Of 57 patients with chronic renal failure who all had deposition of calcium salts in the conjunctival and corneal tissue two developed a brief episode of painful irritation and redness of the conjunctiva and subconjunctiva. This hyperaemia was adjacent to erosions of the corneal epithelium of the eye as a consequence of exfoliation of calcium concretions from the superficial corneal epithelium. Eight patients showed inflammatory reactions of the conjunctivae that were clinically identical to inflamed pingueculae. Three patients showed an inflammatory reaction of the eye that was characterised by a waxy red, more or less diffuse, episcleral and conjunctival hyperaemia extending beyond the palpebral fissure. The average value of the serum calcium concentration in these patients was particularly high and statistically significantly higher than in patients with calcification but without inflammatory signs and also higher than in patients who showed pingueculitis. We propose to reserve the term 'red eye of renal failure' for the latter group of patients. (+info)
Immunopathological findings in conjunctival cells using immunofluorescence staining of impression cytology specimens.
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The conventional technique of impression cytology provides a non-invasive method for the evaluation of conjunctival epithelium alterations. Using indirect immunofluorescence procedures two inflammatory markers, class II MHC antigens HLA DR and the receptor to IgE (CD23), were sought in impression cytology specimens obtained from 80 patients. In normal subjects conjunctival epithelial cells did not show any reactivity. Only scattered dendritic cells were found to express class II antigens but not the receptor to IgE. In contrast patients with chronic conjunctivitis of various aetiologies, mainly infectious or allergic, had 40-100% of brightly positive conjunctival cells for one or both antigens. In these cases epithelial cells and goblet cells reacted similarly. Twenty four eyes in 12 patients with idiopathic dry eye syndrome disclosed results similar to those from normal conjunctival specimens. However 18 other specimens from patients suffering from idiopathic tear deficiency but undergoing multiple substitutive treatments for dry eye had moderate to strong positivity for HLA DR and/or the receptor to IgE (20-100% of cells). As these results were independent of the degree of squamous metaplasia the expression of these membrane markers may reflect local inflammation in addition to tear deficiency, possibly due to sensitisation to the eye drops used. These immunocytological techniques thus provide useful methods of investigating conjunctival inflammation and allergy. They may constitute valuable aid in the diagnosis and appropriate treatment of ocular surface disorders. (+info)
Characterisation of corneal fibrotic wound repair at the LASIK flap margin.
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AIM: To characterise temporal changes in corneal wound repair at the LASIK flap margin. METHODS: 18 rabbits received monocular LASIK and were evaluated during 6 months using slit lamp and in vivo confocal microscopy. In three corneas, the exposed stroma was stained with DTAF. At various time points, corneas were processed for histology and stained for nuclei, f-actin, ED-A fibronectin, alpha-smooth muscle actin, TGF-beta1, TGF-beta2, TGF-beta receptor II, and CTGF. RESULTS: At day 1, leucocytes migrated from the conjunctival vessels into the cornea. Near the limbus, the leucocytes were organised in long chains stretching towards the flap edge. From day 4, elongated fibroblasts migrated from the periphery to align in a circumferential band (approximately 250 microm wide) next to the flap edge. The lateral extension of this stromal band was delimited by the incisional gap in the epithelial basement membrane. TGF-beta1, TGF-beta2, TGF-beta receptor II, and CTGF were expressed in the band from day 2. Myofibroblasts were identified at week 3 and over time a 50 microm thick layer of fibrotic matrix was deposited. Concurrently, the peripheral circumferential band became narrower (width decreasing to 33% (SD 7%) at 4 months; n = 5) and showed an increased organisation with a gradual decline in reflectivity. At all time points, keratocytes within and below the flap remained quiescent and only minimal fibrosis developed at the interface. CONCLUSIONS: Fibrotic wound repair following LASIK is restricted to a narrow band peripheral to the corneal flap edge. The lateral extension of the fibrosis is sharply delimited by the incisional gap in the epithelial basement membrane. The fibrotic wound healing at the LASIK flap margin is associated with myofibroblast transformation and wound contraction and involves a TGF-beta signalling pathway. (+info)
Ag-specific recognition, activation, and effector function of T cells in the conjunctiva with experimental immune-mediated blepharoconjunctivitis.
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PURPOSE: To investigate antigen (Ag) specificity, activation, and effector function of the Ag-specific T cells involved in the development of experimental immune-mediated blepharoconjunctivitis (EC), an experimental conjunctivitis. METHODS: EC was induced in Brown Norway rats by injection of ovalbumin (OVA)-specific T cells followed by OVA challenge with eye drops. Eyes, including the conjunctivas, were harvested at different time points after challenge. The dependence of EC onset on the challenging Ag was assessed by challenge with an irrelevant Ag or stimulatory OVA peptides. To show the infiltration of transferred T cells into the conjunctiva, T cells were labeled with 5-(and-6)-carboxyfluorescein diacetate succinimidyl ester (CFSE) before transfer. The activation of T cells in the conjunctiva was assessed by measuring phosphorylation of Lck-associated molecules by Western blot analysis. Conjunctivas were also examined by immunohistochemistry and used for reverse transcription-polymerase chain reaction to determine the phenotype of the infiltrating cells and cytokine, chemokine, and chemokine receptor expression. To investigate infiltration of non Ag-specific T cells into the conjunctiva, ragweed (RW)-primed lymphocytes were transferred into OVA-specific T-cell receptor transgenic (DO11.10) mice. The mice were then challenged with RW and the conjunctivas were harvested for immunohistochemistry to detect T cells derived from DO11.10 mice. RESULTS: EC was induced only when challenged with OVA protein or stimulatory OVA peptides, and CFSE-labeled transferred cells were found in the conjunctiva. Phosphorylation of Lck and an 85-kDa Lck-associated molecule were observed in the conjunctiva 6 hours after challenge. Many cytokines and chemokines began to be expressed at 6 hours, and individual expression patterns over time correlated well with the infiltration patterns of different inflammatory cells. In DO11.10 mice that received RW-primed lymphocytes, T cells derived from the recipient mice infiltrated the conjunctiva after RW challenge. CONCLUSIONS: Ag-specific T cells initiate EC by first infiltrating the conjunctiva, where they become activated by the specific Ag in the conjunctiva. (+info)
Ophthalmological and biological features of the oculorespiratory syndrome after influenza vaccination.
