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Biomedical subjects

R L Farris

Publications and source records attributed to R L Farris.

At least 19 recordsLinked to original sources

Sjogren's syndrome and keratoconjunctivitis sicca.

Keratoconjunctivitis sicca patients diagnosed on the basis of a history, dry-eye symptoms, and definite clinical signs of keratoconjunctivitis sicca, with the associated symptoms of dry mouth and/or arthritis, had measurements of tear osmolarity, Schirmer tear test without anesthetic, stimulated parotid salivary flow, and serum analysis for the presence of autoantibodies associated with Sjogren's Syndrome. In contrast to previous studies, a lower incidence of SS-A or SS-B (1-3%), ANA (41-47%), DNA (11-16%), and RF (9-12%) serum antibodies was detected. Salivary-stimulated parotid flow was abnormally decreased in 59% of the patients. Sjogren's syndrome, as indicated by the presence of serum antibodies, appears to have a lower incidence in keratoconjunctivitis sicca than considered previously.

Adult

Staged therapy for the dry eye.

A variety of therapeutic options are now available for treating the dry eye. As a result, an ophthalmologist faced with an untreated dry eye patient will have to select an initial treatment modality from a range of possibilities. More often, however, a dry eye patient will have already been treated with a variety of eye drops, devices, and procedures, so that a fresh approach is needed, following analysis of the patient's current condition. This article reviews one specialist's therapy for dry eye and the rationale for that therapy. An approach is recommended in which treatment of the dry eye is advanced in stages according to the severity of the condition and its response to each level of therapy.

Dry Eye Syndromes

Keratoconjunctivitis sicca in male patients infected with human immunodeficiency virus type 1.

Keratoconjunctivitis sicca (KCS) has not been reported as occurring as a single entity in the acquired immune deficiency syndrome (AIDS) population. In a survey of human immunodeficiency virus type 1 (HIV-1) infected male patients, the authors found that 21% (9/42) had signs and symptoms compatible with KCS with positive Schirmer test results. Tear osmolarity determinations were obtained from this group and from an age- and sex-matched group of HIV-infected patients without symptoms of KCS and with negative Schirmer test results. Eighty-nine percent of the suspect group had increased tear osmolarity, whereas none of the control patients had a hyperosmolar tear film (P less than 0.0001). Results strongly suggest that KCS occurs at a significantly greater rate in male individuals infected with HIV-1 than in the general population.

Adult

Is your office safe? No.

The practitioner's office can be an unsafe environment for fitting contact lens (CLs), owing to numerous reservoirs of microbial contamination. These include sinks, trial lenses, solutions, lens cases, multidose dropper bottles, and storage trays. Microbes may also be introduced to the eyes via the practitioner's fingers, the patient's lashes or lids, or cosmetic residues on the ocular adnexa. Because sterility is difficult to achieve in an office, CL fitters must accept the more realistic goal of disinfection. Periodic cultures are necessary to monitor the effectiveness of office hygiene and disinfection. Cultures are especially important, considering that the panel of organisms routinely used to test lens care solutions may not reflect those in office settings, which may become resistant to preservatives. It has been shown, for example, that 50% of chlorhexidine-preserved solutions used in offices can become contaminated with Serratia marcescens within 7 days of bottle opening. At present, it appears that contamination is best avoided by using solutions containing 15 ppm of polyaminopropylbiguanide (PAPB). Frequent replacement of solutions, trial lenses, and lens cases may also help to reduce the likelihood of microbial contamination in the office.

Accident Prevention

Sodium hyaluronate and polyvinyl alcohol artificial tear preparations. A comparison in patients with keratoconjunctivitis sicca.

An unpreserved artificial tear substitute containing 0.1% sodium hyaluronate was compared with a preparation containing 1.4% polyvinyl alcohol and 0.5% chlorobutanol in a controlled, double-masked, randomized study in patients with moderately severe keratoconjunctivitis sicca. Patients were evaluated initially, at 1, 4, and 8 weeks. The dry-eye status was evaluated by means of tear-film osmolality, tear breakup time, rose bengal staining, Schirmer's test (without anesthesia), and ocular surface-impression cytology. In general, neither preparation was found to be superior to the other. In both study groups, the mean tear-film osmolality and rose bengal staining score improved over the eight-week study, but the degree of squamous metaplasia of the bulbar conjunctival surface, as shown by impression cytology, did not change significantly.

Clinical Trials as Topic

Tear analysis in contact lens wearers.

