No secret hiding place? Absence of SARS-CoV-2 on the ocular surface of 1145 hospitalized patients in a pandemic area.

OBJECTIVES: The aims of this study were to evaluate the isolated prevalence of real-time reverse transcriptase-polymerase chain reaction (RT-PCR)-confirmed SARS-CoV-2 on the ocular surface without systemic infection in hospitalized asymptomatic patients and to determine the risk for ophthalmologists and medical staff to be infected by prescreened asymptomatic patients in a tertiary eye care center. METHODS: In this prospective, observational study, bilateral swaps of the conjunctiva in the lower fornices as well as nasopharyngeal swaps were collected in 1145 hospitalized asymptomatic patients of a tertiary eye care center. Real-time reverse transcriptase-polymerase chain reaction (RT-PCR) analysis was performed for each swap to evaluate the prevalence of SARS-CoV-2. Demographic data and potential risk factors for an isolated infection of the ocular surface were noted. RESULTS: Two thousand two hundred eighty-eight (99.9%) of all 2290 tested eyes had negative results in the RT-PCR analysis of the conjunctival swabs. One patient had bilateral false-positive results in the conjunctival swabs. None of the 1145 patients had any positive RT-PCR-confirmed result in the nasopharyngeal swabs. CONCLUSIONS: The risk for an isolated conjunctival viral activity in patients with a negative nasopharyngeal swab-based RT-PCR seems to be absent or extremely low, suggesting no need to perform additional conjunctival swabs in patients with negative nasopharyngeal swabs. Furthermore, the risk of a work-related SARS-CoV-2 infection due to direct contact with preselected asymptomatic patients in an eye care center is very low, especially when additional hygiene standards and safe distances are respected carefully. This might reassure medical staff and reduce the fear of SARS-CoV-2 infection.

Giant molluscum contagiosum presenting as lid neoplasm in an immunocompetent child.

A three-year-old boy presented to our oculoplastic clinic with complaints of painless gradually increasing right upper lid mass for the last 6 months. On examination a firm mass measuring roughly 1x1 cm was present on the upper lid. The mass was non tender with fine superficial vessels running over it. A differential diagnosis of epidermoid cyst, vascular malformation, pilomatrixoma, and juvenile xanthogranuloma was considered. The patient underwent excisional biopsy of the mass. On gross examination the mass had a brain like appearance. Histopathological examination confirmed the diagnosis of molluscum contagiosum. It is rare for molluscum contagiosum to present as a solitary lid tumor. A brain like appearance of the excised mass can provide a clue towards the diagnosis.

Cowpox: How dangerous could it be for humans? Case report.

Cowpox is a rare zoonosis transmitted to humans mainly from cats. The disease usually causes skin lesions; however, the ocular form may lead to other serious complications. We describe a case of cowpox in a rare location of the upper eyelid of an immunocompetent male, which lead to necrosis of the upper eyelid, keratitis and leucomatous opacity, and the neovascularization of the cornea. The patient underwent several surgeries, including reconstruction surgery of the eyelids, correction of the medial canthus, and corneal neurotization with supraorbicular nerve transplantation. Suspicion of cowpox should be made in patients where there are poorly healing skin lesions accompanied by a painful black eschar with erythema and local lymphadenopathy. Ocular cowpox may lead to serious complications and possibly mimic anthrax. Diagnosis of cowpox can be confirmed by detection of cowpox virus DNA by polymerase chain reaction. Patients should be advised to protect themselves while handling sick animals.

Periocular molluscum contagiosum: six different clinical presentations.

PURPOSE: To describe the different clinical presentations of periocular molluscum contagiosum (MC) lesions and their epidemiological, clinical and histopathological features. METHODS: Medical records and histopathological sections of all cases of periocular MC treated at the oculoplastic clinic of the Goldschleger Eye Institute, Sheba Medical Center, Israel, between 1995 and 2016 were retrospectively reviewed. The following data were extracted: gender, age at the time of MC diagnosis, immune competency, location of the periocular lesions, number of lesions, dimensions of the lesions, clinical presentation, histopathological features, suspected clinical diagnosis before histopathological diagnosis and treatment. RESULTS: The series was composed of 41 patients (19 males, 22 females) whose mean age at presentation was 20.41 â€Š± â€Š21.10 years (range 1-71 years). Only one patient was immunosuppressed. The cases were classified into six proposed clinical presentations: 'umbilicated nodular', 'big/giant', 'conglomerated', 'erythematous', 'inflamed' and 'pedunculated'. CONCLUSION: This is the first time that different clinical types of MC lesions are labelled. The current evidence also indicates that MC lesions should be suspected not only in children and in immunosuppressed adult patients but also in immunocompetent patients of all ages.

