Tear electrophoretic changes in Nigerian children after measles.

At the laboratory of the National Centre of Ophthalmology, Paris, tear electrophoresis on cellulose acetate support was studied in 56 Nigerian children--32 during and shortly after measles infection and 24 healthy controls. The controls had a normal pattern, while those with measles had patterns consistent with inflammation, most severe in the first week but showing varying degrees of recovery by the third week. Four weeks after measles all cases suffering from malnutrition had patterns with an additional peak. This was shown on further investigation by electrophoresis on polyacrylamide cellulose gel and immunoelectrophoresis to be due to serum transferrin. The normal protein pattern of tears is shown to be altered during and after measles infection.

Factors responsible for tear ferning.

The biochemical agents involved in fern formation on drying tears were investigated by studying the different patterns of ferning of tears from normal and pathological eyes, mucus glycoprotein, saliva, serum, and various salt solutions. We conclude that the ferning phenomenon observed when a drop of tears is allowed to dry at room temperature on a clean microscope slide is to a large extent determined by the electrolyte concentration, especially the ratio of monovalent sodium and potassium ions to divalent calcium and magnesium ions. The presence of a biopolymer is essential, but this need not specifically be mucus as previously thought. The test may therefore be useful clinically in indicating the need for further tear analysis.

Sjögren's syndrome diagnosis: a comparison of conjunctival and gingival impressions and salivary gland biopsy.

This study reviewed 43 patients with Sjögren's syndrome. All of the patients complained of either dry eye and/or dry mouth. Their clinical records were compared with results of three laboratory diagnostic tests to determine the most sensitive test. Out of 30 patients who complained of both dry eye and dry mouth, 10 had positive conjunctival impressions, 20 had positive gingival impressions and 24 had positive salivary gland biopsies. Of 5 patients who suffered from only dry mouth, 2 had positive conjunctival impressions, 3 had positive gingival impressions and 3 had positive salivary gland biopsies. Of 7 patients with only dry eye complaints, there were 3 positive conjunctival impressions, 5 positive gingival impressions, and 6 positive salivary gland biopsies. Out of 6 healthy controls without complaints of dry eyes/mouth, there were no positive conjunctival impressions, 4 positive gingival impressions, and 5 positive salivary gland biopsies. Gingival impression appears to be nearly as sensitive as salivary gland biopsy in this group of patients suffering from Sjögren's Syndrome.

[Preoperative conjunctival bacterial flora and sensitivity to antibiotics (author's transl)]. / La flore microbienne conjonctivale préopératoire et sa sensibilité aux antibiotiques.

2 973 preoperative cultures of conjunctiva have placed in a prominent position 834 pathogenic germs. Cultures in an enriched medium and in an atmosphère including ten per cent of carbonic gas (10% of CO2) have widely increased the number of isolated Streptococus. A study of spectra of antibiotics used in ophtalmology has been made for all these germs. The instability of conjunctival flora with time implies a modification in tactics of bacteriological preoperative samples in order to obtain a better operative security.

[Importance of the assay of T3 and T4 tears and plasma for the diagnosis of endocrine exophthalmos]. / Importance pour le diagnostic des exophtalmies endocriniennes du dosage de T3 et T4 dans les larmes et le plasma.

In the control subject, the thyroidal hormones have been found to be always present in similar quantities in both eyes tears. The proportion of T3 is much more important in the tears (23-40%) than in the plasma (1-2%). It is close to the concentration of deiodinated T4 found in many tissues. In ocular tissues, the T3 is thus very little or even not broken down. This led us to define the tear plasma relationship parameters. We studied lacrimo-plasmatic thyroidal parameters in cases with thyroidal dysfunction without ocular affection: 3 cases of hyperthyroidism, and 2 of hypothyroidism, to study modifications in case of endocrinal problems only. We also studied various types of exophthalmos: 31 cases of endocrine exophthalmos, whether the thyroidal plasma values were normal or not, and 2 cases of exophthalmia with expansive orbital hyperplasia in which there had been no previous thyroidal disturbance. An exophthalmia patient studied, including those with expansive orbital tissue, important changes, specific enough were associated in the tear/plasma parameters, correlated with the changes in the retro-orbital muscular tissues or fat detected by scanning. The study of these parameters, lacrimal thyroid is thus interesting for the diagnosis of endocrine exophthalmos and shows that only a local modification of the metabolism of T3 and T4, mainly from deiodination , process is probably implied in the pathology of these exophthalmos.

