[Viral Conjunctivitis: Findings, Therapy, and Prophylaxis]. / Virale Bindehautentzündungen: Befunde, Therapie und Prophylaxe.

Viral conjunctivitis is one of the most common acute eye diseases. The fall and winter months are known to be the main season for viral infections which is also reflected in the ophthalmological outpatient clinics. Viral conjunctivitis is often accompanied by symptoms of the upper and lower respiratory tract, fever, chills, arthralgia or skin lesions. The spectrum of pathogens comprises DNA viruses such as Adeno-, Herpes simplex and Molluscum contagiosum as well as RNA viruses. Symptoms caused by pandemic pathogens such as SARS-CoV-2 and mpox viruses can also cause ocular manifestation. Viral conjunctivitis is often self-limiting leaving no residual symptoms, however an ophthalmologist should be consulted if there are inflammatory symptoms of the anterior eye accompanied by visual disturbance. It is particularly important to recognize the affection of corneal or even intraocular structures early to initiate an adequate and effective therapy. Affection of the cornea, vitreus or retina can result in temporary or permanent impairment of the field of vision and visual acuity. The diagnosis is usually made without further tests on the basis of the typical clinical presentation. Rapid tests or PCR diagnostics are also available for confirmation. In most patients the treatment is symptomatically with artificial tears and antibiotic eye drops in cases accompanied by secondary bacterial infections, not prophylactically. If the cornea or other ocular structures are affected by certain viruses, local as well as systemic virostatic therapy is initiated. The most important prophylactic measure is meticulous and consistent hygiene.

Evaluation of knowledge, attitude, and behaviour of ophthalmologists about adenoviral conjunctivitis transmission and treatment : An online survey for Turkish ophthalmologists.

PURPOSE: To determine the prevalence of adenoviral conjunctivitis in Turkish ophthalmologists, to provide an overview of the treatment and prophylaxis of adenoviral conjunctivitis, and to analyze the data in the context of evidence-based treatment recommendations. METHODS: An online questionnaire consisting of 20 multiple-choice questions about the characteristics of the respondents, the individual adenoviral conjunctivitis history of the ophthalmologists, their practice's approaches, and prescription preferences were emailed to Turkish ophthalmologists. RESULTS: The survey was emailed to 500 ophthalmologists; 45% of them returned the questionnaire. According to the responses, the history of adenoviral conjunctivitis infections was positive in 46.7% (n: 120), recurrent attack prevalence was 16.2% in ophthalmologists. Lubricants (67.6%) are the most preferred first-line treatment options for adenoviral conjunctivitis, followed by povidone-iodine (59.6%), topical antibiotics (51.1%), topical antivirals (29.3%), topical corticosteroids (26.7%), and topical nonsteroidal anti-inflammatory agents (19.6%). A total of 98.2% preferred to dismiss infected patients. The preferred prophylaxis options were frequent hand washing/use of gloves (97.8%), disinfection of medical devices (95.1%), isolation of infected patients (79.1%), hand hygiene with gemicides (58.7%). The percentage of single-dose eye drop selection was 46.2. CONCLUSIONS: The findings of this survey showed that most Turkish ophthalmologists generally follow international guidelines for the treatment of adenoviral conjunctivitis. The treatment algorithm is still controversial, so ophthalmologists should be aware of treatment guideline updates in line with evidence-based recommendations. Having sufficient knowledge of the basic characteristics of viruses is important to control the spread of the disease.

