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 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*

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

PURPOSE: To report two cases of intractable superior limbic keratoconjunctivitis (SLK) treated with bevacizumab and triamcinolone injection. CASE SUMMARY: A 69-year-old female visited our clinic with pain in the left eye for 3 days and was diagnosed with SLK in her left eye. After 3 months of using steroid eye drops, artificial tears, and oral steroid intermittently, there was no improvement in symptoms and signs, thus this case was considered intractable with the conventional therapy. A mixture of bevacizumab (0.15 cc) and triamcinolone (0.05 cc) was injected into the sub-tenon's capsule of the left eye. After 1 week, all symptoms and signs disappeared, and there was no recurrence for 6 months. A 55-year-old female was transferred to our clinic due to SLK that did not respond to artificial tears, steroid eye drops, punctal occlusion, and botox injection for 3 months. A mixture of bevacizumab (0.15 cc) and triamcinolone (0.05 cc) was injected into the sub-tenon's capsule of the left eye. After 2 weeks, all symptoms and signs were improved, and there was no recurrence for 4 months. CONCLUSIONS: The presented 2 SLK cases are meaningful, because neovascularization disappeared and controlled inflammation was obtained following sub-tenon injection with both bevacizumab and triamcinolone.
Aged ; Female ; Humans ; Inflammation ; Keratoconjunctivitis* ; Middle Aged ; Ophthalmic Solutions ; Recurrence ; Triamcinolone* ; Bevacizumab

This study was performed to investigate the morphological changes of the human conjunctival epithelium when the cultured conjunctival tissue was co-cultivated with the inoculated adenovirus. Specimens swabbed from the lower conjunctival sac of patients with epidemic Keratoconjunctivitis were inoculated into the cultured conjunctival epithelial cells and co-cultivated. The adenovirus-infected cell revealed viral particles, crystalline arrays of adenovirus, paracrystalline inclusions and three types of inclusions within the nucleus. The cytoplasm did not show the specific pathologic changes. These results suggest that adenovirus can be co-cultured with conjunctival epthelial cell and the infected cell showes the typical morphological changes within the nucleus. This in-vitro co-cultivation of adenovirus with conjunctival epithelial cell may be used for an in-vitro model in the research of adenovirus.
Adenoviridae* ; Crystallins ; Cytoplasm ; Epithelial Cells* ; Epithelium ; Humans ; Inclusion Bodies ; Keratoconjunctivitis ; Virion

Conjunctivitis of allergic origin is associated with a diversity of clinical presentation. The common features include pronounced itching, a milky conjunctival appearance, a stringy or ropy discharge & papillary hypertrophy of the tarsal conjunctiva in severe cases, and a family history of allergy. The pathogenesis of ocular allergy involves multiple mechanisms, which lead to mast cell degranulation & the release of chemical mediators. The current therapy of ocular allergy involves elimination of the offending allergen, modulation of the immune system, & pharmacologic inhibition of chemical mediators. We are reporting 5 cases of severe allergic keratoconjunctivitis.
Conjunctiva ; Conjunctivitis ; Humans ; Hypersensitivity ; Hypertrophy ; Immune System ; Keratoconjunctivitis ; Mast Cells ; Pruritus