caused the HSV infection. CONCLUSIONS: Herpes simplex virus keratitis may develop after penetrating keratoplasty even without a clinical history of HSV in the host. Thus, HSV should be considered in the differential diagnosis of a postpenetrating keratoplasty epithelial defect. The high incidence of this infection in the first 2 years after such surgery suggests a causal relation between corneal transplantation and the HSV infection.

Adult↗
PubMed1992

Cataract as a complication of severe microbial keratitis.

Complicated cataract results from local ocular disease; we report five cases that followed severe anterior segment infection. Three patients had Pseudomonas keratitis and two Acanthamoeba keratitis. All patients had severe keratitis and iridocyclitis. Mature cataracts developed after a mean of 5.5 months from the onset. Cataract formation with severe keratitis may be attributable to bacterial toxins, iridocyclitis and treatment toxicity. All these factors may cause cataract by interference with lens metabolism. One of our cases had no steroid treatment; the remaining four had between 7.7 and 28.14 mg of topical steroid (256-938 drops of Dexamethasone 0.1%). Cataract formation may result from severe microbial keratitis alone but is probably enhanced by concurrent treatment with high doses of topical steroid. The potential for cataract formation must be considered when managing microbial keratitis with the use of steroids and when planning surgical rehabilitation of the anterior segment.

Acanthamoeba Keratitis↗
PubMed1996

Severe microbial keratitis in temperate and tropical Western Australia.

To determine the patterns of severe microbial keratitis in Western Australia, all acute admissions over a 2 year period to the Department of Ophthalmology, Royal Perth Hospital were assessed. Fifty-three cases (n = 53) of severe, presumed microbial keratitis were identified. Seventy per cent of these eyes had a visual acuity of 6/60 or less on admission and only 38.8% had 6/12 or better corrected acuity following resolution of the keratitis. The most commonly identified predisposing factors were: prior ocular surgery with or without exposed monofilament sutures (43.4%); contact lens wear (22.6%); lid malposition (17.0%); history of ocular trauma (15.1%); and history of previous herpes simplex keratitis (13.2%). It is notable that 26.4% of the subjects had been applying topical ophthalmic corticosteroids prior to admission. Following corneal scrape or biopsy a positive microbial diagnosis was made in 71% of samples, with Gram-negative and Gram-positive bacterial isolates being equally frequent. Five cases of Acanthamoeba keratitis were identified following corneal biopsy. Where antibiotic sensitivities were available, it was noted that 61.5% of Gram-positive and 46.1% of Gram-negative bacteria were susceptible to chloramphenicol, with 84.6% of Gram-negative bacteria being sensitive to gentamicin. Many of these severe cases of microbial keratitis might have been avoided, or their severity lessened, by earlier identification of predisposing risk factors, more intensive and appropriate antibiotic administration, and improved patient education following ocular surgery.

Acanthamoeba Keratitis↗
PubMed1983

[Dimmer's keratitis nummularis, a doubtful disease].

From Dimmer's original description of 4 cases of keratitis, it would seem that what is now known as a keratitis nummularis (Dimmer), is not one specific corneal disease but a heterogeneous group of diseases. Salzmann demonstrated in certain cases a clear relationship between it and herpetic keratitis and its corneal complications. Later authors have not convincingly differentiated KND from herpetic keratitis, as no tests have been performed to determine corneal sensitivity. Pillat, who did use the criterion of normality of corneal sensitivity for the diagnosis of KND, was unable to differentiate KND adequately from the sequelae of adenovirus keratitis. Nummular keratitis (Dimmer) does not play a diagnostic part in ophthalmology, as we are not dealing with a nosological entity.

Cornea↗
PubMed1998

Antimicrobial management of presumed microbial keratitis: guidelines for treatment of central and peripheral ulcers.