Endotelitis por citomegalovirus y su diagnóstico mediante la microscopia confocal / Cytomegalovirus endotheliitis and its diagnosis by confocal microscopy

Objetivo: Describir las características del endotelio corneal por microscopia confocal en pacientes con lesiones basofílicas de inclusión como patognomónicas de endotelitis por citomegalovirus. Métodos: Se realizó un estudio observacional de casos clínicos en pacientes con diagnóstico de endotelitis por citomegalovirus, atendidos en la Consulta de Córnea del Instituto Cubano de Oftalmología "Ramón Pando Ferrer", entre febrero del año 2010 y junio del 2018. La muestra incluyó 39 pacientes con diagnóstico clínico de endotelitis, a quienes se les realizó microscopia confocal con el equipo Confoscan 4 (Nidek Technologies). Resultados: De los 39 pacientes, 29 fueron del sexo masculino y 10 del femenino. Todos tenían entre 41 y 60 años de edad. En el 97,4 por ciento de los casos existió el antecedente de una conjuntivitis viral y un solo paciente fue positivo de HIV (2,6 por ciento). La mejor agudeza visual corregida de 0,3 o menos se mostró en el 100 por ciento de ellos antes del tratamiento, y después de este los 39 tenían entre 0,8 y 1,0. En el 100 por ciento de los casos se observaron cuerpos de inclusión basofílicos en el endotelio corneal, que fueron apreciables mediante la microscopia confocal. Conclusiones: Existe una relación entre la presencia de cuerpos de inclusión basofílicos en el endotelio corneal y las pruebas virológicas a citomegalovirus positivas, lo que puede permitir hacer PCR a casos que ya tienen confirmación mediante microscopia confocal de las características patognomónicas del endotelio corneal(AU)

Objective: Describe the characteristics of the corneal endothelium by confocal microscopy in patients with inclusion basophilic lesions as pathognomonic signs of cytomegalovirus endotheliitis. Methods: An observational study was conducted of clinical cases of patients diagnosed with cytomegalovirus endotheliitis attending the Cornea Service at Ramón Pando Ferrer Cuban Institute of Ophthalmology from February 2010 to June 2018. The study sample was 39 patients with a clinical diagnosis of endotheliitis who underwent confocal microscopy with a Confoscan 4 device (Nidek Technologies). Results: Of the 39 patients examined, 29 were male and 10 were female. All were aged 41-60 years. 97.4 percent had a history of viral conjunctivitis and only one was HIV positive (2.6 percent). Best corrected visual acuity was 0.3 or less in 100 percent before treatment, and 0.8 to 1.0 after treatment. Inclusion basophilic bodies visible by confocal microscopy were observed in the corneal endothelium of all patients. Conclusions: A relationship exists between the presence of inclusion basophilic bodies in the corneal endothelium and virological tests positive for cytomegalovirus, making it possible to perform PCR testing in cases with confocal microscopy confirmation of the pathognomonic characteristics of the corneal endothelium(AU)

Atypical ocular Chelonoid herpesvirus manifestations in a captive Loggerhead turtle (Caretta caretta).

A captive loggerhead turtle (Caretta caretta) of unknown sex, 3 years of age, presented with bilateral mucoid secretions, severe chemosis, conjunctival hyperemia, and globe retraction. The animal was evaluated ophthalmologically and systemically, and hematological, microbiological, and conjunctival cytological and biopsy samples were collected for complementary diagnosis. The histopathological examination showed amphophilic intranuclear inclusions associated with severe inflammatory infiltrate. The diagnosis of Chelonid alphaherpesvirus 5 (ChAHV 5) was confirmed with end point PCR. Following systemic treatment with L-lysine, acyclovir and vitamin A, the ocular signs resolved. No amphophilic intranuclear inclusions were seen in a follow-up biopsy 5 months later, and there has been no recurrence of clinical ophthalmic signs during a 4-year follow-up. It is suggested that ChAHV 5 be considered as a differential diagnosis in captive marine turtles that present for conjunctival disease other than fibropapillomatosis.

Positive detection of SARS-CoV-2 combined HSV1 and HHV6B virus nucleic acid in tear and conjunctival secretions of a non-conjunctivitis COVID-19 patient with obstruction of common lacrimal duct.

