Tear levels of neuropeptides increase after specific allergen challenge in allergic conjunctivitis.

PURPOSE: Growing evidence is showing a role of neurogenic inflammation in allergic reactions, with sensory and autonomic nerve fibers releasing neuromediators, which may actively participate in the allergic inflammatory cascade. Although the cornea is the most densely innervated tissue of the human body, little is known on the role of neuromediators at the ocular surface. In this study, we aimed at evaluating the role of substance P (SP), calcitonine gene related peptide (CGRP), neuropeptide Y (NPY) and vasoactive intestinal peptide (VIP) in allergic reactions of the ocular surface. METHODS: Fifteen patients with allergic conjunctivitis (6 female, 9 male, mean age 30±8 years) in non-active phase, and 10 age-matched healthy subjects were included in this study. The conjunctival provocation test (CPT) with allergen was performed in all allergic patients and in 5 healthy subjects. Tear samples were collected and the tear content of VIP, NPY, CGRP, and SP was measured by ELISA at baseline and after CPT. The Mann-Whitney U-test and Wilcoxon test were used to compare neuromediator tear levels. RESULTS: No significant differences in neuropeptide tear levels were observed between healthy and allergic patients in non-active phase. CPT induced conjunctival hyperemia and itching in all allergic patients, while no reaction was observed in the control eyes and in healthy subjects. In allergic patients SP, CGRP, and VIP, but not NPY, were significantly higher after CPT as compared to baseline (SP: 3.9±1.3 ng/ml versus 5.8±1.1 ng/ml, p=0.011; CGRP: 5.5±2.3 ng/ml versus 7.3±2.7 ng/ml; p=0.002; VIP: 4±0.9 ng/ml versus 5.1±1.5 ng/ml, p=0.007). No significant changes were observed in the control eyes of allergic patients challenged with diluent and in healthy subjects after allergen provocation. CONCLUSIONS: Locally-released neuromediators may participate in modulating the allergic response of the ocular surface.

Paracentral corneal melting in a patient with Vogt-Koyanagi-Harada's syndrome, psoriasis, and Hashimoto's thyroiditis.

The paper describes the occurrence of unilateral paracentral corneal melting in a 65-year-old woman with ocular and systemic signs of Vogt-Koyanagi-Harada's syndrome (VKH), psoriasis, and Hashimoto's thyroiditis. Corneal melting, often occurring in association with systemic vasculitis and connective tissue diseases, has rarely been reported in relation to diffuse psoriasis and never in association with VKH. A possible relationship between corneal melting and VKH is suggested.

Uveitis in Turner's syndrome.

BACKGROUND: Turner's syndrome is a chromosomal abnormality where phenotypic females have either a missing X chromosome or a structural aberration of the X chromosome. Several ocular diseases have been associated with Turner's syndrome in the past, including one case only of proven iridocyclitis. METHODS: In this study we report the clinical findings of three females with Turner's syndrome and uveitis followed up for a mean period of 12.6 months. Two were observed in childhood or adolescence (10 and 16 years old). RESULTS: All the patients showed iridocyclitis, in one case complicated by the onset of papilledema and cystoid macular edema. Associated systemic diseases (psoriasis and juvenile seronegative arthritis) were diagnosed in two cases. The third patient showed positive antinuclear antibody and HLA-DR11, without any clinical or radiologic signs of arthritis. The iridocyclitis tended to become chronic with time, and this may be partially due to the endocrinologic contraindications to the use of systemic steroids. Nevertheless, the final visual acuity was > or =8/10 in all three cases. CONCLUSIONS: Iridocyclitis should be included in the list of ocular manifestations in Turner's syndrome. It may tend to become chronic and may be found especially in those patients presenting other associated autoimmune systemic disease.