[Comparative cytological study of conjunctival secretions and smears]. / Etude cytologique comparée des sécrétions conjonctivales et des frottis de raclage.

Conjunctival cytology is a part of the biological investigations of conjunctivitis. The actual diagnostic interest of this examination has been evalued in 200 cases. The conclusion of this study is that the direct microscopic examination of conjunctival secretions is simple, fast, inexpensive, very useful, and may be indispensable, in the presence of every type of conjunctivitis. On the other hand, cytologic examination of conjunctival scrapings is of a little interest and its indication must be restricted to a limited number of cases according to the clinical context.

[Role of antisepsis in the preventive chemo-antibiotic treatment of postoperative endophthalmitis]. / Rôle de l'antisepsie dans le traitement chimio-antibiotique prophylactique de l'endophtalmie postopératoire.

A protocol associating chemoprophylaxis and two-agent flash antibioprophylaxis was performed for more than two years in order to prevent postoperative endophthalmitis in elective open-globe surgery. The aim of this study is to appreciate whether antibiotic therapy is really useful as a complement to chemoprophylaxis. Three successive conjunctival scrapings were performed in the operating room: two before surgery (one before and one after conjunctival disinfection by povidone iodine), and the third one at the end of the operation. The total number of positive scrapings significantly decreased after disinfection but, some changes appeared on the final scrapings positive and negative. The risks of a positive scraping after the disinfection are greater if the scraping was initially positive. The persistence of a positive scraping after disinfection is noted in about 20% of cases. Therefore, there is a risk for microorganisms to penetrate into the eye, still present on the conjunctiva after povidone iodine. This risk is an argument to carry on the flash antibiotic therapy before surgery, in order to obtain a high intravitreal concentration of antibiotics at the precise time when the bacteria may penetrate into the eye, and to stop their multiplication.

[Fungal contamination of hydrophilic contact lenses (author's transl)]. / Contamination fongique des lentilles molles.

A study was conducted on 113 contact lens showing fungal colonies. The main genus isolated was Cepohalosporium (59.4 p. cent). Lens contamination is favoured by a major factor: contact lens spoliation, a secondary factor being inadequate contact lens maintenance. This contamination raises an economic problem, as every affected contact lens must be replaced.

[Epidemiological study of 1705 malignant tumors of the eye and adnexa]. / Etude épidémiologique de 1,705 tumeurs malignes de l'oeil et de ses annexes.

PURPOSE: Malignant tumours of the eye and adnexa are generally rare, and in the absence of a French national register of declaration of cancers, only an approximate evaluation can be made. We studied the epidemiology of tumours of the eye and adnexa from the laboratory results of anatomical pathology of biopsies examinated at the laboratory of Centre Hospitalier National d'Ophtalmologie des Quinze-Vingts in Paris. MATERIALS AND METHODS: Statistical analysis of the results of histological diagnoses, their sites and the personal histories recovered from the laboratory registers from 1925-1995, a period of 70 years, were carried out. RESULTS: 1705 malignant tumours of the eye and adnexa diagnosed over 70 years consisted of 760 melanomas (44.6%), 450 carcinomas (26.4%), 338 retinoblastomas (19.8%), 95 haematopoetic tumours (5.6%), and 62 diverse others (3.6%). These tumours were localised in: the endo-ocular (1035 cases), lids (398 cases), conjunctiva (119 cases), orbit (90 cases), lacrimal glands (23 cases), caruncle (10 cases), eye lashes (8 cases), optic nerve (6 cases), cornea (3 cases), lacrimal sac (2 cases) and undefined (11 cases). CONCLUSION: In our study, endo-ocular tumours are the most frequently seen of all tumours of the eye and adnexa (60.7%) and are essentially represented by melanomas in the elderly and by retinoblastomas in the newborn and infants. Carcinomas are the most frequent lid malignant pathology whose presence increases with age. Tumours originating from haematopoetic tissues are often seen in the sub-epithelial tissues of orbit, lids, conjunctiva and lacrimal gland.

[Etiology of enucleations. Apropos of 3,246 cases]. / Etiologie des énucléations. A propos de 3,246 cas.

