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 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 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*

Sjogren's syndrome is an autoimmune disease that is characterized by keratoconjunctivitis sicca and xerostomia. Small-fiber neuropathy is rare, although neurological manifestations occur in as many as 30% of patients with Sjogren's syndrome. We report herein a patient with Sjogren's syndrome who presented with autonomic neuropathy and painful sensory neuropathy. Primary Sjogren's syndrome should be considered in the differential diagnosis of small-fiber neuropathy.
Autoimmune Diseases ; Diagnosis, Differential ; Humans ; Keratoconjunctivitis Sicca ; Neurologic Manifestations ; Sjogren's Syndrome ; Xerostomia

PURPOSE: To evaluate the ocular manifestations of patients with rheumatic disease and dry eye symptom. METHODS: We analized the results of ocular examinations and complications of 78 rheumatoid disease patients who were refered for dry eye symptom from the general medicine from 1998, May to 1999, May. RESULTS: Ocular complications were seen in 47 patients (60.3%). Keratoconjunctivitis sicca was the most common ocular finding (48.7%). Other lesions were episcleritis, scleritis, peripheral corneal erosion, marginal keratitis, stromal corneal opacity, and so on. Thirty six patients (46.2%) showed sero-positivity for RA, ANA or CRP. The result was 6.87+/-4.44 mm (mean+/-standard deviation) in Schirmer test,6.64+/-2.27 sec in Tear Film Break Up Time (TBUT). Among sero-positive patients, Schirmer test was 5.46+/-4.05 mm and TBUT was 5.64+/-2.38 sec, while among sero-negatives the result was 8.21+/-4.33 mm, 7.40+/-1.89 sec respectively. It was statistically significant (P< 0.05). Schirmer test was 4.60+/-3.55 mm in RA positive, 2.50+/-1.60 mm in RA and ANA positive, 7.35+/-4.92 mm in CRP positive. TBUT was 5.57+/-2.39 sec, 4.00+/-1.31 sec, 5.69+/-2.04 sec in each group. CONCLUSIONS: Ocular complications were increased in rheumatoid patients, especially with sero-positive for RA, ANA or CRP. The results of Schirmer test and TBUT were most decreased in patients with RA and ANA positivity.
Corneal Opacity ; Humans ; Keratitis ; Keratoconjunctivitis Sicca ; Rheumatic Diseases* ; Rheumatoid Factor ; Scleritis ; Tears

Dry eye disease (also known as keratoconjunctivitis sicca) is a multifactorial disease of the tear film and ocular surface. It results in various symptoms of discomfort such as pain, tearing, fatigue, and headache. Visual function can also deteriorate, and quality of life is negatively affected. Tear film instability which may lead to damage to the ocular surface with an inflammatory reaction is key to the pathogenesis of dry eye disease. This review discussed the classification, pathogenesis, diagnostic approaches, and treatment options of dry eye disease.
Dry Eye Syndromes ; Fatigue ; Headache ; Inflammation ; Keratoconjunctivitis Sicca ; Quality of Life ; Tears

OBJECTIVES: Dry eye disease (DED) is an increasingly important public health problem in Korea. Previous studies conducted in Korea have reported inconsistent results regarding the protective effects of vitamin D on DED, and these discrepancies may be related to the relatively simple questionnaire that has been used. Thus, we evaluated the association of serum vitamin D levels with DED using the ocular surface disease index (OSDI). METHODS: The present study evaluated data from participants in the Study Group for Environmental Eye Disease (2014-2015). This group included data from 752 participants, and data from 740 participants (253 men and 487 women) were analyzed in the present study. DED severity was evaluated using the OSDI. RESULTS: Higher serum vitamin D levels were associated with a non-significantly reduced risk of DED in the crude analysis (odds ratio [OR], 0.991; 95% confidence interval [CI], 0.971 to 1.011) and in the adjusted analysis (OR, 0.988; 95% CI, 0.966 to 1.010). In the crude analysis of no/mild DED vs. moderate/severe DED, men exhibited a decreased risk with increasing serum vitamin D levels (OR, 0.999; 95% CI, 0.950 to 1.051), while women exhibited an increased risk (OR, 1.003; 95% CI, 0.979 to 1.027). In these analyses, we found no significant associations. CONCLUSIONS: The findings of the present study support previous reports that serum vitamin D levels are not associated with DED.
25-Hydroxyvitamin D 2 ; Dry Eye Syndromes ; Eye Diseases* ; Female ; Humans ; Keratoconjunctivitis Sicca ; Korea ; Male ; Public Health ; Vitamin D* ; Vitamins*

Dry eye syndrome is a relatively common disease of the tears and ocular surfaces that results in discomfort, visual disturbance, and tear film instability with possible damage to the ocular surfaces. Microvascular submandibular gland (SMG) transfer offers a surgical alternative for a permanent autologous substitution of tears using the basal secretion of a transplanted SMG. Long-term follow-up reveals that this technique is a lasting and effective solution for patients with severe dry eye syndrome. The uncomfortable symptoms were relieved, and the frequency of use of pharmaceutical tear substitutes was reduced. Objective examination showed significant improvement in tear film and some features of ocular surface such as breakup time of tear film and corneal staining. Patients may suffer from obstruction of Wharton's duct or epiphora after surgery. Activation of secretion-related receptors could improve the early hypofunction of the denervated SMG and prevent the duct obstruction. Reduction surgery, partial SMG transplantation, uses of atropine gel or Botulinum toxin A could be the choices of treatment for epiphora.
Atropine ; Botulinum Toxins ; Dry Eye Syndromes ; Follow-Up Studies ; Humans ; Keratoconjunctivitis Sicca* ; Lacrimal Apparatus Diseases ; Salivary Ducts ; Submandibular Gland* ; Tears