Bacteriology and tear protein profiles of the dry eye.

The concentrations of tear lysozyme, lactoferrin, ceruloplasmin, IgA, and IgG have been estimated in patients with dry eyes at the same time as semiquantitative bacterial culture was performed of the conjunctivae and lids. Staphylococcal isolations were quantified and biotyped. There was no increased conjunctival colonisation by any particular biotype of Staphylococcus aureus or Staph. epidermidis, and similar numbers of conjunctivae were sterile as in controls (33%); neither were any pathogens such as pneumococci or haemophili isolated. We consider that the conjunctiva of the dry eye, without the lacrimal secretion components of lysozyme and lactoferrin, has an alternative protective antibacterial mechanism which is derived from serum proteins via chronically inflamed vessels.

Microbial and immunological investigations of chronic non-ulcerative blepharitis and meibomianitis.

Concentrations of tear lysozyme, lactoferrin, ceruloplasmin, IgG, and IgA have been measured by enzyme linked immunosorbent assay (ELISA) in patients with chronic non-ulcerative blepharitis and meibomianitis at the same time as the lid and conjunctivae were cultured for bacteria and fungi by a semiquantitative method. A group of normal controls aged 20 to 80 were similarly sampled, when strains of Staphylococcus epidermidis from their eyes and the patients' eyes were biotyped according to Baird-Parker's scheme. 5% of blepharitis cases had increased numbers of Staph. aureus present on the lids, compared with only a scanty growth obtained from 5% of normals. 7% of blepharitis cases had increased numbers of Staph. epidermidis type VI (coagulase-negative, mannitol-fermenting) present compared with a scanty growth obtained from 6% of normals. Isolation rates of other types of Staph. epidermidis did not differ from those in normals; no types were associated with meibomianitis. Tear protein profiles were normal in most patients, and there was no increase in tear IgA or IgG, which is expected with chronic infection. Overall our evidence suggests that in 88% of cases these lid conditions have an inflammatory aetiology not associated with infection. Staphylococcal isolates often found in the eye usually represent a normal commensal rather than pathogenic flora.

Normal tear protein profiles and age-related changes.

The specific and non-specific tear proteins have been analysed by means of the ELISA technique to establish the normal and age-related values. There is a linear and related decline of lysozyme and lactoferrin with age, and a similar but unrelated reduction in tear volume. IgA levels gradually decline, while caeruloplasmin and IgG both increase after the fifth decade. The results suggest that tear IgG and caeruloplasmin are probably transudates from the serum, that IgA is secreted independently of tear volume, and that lysozyme and lactoferrin are secreted at the same site but independently of tear volume.

Ocular complications in craniofacial fibrous dysplasia.

Three cases of craniofacial fibrous dysplasia are reported, all presenting to the ophthalmologist first. They all had ocular complications due either to direct involvement of the orbital bones or to secondary complications. Sphenoidal mucocele is added to the other complications previously reported, and accordingly a classification of the various ways that fibrous dysplasia can affect the ocular structures is proposed.

Anhidrotic ectodermal dysplasia with lacrimal anomalies.

Ectodermal dysplasia and its related disorders may present with ocular symptoms due to involvement of the ectodermal components of the eye. This paper reports a case of congenital anhidrotic ectodermal dysplasia presenting to the ophthalmologist with epiphora due to lacrimal atresia. The embryonic origin of the lacrimal system suggests that lacrimal anomalies in association with ectodermal disorders are commoner than reports indicate. Their management consists in accurate evaluation of the anomaly followed by surgery.

Intracorneal and sclerocorneal cysts.

Two cases of corneal cysts are reported, one sclerocorneal and the other intracorneal. The two conditions differ in pathogenesis, appearance, course, and management.

Posterior polymorphous keratopathy.

Seven cases with posterior polymorphous changes of the cornea are reported. After clinical and pathological examination of the above cases, as well as a short review of the literature, the following points are made: (1) Some cases are congenital, being either familial or sporadic, but others are acquired. (2) The term "posterior polymorphous keratopathy" covers all the variants of the condition and is preferred to the traditional "posterior polymorphous dystrophy". (3) The congenital type is a mild variant of the mesodermal dysplasia, whereas the acquired type follows local disease. (4) The condition can be static, but over 50% of cases are slowly progressive, calling for penetrating keratoplasty.