PURPOSE: An epidemiological study of the aetiology of enucleation was conducted in patients seen at the Centre Hospitalier National d'Ophtalmologie des Quinze-Vingts, Paris. The enucleated globes were systematically sent to the laboratory for histological examination. METHODS AND MATERIALS: Histological results of the cases from the register of Anatomo-Pathology section of the laboratory of the C.H.N.O. des Quinze-Vingts, over a 70-year period from 1925-1995 were used; 3,246 globes were examined, that is, 32.83% of all histological examinations. RESULTS: In our series, malignant tumours were the most frequent cause of enucleation (32%), followed by trauma (18%), glaucoma (16%), atrophies-dystrophies (16%) and inflammatory causes (12%). Globes without histological pathology were rare (0.12%). The majority of ophthamic tumours with histological confirmation were melanomas (65.2%) in old age and retinoblastomas (32.5%) in the newborn and early infancy. Our results are compared with those of other authors. CONCLUSION: Great improvements in medicine and diagnostic techniques have taken place, these last decades, and with the possibilities of early diagnosis, enucleation has become rare as it is being replaced by conservative management.

[Epidemiological study of benign tumors and inflammatory pseudotumors of the eye and its adnexa]. / Etude épidémiologique des tumeurs bénignes et des pseudo-tumeurs inflammatoires de l'oeil et de ses annexes.

PURPOSE: Benign tumors and the inflammations of the eye and its adnexa are about twice as frequent as malignant tumours. Because of the aesthetic value or functional importance and the diagnostic difficulties that they can induce, we thought it interesting to conduct an epidemiological study including the localization and the different histological forms of benign tumors and inflammations of theeye. MATERIAL AND METHODS: This study was carried out for a period of 70 years between 1925 and 1995, utilizing case histories and results of the histological examinations of the Pathology Department of the Centre Hospitalier National d'Ophtalmologie des Quinze-Vingts in Paris. The statistics included the histological diagnostic, the localization and the civil data. RESULTS: Benign tumors and inflammations of the eye and its adnexa corresponded respectively to 25.9% and 7.1% of the histological results accomplished in the laboratory. Papilloma (31.4%) and cysts (28.2%) were the most frequent benign tumors. Chalazions represent the most frequent aetiology of inflammation (49%), followed by granuloma (30%). Our results are compared to those of other laboratories. CONCLUSION: While malignant tumors account for the majority of endo-ocular tumors, benign tumors and inflammatory processes are almost always extra-ocular involving the conjunctiva and the eye lids (in particular the inferior eye lid). Papilloma and cysts together account for about 50% of the benign tumors and inflammations of the eye.

[Intolerance causes of indentation material in retinal detachment surgery (author's transl)]. / Intolérance du matériel d'indentation pour décollement de rétine (ses causes).

129 Lincoff sponge's rejection, representing 4,3% of our retinal detachment surgeries during 4 years have been studied. Men were twice more than women, the larger the amount of material was placed the more frequent rejections appeared. Most rejections (56,2%) occured during the first 4 months. Percentage of infection was roughly not influenced by the time after retinal detachment surgery.

[Essay about lacrymal proteins during sicca syndromes (author's transl)]. / Etude des protéines lacrymales au cours des syndromes secs.

Most of sicca syndromes are expressed in a modification of specifically lacrimal proteins. These modifications are involving:--perturbations in tears-electrophoresis, residing in a more or less important decrease of one or several lacrimal proteins,--a frequent sinking in rate of total lacrimal proteins,--a slump of antimicrobial property in tears. The electrophoretic modifications could serve for base to biological classification of sicca syndromes.

[Immune complexes and soluble immunoglobulin G aggregates: error factors when determining immunity loads in tears and serum (author's transl)]. / Immuns complexes, agrégats d'immunoglobulines G solubles: facteurs d'erreurs dans la détermination du rapport des charges immunitaires des larmes et du sérum.

The search for immune complexes or immunoglobulin G aggregates in ocular liquids is often positive, particularly in tears. Immunoglobulin G titration is therefore as only free immunoglobulin are detected. Immunity load and Witmer ratio are also increased leading to inaccurate results. Systematic tests for immune complexes or immunoglobulin aggregates are necessary in order to obtain objective results.

[Conjunctival fungal flora of healthy people (author's transl)]. / Flore fungique conjonctivale des sujets sains.

