PURPOSE: To evaluate tear eosinophil cationic protein (ECP) as a severity marker for atopic keratoconjunctivitis (AKC) and seasonal/perennial allergic conjunctivitis (SAC/PAC). METHODS: Tear ECP levels were measured by chemiluminescent immunometric assay in 7 eyes of 7 patients with AKC, 13 eyes of 13 patients with SAC/PAC, and 10 eyes of 10 healthy control subjects. All AKC and SAC/PAC patients underwent conjunctival injection and papillary formation grading. Tear ECP levels were investigated with reference to the clinical parameters of allergic conjunctivitis (papillary formation and conjunctival injection scoring). RESULTS: Tear ECP levels in patients with AKC were significantly higher than those in patients with SAC/PAC and in control subjects (p = 0.012 and p = 0.003, respectively). The number of patients with papillary formation scores of 2-3 was significantly higher in the AKC group than in the SAC/PAC group (p = 0.016). The number of patients with conjunctival injection scores of 2-3 did not significantly differ between the AKC and SAC/PAC groups (p = 0.128). All AKC patients obtained papillary formation scores of 2-3, and tear ECP levels in patients with conjunctival injection scores of 2-3 were significantly higher than in patients with scores of 0-1 in the AKC group (p < 0.001). In the SAC/PAC group, tear ECP levels in patients with papillary formation scores of 2-3 were significantly higher than in patients with scores of 0-1 (p = 0.046). CONCLUSIONS: This study suggests that tear ECP was a useful marker to diagnose and assess the severity of disease in patients with AKC as well as SAC/PAC. It would be useful to monitor therapeutic outcome in allergic conjunctivitis.
Conjunctivitis, Allergic ; Eosinophil Cationic Protein* ; Humans ; Keratoconjunctivitis*

A sterile disposable tip for the Goldmann applanation tonometer was designed with the material of methylmetacrylate. With this tip, applanation tonometry showed in relatively good agreement to the data measured by the tonometry without the use of tips. With the use of this disposable tips, applanation tonometry can be measurable in cases of active infectious eye diseases such as epidemic keratoconjunctivitis, and also can definitely eliminate any intra-hospital eye infection through the applanation tonometry.
Eye Diseases ; Eye Infections ; Keratoconjunctivitis ; Manometry

PURPOSE: To examine histopathological findings of filamentary keratitis due to corneal occlusion. METHODS: We analyzed filamentary keratitis in 11 eyes with corneal occlusion due to blepharospasm, ptosis and paralytic strabismus, 11 eyes with keratoconjunctivitis sicca, and 13 eyes with both corneal occlusion and keratoconjunctivitis sicca. The following protocols were used for filament analyses: slit lamp examination for counting filament numbers, impression cytology for grading mucin content, and histopathology (hematoxylin and eosin staining) and immunohistochemistry (with AE1/AE3, MUC1, 5AC, 16) for histological analysis. RESULTS: Slit lamp biomicrosopy showed a significantly smaller number of filaments in the corneal occlusion group (11 eyes, 2.7 +/- 1.4) than the keratoconjunctivitis sicca group (11 eyes, 5.1 +/- 2.2, p = 0.009). In impression cytology, the standard photograph grade of mucin content was significantly higher in the corneal occlusion group (2.7 +/- 0.9) than the keratoconjunctivitis sicca group (1.9 +/- 0.8, p = 0.034). On pathological exam, filaments showed a central filament with peripheral mucin. The central filaments were composed of core and cortex, and the core contained multiple deformed nuclei. However, the cortex was not stained by AE1/AE3, MUC1, 5AC, 16. CONCLUSIONS: Filamentary keratitis due to corneal occlusion showed a smaller number of filaments and higher mucin content than filamentary keratitis induced by keratoconjunctivitis sicca and should be considered during treatment.
Blepharospasm ; Eosine Yellowish-(YS) ; Immunohistochemistry ; Keratitis ; Keratoconjunctivitis Sicca* ; Keratoconjunctivitis* ; Mucins ; Strabismus

The Schirmer test was performed 1350 times in 110 normal individuals and 15 dry eye patients to investigate the significance of the test as a diagnostic method for dry eye. The reproducibility of the Schirmer test was 54.5% in normal individuals and 41.9% in dry eye patients. There was no difference in the reproducibility between the groups with topical anesthesia and those without it. The ratio of misdiagnosis by Schirmer test was 48.4%. These results suggest that it is impossible to differentiate dry eye patients from normal individuals by the Schirmer test.
Diagnostic Errors ; Humans ; Keratoconjunctivitis/*diagnosis ; Keratoconjunctivitis Sicca/*diagnosis ; Reproducibility of Results ; Time Factors