Tear analysis in contact lens wearers was compared with tear analysis in aphakics without contact lens wear and normal phakic patients. Subjects were divided into five groups: group 1, aphakic without contact lens; group 2, phakic with daily-wear hard contact lens; group 3, phakic with daily-wear soft contact lens; group 4, phakic with extended-wear soft contact lens; and group 5, aphakic with extended-wear soft contact lens. The experimental groups were compared with age- and sex-matched control groups for statistical analysis of tear variables by means of the Student's t-test. The variables measured were tear osmolarity, tear albumin, and lysozyme and lactoferrin concentrations in basal and reflex tears. Highly significant elevations of tear osmolarity were found in aphakic subjects without contact lenses. Less significant differences in tear osmolarity were found in phakic subjects with hard daily-wear lenses or with extended-wear soft lenses. Tear albumin, lysozyme, and lactoferrin in basal and reflex tears were not significantly different in the different groups of contact lens wearers or in the group of aphakic subjects without contact lenses compared with their control groups. Individual variations in tear albumin, lysozyme, and lactoferrin appeared to be responsible for the inability to demonstrate significant differences in tear composition in association with the wearing of different types of contact lenses. Older and aphakic patients demonstrated a tendency to have increased concentrations of proteins in the tears compared with younger, phakic contact lens wearers and normal controls without contact lenses.

Adolescent

Tear osmolarity and ocular surface disease in keratoconjunctivitis sicca.

Tear osmolarity and Rose Bengal staining were studied in a group of patients with keratoconjunctivitis sicca (KCS) before and after treatment with isotonic and one-half isotonic saline to compare treatment with these two solutions and to ascertain whether tear film osmolarity could be correlated with ocular surface disease. When 20 KCS eyes were treated with isotonic saline drops every three hours for one week, the average (+/-SD) tear osmolarity decreased from 365 +/- 77 mOsm/L to 329 +/- 47 mOsm/L, and the average (+/-SD) Rose Bengal staining score decreased from 4.1 +/- 3.1 to 3.6 +/- 3.3. There was no objective difference between treatment with isotonic and one-half isotonic solutions, in a double-masked comparison, however, four of five patients with diagnostically significant Rose Bengal staining preferred the half isotonic solution. There was a significant positive correlation between tear film osmolarity and Rose Bengal staining.

Aged

Studies on competitive inflammatory sites. I. Influence of the size of sensitizing skin implants on second-set corneal graft reactions.

A dependence of second-set corneal graft reactions on the size of the sensitizing skin allografts was established in different rat donor-recipient pairs, each of which involved a response to the B2 major histocompatibility antigen. Sensitizing skin sizes larger or smaller than the optimal size were found to result in less intense reaction in subsequently placed second-set corneal allografts. The data obtained support the view that a persisting skin allograft not only sensitizes, but constitutes a competitive inflammatory site. The latter role of a first-set skin allograft may be facilitated by being both more accessible to inflammatory cells and larger than corneal grafts. The relative strength of the sensitizing and competitive effects of a first-set skin allograft apparently influences the fate of a second-set corneal allograft.

Animals

Osmolarity of tear microvolumes in keratoconjunctivitis sicca.

Determinations of tear film osmolarity were performed to evaluate their usefulness in diagnosing keratoconjunctivitis sicca (KCS) and to evaluate the possible role of elevated tear osmolarity in this disorder's pathogenesis. Tear samples were obtained using a new technique that virtually eliminates the problems of reflex tearing and sample evaporation. The tear osmolarity of 36 samples obtained from 31 normals eyes averaged 302 +/- 6.3 (SD) mOsm/liter; 38 samples obtained from 30 KCS eyes averaged 343 +/- 32.3 (SD) mOsm/liter. The sensitivity of a single measurement was 94.7% and the specificity was 93.7%. Tear samples taken on separate occasions from one normal subject ranged between 295 and 309 mOsm/liter; those obtained from a KCS patient ranged between 312 and 424 mOsm/liter. Hypersmolarity of the tear film in KCS may play an important role in inducing the disease seen in the cornea and conjunctiva.

Adolescent

Ultrastructural variation in granular dystrophy of the cornea.

Corneal deposits of granular dystrophy were studies in six corneas from five patients. Two additional corneas from two patients with lattice dystrophy were used for comparison. The diagnoses were confirmed by light and electron microscopy. Three types of ultrastructural features were distinguished in the electron-dense rod-shaped deposits of granular dystrophy, i.e., Type 1 with homogenous structure, Type 2 with fibrillar constituents, and Type 3 with a moth-eaten or sponge-like appearance. In polarization microscopy of Congo-red stained sections, the Type 2 tended to show an increased birefringence without green dichroism, while the other types were less birefringent than the stroma. Three different components were found immediately around the deposits, i.e., 1. normal collagen fibrils, 2. finely filamentous substance, and 3. areas of thin fibrils (70-100 A in diameter). While the second component appeared non-specific, the third component was found only in two corneas, superimposed on the lesions of granular dystrophy, and showed light and electron microscopic characteristics of the lesions of amyloid as well as of lattice dystrophy.

Aged