Molluscum contagiosum eyelid lesions as the initial manifestation of acquired immunodeficiency syndrome.

PURPOSE: To report molluscum contagiosum as the initial manifestation in acquired immunodeficiency syndrome (AIDS). METHOD: Case report. A 34-year-old man was examined with atypical, extensive molluscum contagiosum of the eyelids. RESULTS: Biopsy of the lesions confirmed molluscum contagiosum, and a previously normal fundus now disclosed bilateral cotton wool spots and classic signs of cytomegalovirus retinitis in the left eye. Human immunodeficiency virus (HIV) antibody testing was positive. CONCLUSIONS: Manifestation of atypical and extensive eyelid molluscum contagiosum may warrant additional history taking, comprehensive ophthalmic examination, including dilated ophthalmoscopic examination, and HIV testing.

Herpes simplex virus dermatitis in patients using latanoprost.

PURPOSE: To describe the possible association of latanoprost with herpetic dermatitis of the periocular skin. METHOD: Interventional case reports. A 79-year-old woman with open-angle glaucoma developed a vesicular dermatitis of the left lower eyelid 14 months after starting latanoprost therapy. An 84-year-old man with pigmentary glaucoma developed a vesicular dermatitis of the right upper lid after 2 months of treatment with latanoprost and 8 days of treatment with tobramycin/dexamethasone for presumed bacterial conjunctivitis. In both cases, the dermatitis was characteristic of a herpetic infection. RESULTS: Latanoprost was discontinued in both cases. The woman was treated with vidarabine 3% ointment, and the man was not treated with antiviral agents. In both patients, the dermatitis healed uneventfully. The lesions of the man were cultured, and a biopsy was performed; herpes simplex virus type 1 was recovered from the culture and confirmed by immunofluorescence testing. CONCLUSION: Latanoprost, which has been associated with reactivation of herpetic keratitis, may also cause reactivation of herpetic dermatitis of the periocular skin.

Herpes simplex blepharoconjunctivitis presenting as complete acquired ankyloblepharon.

PURPOSE: A 90-year-old woman was referred to us with a 1-month history of progressively worsening blepharoconjunctivitis. She had a complete acquired ankyloblepharon of the right lids, which resulted in the appearance of a right upper lid abscess on computed tomography. METHODS: Blepharotomy with separation and debridement of the lid margins was performed. RESULTS: Cultures were positive only for herpes simplex virus, type II. CONCLUSIONS: Herpes simplex blepharoconjunctivitis may take many clinical forms. Our patient's severe manifestations led to the clinical and radiologic appearance of preseptal cellulitis with a right upper lid abscess.

Comparison of pathology-based techniques for detection of viscerotropic velogenic Newcastle disease virus in chickens.

Two pathology-based techniques, immunohistochemistry and riboprobe in-situ hybridization, were applied to formalin-fixed, paraffin wax-embedded tissues from chickens infected with three different isolates of velogenic viscerotropic Newcastle disease virus (VVNDV). With the immunohistochemical method, viral protein was consistently detectable in the spleen and caecum at the terminal phase of the infection. With in-situ hybridization, viral nucleic acid was consistently detected in the eyelid, spleen and caecum in both the acute and terminal phases. Hybridization with anti-sense probe to detect viral mRNA was often more intense than hybridization with sense probe to detect viral genomic RNA.

An immunohistochemical study of the pathogenesis of virulent viscerotropic Newcastle disease in chickens.

Ten specific pathogen-free cockerels aged 8-12 months were infected by ocular instillation of 2 x 10(7) embryo-lethal doses 50% of a virulent viscerotropic strain of Newcastle disease virus (Fontana 1083 strain). The birds were killed at 24-h intervals after infection and tissues were collected for histological and immunohistochemical evaluation. The infection ran an acute course, severe clinical disease occurring within 72 h of infection. By gross and histological examination, the most severe damage detected was found to occur in lymphoid areas in a number of tissues. The greatest amounts of viral antigen detected occurred in the proventriculus, small intestine, spleen, thymus and eyelid. Immunohistochemical labelling was confined to large mononuclear cells.

The efficacy of two vaccination schemes against experimental infection with a virulent amyxomatous or a virulent nodular myxoma virus strain.

