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PubMed1993

Propionibacterium propionicum and infections of the lacrimal apparatus.

Analysis of the clinical details associated with 26 referred isolates of Propionibacterium propionicum revealed the marked propensity of this anaerobe to be involved with infections of the lacrimal apparatus; 18 (69%) of the 26 referred isolates were from cases of canaliculitis in which this organism was regarded as the significant pathogen. Further analysis of data showed a significant correlation with the sex of the patient. Of the 18 cases of canaliculitis, the sex of the patient was reported in 16; 14 (88%) of these 16 patients were females (P < .005). The age of 13 of the 18 patients with canaliculitis was known (mean, 61.6 years; range, < 1-80 years); it appears from these cases that P. propionicum lacrimal infections are more common in later life. None of the referred isolates were identified as Actinomyces species. Despite the fact that infection of the lacrimal apparatus is known as ocular actinomycosis, it appears that P. propionicum is more frequently associated with the condition than are true Actinomyces species.

Actinomyces↗
PubMed1985

Silicone intubation for partial and total nasolacrimal duct obstruction in adults.

We performed silicone intubation for both partial and total nasolacrimal duct obstructions in adults. Twenty-three cases with partial obstructions and nine patients with total observations were untubated. The final results were good (73.9%), fair (8.7%), and poor (17.4%) in the partial obstruction group; and good (22.2%) and poor (77.8%) in the total obstruction group. Complications were minimal and did not affect the outcome. We recommend silicone intubation for partial nasolacrimal duct obstructions and dacryocystorhinostomy for total obstructions.

Adolescent↗
PubMed1987

An acute inflammatory reaction to silicone stents.

Silicone stents are commonly used to intubate the nasolacrimal system, and are left in place for several months. They are generally well-tolerated, but are not without complications. We report an unusual inflammatory reaction associated with the presence of a silicone stent that occurred in an individual who previously rejected several silicone implants in her metatarsal joints. The possible etiology and significance of a silicone allergy are discussed.

Dacryocystitis↗
PubMed1992

Acute dacryoadenitis and Crohn's disease: findings and management.

Concurrent orbital pseudotumor and Crohn's disease, although rare, have been described. To the best of our knowledge, pseudotumor isolated to the lacrimal gland (dacryoadenitis) with concurrent Crohn's disease has never been reported. We present the clinical course and ultrasonographic and radiologic findings of an acute case of isolated bilateral lacrimal gland pseudotumor in a patient with Crohn's disease. The treatment and review of the literature are discussed.

Acute Disease↗
PubMed1997

Restoration of the patency of the nasolacrimal drainage system.

The anatomical lacrimal drainage system was restored in 30 patients who suffered from dacryostenosis and tearing. Previously, in order to alleviate these patients' symptoms, a dacryocystorhinostomy had had to be performed. In the new procedure, local anesthesia was given, and a 600-micron fiberoptic was introduced through the lacrimal drainage system to the obstruction area. A continuous 20 W/s Neodymium:YAG laser energy was used to reopen the drainage system. This is a simple office procedure. No skin cuts are required, no anatomical changes are made, and there is practically no bleeding. All patients returned to their normal everyday activity within a few hours after the procedure.

Aged↗
PubMed1983

Orbital accumulation of gallium-67 citrate.

In order to determine the normal range of Gallium-67 citrate (Ga-67) accumulation in the orbital regions, and to possibly identify groups tending to have increased Ga-67 concentration in the eyes, 75 studies were performed prospectively over a two-month period. No difference in the ocular count/background ratio was found on the basis of sex, or on the basis of symptomatic ocular involvement in a systemic disease process. A significant difference in this ratio was found between age groups separated by 20 years or more, with younger patients tending to have higher ocular counts. This decrease in the ratio with age possibly reflects the physiologic senile involution of the lacrimal apparatus with time. The wide range of normal ocular Ga-67 accumulation should be kept in mind, and demonstrable Ga-67 concentration in the orbital regions need not be automatically ascribed to a pathologic process.

Adolescent↗
PubMed1991

Wegener's granulomatosis presenting as dacryoadenitis.

Wegener's granulomatosis is a life-threatening condition characterized by the triad of necrotizing granulomatous inflammation of the respiratory tract, vasculitis, and glomerulonephritis. During early stages of the disease, some patients may present with only one or two components of the triad. Other patients may be affected by the limited form of Wegener's which lacks the renal involvement. We report an 18-year-old female who initially presented with bilateral dacryoadenitis. A lacrimal gland biopsy was consistent with Wegener's granulomatosis. A few months later she developed glomerulonephritis and responded well to cyclophosphamide treatment. Wegener's granulomatosis remains a diagnostic challenge and is frequently underdiagnosed. Early diagnosis is crucial in saving many lives because the disease is potentially curable with cytotoxic therapy. Dacryoadenitis may be one of the initial presentations of Wegener's granulomatosis.

Adolescent↗
PubMed2002

Expression of IL-10 and TNF-inhibitor genes in lacrimal gland epithelial cells suppresses their ability to activate lymphocytes.