AIMS: To determine the quantitative relation between the major risk factors for microbial keratitis of previous ocular surface disease and contact lens wear and central and peripheral infiltration, often associated with ulceration, in order to establish a rational chemotherapeutic management algorithm. METHODS: Data from 55 patients were collected over a 10 month period. All cases of presumed microbial keratitis where corneal scrapes had been subjected to microbiological examination were included. Risk factor data and laboratory outcome were recorded. Antimicrobial regimens used to treat each patient were documented. RESULTS: 57 episodes of presumed microbial keratitis were identified from 55 patients, 24 male and 31 female. There were 30 central infiltrates and 27 peripheral infiltrates of which 28 were culture positive (73% of central infiltrates, 22% of peripheral infiltrates). 26 patients had worn contact lenses of whom 12 had culture positive scrapes (9/14 for central infiltrates, 3/12 for peripheral infiltrates). 31 patients had an ocular surface disease of whom five previous herpes simplex virus keratitis patients developed secondary bacterial infection. Anterior chamber activity and an infiltrate size > or = 4 mm2 were more common with culture positive central infiltrates than peripheral infiltrates (chi 2 test = 11.98, p < 0.001). CONCLUSIONS: Predisposing factors for "presumed" microbial keratitis, either central or peripheral, were: ocular surface disease (26/57 = 45.6%), contact lens wear (26/57 = 45.6%), and previous trauma (5/57 = 8.8%). Larger ulceration (> or = 4 mm2) with inflammation was more often associated with positive culture results for central infiltration. None of these four variables (contact lens wear, ocular surface disease, ulcer size, anterior chamber activity) were of intrinsic value in predicting if a peripheral infiltrate would yield identifiable micro-organisms. Successful management of presumed microbial keratitis is aided by a logical approach to therapy, with the use of a defined algorithm of first and second line broad spectrum antimicrobials, for application at each stage of the investigative and treatment process considering central and peripheral infiltration separately.

Acanthamoeba Keratitis↗
PubMed2001

[Infectious keratitis after penetrating keratoplasty].

PURPOSE: To investigate the prevalence of microbial keratitis, predisposing risk factors, the spectrum of pathogens and the prognosis for graft survival and visual outcome in patients who developed microbial keratitis following penetrating keratoplasty (PK). MATERIAL: and methods: We reviewed 16 cases (15 patients) of microbial keratitis after PK. In all cases, corneal scrapings were obtained and microbiologically analyzed. Efficacy of treatment was evaluated by anatomical (clarity of graft) and visual recovery. RESULTS: Principal indications for PK were pseudophakic bullous keratopathy (50%) and microbial keratitis in the previous graft (25%). Sixty-three per cent of infections occurred within 1 year of PK. Principal predisposing risk factors were suture-related problems (44%) and microbial keratitis in the previous graft (25%). All of the scrapings were positive according to the microbiological evaluation with gram-positive cocci (64%), gram-positive rods (12%), fungi (18%), and Acanthamoeba (6%). We found 1 case of polymicrobial infection. Best visual and anatomical results were observed in nonadvanced cases and/or these treated early. After medical and surgical treatments, 8 patients (50%) had a clear graft and 10 patients (63%) had visual acuity less than 20/200. CONCLUSION: Postoperative control of risk factors and early recognition of infectious complications may decrease the incidence of severe microbial keratitis after PK.

Acanthamoeba Keratitis↗
PubMedDate not supplied

[Non-viral infectious keratitis: predisposing factors, etiologic agents and laboratory diagnosis].

Infectious keratitis cause significant morbidity and, if it is not promptly and appropriately treated, can lead to severe ocular disability. Almost all cases of keratitis are associated to predisposing conditions. In occident, the main risk factor is contact lens wear, but previous ocular surgery or trauma are also important, as well as various ocular surface diseases. An enormous diversity of etiologic agents for infectious keratitis exist, including virus, bacteria, mycobacteria, fungi and parasites. This review provides literature and personal based information about main predisposing factors, etiologic agents and pathophysiology of infectious keratitis, excluding those of viral origin. Focus is made on microbiologic procedures, describing stains and media that should be used, and highlighting their utility. A special mention on particular situations is made, including laboratory diagnosis of Acanthamoeba keratitis, utility of lens cases analysis, keratitis in patients with previous treatment, as well as molecular biology techniques described in ophthalmology.