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We report the ophthalmological and laboratory findings of 6 patients who, after influenza vaccination, were affected by oculorespiratory syndrome (ORS), complaining of red eyes, photophobia, blurred vision, palpebral edema, ocular pain and itching, and conjunctival secretions. The conjunctivae were mildly hyperemic with few follicles, but the ophthalmological examination findings were otherwise normal. Patients had lymphopenia and decreased levels of the total hemolytic complement and the third and fourth component of the complement. We conclude that ORS causes conjunctivitis and seems to involve the complement. (+info)
An outbreak of conjunctivitis caused by multiresistant Pseudomonas aeruginosa in a Brazilian newborn intensive care unit.
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We report an outbreak of conjunctivitis due to Pseudomonas aeruginosa involving seven infants admitted in the Neonatal Intensive Care Unit (NICU) of the Uberlandial Federal University Hospital between March and September 2001. Three infants developed systemic complications (01 sepsis and 02 pneumonias). Ten isolates were obtained from conjunctival cultures and all were resistant to ceftazidime and aminoglycosides. Fast identification of the organism and treatment with imipenem were important in containing the outbreak of P. aeruginosa. (+info)
Differences in clinical parameters and tear film of tolerant and intolerant contact lens wearers.
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PURPOSE: To determine whether intolerance to contact lens wear is attributable to clinical or protein characteristics of the tear film. METHODS: Thirty-eight subjects participated; 20 were successful contact lens wearers and 18 had discontinued contact lens wear because of discomfort. Baseline tear film (no lens wear) was analyzed with a range of clinical measurements and protein analyses (lactoferrin, sIgA, and lysozyme). Comfort was determined after 6 hours of lens wear, and differences in tear film characteristics between subject groups were determined. In half of the subject group (n = 19), discriminant analysis was used to develop an equation for predicting the likelihood of intolerance to lens wear. Sensitivity and specificity were determined by testing the formula on the remaining subjects. These formulas were also tested on a separate group of subjects enrolled in a contact lens-wearing trial. RESULTS: Tear volume (meniscus height and phenol red thread test) and tear stability (noninvasive tear break up time [NI-TBUT]) were significantly reduced in intolerant wearers (P < 0.05). A greater number of symptoms were reported by intolerant than by tolerant wearers (P < 0.05). Tolerance was associated with clinical but not protein characteristics of the tear film. Formulas best able to predict contact lens intolerance included NI-TBUT, number of symptoms experienced, and tear film meniscus height. Formulas had high sensitivity, and specificity which ranged from 29% to 57%. CONCLUSIONS: Contact lens intolerance appears to be best predicted by a combination of clinical variables, including tear film stability, tear volume, and symptom reporting. (+info)
Ocular anterior segment pathologies and tear film changes in patients with psoriasis vulgaris.
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Ocular manifestations in patients with psoriasis vulgaris have been investigated in only a small number of studies. Our purpose was to identify tear film function and ocular pathologies associated with psoriasis vulgaris in patients who had received neither oral retinoids nor phototherapy. We examined 62 eyes of 31 patients with psoriasis and 60 eyes of 30 age-and-sex matched healthy volunteers. In addition to complete ocular and dermatological examination, tear film function (i.e., tear secretion and tear film stability) were assessed by the Schirmer-I test, as well as by tear film break-up time. None of the controls had any ocular abnormalities, whereas 67.74% of patients with psoriasis had various anterior segment pathologies (P<0.00009). The most prevalent finding was chronic blepharoconjunctivitis (64.5%), as the only pathology (n=9) or in association with other findings, including nonspecific corneal opacities (n=4), cataract (n=3), both corneal opacities and cataract (n=2), and corneal pigment dispersion (n=2). The Schirmer-I test results revealed comparable mean values in the patient group (9.8+-4.2 mm) and in the controls (11.2+-3.7 mm; P=0.078). However, mean tear film break-up time was significantly shorter in the patients (7.2+-2.5 sec) than in the healthy persons (11.7+-3.1 sec; P=0.001). In agreement with some previous reports, our findings clearly demonstrated that early ocular involvement occurs in patients with psoriasis vulgaris, irrespective of the history of previous therapeutic modalities (e.g., retinoid therapy and phototherapy). Thus, the present findings are suggestive of the contributory role of primary etiologic factors of psoriasis in the pathogenesis of ocular changes in patients with psoriasis vulgaris. (+info)