High incidence of dry eye in young children with allergic conjunctivitis in Southwest China.

PURPOSE: To identify the prevalence of dry eye in pediatric population with allergic conjunctivitis in Southwest China. METHODS: A single-centre, prospective, case-control study conducted between May 2015 and December 2015 included 40 children, 3-6 years of age, with seasonal allergic conjunctivitis (SAC) or perennial allergic conjunctivitis (PAC) and 40 age- and gender-matched children undergoing medical healthy examination without history of allergy or dry eye as a control. A dry eye score system (DESS) was administered to both groups. Slit-lamp examinations including tear film break-up time (TFBUT) and fluorescent corneal staining (FCS) were performed. Correlation analyses were performed to evaluate associations between measures of dry eye and signs and symptoms of AC. RESULTS: The prevalence of dry eye was 97.5% (78/80 eyes) in cases and 27.50% (22/80 eyes) in controls. Mean DESS score was 4.75 ± 2.22 in the case group and 0.80 ± 1.22 in the control group (p < 0.001). Symptoms of dry eye in the case group were mild (<6). Mean tear film break-up time was 6.54 ± 1.48 seconds in the case group and 10.04 ± 1.79 seconds in the control group (p < 0.001). Mean FCS scores were 0.79 ± 1.34 and 0.21 ± 0.57, respectively (p = 0.001). The DESS score and TFBUT were both associated with the duration of allergic conjunctivitis. CONCLUSION: The incidence of dry eye assessed by TFBUT was higher in young children with SAC and PAC than in controls. However, subjective symptoms of dry eye (DESS) were inconsistent with objective signs, indicating that close attention should be paid to the evaluation and treatment of dry eye in pediatric population with AC.

In vivo confocal microscopy of long-standing mixed-form vernal keratoconjunctivitis.

PURPOSE: To report the morphological characteristics of long-term mixed-form vernal keratoconjunctivitis (VKC) using in vivo laser scanning confocal microscopy (LSCM). DESIGN: Descriptive case report. METHODS: In vivo LSCM was performed on a Chinese patient diagnosed as bilateral mixed-form VKC for 14 years. Central cornea, inferior limbus, bulbar conjunctiva, and upper tarsal conjunctiva of both eyes were examined. RESULTS: Infiltration of numerous dendritic cells and inflammatory cells in both bulbar conjunctiva and tarsal conjunctiva were identified under in vivo LSCM, along with proliferation of fibrous tissue in the conjunctival stroma and damage of Vogt palisades. Apart from abnormal appearance of corneal epithelial cells, the infiltration of dendritic cells was occasionally found in the cornea. CONCLUSIONS: In vivo LSCM is a useful tool to evaluate the morphology of VKC.

Vernal keratoconjunctivitis and intestinal parasitic infestations in black children.

The study aimed at finding out any association between vernal keratoconjunctivitis (VKC) and intestinal worm infestations in black children in Nigeria. This is a report of a case-control study of a total of 117 cases of VKC and 198 controls, who were newly presenting to two hospitals in Ibadan. The controls were comparable to the cases in many respects. While 67 (57%) of cases admitted to previous passage of worms, 59 (50.5%) children actually had parasitic infestations. Of these 59 children, 30 (51%) were due to roundworm, 12 (20%) to hookworm, 14 (24%) to protozoal infestation and others, e.g., tapeworms, 13 (5%). Among controls, 36.8% had parasitic infestation, out of which roundworms were responsible for 11.6%, hookworms 7.6%, protozoa 14.1% and others 3.5%. Children with VKC have almost twice (odds ratio = 1.68) the risk of having been infested by worms. Both older age in children and roundworm infestation were not independent risk factors for VKC. There was no significant association among all ages, sex, hookworm and other worms with VKC. Deworming may prove beneficial for children with VKC; however, more studies with appropriate design are required to prove this.

Caesarean section delivery and the risk of allergic disorders in childhood.

