The effect of lubricating eye drop containing hydroxypropyl guar on perimetry results of patients with glaucoma and trachomatous dry eye.

PURPOSE: To evaluate the effects of a mid-viscosity mucomimetic lubricant eye drop containing hydroxypropyl guar (HPG) as a gelling agent on computerized perimetry FASTPAC test results of primary open-angle glaucoma (POAG) patients with trachomatous dry eye. METHODS: Both eyes of 33 patients with bilateral POAG and trachomatous dry eye were included in the study. They were treated with the same antiglaucomatous eye drop and underwent computerized perimetry. Before and after the treatment with lubricant eye drop (Systane) for 8 weeks, tear function tests (Schirmer test with topical anesthesia, fluorescein staining and tear film break-up time) and FASTPAC test with computerized perimetry were performed. Pre- and posttreatment tear functions, visual field test global indices, reliability indices, test duration and numbers of depressed points in pattern deviation plots were compared. RESULTS: We found significant improvements in tear function tests results, in computerized perimetry FASTPAC test indices, test duration and the number of depressed points in pattern deviation plots in the posttreatment evaluations. CONCLUSION: This study indicates that there was a benefit of mid-viscosity lubricant eye drop containing HPG treatment on computerized perimetry FASTPAC test performance in POAG subjects with trachomatous dry eye. We assume that the positive effect of this therapy is probably due to a better tear film stability, resulting in a higher optical quality of the repaired anterior corneal surface.

Efficacy of topical cyclosporine A in the treatment of severe trachomatous dry eye.

PURPOSE: The purpose of this study was to evaluate the efficacy of topical cyclosporine A (CsA) treatment in patients with severe trachomatous dry eye. METHODS: Sixty-four severe trachomatous dry eye patients who had undergone Schirmer testing with topical anaesthetic measured 5 mm or less and a tear film break-up time (TFBUT) of 5 s or less were included in the study. Thirty-two patients were treated with CsA 0.05% ophthalmic emulsion twice daily and concomitant five times daily non-preserved artificial tear, and the other 32 patients who were designated as the control group received vehicle emulsion twice daily and non-preserved artificial tear five times daily. Pretreatment and post-treatment evaluations included subjective assessment of the patients (total symptoms scores and ocular surface disease index [OSDI] scores), Schirmer testing with topical anaesthesia, TFBUT, rose Bengal and fluorescein staining scores, conjunctival impression cytological scoring and goblet cell counting. RESULTS: Following 6 months of CsA treatment, the differences between the pretreatment and post-treatment test results including total symptoms scores and OSDI scores, the rose Bengal and fluorescein staining scores, TFBUT values, and the Schirmer testing measurements were found to be statistically significant. Impression cytology also showed improvement of squamous metaplasia in 26 patients (81.25%) and increase in goblet cell density in 23 patients (71.88%). CONCLUSIONS: Topical CsA was effective in the treatment of severe trachomatous dry eye, yielding improvements in both objective and subjective measurements with a safety profile.

The effect of topical cyclosporine A treatment on corneal thickness in patients with trachomatous dry eye.

PURPOSE: The purpose of the present study was to evaluate the effect of topical cyclosporine A (CsA) treatment on corneal thickness (CT) in patients with trachomatous dry eye. METHODS: Sixty-four patients with trachomatous dry eye with a Schirmer test showing 5 mm or less and a tear film break-up time (TFBUT) of five seconds or less were included. Thirty-two patients were treated with twice daily application of CsA (0.05% ophthalmic emulsion) plus non-preserved artificial tears, while the remaining 32 patients serving as controls received only non-preserved artificial tears. CT was measured using ultrasonic pachymetry at five locations of the central (CCT) and mid-peripheral cornea, at baseline and after one, three and six months of treatment. RESULTS: At the sixth month of treatment, CT measurements were significantly changed in both groups, compared to baseline. In the CsA treatment group, the mean CCT before and after six months of treatment were 517.4 +/- 36.2 and 546.5 +/- 32.4 microm, respectively (p < 0.001); yielding an average CCT increase of 29.1 +/- 8.0 microm (5.62 per cent) from baseline. In the control group, corresponding figures were 520.2 +/- 34.2 and 526.0 +/- 35.4 microm, respectively (p < 0.01), with an average increase of 5.8 +/- 3.1 microm (1.11 per cent). CONCLUSIONS: In the present study, the CsA treatment group exhibited significantly greater increases in CT compared to controls. Such an increase may indicate an improvement in the integrity of the ocular surface and resolution of the underlying inflammation as a consequence of topical CsA treatment.

Relationship between Tear TNF-alpha, TGF-beta1, and EGF levels and severity of conjunctival cicatrization in patients with inactive trachoma.

