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Vernal conjunctivitis and contact lens-associated giant papillary conjunctivitis compared and contrasted.

We compared quantitative histologic counts of ten subjects with vernal conjunctivitis to counts of 15 subjects with contact lens-associated giant papillary conjunctivitis and to counts of 15 normal subjects. Both vernal conjunctivitis and contact lens-associated giant papillary conjunctivitis subjects had abnormalities of mast cells in the epithelium, and eosinophils and basophils in epithelium and substantia propria. No normal individuals had these abnormalities. An additional 28 subjects with ocular inflammatory conditions had tissue evaluation for abnormalities of mast cells, eosinophils, and basophils. A few eosinophils were found in four subjects. The histologic abnormalities of vernal conjunctivitis are shared by contact lens-associated giant papillary conjunctivitis but not by conjunctival inflammation in general. Vernal conjunctivitis and contact lens-associated giant papillary conjunctivitis may represent different subtypes of a general category of conjunctival abnormality characterized by giant papillae.

Adolescent

Characteristics of an adenovirus type 19 conjunctivitis isolate and evidence for a subgroup associated with epidemic conjunctivitis.

Although adneovirus type 19 (Ad19) was first described in 1955, this virus was not associated with disease until its isolation from outbreaks of conjunctivitis in 1973. A strain of Ad19 isolated from a case of conjunctivitis in Seattle in 1974 was compared with the reference strain (3911). Plaque number and size were enhanced by 30 mM MgCl2. Low pH and chloroform treatment had no effect on either strain's activity, but the two strains were sensitive to pH 8. Growth curves were characteristic of adenoviruses, but differences were seen in the amount of virus released. The ratios of particles to plaque-forming units (approximately 10,000:1) were similar for both. Both virus preparations contained high concentrations of group-specific complement-fixing antigen. Cross-reactions were seen by hemagglutination inhibition and immunoelectron microscopy between antisera to Ad8, Ad9, and Ad10 versus both strains of Ad19, but were not seen by neutralization. We would like to suggest, based on exclusive conjunctivitis association and cross-reactions, that the four cross-reacting serotypes, Ad8, Ad9, Ad10, and Ad19, represent a subgroup of adenoviruses specfically associated with conjunctivitis.

Adenoviruses, Human

Simple tests for the diagnosis of picornavirus epidemic conjunctivitis (acute haemorrhagic conjunctivitis).

Simple tests for the study of picornavirus epidemic conjunctivitis are described. The virus was successfully isolated in wells of microtitration plates containing HeLa cell suspension and the isolates were easily identifiable by neutralization in the micrometabolic inhibition test. For the estimation of antibody titre in patients' sera, the latter procedure was found to be as reliable as neutralization in tissue culture tubes. These micromethods would enable virus laboratories not equipped for tissue culture work to study this new ocular disease, which has been endemic in a number of countries since the pandemic outbreak of 1969-72 in Africa, Asia, and Europe (London).

Conjunctivitis

A microbiological study of neonatal conjunctivae and conjunctivitis.

To investigate the importance of chlamydiae, ureaplasmas, Mycoplasma hominis, and anaerobic bacteria in the pathogenesis of neonatal conjunctivitis in the Harrow population conjunctival specimens from 104 infants with conjunctivitis and 104 similar healthy neonates were examined. The incidence of neonatal conjunctivitis was 8-2%, and no case of neomycin-resistant disease occurred during the study. Staphylococcus aureus, viridans Streptococci, and Escherichia coli were the only micro-organisms isolated significantly more frequently from affected than from control eyes, which suggests that these bacteria may be a cause of the conjunctivitis. All cultures for chlamydiae, M. hominis, Neisseria gonorrhoeae, and anaerobic bacteria were negative. The mother's race, social status, illness, and obstetric events were found to have no effect on the incidence, time of onset of conjunctivitis, or micro-organisms isolated. The clinical characteristics of conjunctivitis were also not related to the micro-organisms isolated. No potential pathogens were isolated from 63-5% of the eyes showing conjunctivitis. The results suggest that some of these cases may be caused by chemical irritation, and the possibility of an infectious aetiology is also discussed.

Conjunctiva

Neonatal conjunctivitis caused by Neisseria gonorrhoeae and Chlamydia trachomatis.

In a selected group of 103 babies referred with neonatal conjunctivitis Neisseria gonorrhoeae was isolated from 11 and Chlamydia trachomatis from 33. Concurrent infection was present in three. On toddler sibling developed chlamydial conjunctivitis. After treatment C. trachomatis was re-isolated from six babies during the follow-up period. The discharge started one to three days after delivery in only three babies with gonococcal conjunctivitis and at five to eight days in eight babies. One baby was delivered by caesarean section. N. gonorrhoeae was isolated from four asymptomatic fathers, all of whom had urethritis. The mean onset of discharge in the 33 babies from whom Chlamydia was isolated was 7-1 days. One baby was delivered by caesarean section. Chlamydial conjunctivitis was associated with a high incidence of prematurity and of postpartum infection in the mother. Ten fathers of Chlamydia-positive babies were examined. C. tachomatis was isolated from four, all of whom were asymptomatic but had low-grade urethritis. These findings confirm the pathogenic role of C. trachomatis in the cervix and indicate the importance to the family of an adequate microbiological investigation of neonatal conjunctivitis.