PURPOSE: To evaluate clinical findings in phlyctenular keratoconjunctivitis patients and assess the function and morphology of Meibomian glands using an interferometer (LipiView®, TearScience, Morrisville, NC, USA) in such patients.METHODS: This retrospective study included 19 eyes of 13 patients diagnosed with phlyctenular keratoconjunctivitis. The lipid layer thickness (LLT) and meibograph of each eye was quantified by tear interferometry. Tear film break-up time (TBUT) and corneal staining score were measured. Meibomian gland morphology (lid margin vascularity, plugging of gland orifices, lid margin irregularity, lid margin thickening, and partial glands) was evaluated based on anterior photographs and meibographs.RESULTS: The mean age was 21.3 years (8–44 years). Mean BUT and Oxford corneal staining scores were 2.6 ± 1.2 seconds and 1.9 ± 0.8, respectively. Abnormal findings of the Meibomian glands were observed in all patients. The mean LLT was 79.6 ± 27.4 µm and the incomplete eye blinking frequency was 3.8 ± 5.9 during 20 seconds. The graphs of the tear lipid layer showed various patterns such as flat, up-hill, down-hill, and mixed.CONCLUSIONS: Meibomian gland dysfunctions and changes in the tear film lipid layer were noted in patients with phlyctenular keratoconjunctivitis. These factors are to be considered for the treatment of phlyctenular keratoconjunctivitis in young patients under 10 years of age.
Blinking ; Humans ; Interferometry ; Keratoconjunctivitis ; Meibomian Glands ; Retrospective Studies ; Tears

PURPOSE: To compare nerve growth factor (NGF) levels in tears and on the ocular surface of normal controls with those of non-Sjogren type keratoconjunctivitis sicca (KCS) subjects, and investigate the effect of 0.1% prednisolone eye drops on NGF levels in KCS patients. METHODS: Baseline tear NGF levels were measured in 41 KCS patients and 23 healthy control subjects using enzyme-linked immunosorbent assays (ELISA). KCS patients received 0.1% prednisolone drops in one eye, and 0.1% hyaluronic acid drops in the other eye, three times daily for 28 days. Impression cytology (IC) and immunostaining for NGF on conjunctival epithelium was performed for both groups. RESULTS: KCS patients were found to have higher baseline tear NGF concentrations compared to age- and sex-matched healthy control subjects (65.9+/-14.5 vs. 122.1+/-45.3, p<0.0001). In KCS patients, prednisolone treatment for 28 days resulted in a decrease in tear NGF levels, symptom scores and IC scores, whereas hyaluronic acid treatment had no such effect (68.2+/-25.0 pg/microgram vs. 108.0+/-43.4 pg/microgram, p<0.0001 for tear NGF/TP ratio; 2.16+/-1.01 vs. 3.39+/-1.50, p=0.0014 for symptom scale; 1.05+/-0.67 vs. 1.61+/-0.86, p=0.0317 for IC). Measurements taken at both 14 and 28 days indicate that neither prednisolone nor hyaluronic acid treatment affected BUT or Schirmer values. CONCLUSIONS: KCS patients showed elevated levels of tear NGF, which were decreased by treatment with 0.1% prednisolone. These data suggest that the ocular surface NGF may play an important role in ocular surface inflammation processes associated with dry eyes.
Enzyme-Linked Immunosorbent Assay ; Epithelium ; Humans ; Hyaluronic Acid ; Inflammation ; Keratoconjunctivitis Sicca* ; Keratoconjunctivitis* ; Nerve Growth Factor* ; Ophthalmic Solutions ; Prednisolone*

PURPOSE: To report a case of the keratoconjunctivitis sicca (KCS) associated idiopathic hypereosinophilic syndrome (IHES). METHODS: We present a report and review of a 53-year-old man who suffered from IHES and KCS. The ocular examination showed conjunctival papillary hypertrophy, interpalpebral corneal and conjunctival punctate staining with fluorescein dye, and peripheral corneal neovascularization. His Schirmer I test results were nearly zero mm of wetting in both eyes. Impression cytology showed squamous metaplasia. RESULTS: He had treated with low dose systemic steroid since October 2003. Because he showed a side effect of steroid induced myopathy, we could not increase the dosage. We added topical steroid (Pred Forte(R)), conservative free artificial tear and topical antibiotics, after which his ocular condition improved. Neovascularization was regressed, punctate staining decreased, and his visual acuity increased to 20/25 2 months later. CONCLUSIONS: This case demonstrates that the KCS can be associated with IHES and be treated with systemic and topical steroid.
Anti-Bacterial Agents ; Corneal Neovascularization ; Fluorescein ; Humans ; Hypereosinophilic Syndrome* ; Hypertrophy ; Keratoconjunctivitis Sicca* ; Keratoconjunctivitis* ; Metaplasia ; Middle Aged ; Muscular Diseases ; Tears ; Visual Acuity