Two types of myxomatosis vaccine are available commercially, namely, vaccine prepared from the Shope fibroma virus (SFV) and that prepared from an attenuated myxoma virus (MV) strain, e.gSG33. An experiment was designed to compare two vaccination schemes for their ability to protect rabbits against challenge with either a virulent amyxomatous MV strain or a virulent nodular MV strain. Apart from a difference in the cutaneous expression of the disease, the two challenge strains resembled each other in respect of mortality rate, naso-conjunctival shedding of virus, and tissue infection. Vaccination with SFV alone failed to prevent clinical signs, naso-conjunctival shedding or tissue infection. Vaccination with SFV followed by a booster inoculation with SG33 protected rabbits against the development of clinical signs and significantly reduced both viral shedding in naso-conjunctival exudates and viral infection of eyelids, lungs and testes; virus was, however, isolated from testes of some surviving animals.

Immunohistochemical detection of rinderpest virus: effects of autolysis and period of fixation.

Samples of eyelid, tongue, soft palate and palatine tonsil were collected from calves infected experimentally with rinderpest virus. The tissues were fixed in 10 per cent neutral buffered formalin immediately, 24 or 48 hours post mortem. Then, after three days, 10 days, 28 days or three months in formalin, they were processed into paraffin blocks and examined immunohistochemically for rinderpest viral antigen. The tonsil was the best of the four tissues in providing a consistently positive immunohistochemical signal for the presence of virus, despite autolytic changes and/or prolonged fixation.

A review of three pathology-based techniques for retrospective diagnosis of rinderpest, with comparison to virus isolation.

Base of tongue, eyelid, and retropharyngeal lymph node were collected from three animals experimentally infected with rinderpest and utilised in a study comparing virus isolation with histopathology, immunohistochemistry, and in situ hybridisation to determine the usefulness of the latter three techniques as retrospective diagnostic aids for this disease. Virus isolation was positive for all nine samples. Histopathology was suggestive in all the tissues and definitive in some. Immunohistochemistry and in situ hybridisation highlighted the presence of rinderpest antigen of rinderpest nucleic acid in all of the sections. However, in situ hybridisation was more specific than immunohistochemistry.

Primary herpes simplex virus type 1 infection of the eye triggers similar immune responses in the cornea and the skin of the eyelids.

Herpetic stromal keratitis (HSK) and blepharoconjunctivitis in humans are thought partly to result from immunopathological responses to herpes simplex virus type 1 (HSV-1). The corneas of NIH mice were inoculated with HSV-1 (strain McKrae) and mice were examined for signs of disease and infection on days 1, 4, 7, 10, 14 and 21. The eyes and eyelids of infected and control mice were processed for immunohistochemistry and double stained for viral antigens and one of the following cell surface markers (Gr-1, F4/80, CD4, CD8, CD45R or MHC class II) or one of the following cytokines (IL-2, IL-4, IL-6, IL-10, IL-12 or IFN-gamma). All infected mice developed signs of HSK by day 4 and blepharitis by day 7 and these both persisted until day 21, when signs of resolution where apparent. Virus was detected during the first week of infection and became undetectable by day 10. Large numbers of Gr-1(+) cells (neutrophils) infiltrated infected corneas and eyelids in areas of viral antigen and CD4(+) T cells increased significantly in number after virus clearance. In both sites, the predominant cytokines were IL-6, IL-10, IL-12 and IFN-gamma, with few IL-2(+) and IL-4(+) cells. These observations suggest that the immune responses in the cornea are similar to those in the eyelids but, overall, the responses are not clearly characterized as either Th1 or Th2. In both sites, the neutrophil is the predominant infiltrating cell type and is a likely source of the cytokines observed and a major effector of the disease process.

A case of recurrent, isolated, simultaneous, bilateral herpes simplex lid infection.

BACKGROUND: Ocular herpes simplex is usually diagnosed by its typical clinical presentation. It is generally accepted to be a unilateral disease, with lid eruptions typically occurring in primary ocular herpes simplex, while absent or mild in recurrent disease. Recurrent ocular herpes simplex is generally thought to be characterized by corneal involvement. CASE REPORT: A 35-year-old woman had a 2-day history of a progressive bilateral, erythematous, vesicular rash of the upper and lower eyelids and associated preseptal cellulitis. She had a history of a recurrent, unilateral eyelid rash that was previously diagnosed as herpes zoster. The eyelid involvement was unusual because it was bilateral, severe, recurrent, vesicular, and isolated, with no additional ocular manifestations of herpes simplex. These atypical features are in contrast to the generally accepted manifestations of recurrent ocular herpes simplex. A cytologic evaluation and a viral culture confirmed infection by HSV Type 1. CONCLUSION: Lid involvement occurs in recurrent ocular herpes simplex disease more often than generally accepted, while simultaneous bilateral disease is uncommon. As in this case, when atypical presentations occur, critical review of the differential diagnosis and use of laboratory tests are helpful.