BACKGROUND: The current outbreak of COVID-19 has spread rapidly all over the world. Respiratory droplets and contaction with infected patients are the two major transmission routes. However, the value of tear virus nucleic acid is still not clear. We dynamic detected the SARS-CoV-2 in eye sample of one COVID-19 patient with obstruction of common lacrimal ducts. METHODS: Besides the routine examination, nasopharyngeal and eye swab were continuously measured by polymerase chain reaction assay and next-generation sequencing (NGS). Gene detection was performed for drug use guidance, and flow cytometry was performed to analyse the lymphocyte subsets. RESULTS: Nasopharyngeal swabs were positive for 22 days, but eye swabs were still continuously positive for 2 weeks after nasopharyngeal swabs turned negative. The low level of lymphocyte and the high level IL-6 lasted for almost 4 weeks, then became near normal. Next-generation sequencing (NGS) confirmed the existing of SARS-CoV-2, HSV1 and HHV6B virus nucleic acid. The gene detection for drug use guidance showed the genetic locus ABCB1 (3435T>C) rs1045642 belonged to type CC and it mean the efficiency of lopinavir-ritonavir would be significantly decreased. The flow cytometry of lymphocyte subsets showed PD-1+  CD95+ cells was accounting for 94.8% in CD3+  CD8+ T subset and for 94.8% in CD3+  TCRγδ+ T subset. CONCLUSIONS: As obstruction of common lacrimal duct, positively detection in one eye for 2 weeks more after nasopharyngeal swab became negative. More eye swabs should be collected from COVID-19 patients, especially from those immunocompromised, those with eye symptoms and those had a history of ocular diseases.

Comparative study on the efficacy of non-steroidal, steroid and non-use of anti-inflammatory in the treatment of acute epidemic conjunctivitis.

PURPOSE: To evaluate the effects of prednisolone against sodium diclofenac both with ciprofloxacin compared to artificial tears on the symptoms and signs of acute viral conjunctivitis. METHODS: Study included 37 patients diagnosed with acute conjunctivitis and distributed by three groups: A (1% prednisolone acetate + ciprofloxacin (0.3%); B (Sodium diclofenac (0.1%) + ciprofloxacin (0.3%) and C (artificial tears + ciprofloxacin (0.3%). Patients received medication 6/6 hours daily. Signs and symptoms (e.g. lacrimation, burning, photophobia, etc.) were scored at baseline and on the first, third, fifth and seventh days and in the end of treatment using a standardized questionnaire and slit lamp anterior segment examination. RESULTS: All three groups demonstrated an improvement in the signs and symptoms of conjunctivitis in their follow-up visits. There was no significant difference in symptom and sign scores between Group A and B and B and C in the study visits ( p >0.05). However, the comparison between groups A and C showed a clinical trend (p=0.05) on third evaluation suggesting better clinical action using the corticosteroids. CONCLUSION: The prednisolone acetate was not superior to the use of sodium diclofenac or artificial tears in relieving the signs and symptoms of viral conjunctivitis.

Comparative study on the efficacy of non-steroidal, steroid and non-use of anti-inflammatory in the treatment of acute epidemic conjunctivitis

Abstract Purpose To evaluate the effects of prednisolone against sodium diclofenac both with ciprofloxacin compared to artificial tears on the symptoms and signs of acute viral conjunctivitis. Methods Study included 37 patients diagnosed with acute conjunctivitis and distributed by three groups: A (1% prednisolone acetate + ciprofloxacin (0.3%); B (Sodium diclofenac (0.1%) + ciprofloxacin (0.3%) and C (artificial tears + ciprofloxacin (0.3%). Patients received medication 6/6 hours daily. Signs and symptoms (e.g. lacrimation, burning, photophobia, etc.) were scored at baseline and on the first, third, fifth and seventh days and in the end of treatment using a standardized questionnaire and slit lamp anterior segment examination. Results All three groups demonstrated an improvement in the signs and symptoms of conjunctivitis in their follow-up visits. There was no significant difference in symptom and sign scores between Group A and B and B and C in the study visits ( p >0.05). However, the comparison between groups A and C showed a clinical trend (p=0.05) on third evaluation suggesting better clinical action using the corticosteroids. Conclusion The prednisolone acetate was not superior to the use of sodium diclofenac or artificial tears in relieving the signs and symptoms of viral conjunctivitis.