A study has been carried out on three groups of subjects. The first group, living in the surrounding of Paris, without inflammatory diseases and without local treatments, gives a contamination rate of 3,92%, which is well balanced with yeasts and fungoid growth myceliums. The principal isolated species were: Penicillium, Aspergillus, Candida, Rhodotorula. The second group with local treatment by mercurothiolate natrium was sterile. The third group, whose subjects had nearly a daily cultivation, allows to establish that: -- The conjunctival fungic flora is variable with time, and differ of a eye from the other for a given subject and its continuance is short; -- The subject contamination seems to be different according to the quality of the immune defenses, the less effective showing always yeasts and fungoid growth myceliums, the other ones slightly infected and only with fungoid growth myceliums; -- The contamination rate seems to be directly related to the intensity of the surrounding atmosphere agitation.

[Immediate hypersensitivity to lacrimal gland proteins in sicca syndromes]. / Hypersensibilité immédiate aux protéines de la glande lacrymale au cours des syndromes secs.

A biological study was conducted on tears from 20 subjects with a clinical sicca syndrome. Electrophoresis of lacrymal proteins, determination of lacrymal and salivary immunoglobulins G, and a human basophil degranulation test (HBDT) with a lacrymal gland extract as antigen were performed in each patient. Three different groups could be distinguished: a group with normal electrophoresis and normal HBDT corresponding to hyposecretion; a second group with abnormal electrophoresis and negative HBDT corresponding to an inflammatory state of the lacrymal gland; and a third group with abnormal electrophoresis and positive HBDT corresponding to a deficit in synthesis function of the lacrymal gland. These findings demonstrate that HBDT with lacrymal gland extract as antigen is a reliable means of diagnosis of the sicca syndrome.

[Chronic blepharoconjunctivitis during a treatment with acitretin (Soriatane)]. / Blépharo-conjonctivite chronique au cours d'un traitement par acitrétine (Soriatane).

We report external ocular side effects after treatment with acitretin, a new synthetic vitamin A analogue and the main metabolite of etretinate. A patient treated with 20-25 mg/day of acitretin for psoriasis suffered from chronic blepharoconjunctivitis. Schirmer tests, tear lysozyme were normal while rose bengal and fluorescein staining disclosed epithelial punctate defects and tear break-up time was shortened. Meibomian glands of the lower lid were photographed with transillumination and appeared atrophic. Conjunctival cytology and biopsy showed snake-like chromatine appearance, keratinized epithelial cells and some lymphocytes infiltrates. Accessory salivary gland histological aspects were nonspecific. There was a clear relationship between restarting the acitretin therapy and recurrence of ocular symptoms. Acitretin, like other retinoids, may induce or exacerbate blepharoconjunctivitis in patients with psoriasis.

[Antibiotic therapy in ophthalmology]. / L'antibiothérapie en ophtalmologie.

Eye drops containing antibiotics are more and more numerous, we prescribe them more and more frequently. We found it interesting first to gather in six lists all antibiotics used locally in ophthalmology and to study for everyone its bacterial spectrum. After that we see which bacteria are most frequently met by ophthalmologists and when (presurgery examination, conjunctivitis, blepharitis, chalazion, meibomianitis, sty, corneal ulcer, lens infection). All this helps the ophthalmologist to choose the antibiotic he prescribes before the bacteriological specimen, with high confidence. At last, we sum up the little that is presently known about penetration of antibiotics into the eye.

[Ocular loaiasis in a young Caucasian tourist (author's transl)]. / Loase conjonctivale chez une touriste de race blanche.

This observation perfectly illustrates the main epidemiological, clinical and biological peculiarities of this parasitic disease. Particularly, as it concerns a tourist who travelled across Africa for a short period of time it is possible to assess the time of exposure to infecting mosquito bites, the maturation period of time as well as the time of clinical incubation. On the other hand the value of the immunological techniques to make the diagnosis of loaiasis as well as the difficulties to treat this affection are stressed upon.

[Blood histamine levels in patients infected with the human immunodeficiency virus]. / Histaminémie des malades infectés par le virus de l'immunodéficience humaine.

Serum histamine levels are significantly lowered in patients with human immunodeficiency virus (HIV) infection. Treatment with zidovudine has no effect on histaminaemia, but HIV-positive patients with thrombocytopenic purpura who underwent splenectomy are known to have had a rise in serum histamine levels after the operation. This parameter might be used as prognostic factor in the evaluation of patients with HIV infection.