Time course of human conjunctival mast cell degranulation in response to compound 48/80

Compound 48/80, a non-immunogenic mast cell degranulatory agent, is known to produce the signs and symptoms of ocular allergy. Maximal mast cell degranulation of human conjunctiva occurred within the first hour after stimulation by a single topical dose of compound 48/80 (20 microliters, 7.5 mg/ml). The average percentage of fully degranulated mast cells in treated specimens (n = 9) was 31% (range 5-60%) versus 6% (range 0-20%) in control specimens (n = 5). Exact correlates of representative granulated, partially degranulated, and fully degranulated mast cells were determined by light and transmission electron microscopy.

Keratitis, ulceration, and perforation associated with topical nonsteroidal anti-inflammatory drugs

PURPOSE

To report corneal complications associated with topical nonsteroidal anti-inflammatory drugs (NSAIDs).

DESIGN

Retrospective, noncomparative interventional case series.

PARTICIPANTS

Eighteen eyes of 16 patients with adverse corneal events associated with NSAID use.

METHODS

Evaluation of 16 patients referred for management of corneal complications during use of topical NSAIDs (ketorolac tromethamine [Acular], diclofenac sodium [Voltaren], diclofenac sodium [Falcon DSOS]).

MAIN OUTCOME MEASURES

Type and severity of corneal complications.

RESULTS

Of the 16 patients, two experienced severe keratopathy, three experienced ulceration, six experienced corneal or scleral melts, and five experienced perforations. Eleven patients had recent cataract surgery; nine of these were on concurrent topical steroids and antibiotics. Another patient who did not have recent surgery was using concurrent topical steroids without antibiotics for sarcoid uveitis. Systemic associations included two patients with rheumatoid arthritis, one patient with asymptomatic Sjogren's syndrome, and two with rosacea.

CONCLUSIONS

Topical NSAIDs were associated with corneal complications in 18 eyes of 16 patients. Potential risk factors include conditions that predispose the patient to corneal melting, concurrent topical steroids, and epithelial keratopathy in the early postoperative period.

Advancing wave-like epitheliopathy. Clinical features and treatment

PURPOSE

The purpose of the study is to describe an entity referred to as advancing wave-like epitheliopathy and successful treatment of this keratopathy with 1% silver nitrate solution.

METHODS

Eleven eyes of 7 patients were identified with advancing wave-like epitheliopathy. A thorough history and physical examination was performed on each patient, and attempts were made to identify the cause for the epitheliopathy. Six eyes with associated visual loss due to the epitheliopathy involving the visual axis were treated with 1% silver nitrate solution to the superior conjunctival limbus.

RESULTS

Possible causes for the epitheliopathy included use of antiglaucomatous medications or contact lens care solutions (6 of 11 eyes), soft contact lens wear (4 of 11 eyes), a history of ocular surgery (3 of 11 eyes), or the presence of an underlying dermatologic or inflammatory disorder (3 of 11 eyes). All patients treated with 1% silver nitrate solution (6 of 6 eyes) experienced resolution of their symptoms with either complete or partial resolution of the epitheliopathy.

CONCLUSIONS

Advancing wave-like epitheliopathy is a keratopathy characterized by centripetally advancing waves of coarse, irregular epithelium arising from the superior limbus. The cause appears to be multifactorial. Symptoms include ocular redness, irritation, and a decrease in visual acuity if the visual axis is involved. Application of 1% silver nitrate solution to the superior limbus is well tolerated and effective in treating this condition.

Extralimbal Trantas' dots: a clinicopathologic report

We report a 29-year-old man with a recurrent history of conjunctival redness, itching, and tearing, who was first seen with transient, multiple Trantas' dots bilaterally on the bulbar, forniceal, and palpebral conjunctiva. Conjunctival scrapings and biopsy revealed histopathologic features consistent with Trantas' dots. To our knowledge, this is the first case report that clearly documents the occurrence of extralimbal Trantas' dots on the bulbar, forniceal, and palpebral conjunctiva.

Molluscum contagiosum of the eyelids in patients with acquired immune deficiency syndrome

BACKGROUND

Infection with molluscum contagiosum has been reported in patients with acquired immune deficiency syndrome (AIDS). Involvement of the eyelids by molluscum in patients with AIDS has rarely been mentioned.