Causes of epidemic keratoconjunctivitis and therapeutic measures

Epidemic keratoconjunctivitis is the most common type of infectious conjunctivitis, and is caused by adenoviruses. The mode of transmission is mainly through direct contact with ocular secretions. Epidemic keratoconjunctivitis is generally diagnosed based on a patient's clinical features, and additional measures, such as cell cultures, polymerase chain reaction, and rapid antigen detection tests, can further confirm the diagnosis. The most common symptoms include a foreign body sensation, tearing, and photophobia. The symptoms are usually expressed unilaterally in the initial phase, but gradually become bilateral. Frequently occurring complications include pseudomembrane formation and subepithelial infiltrates. Currently, no antiviral agent has been proven effective to alter the natural course of the disease, and treatment merely has a supportive role instead of a curative role. Therefore, preventive measures in medical offices and in the community are the most important methods of controlling the propagation of this disease.

Conjuntivitis aguda causada por Metapneumovirus humano / Acute conjunctivitis caused by Human Metapneumovirus

Se presenta el caso de un varón prematuro y con cardiopatía congénita de 4 meses de edad que presentaba unas bronquiolitis y conjuntivitis causadas por CI Metapneumovirus humano. El virus se detectó tanto en el aspirado nasofaríngeo como en la secreción conjuntival. Debido a la rareza de esta entidad, se revisa la literatura correspondiente a esta entidad (AU)

A premature male with congenital heart disease and 4 months of age had a bronchiolitis and conjunctivitis caused by human metapneumovirus. The virus was detected in both the nasopharyrngeal aspirate as coniunctival secretion. Because of the rarity of this entity we reviewed scientific literature (AU)

Herpes gladiatorum with ocular involvement in a mixed martial arts fighter.

We report a case of herpes gladiatorum (HG) in a professional mixed martial arts (MMA) fighter. The eruption appeared following a sparring session with a new partner and progressed to involve the left eye. Fever and facial rash prompted the patient to go to the hospital where he was treated with antiviral therapy. The considerable increase in popularity of MMA may lead to a greater prevalence of HG as well as other cutaneous infections contracted through skin-to-skin contact.

Comparação do tratamento homeopático e convencional numa epidemia de conjuntivite / Comparison between homeopathic and conventional treatment in a conjunctivitis epidemic

Objetivo: Comparar os resultados dos tratamentos homeopático e convencional na epidemia de conjuntivite viral em 1997 em Ranchuelo, VC, Cuba. Materiais e métodos: Estudo retrospectivo de 67 pacientes diagnosticados e hospitalizados durante uma epidemia de conjuntivite viral que aconteceu entre julho e setembro de 1997 na área de saúde de Ranchuelo, divididos em dois grupos; um grupo de 47 pacientes foi submetido a tratamento convencional, e em segundo grupo de 20 pacientes a tratamento homeopático. Resultados: Comprovou-se que o tratamento homeopático induziu a cura em menor tempo, o tratamento convencional requereu quase o dobro do tempo. Além do mais, o tratamento homeopático teve custo menor que o convencional, que foi mais do dobro. Conclusões: Foi demostrada a ação benéfica do tratamento homeopático no controle da epidemia, enquanto que a cura aconteceu num tempo mais breve e com menos custo que o tratamento convencional.(AU)

Aim: To compare results of homeopathic and conventional treatment in a conjunctivitis epidemic in 1997 in Ranchuelo, VC, Cuba. Materials and methods: Retrospective study comprising 67 patients diagnosed and hospitalized during a viral conjunctivitis epidemic between July and September 1997 in Ranchuelo health district divided in two groups; one group comprising 47 patients was given conventional treatment, and a second group comprising 20 patients was given homeopathic treatment. Results: Homeopathic treatment elicited faster healing, since conventional treatment required almost twice as long. Moreover, cost of homeopathic treatment was lowed compared toconventional treatment, the latter was more than twice as expensive. Conclusions: Homeopathic treatment proved beneficial to control this epidemic since healing was faster and less expensive than conventional treatment.(AU)