Adult

A coxsackievirus type A24 epidemic conjunctivitis in Brunei.

The paper reports on a coxsackievirus type A24 epidemic of acute conjunctivitis in Brunei. The role of the Singapore Epidemic Conjunctivitis 1970 (coxsackievirus type A24) virus in the new disease syndrome variously known as the "Epidemic Haemorrhagic Conjunctivitis", "Picornavirus Epidemic Conjunctivitis" and "Acute Haemorrhagic Conjunctivitis" is again established.

Brunei

[Long lasting conjunctivitis: research of etiological factors].

Forty children with long-lasting or recurrent conjunctivitis were included in this etiological study. It is well known that purulent conjunctivitis is mainly bacterial, with a major source of infection from Chlamydia; recently, however, a greater percentage of viral forms, with the exception of conjunctivitis without secretion, has been reported. The authors focused their attention on the clinical symptoms and on bacteriological studies of the forms of Chlamydia and Mycoplasma conjunctivitis, highlighting their marked sensitivity to antibiotics and the clinical response and recommending the importance of an etiological study in all cases in which conjunctivitis does not resolve within a short period of time.

Child

[Allergic conjunctivitis].

The eye reacts to foreign substances through a variety of specific and non-specific defense mechanisms. Constantly exposed to a great variety of microorganisms, the eye is capable of protecting itself without altering its own structure and function. Its resistance relies upon anatomic and physiological properties of its external components (eyelids, tears, conjunctiva and cornea). Most of the times, the conjunctiva becomes affected, resulting in a clinical picture of conjunctivitis where allergy predominates, expressed as allergic rhinoconjunctivitis, allergic conjunctivitis, vernal keratoconjunctivitis, giant papillary conjunctivitis and flictenular conjunctivitis. The physiopathology is considered to be of type I reaction (IgE mediated). Frequent complains often associated with other allergic diseases are: pruritus, tearing, photofobia and ocular redness. The diagnosis of allergic conjunctivitis in done by means of a throughout clinical history, conjunctival citology and evaluation of specific IgE with immediate skin tests. Treatment is symptomatic (antihistamines, antibiotics and/or topic steroids), but prevention (environmental control and sodium cromoglycate) and specific immunotherapy must be considered.

Conjunctivitis, Allergic

[A study in immunofluorescence of the plasma cells in allergic conjunctivitis, in particular of the cells forming immunoglobulin E (IgE) (author's transl)].

The relatively simple and precise technique of direct immunofluorescence on a tissue section enables the study and enumeration of all types of plasma cells including mastocytes (stained with acridine orange) in normal conjunctiva (5 cases), chronic non-allergic conjunctivitis (5 cases), allergic conjunctivitis of the educt (11 cases) and vernal conjunctivitis (11 cases). There is evidence of elevation of IgE plasma cells in type I allergic conjunctivitis where they are twice as raised as in non-allergic cases in adult forms, and three times more elevated in vernal conjunctivitis. There was no correlation between the number of IgE plasma cells in the tissues and IgE level in sera. Thus in air-borne conjunctival allergies local hypersensitivity seems to be the predominant, even exclusive, feature.

Adult

Human conjunctivitis. II. Treatment.

One hundred forty-three patients (207 eyes) with conjunctivitis or blepharoconjunctivitis were investigated to determine (1) the safety of topical corticosteroid therapy and the relative efficacy of formulations of increasing potency and (2) the effectiveness of a steroid-antibiotic preparation compared to each of its components alone and to a placebo. The corticosteroids were equally effective in suppressing conjunctival inflammation; all were more effective than the placebo. Active conjunctivitis was controlled more readily by those preparations containing a steroid, both alone and in combination. The corticosteroid alone (dexamethasone) was more effective in producing inactivation of conjunctivitis than the antibiotic alone ( a mixture of neomycin sulfate and polymyxin B sulfate). This observation remained unchanged when cases of Staphylococcus aureus conjunctivitis were analyzed separately. No serious complications resulted from any treatment regimen.

Administration, Topical

Meningococcal conjunctivitis.

Meningococcal conjunctivitis is typically described as an acute purulent infection. An atypical case of mild catarrhal conjunctivitis occurred in a 19-year-old college student. The meningococci were identified as Neisseria meningitidis, group A, and were isolated from the throats of the patient and her roommate. The conjunctivitis responded rapidly to treatment with sodium sulfacetamide, and it was not treated systemically. A short review of the literature of meningococcal conjunctivitis is presented, and the current recommendation for prophylaxis is discussed.