PURPOSE: To determine whether the expression of either interleukin-10 (IL-10) or tumor necrosis factor (TNF) inhibitor genes in transduced rabbit lacrimal gland epithelial cells suppresses lymphocyte proliferation in an autologous mixed cell reaction, an apparent in vitro model of autoimmune dacryoadenitis. METHODS: Purified lacrimal gland epithelial cells, transduced with an adenovirus vector carrying either viral IL-10 or TNF-inhibitor genes, were used to study their effects on the proliferation of autologous lymphocytes as monitored by 3H-thymidine incorporation in a mixed cell reaction. After transduction, both epithelial cells and lymphocytes were cultured separately for 2 days and then epithelial cells were irradiated. Equal numbers of both cell types were then cocultured together for 5 days. Cocultures were pulsed with 3H-thymidine and isotope incorporation was determined. Gene expression was detected by enzyme-linked immunosorbent assay and Western blots. RESULTS: Lymphocyte proliferation was stimulated by epithelial cells and 3H-thymidine incorporation was significantly greater in these cocultures than in controls. The proliferation was significantly diminished in the presence of transduced cells producing either IL-10 or TNF inhibitor. CONCLUSIONS: Transduction of lacrimal gland epithelial cells with adenovirus vectors encoding for either IL-10 or TNF-inhibitor proteins leads to expression of functional proteins capable of suppressing lymphocyte proliferation. Thus, lacrimal gland epithelial cells are a plausible target for gene therapy methods meant to produce immunoregulatory proteins.

Adenoviruses, Human↗
PubMed2003

Lacrimal histopathology and ocular surface disease in a rabbit model of autoimmune dacryoadenitis.

PURPOSE: To study the effects of induced autoimmune dacryoadenitis on lacrimal gland function, histopathology, and ocular surface disease in a rabbit model. METHODS: One lacrimal gland was surgically excised from each experimental rabbit, and epithelial cells were purified, cultured, irradiated, and then cocultured with autologous peripheral blood lymphocytes (PBLs) for 5 days. Autoimmune dacryoadenitis was induced by injecting the autologous mixed cell reactions (AMCRs) into the rabbit's remaining lacrimal gland. Normal rabbits and rabbits with both lacrimal glands injected with nonstimulated PBLs were examined as controls. Eyes were evaluated biweekly for 8 weeks by slit-lamp biomicroscopy, Schirmer testing, tear break-up time measurement, and rose bengal examination. Sections of lacrimal glands removed at 8 weeks post-operation were immunostained using antibodies against rabbit class II major histocompatibility complex molecule (MHC-II), CD4, CD8, CD18, and rabbit thymic lymphocyte antigen (RTLA). Relative numbers of positively stained cells were quantified with a ChromaVision image analysis system. RESULTS: During an 8-week period, a continuous decrease in tear production and stability, accompanied by a continuous increase in rose bengal staining, occurred in eyes in which AMCR-PBL had been injected into the ipsilateral lacrimal glands. Similar, though generally less severe, changes occurred in eyes contralateral to the AMCR-PBL-injected eyes. No obvious changes by 8 weeks in these parameters were found in eyes in which the lacrimal glands had been injected with nonstimulated PBLs or in the lacrimal gland-excised eyes contralateral to normal eyes. Interstitial cells in normal lacrimal glands expressed CD18 and RTLA antigens, but few expressed CD4, CD8, or MHC-II. Focal mononuclear cell infiltrates were only found in lacrimal glands from animals with induced autoimmune dacryoadenitis. These cells were predominantly positive for CD4 (7.3-fold increase), RTLA (7.8-fold increase), or CD18 (42-fold increase). MHC-II expression in interstitial and ductal epithelial cells was also significantly greater in these animals than in control animals. The mononuclear cell infiltrates were frequently found enveloping venules, some of which appeared to be high endothelial cell venules. The ductal epithelium also contained CD4 and CD8 immunopositivity, within the epithelium, at the lumenal surface, or surrounding the ducts. Occasionally CD4 and CD8 immunopositive cells could be identified within the acinar lumens. CONCLUSIONS: Injection of activated PBLs (i.e., AMCR-PBLs) in the lacrimal gland induces autoimmune dacryoadenitis with immunopathologic features similar to those of Sjögren's syndrome. The lacrimal immunopathology is accompanied by typical clinical manifestations of dry eye syndrome. The persistent significant dry eye does not appear to result just from failure of the diseased gland but from a more general dysfunction of the surface secretory tissues.

Animals↗
PubMed2003

Tumor necrosis factor inhibitor gene expression suppresses lacrimal gland immunopathology in a rabbit model of autoimmune dacryoadenitis.