Comparación del tratamiento homeopático y convencional en unaepidemia de conjuntivitis / Comparison between homeopathic and conventional treatment in a conjunctivitis epidemic

Objetivo: Comparar los resultados de los tratamientos homeopático y convencional sobre la epidemia de conjuntivitis viral del año 1997 en Ranchuelo, VC, Cuba. Material y métodos: Se trata de un estudio retrospectivo de un total de 67 pacientes que se diagnosticaron y se ingresaron durante la epidemia de conjuntivitis viral que se produjo en los meses de julio a septiembre de 1997 en el área de salud de Ranchuelo, conformados en dos grupos, un primer grupo de 47 pacientes tratados con medicamentos convencionales y un segundo grupo de 20 pacientes tratados con medicamentos homeopáticos, Resultados: Se comprobó que el tratamiento homeopático produjo la curación en menor tiempo, necesitando el otro tratamiento casi el doble del tiempo y además, que el tratamiento homeopático demostró ser más barato que el convencional, siendo el costo de éste último más del doble. Conclusiones:Quedó demostrada la buena acción del medicamento homeopático sobre la epidemia, con la curación que se produjo en mucho menos tiempo y con menos costo que con los otros medicamentos.(AU)

Aim: To compare results of homeopathic and conventional treatment in a conjunctivitis epidemic in 1997 in Ranchuelo, VC, Cuba. Materials and methods: Retrospective study comprising 67 patients diagnosed and hospitalized during a viral conjunctivitis epidemic between July and September 1997 in Ranchuelo health district divided in two groups; one group comprising 47 patients was given conventional treatment, and a second group comprising 20 patients was given homeopathic treatment. Results: Homeopathic treatment elicited faster healing, since conventional treatment required almost twice as long. Moreover, cost of homeopathic treatment was lowed compared toconventional treatment, the latter was more than twice as expensive. Conclusions: Homeopathic treatment proved beneficial to control this epidemic since healing was faster and less expensive than conventional treatment.(AU)

Comparação do tratamento homeopático e convencional numa epidemia de conjuntivite / Comparación del tratamiento homeopático y convencional en una epidemia de conjuntivitis / Comparison between homeopathic and conventional treatment in a conjunctivitis epidemic

Objetivo: Comparar os resultados dos tratamentos homeopático e convencional na epidemia de conjuntivite viral em 1997 em Ranchuelo, VC, Cuba. Materiais e métodos: Estudo retrospectivo de 67 pacientes diagnosticados e hospitalizados durante uma epidemia de conjuntivite viral que aconteceu entre julho e setembro de 1997 na área de saúde de Ranchuelo, divididos em dois grupos; um grupo de 47 pacientes foi submetido a tratamento convencional, e em segundo grupo de 20 pacientes a tratamento homeopático. Resultados: Comprovou-se que o tratamento homeopático induziu a cura em menor tempo, o tratamento convencional requereu quase o dobro do tempo. Além do mais, o tratamento homeopático teve custo menor que o convencional, que foi mais do dobro. Conclusões: Foi demostrada a ação benéfica do tratamento homeopático no controle da epidemia, enquanto que a cura aconteceu num tempo mais breve e com menos custo que o tratamento convencional.(AU)

Aim: To compare results of homeopathic and conventional treatment in a conjunctivitis epidemic in 1997 in Ranchuelo, VC, Cuba. Materials and methods: Retrospective study comprising 67 patients diagnosed and hospitalized during a viral conjunctivitis epidemic between July and September 1997 in Ranchuelo health district divided in two groups; one group comprising 47 patients was given conventional treatment, and a second group comprising 20 patients was given homeopathic treatment. Results: Homeopathic treatment elicited faster healing, since conventional treatment required almost twice as long. Moreover, cost of homeopathic treatment was lowed compared to conventional treatment, the latter was more than twice as expensive. Conclusions: Homeopathic treatment proved beneficial to control this epidemic since healing was faster and less expensive than conventional treatment.(AU)