METHODS

Two patients with AIDS presented with eyelid molluscum contagiosum. Detailed examination and follow-up was performed.

RESULTS

One patient had noted ocular irritation with epiphora for several weeks and showed a typical viral keratoconjunctivitis in both eyes. The other patient progressed to confluent masses involving the entire lower eyelid on one side. Removal of the lesions by surgery and cryotherapy was followed by recurrences in both patients within 6 to 7 weeks, the incubation period for this viral infection.

CONCLUSION

Molluscum contagiosum can form confluent lesions on the eyelids in patients with AIDS, which may cause a keratoconjunctivitis. Local removal of molluscum eyelid nodules appears to be of limited long-term value in patients with T-cell immunodeficiency.

Keratoconus associated with floppy eyelid syndrome

Floppy eyelid syndrome is a recently described entity, which characteristically involves overweight individuals. The characteristic findings are an upper lid that may be readily everted, tarsal laxity, and diffuse papillary conjunctival changes. The cause of floppy eyelid syndrome is believed to be a mechanical disorder due to the eversion of the lids while sleeping. The cause of keratoconus remains uncertain. There are strong proponents to a mechanical etiology for this disease. The authors report five cases of floppy eyelid syndrome with concomitant keratoconus. One patient with bilateral keratoconus had bilateral symmetric floppy eyelid syndrome. The other four patients had asymmetric keratoconus and floppy eyelid syndrome. In all four patients, the keratoconus was significantly worse in the eye with the more severe case of floppy eyelid syndrome. In addition, these four patients all gave a history of sleeping with their head facing predominantly on the side with the floppy eyelid syndrome and keratoconus. Two patients with keratoconus and floppy eyelid syndrome were able to undergo successful contact lens rehabilitation of their keratoconus after treatment of the floppy eyelid syndrome.

Management of contact lens associated Acanthamoeba keratitis

Four patients with contact lens associated Acanthamoeba keratitis were treated at Wills Eye Hospital between 1987 and 1989. Two patients had used daily wear soft contact lenses and two had worn hard contact lenses. All four patients were treated with topical antibiotics (propamidine and neomycin), oral ketoconazole, and varying amounts of topical steroids. Two of these patients received topical clotrimazole. All four patients eventually required surgery for either control of their infection (three cases) or control of secondary disease (glaucoma and cataract). Medical therapy for Acanthamoeba keratitis remains problematic, and therefore prevention of this disease by avoidance of risk factors remains paramount.

Treatment of superior limbic keratoconjunctivitis by thermocauterization of the superior bulbar conjunctiva

Superior limbic keratoconjunctivitis (SLK) is a chronic and recurrent inflammatory disease of the superior tarsal, bulbar and limbal conjunctiva that often responds to topical treatment with silver nitrate. As an alternative treatment in 11 patients (13 eyes), we applied thermal cautery to the inflamed superior bulbar conjunctiva following subconjunctival injection of 2% xylocaine. The overall positive response rate to thermocautery was 73% (8 patients). Of the positive responders, 63% (5 patients) had been considered silver nitrate treatment failures. Keratitis sicca was additionally noted in 55% of the patients studied. Impression cytology of involved superior bulbar conjunctiva was nearly devoid of goblet cells during the acute stage of the disorder. Following successful cauterization, goblet cells returned. Thus, thermocauterization of the superior bulbar conjunctiva appears to be a safe and effective mode of therapy for SLK.

Conjunctival eosinophils in compound 48/80 rabbit model

Compound 48/80 (N-methyl-p-methoxyphenethylamine formaldehyde condensation product) was used to selectively degranulate mast cells to induce conjunctival eosinophilia in 12 rabbits. Biopsy specimens of bulbar conjunctiva showed that eosinophils were present in all treated eyes. With repeated treatments the number of eosinophils increased; these cells were concentrated in the subepithelial and epithelial zones by day 3. Eosinophils were not found on scrapings of the bulbar conjunctiva in 75% of the rabbits that received single or multiple treatments. We conclude that deep and superficial eosinophil infiltration may be present even when eosinophils are not seen on conjunctival scrapings. Therefore, the absence of eosinophils in scrapings should not rule out the diagnosis of ocular allergy.