Acanthamoeba Keratitis↗
PubMed2000

Confirmation of confocal microscopy diagnosis of Acanthamoeba keratitis using polymerase chain reaction analysis.

BACKGROUND: Acanthamoeba keratitis has commonly been identified with in vivo confocal microscopy and confirmed with histologic examination of an epithelial biopsy specimen. OBJECTIVE: To determine if Acanthamoeba keratitis can be verified using polymerase chain reaction (PCR) of epithelial biopsy specimens. METHODS: Epithelial specimens from patients with suspected Acanthamoeba keratitis by confocal microscopy were tested for Acanthamoeba with PCR of Acanthamoeba ribosomal DNA. RESULTS: Twenty-four of 31 patients with evidence of Acanthamoeba keratitis were positive for Acanthamoeba on PCR analysis using 3 sets of primers. In 22 cases, the sequence obtained closely matched Acanthamoeba castellanii. CONCLUSIONS: This study demonstrates that PCR analysis of epithelial biopsy specimens can provide definitive verification of the confocal microscopic and histologic identification of Acanthamoeba organisms associated with keratitis. Acanthamoeba keratitis is probably quite common, especially in contact lens wearers, although more than half of the patients in this study did not wear contact lenses.

Acanthamoeba↗
PubMed2006

Dacryoadenitis associated with Acanthamoeba keratitis.

OBJECTIVE: To report the incidence of dacryoadenitis as a symptom associated with Acanthamoeba keratitis. METHODS: We investigated all cases of Acanthamoeba keratitis (20 patients and 21 eyes) diagnosed and treated at Tokyo Dental College, Ichikawa General Hospital, Ichikawa, Japan, between May 1, 1994, and November 30, 2005. We recorded the incidence of dacryoadenitis diagnosed using clinical signs of lacrimal gland swelling and pain on pressure, computed tomography, magnetic resonance imaging, and histopathologic analysis. RESULTS: Eight eyes (38%) of 8 patients had dacryoadenitis simultaneously with Acanthamoeba keratitis. Dacryoadenitis was diagnosed using histopathologic analysis and computed tomography in 1 patient, histopathologic analysis and magnetic resonance imaging in 1, magnetic resonance imaging in 2, and clinical signs alone in 4. Histopathologic examination in 2 patients revealed moderate infiltration of lymphocytes and plasma cells in the lacrimal gland compatible with dacryoadenitis. No Acanthamoeba organisms were found in the lacrimal gland. The standard protocol for Acanthamoeba keratitis was performed without particular treatment of dacryoadenitis in all patients. Lacrimal gland swelling improved after a mean of 10 weeks (range, 4-17 weeks) in conjunction with symptoms of keratitis; however, 1 patient (patient 1) required levator muscle surgery and blepharoplasty for residual ptosis. CONCLUSION: Dacryoadenitis is a clinical finding associated with Acanthamoeba keratitis.

Acanthamoeba Keratitis↗
PubMed1988

Experimental interstitial keratitis induced by Onchocerca volvulus antigens.

To elucidate the pathogenic mechanisms involved in onchocercal sclerosing keratitis in humans, we developed a model of onchocercal interstitial keratitis in guinea pigs. Onchocerca volvulus antigens injected intrastromally into corneas of preimmunized Hartley guinea pigs induced an intense stromal keratitis with corneal edema, neovascularization, and infiltration with acute and chronic inflammatory cells. This reaction subsided after two weeks. Repeated intrastromal injection resulted in an exacerbation of the keratitis and ultimately in residual scarring. These findings are consistent clinically and histopathologically with the chronic interstitial keratitis observed in humans. To define which antigens induce the corneal reaction, O volvulus antigens were separated by molecular sieve chromatography and injected intrastromally. The highest activity was shown to reside in the fraction containing molecules of intermediate molecular weight. This model will be useful in defining O volvulus antigens and their role in sclerosing keratitis as well as in elucidating the immune mechanisms involved.

Animals↗