Objetivo: Comparar los resultados de los tratamientos homeopático y convencional sobre la epidemia de conjuntivitis viral del año 1997 en Ranchuelo, VC, Cuba. Material y métodos: Se trata de un estudio retrospectivo de un total de 67 pacientes que se diagnosticaron y se ingresaron durante la epidemia de conjuntivitis viral que se produjo en los meses de julio a septiembre de 1997 en el área de salud de Ranchuelo, conformados en dos grupos, un primer grupo de 47 pacientes tratados con medicamentos convencionales y un segundo grupo de 20 pacientes tratados con medicamentos homeopáticos, Resultados: Se comprobó que el tratamiento homeopático produjo la curación en menor tiempo, necesitando el otro tratamiento casi el doble del tiempo y además, que el tratamiento homeopático demostró ser más barato que el convencional, siendo el costo de éste último más del doble. Conclusiones: Quedó demostrada la buena acción del medicamento homeopático sobre la epidemia, con la curación que se produjo en mucho menos tiempo y con menos costo que con los otros medicamentos.(AU)

Comparação do tratamento homeopático e convencional numa epidemia de conjuntivite / Comparación del tratamiento homeopático y convencional en una epidemia de conjuntivitis / Comparison between homeopathic and conventional treatment in a conjunctivitis epidemic

Objetivo: Comparar os resultados dos tratamentos homeopático e convencional na epidemia de conjuntivite viral em 1997 em Ranchuelo, VC, Cuba. Materiais e métodos: Estudo retrospectivo de 67 pacientes diagnosticados e hospitalizados durante uma epidemia de conjuntivite viral que aconteceu entre julho e setembro de 1997 na área de saúde de Ranchuelo, divididos em dois grupos; um grupo de 47 pacientes foi submetido a tratamento convencional, e em segundo grupo de 20 pacientes a tratamento homeopático. Resultados: Comprovou-se que o tratamento homeopático induziu a cura em menor tempo, o tratamento convencional requereu quase o dobro do tempo. Além do mais, o tratamento homeopático teve custo menor que o convencional, que foi mais do dobro. Conclusões: Foi demostrada a ação benéfica do tratamento homeopático no controle da epidemia, enquanto que a cura aconteceu num tempo mais breve e com menos custo que o tratamento convencional.

Aim: To compare results of homeopathic and conventional treatment in a conjunctivitis epidemic in 1997 in Ranchuelo, VC, Cuba. Materials and methods: Retrospective study comprising 67 patients diagnosed and hospitalized during a viral conjunctivitis epidemic between July and September 1997 in Ranchuelo health district divided in two groups; one group comprising 47 patients was given conventional treatment, and a second group comprising 20 patients was given homeopathic treatment. Results: Homeopathic treatment elicited faster healing, since conventional treatment required almost twice as long. Moreover, cost of homeopathic treatment was lowed compared to conventional treatment, the latter was more than twice as expensive. Conclusions: Homeopathic treatment proved beneficial to control this epidemic since healing was faster and less expensive than conventional treatment.

Objetivo: Comparar los resultados de los tratamientos homeopático y convencional sobre la epidemia de conjuntivitis viral del año 1997 en Ranchuelo, VC, Cuba. Material y métodos: Se trata de un estudio retrospectivo de un total de 67 pacientes que se diagnosticaron y se ingresaron durante la epidemia de conjuntivitis viral que se produjo en los meses de julio a septiembre de 1997 en el área de salud de Ranchuelo, conformados en dos grupos, un primer grupo de 47 pacientes tratados con medicamentos convencionales y un segundo grupo de 20 pacientes tratados con medicamentos homeopáticos, Resultados: Se comprobó que el tratamiento homeopático produjo la curación en menor tiempo, necesitando el otro tratamiento casi el doble del tiempo y además, que el tratamiento homeopático demostró ser más barato que el convencional, siendo el costo de éste último más del doble. Conclusiones: Quedó demostrada la buena acción del medicamento homeopático sobre la epidemia, con la curación que se produjo en mucho menos tiempo y con menos costo que con los otros medicamentos.