Aspergillus keratitis with intraocular invasion

A healthy 48-year-old man developed Aspergillus keratitis following mild corneal trauma. Intensive medical therapy, initially empirical, then guided by in vitro sensitivity testing, as well as attempts at surgical excision of the infection, were ultimately unsuccessful. The poor therapeutic response may have been due to fungal penetration of the deep corneal stromal before treatment was initiated. The clinical and histologic features of A keratitis are described and related to fungal keratitis in general. The strengths and limitations of laboratory diagnostic aids are discussed. Fungal keratitis may follow a disarmingly mild early clinical course, but requires prompt, aggressive therapy if serious complications are to be avoided.

Eosinophil granule major basic protein and Charcot-Leyden crystal protein in human tears

We measured the levels of major basic protein and Charcot-Leyden crystal protein in tears from patients with ventral keratoconjunctivitis or miscellaneous inflammatory or noninflammatory ocular conditions, and from normal subjects. Patients with vernal keratoconjunctivitis had significantly increased levels of both proteins in their tears compared with the other subjects tested; levels of major basic protein seemed to correlate with the severity of the disease. The levels of Charcot-Leyden crystal protein paralleled those of major basic proteins.

Subconjunctival lymphoma: a review of six suspected cases and the use of immunologic surface markers

Six cases of subconjunctival tumor clinically compatible with the appearance of subconjunctival lymphoma were evaluated. Two of the patients, Cases 1 and 2, were under treatment with either prednisone or gold therapy for severe rheumatoid arthritis. Patient 3 manifested further evidence of systemic disease (auxillary lymph node). Of the remaining cases, patient 4 had no further evidence of systemic involvement, whereas patient 5 was suspected of having a gastrointestinal tumor. The last case, a patient known to have pulmonary lymphoma, presented with dry eye and multiple subconjunctival lymphomatous masses. Immune surface marker studies demonstrated a B-cell monoclonal subconjunctival lymphoma, suggestive of an improved survival when compared to null cell-type lesions. Immune surface marker studies offer a new commercially available method for classifying and prognosticating subconjunctival lymphomas.

Normal human tear pH by direct measurement

Tear pH was measured in 44 normal subjects by immersing the lip of a microcombination glass pH probe in the tear fluid in the inferior cul-de-sac. The normal pH range was 6.5 to 7.6; the mean value was 7.0. This method provides a rapid and accurate measure of tear pH and may better our understanding of tear physiology and tear buffering capacity.

H2-receptors in the human ocular surface

Ten normal human volunteers participated in a two-part study of H2-receptor activity in the ocular surface. Dimethylaminopropylisothiourea (trivial name, dimaprit dihydrochloride), a highly selective H2-receptor agonist, produced vasodilation without itch. Pretreatment with the H2-receptor antagonist, cimetidine, significantly blocked the vasodilatory effect of dimethylaminopropylisothiourea, whereas pretreatment with the H1-receptor antagonist, antazoline phosphate, did not. We conclude that H2-receptors are present in the human ocular surface.

Animal and human ocular surface response to a topical nonimmune mast-cell degranulating agent (compound 48/80)

Topical application of the nonimmune selective mast-cell degranulating agent, compound 48/80, produced the signs and symptoms of ocular allergy (itching, injection, chemosis, and mucous discharge) in eight guinea pigs, eight rabbits, and nine humans. The histamine H1 receptor antagonist, antazoline phosphate, blocked itching but not vasodilation in five humans pretreated with compound 48-80. This suggests that histamine was one of the mediators released by compound 48-80-induced degranulation. Compound 48-80 may be helpful in evaluating the effects of therapeutic agents capable of modifying mast-cell degranulation and in the study of mediators involved in external ocular inflammation.

Alkaline tear pH in ocular rosacea

We compared the tear pH values of 44 normal, healthy volunteers, 20 patients with ocular disorders other than rosacea, seven patients with untreated, active ocular rosacea, and five patients with tetracycline-treated ocular rosacea. The group with untreated, active ocular rosacea had significantly more alkaline tear pH values than the other groups tested. In patients with tetracycline-treated ocular rosacea, tear pH values were not significantly different from those of normal subjects.