Administration, Topical

New trends in the treatment of allergic conjunctivitis.

Histamine is the key mediator producing itching, redness and chemosis in allergic conjunctivitis. Histamine levels in tears are increased ten-fold in patients with this allergic condition. Levocabastine is a newly synthesized histamine H1 antagonist which has been formulated as both eye drops and nasal spray. In well established assays of antihistamine activity, levocabastine was found to be the most potent antihistamine compound available, being 15,000 times more potent than chlorpheniramine. Ocular provocation studies in man have shown that levocabastine protects against the symptoms of allergen-induced conjunctivitis. Ophthalmological examinations, including slit lamp and ophthalmoscopy showed no adverse effects. Data from therapeutic studies are available for more than 1700 patients with allergic conjunctivitis treated for 2-16 weeks. One drop of levocabastine (0.5 mg/ml) per eye given two to four times daily provided significantly better symptom control than placebo, with good to excellent results in 71% of patients on levocabastine compared to 55% on placebo (p < 0.001). Levocabastine has a fast onset of action. In one study 94% of patients experienced symptom relief within 15 minutes after the first instillation. The effects observed with levocabastine were at least as good as those with ocular cromoglycate or oral terfenadine. The incidence of adverse experiences was not different from placebo. Levocabastine promises to be a valuable treatment for patients with allergic conjunctivitis.

Animals

Pseudogonococcal ophthalmia neonatorum. Branhamella (Neisseria) catarrhalis conjunctivitis.

A culture from conjunctivitis occurring in a neonate in association with a recurrent fever yielded a nearly pure growth of Branhamella (Neisseria) catarrhalis. The conjunctivitis was not appreciated and effectively treated until a second hospitalization in the fourth week of life. Partial suppression of symptoms had followed short-term parenteral antibiotic therapy during the first admission. Resolution quickly occurred in response to instillation of sodium sulfacetamide ophthalmic solution. Although B. catarrhalis is considered a non-pathogen, the literature reviewed included a number of diverse infections, but no previous instance of conjunctivitis. The organism's close similarities to Neisseria gonorrhoeae necessitate isolation and correct biochemical differentiation. Misdiagnosis of gonococcal conjunctivitis carries obvious social, psychological and medical impact.

Conjunctivitis

Acute purulent conjunctivitis in Nigerian children in Zaria.

A prospective study of 61 acute purulent conjunctivitis seen in children up to 10 years of age at the Ahmadu Bello University Hospital, Zaria, Nigeria, between October 1975 and September 1976 showed H influenzae as the most common etiologic agent (26.2%), followed by S aureus (16.4%), N gonorrhoeae (14.8), and D pneumoniae (9.8%). N gonorrhoeae was the most common cause of conjunctivitis in the first month of life (43.8%) followed by S aureus (37.5%). Conjunctivitis from H influenzae occurred in older children, was more often bilateral, and had a male predilection. Gonococcal conjunctivitis occurred mostly in neonates and was largely unilateral. A good response to treatment with parenteral penicillin and topical Neosporin or chloramphenicol was noted in all the cases of gonococcal infection.

Anti-Bacterial Agents

[Vitamin A and carotene concentration in serum in persons with chronic conjunctivitis and pterygium].

In 41 persons with chronic conjunctivitis, 28 persons with pterygium and 61 eye-healthy persons the Vitamin A and carotene blood level have been examined. All persons with chronic conjunctivitis and pterygium have subjective eye disturbances. In persons with chronic conjunctivitis the vitamin A blood level was lower (men 32 mcg%, women 20 mcg%). In almost all persons with chronic conjunctivitis and pterygium delayed dark adaptation was recorded and the skin-mucosal changes are more frequent.

Carotenoids

A coxsackievirus type A24 epidemic of acute conjunctivitis.

The 1975 epidemic of acute conjunctivitis was caused by the return of S.E.C. 1970 virus (CA24). The clinical manifestations of cases seen in the recent epidemic were similar to those seen during the 1970 epidemic caused by S.E.C. 1970 virus (CA24) and the 1971 epidemic caused by S.E.C. 1971 virus (entero-virus type 70). In our opinion, both the S.E.C. 1970 VIRUS (CA24) and S.E.C. 1971 virus (enterovirus type 70) are equally important causes of epidemics of acute conjunctivitis more commonly known as the "Acute Haemorrhagic Conjunctivitis". Although these two enteroviruses affect mainly the eye, apart from conjunctival secretions, they could be transmitted in respiratory droplets and faeces. The authors would prefer to retain the term "Picornavirus Epidemic Conjunctivitis" to denote infection by S.E.C. 1970 virus (CA24) and S.E.C. 1971 virus (enterovirus type 70).

Acute Disease