Self-medication: initial treatments used by patients seen in an ophthalmologic emergency room.

OBJECTIVE: This study seeks to identify practices of self-medication in the treatment of ocular emergencies. We examine patients' use of both homemade preparations and manufactured products before seeking specialized care. MATERIALS AND METHODS: We conducted a cross-sectional analytic survey of consecutive patients seen in the ophthalmology emergency room of a teaching hospital. RESULTS: The sample included 561 subjects, 51.3% males and 48.7% females, with a mean age of 39.8 years. Prior to seeking emergency care, 40.5% reported self-medicating; 29.4% used a homemade preparation (13.9% referred to an industrialized product like boric acid as a homemade preparation), and 11.1% used a manufactured product. The most frequently used products included a boric acid solution (53.3%), a normal saline solution (35.7%), herbal infusions (6.1%) and breast milk (4.8%). Viral conjunctivitis was the most frequent diagnosis (24.4%), followed by the presence of a corneal foreign body (7.4%). No significant differences were found in the self-treatment of ocular injuries according to gender (p = 0.95), level of education (p = 0.21) or age (p = 0.14). In addition, self-medication practices were not related to the medically judged severity of the condition. CONCLUSION: Patients often attempt to treat conditions that require ophthalmologic emergency care by self-medicating with homemade or manufactured products. The most widely used products include boric acid, normal saline, leaf infusions and breast milk. This behavior occurs independently of educational level, gender, age or the nature of the ocular condition. Self-medication is a culturally driven practice that is used even in cases of acute ocular injuries.

Self-medication: initial treatments used by patients seen in an ophthalmologic emergency room

OBJECTIVE: This study seeks to identify practices of self-medication in the treatment of ocular emergencies. We examine patients' use of both homemade preparations and manufactured products before seeking specialized care. MATERIALS AND METHODS: We conducted a cross-sectional analytic survey of consecutive patients seen in the ophthalmology emergency room of a teaching hospital. RESULTS: The sample included 561 subjects, 51.3 percent males and 48.7 percent females, with a mean age of 39.8 years. Prior to seeking emergency care, 40.5 percent reported self-medicating; 29.4 percent used a homemade preparation (13.9 percent referred to an industrialized product like boric acid as a homemade preparation), and 11.1 percent used a manufactured product. The most frequently used products included a boric acid solution (53.3 percent), a normal saline solution (35.7 percent), herbal infusions (6.1 percent) and breast milk (4.8 percent). Viral conjunctivitis was the most frequent diagnosis (24.4 percent), followed by the presence of a corneal foreign body (7.4 percent). No significant differences were found in the self-treatment of ocular injuries according to gender (p = 0.95), level of education (p = 0.21) or age (p = 0.14). In addition, self-medication practices were not related to the medically judged severity of the condition. CONCLUSION: Patients often attempt to treat conditions that require ophthalmologic emergency care by self-medicating with homemade or manufactured products. The most widely used products include boric acid, normal saline, leaf infusions and breast milk. This behavior occurs independently of educational level, gender, age or the nature of the ocular condition. Self-medication is a culturally driven practice that is used even in cases of acute ocular injuries.

Magnetotherapy in the treatment of viral conjunctivitis and keratitis.

Ocular infections are one of the most frequent causes of ailments among the patients coming to ophthalmologic offices. This article presents one of the physical medicine's methods--magnetotherapy--which uses the alternating low frequency magnetic fields in the therapy of viral conjunctivitis and keratitis in a 49-year-old female patient. Basing on the obtained results it was stated that this method broadens the treatment possibilities becoming a precious supplement and support treatment method in ophthalmology.

Evaluation of sampling technique and transport media for the diagnostics of adenoviral eye infections. Adenovirus sampling and transport.