PURPOSE: To evaluate the effect of tumor necrosis factor (TNF) inhibitor protein on lacrimal gland immunopathology and ocular surface disease resulting from induced dacryoadenitis. METHODS: Autoimmune dacryoadenitis was induced in rabbits by injecting the lacrimal glands with peripheral blood lymphocytes (PBLs) activated by 5 days of coculture with autologous acinar cells in a mixed cell reaction. In the treated group, an adenoviral vector carrying the TNF inhibitor gene (AdTNFRp55-Ig) was concurrently injected with AMCR-PBL. Tear production was monitored by Schirmer test, and tears were collected for detection of TNF-inhibitor protein. Frozen sections of the glands were immunostained for expression of CD4, CD8, rabbit thymic lymphocyte antigen (RTLA), and CD18. Histological sections of lacrimal glands were examined using the TUNEL technique to monitor apoptosis. RESULTS: Soluble TNF-inhibitor protein was detected by ELISA in tears, with titers at a maximum on day 3, declining by day 7, and undetectable by day 14. Tear production declined in the induced dacryoadenitis group but did not change when glands had been treated with AdTNFRp55-Ig simultaneously with disease induction. Tear break-up time and rose bengal staining properties were not altered by treatment. Fourteen days after the glands were injected with activated PBLs, focal mononuclear cell infiltrates were observed around ducts and venules, some of which assumed the high endothelial phenotype, and between acini. Immune cells in the infiltrates stained positive for CD4, RTLA, and CD18. Glands that received AdTNFRp55-Ig concurrently with activated PBLs had decreased numbers of CD4 cells, CD18 cells, RTLA, and apoptotic cells. CONCLUSIONS: In vivo transduction of the lacrimal gland with AdTNFRIp55-Ig resulted in transient expression in the gland and the appearance of TNF-inhibitor protein in tears. The presence of soluble TNF-inhibitor protein partially suppressed the appearance of Sjögren's syndrome-like features of reduced tear production and the immunohistopathology associated with induced autoimmune dacryoadenitis but not tear break-up time and ocular surface disease. This may reflect immunoregulation in the lacrimal gland but not in the conjunctiva.

Animals↗
PubMed1998

Submandibular and lacrimal gland immunoglobulin in the C3H.MRL-Faslpr autoimmune mouse model of Sjögren's syndrome.

OBJECTIVE: To distinguish potential autoimmune and nonautoimmune mechanisms underlying the salivary gland inflammation seen in Sjögren's syndrome and normal aging. STUDY DESIGN: Immunohistochemical studies were conducted on the lacrimal and salivary glands of 2- and 5-month-old C3H.MRL-Faslpr autoimmune strain mice and age-matched C3H/HeJ nonautoimmune controls. METHODS: Glandular inflammatory foci, interstitial areas, and vasculature were stained for immunoglobulin G (IgG), immunoglobulin A (IgA), and complement to determine differences in their local immune parameter. Differences between the two strains were compared for immune changes attributable to autoimmune disease and between the two normal groups for normal aging changes. RESULTS: Greater staining of IgG, IgA, and complement occurred in the inflammatory foci and interstitial areas of 5-month-old C3H.MRL-Faslpr lacrimal and submandibular glands compared with 5-month-old controls. Normal mice showed some increased immunoglobulin staining with aging, but little or no complement in any glands. CONCLUSIONS: These differential findings suggest that the systemic autoimmune disease plays a more direct role in focal glandular inflammation in Sjögren's syndrome, whereas less severe immune mechanisms are involved in the inflammation of normal glands.

Age Factors↗
PubMed1997

Ocular tuberculosis. A prospective study in a general hospital.

Ocular tuberculosis has traditionally been considered uncommon or anecdotal. Imprecise and variable diagnostic criteria have contributed to the confusion surrounding this topic. The increase in extrapulmonary manifestations of tuberculosis during the AIDS era established the need for a prospective study of ocular involvement in patients with all types of tuberculosis using well-defined criteria. During a 15-month period, 300 cases had culture-proven tuberculosis at our institution. We randomly selected 100 for systematic ophthalmologic evaluation. Our criteria for ocular tuberculosis were divided as follows: certainty (isolation of Mycobacterium tuberculosis from ocular specimens), probability (patients with isolation of M. tuberculosis from extraocular samples, with ocular lesions not attributable to other causes that respond to anti-tuberculous treatment), and possibility (same as probability but follow-up impossible). Ocular tuberculosis was present in 18 patients (18%) of which 10 patients fulfilled probability and 8 patients fulfilled possibility criteria. Eleven of 18 patients had HIV infection. In 11 patients, ocular involvement was asymptomatic. Almost all patients (17/18) had choroiditis, and other ocular lesions included papillitis, retinitis, vitritis, vasculitis, dacryoadenitis, and scleritis. Multivariate analysis showed as risk factors independently predicting ocular involvement in patients with ocular tuberculosis the presence of miliary disease (odd ratio 43.92, p = 0.002), ocular symptoms (odds ratio 6.35, p = 0.0143), and decreased visual acuity (odds ratio 0.04, p = 0.012). We observed an unexpectedly high (18%) incidence of ocular involvement, frequently asymptomatic, in patients with tuberculosis. Miliary disease is a clear predisposing factor in both HIV-infected and noninfected populations. Ocular examination should be routinely considered in patients with proven or suspected tuberculosis.

AIDS-Related Opportunistic Infections↗