BACKGROUND: The composition of the intestinal flora in young children, if unfavourable, may increase the susceptibility to allergic disorders. Beneficial intestinal microbes originate from the maternal vaginal tract and thus are more likely to be transferred during vaginal births than during Caesarean sections (C-sections). OBJECTIVE: To determine whether children born by C-section have a different risk of allergic disorders compared with those delivered vaginally. We also tested the hypothesis that the risk of allergic disorders is highest for children born after 'repeat C-sections'. METHODS: A retrospective cohort study of 8,953 children aged 3-10 years. Children diagnosed with allergic rhinoconjunctivitis (AR), asthma, atopic dermatitis (AD), or food allergies were identified from the Kaiser Permanente Northwest Region electronic records. The children's sex, birth weight, birth order, postnatal exposure to antibiotics as well as the mothers' age, ethnicity, education, marital status, smoking status during pregnancy, and use of asthma or hayfever medications were identified through the mothers' medical records or through the Oregon Birth Registry. RESULTS: The risk of being diagnosed with AR was significantly higher in the children born by C-section than in those delivered vaginally: adjusted odds ratio (OR)=1.37%, 95% confidence interval (CI)=1.14-1.63. Delivery by C-section was also associated with the subsequent diagnosis of asthma (OR=1.24%, 95% CI=1.01-1.53); this association was gender specific, with a positive association restricted to girls (OR for asthma in girls: OR=1.53%, 95% CI=1.11-2.10; in boys: OR=1.08%, 95% CI=0.81-1.43). There was no significant association between mode of delivery and AD. If children born in a 'repeat C-section' were considered separately the risk of being diagnosed with AR increased further (OR=1.78%, 95% CI=1.34-2.37). The same increase was noted for asthma in girls (OR=1.83%, 95% CI=1.13-2.97) but not in boys. CONCLUSION: Caesarean sections may be associated with an increased risk of developing AR in childhood.

Perilimbal bulbar conjunctival pigmentation in vernal conjunctivitis: prospective evaluation of a new clinical sign in an Indian population.

OBJECTIVES: To prospectively evaluate the occurrence of perilimbal conjunctival pigmentation in patients with vernal conjunctivitis and normal controls; to document the location, extent, density, and color of such pigmentation; and to correlate these changes with disease severity. METHODS: Prospective, noninterventional case-control study. Demographic data, disease symptoms and duration, clinical signs of disease severity and extent, and characteristics of the perilimbal pigmentation were recorded. RESULTS: Twenty-five patients with vernal conjunctivitis and 30 controls were studied. The mean age of the patients (21 M, 4 F) and controls (18 M, 12 F) was 7.5 +/- 3.7 years and 10.3 +/- 3.1 years, respectively. Perilimbal pigmentation was seen in all patients with vernal conjunctivitis and in none of the controls. The palpebral conjunctival changes and patient symptoms correlated with the severity of the disease in patients with vernal conjunctivitis. However, the extent of perilimbal pigmentation did not correlate with the symptoms and signs of vernal conjunctivitis or the density of palisadal pigment. CONCLUSIONS: Perilimbal bulbar conjunctival pigmentation appears to be a consistent finding in patients with vernal conjunctivitis that is both specific and sensitive. It is also present in eyes with inactive disease and hence is a useful clinical sign that aids diagnosis in patients with mild or quiescent disease. Further studies are required to establish the histopathologic correlation of this finding and its etiopathogenesis. It is also important to establish whether this finding occurs with the same frequency in eyes of whites, as this study was performed in a cohort of Asian patients who have greater limbal pigmentation and a higher incidence of limbal changes in vernal conjunctivitis.

Limbal vernal keratoconjunctivitis in the tropics.

OBJECTIVE: This study aimed to describe the pathology of vernal keratoconjunctivitis (VKC) in children from Kenya. DESIGN: Case series. PARTICIPANTS: Ten patients with clinically active and untreated limbal VKC and five age-matched control subjects without external eye disease were recruited from a district eye hospital in Kenya. MAIN OUTCOME MEASURES: Paraffin sections of limbal and tarsal conjunctiva were examined by tinctorial and immunocytochemical methods to characterize the inflammatory infiltrate. RESULTS: In comparison with control subjects, patients with VKC were more likely to show squamous metaplasia of the tarsal conjunctiva. The patients with VKC had cellular infiltration of both the stroma and epithelium consistent with chronic inflammation, particularly in the biopsy specimens taken from the limbus. In tarsal conjunctiva, the stromal infiltrate consisted of a diffuse T-lymphocyte reaction with clustering of B-lymphocytes; mast cells, immunoglobulin E (IgE) plasma cells, and eosinophils also were prominent. Mast cells and eosinophils were found within the epithelium in the more severely inflamed biopsy specimens. CONCLUSIONS: These features are similar to those in reports of VKC in temperate regions, although the degree of B-lymphocyte clustering is greater in tropical patients with VKC. Although none of the patients had other symptoms of atopy, the authors findings are consistent with those for an allergic basis for this disease.