This study was performed to elucidate the cytologic characteristics of pseudomembrane, which was obtained from eight patients with epidemic keratoconjunctivltis. The predominant cells consisted of lymphocytes and degenerated epithelial cells with a few polymorphonuclear leukocytes and fibrin. Electron micrographs revealed the nuclear segregation, vermicellar body, viral microtubules, and intranuclear inclusion body. These findings suggest that the desquamated epithelial cell was infected by adenovirus.
Adenoviridae ; Epithelial Cells ; Fibrin ; Humans ; Intranuclear Inclusion Bodies ; Keratoconjunctivitis* ; Lymphocytes ; Microtubules ; Neutrophils

PURPOSE: To report a case of keratoconjunctivitis induced by Dieffenbachia plant sap. CASE SUMMARY: A 44-year-old woman presented with severe ocular pain and decreased visual acuity which developed after she accidentally got Dieffenbachia plant sap in her left eye. During her initial evaluation, visual acuity was 0.4 in her left eye. On slit lamp examination, we found that she had moderate injection of the conjunctiva, an epithelial defect, and fine needle-like blue crystals in the stromal layer of the cornea. The patient was treated with topical steroids and antibiotics. We checked the treatment response using a regular slit lamp examination. Six days after the injury, all of the findings which were observed on the first day had resolved except the needle-like blue crystals in the stromal layer of the cornea. These gradually disappeared from the cornea 11 days after the accident. After six weeks, the crystals in the stromal layer had completely resolved. She maintained good visual acuity during this time. There was no opacity noted in her cornea. CONCLUSIONS: We experienced a case of keratoconjunctivitis induced by Dieffenbachia plant sap. This sap caused severe ocular pain and a reversible decrease in visual acuity when in contact with the eye.
Adult ; Anti-Bacterial Agents ; Conjunctiva ; Cornea ; Eye ; Female ; Humans ; Keratoconjunctivitis ; Plants ; Steroids ; Visual Acuity

PURPOSE: To evaluate the changes of tear film and ocular surface in keratoconus patients. METHODS: Twenty-eight eyes of 18 patients with keratoconus and 32 eyes of 16 normal subjects were included. We performed corneal sensitivity test, tear film break-up time (BUT), Schirmer test, fluorescein and rose bengal staining, and conjunctival impression cytology, and compared the results between the two groups. According to the central corneal power, we classified the patients into 3 groups and compared these parameters between groups. RESULTS: Corneal sensitivity was 5.56 +/- 0.34 mm and 5.88 +/- 0.25 mm (p<0.001), BUT was 9.64 +/- 2.51 sec and 10.69 +/- 2.89 sec (p=0.008), basal tear secretion was 9.00 +/- 3.06 mm and 10.88 +/- 3.95 mm (p=0.025), fluorescein staining score was 1.43 +/- 1.87 and 0.69 +/- 1.20 (p=0.105), and rose bengal staining score was 0.86 +/- 0.97 and 0.22 +/- 0.55 (p=0.003) in the patients and control subjects, respectively. The degree of conjunctival squamous metaplasia was 1.04 +/- 0.51 and 0.62 +/- 0.43 (p=0.039), and goblet cell density was 762.65 +/- 76.32 cells/mm2 and 880.21 +/- 82.06 cells/mm2 (p=0.041) in the patients and control subjects respectively. All parameters except basal tear secretion and fluorescein staining score were related to the severity of keratoconus. CONCLUSIONS: Tear film and ocular surface changes in patients with keratoconus are composed of decreased corneal sensitivity, decreased quantity and quality of tear film, and damages to corneal and conjunctival epitheliums, which are similar to the findings in keratoconjunctivitis sicca.
Epithelium ; Fluorescein ; Goblet Cells ; Humans ; Keratoconjunctivitis Sicca ; Keratoconus* ; Metaplasia ; Rose Bengal ; Tears*