BACKGROUND: Human adenoviruses (HAdV) may cause pharyngoconjunctival fever, follicular conjunctivitis or epidemic keratoconjunctivitis (EKC). Especially, outbreaks of the latter may lead to severe economic losses when preventive measures are implemented too late. Thus, a safe sampling method, proper specimen transport conditions and a fast and sensitive diagnostic technique is mandatory. METHODS: Two commercially available virus transport systems (VTS) were compared with two NaCl-moisturised sampling devices, one of which comprises Dacron-tipped plastic-shafted swabs and the other a cotton-tipped wood-shafted swab, available in most ophthalmologists' offices. Downstream methods for specific detection of HAdV included direct immunofluorescence assay (IFA) of conjunctival swabs, virus isolation by cell culture and quantitative real-time polymerase chain reaction (qPCR). Furthermore, the influence of application of local anaesthetics prior to swabbing on subsequent detection of HAdV was investigated. RESULTS: Application of local anaesthetics had a positive influence on the amount of swabbed cells, thus increasing the chance of obtaining positive results by IFA. Neither isolation of HAdV by cell culture nor by qPCR was negatively influenced by this pretreatment. Surprisingly, both commercially available VTS performed significantly worse than the NaCl-moisturised swabs. This was shown with regard to virus recovery rates in cell culture as well as viral genome copy numbers in the qPCR. CONCLUSIONS: Based on our results, the following recommendations are provided to improve sampling, transport and diagnostic techniques regarding conjunctival swabs for diagnosis of human adenovirus infection: (1) application of local anaesthetics, (2) NaCl-moisturised VTS for shipment of specimens, and (3) detection of HAdV by qPCR. The latter method proved to be superior to virus isolation by cell culture, including subsequent identification by IFA, because it is faster, more sensitive and allows simultaneous handling of a number of samples. Hence, countermeasures to prevent further virus spread in an outbreak situation can be implemented earlier, thus reducing the number of subsequent adenoviral infections.

[New medical treatment for viral conjunctivitis].

Around one million people in Japan are suffering from adenoviral conjunctivitis every year and it is recognized as one of the major pathogens of nosocomial infection. Several complications, such as corneal erosion and conjunctival pseudomembrane, are observed in some of the cases and corneal sube- pithelial opacity may bring visual impairment. Moreover, no specific anti-adenoviral agent has been discovered and an effective treatment has not been established for adenoviral infection. We have researched new medical treatment for viral conjunctivitis based on recent findings in adenoviral conjunctivitis. Firstly, anti-adenoviral activity was evaluated in vitro in agents which could possibly act as anti-adenoviral drugs. Twelve candidates, such as zalcitabin, interferon beta, etc., were selected among antiviral drugs, adenoviral receptor inhibitors, natural products and anti-inflammatory drugs. Remarkable anti-adenoviral effect was observed in zalcitabin, sanilbudine, interferon beta and anti-osteopontin peptide. Two anti-human immunodeficiency virus (HIV) drugs with anti-adenoviral activity, zalcitabin and sanilbudine, are nucleoside reverse transcriptase inhibitors, but, in contrast, non-nucleoside reverse transcriptase inhibitors and protease inhibitors were ineffective against adenovirus. Interferon beta and anti-osteopontin peptide displayed anti-adenoviral effects by absorption inhibition. Secondly, side effects caused by possible anti-adenoviral eye drops, including cidofovir whose development as eye drops against eyeball and ocular adnexa had been suspended, were analyzed in a white rabbit model. In animals given cidofovir locally, significant narrowing of lacrimal canaliculus, redness of eyelid and conjunctival injection was observed, but obstruction of the lacrimal duct was not found. Although zalcitabin and sanilbudine eye drops induced eyelid redness, no change was observed in the lacrimal route and conjunctiva. In animals treated by cidofovir, inflammation histologically suggesting mainly allergic change was observed. These results indicate that these four drugs are possible candidate for safe eye drops against adenoviral conjunctivitis. These four agents are divided into two categories, inhibitors of adenoviral replication, zalcitabin and sanilbudine; and suppressors of adenoviral infection, interferon beta and anti-osteopontin peptide. It is expected that eye drops for specific treatment of adenoviral conjunctivitis are going to be available in the near future following investigation of therapeutic effect in adenoviral infected animals and clinical trials in humans.