Tear tumor necrosis factor alpha (TNF-alpha), transforming growth factor beta 1 (TGF-beta1), and epidermal growth factor (EGF) levels were determined in patients with inactive trachoma, and a possible relation between these cytokines and conjunctival cicatrization severity was investigated. Forty-four patients with inactive trachoma who were admitted to the Department of Ophthalmology at the Harran University, Sanliurfa, Turkey, were included in this study. The control group consisted of 20 age- and sex-matched healthy subjects. The levels of cytokines in tears were measured by ELISA. Tear samples were collected from the conjunctival cul-de-sac by means of blunted-tip glass capillary tubes. Eyes with inactive trachoma were classified into three subgroups with respect to conjunctiva cicatrization: mild, moderate, and severe. In 44 patients with inactive trachoma, conjunctival cicatrization was found, including mild (n = 15), moderate (n = 16), and severe (n = 13) cases. In patients with inactive trachoma, decreases in tear EGF (p = 0.000) concentrations and increases in tear TGF-beta1 (p = 0.006) and TNF-alpha (p = 0.046) levels with respect to the control group were found to be concordant with conjunctival cicatrization severity. Statistically significant correlations in tear TNF-alpha (p = 0.018), TGF-beta1 (p = 0.007), and EGF (p = 0.043) levels were found between mild and severe cicatrization groups. TNF-alpha and TGF-beta1 have been implicated in the fibrogenic process. Elevated tear levels of inflammatory/fibrogenic cytokines may play an important role in scar formation in trachoma. It is possible that decreased tear levels of EGF, which may be important for the maintenance of corneal epithelial integrity, are related to fibrosis in the lacrimal gland ductules.

Ocular involvement in cutaneous leishmaniasis four cases with blepharoconjunctivitis.

PURPOSE: To determine the rate of ocular involvement in cutaneous leishmaniasis (CL). METHODS: Nine hundred and eighty seven cutaneous leishmaniasis patients diagnosed and identified by clinical examination and parasitological methods in Harrankapi Health Centre between January 1996 and November 1997 were examined at the Harran University School of Medicine Eye Clinic, Sanliurfa, Turkey. RESULTS: One thousand seven hundred and three CL lesions were identified in 987 patients (484 women and 503 men) with ages ranging from 0 to 78 years (mean +/- SD 16.70 +/- 13.47 years). A total of 33 lesions were located on the eyelid and in the periorbital region, making up 1.93% of all cutaneous lesions and 3.57% of facial lesions. In three cases with ocular involvement, blepharoconjunctivitis was identified, and in one case with ocular involvement, mechanical ptosis, lagophthalmos and blepharoconjunctivitis were identified. CONCLUSIONS: It was observed that the size of the lesions and their vicinity to the marginal free edge of the eyelid played an important role in the occurrence of ocular symptoms. It was concluded that many ocular findings could be missed because of the failure to conduct ophthalmological examination of CL cases with eyelid involvement, and hence, proper follow up and treatment may not be carried out.

The effects of bupivacaine and lidocaine on the corneal endothelium when applied into the anterior chamber at the concentrations supplied commercially.

PURPOSE: To investigate the direct toxic effects of bupivacaine HCl 0.5% and lidocaine HCl 2%, two commonly used injectable local anesthetic agents, on the corneal endothelium when applied intracamerally. METHODS: Two groups were formed, each consisting of 12 pigmented rabbits, and 0.2 ml of the anesthetic agent were injected intracamerally into the right eyes. The central corneal thicknesses and corneal clarities were evaluated preoperatively and at 3, 6, 9, 12 h and 1, 3, 7 days postoperatively. While the central corneal thicknesses were evaluated by ultrasonic pachymetry, the corneal opacification scored between 0 and 3 was assessed by biomicroscopic examination and photographs. RESULTS: Both bupivacaine and lidocaine caused corneal thickening in the 3- to 12-hour measurements. In addition, there was significant corneal opacification in both groups in the 3-hour and 3-day measurements. The corneal thickening and corneal opacification determined during 3- and 6-hour measurements in the eyes which received intracameral bupivacaine were significantly higher than those determined in the lidocaine-injected group. In both groups, the corneal thickness and corneal clarity scores returned to the preoperative values on the 1st and 7th days, respectively. CONCLUSIONS: When applied into the anterior chamber at the concentrations supplied commercially, both bupivacaine and lidocaine cause statistically significant corneal thickening and clinically significant corneal opacification. It should be noted that the injection of these agents into the anterior chamber during the operation at the concentrations supplied commercially may be a potential risk factor for endothelial injury.

Oedematous corneal response of the fellow control eye to lotrafilcon a and vifilcon a hydrogel contact lenses in the rabbit.

PURPOSE: To compare central corneal swelling after 24 h in eyes wearing Lotrafilcon A (high Dk silicone hydrogel) and Vifilcon A (low Dk hydrogel) lenses and the fellow control eyes of rabbits. METHODS: 24 New Zealand albino rabbits, free of corneal and conjunctival disease, were anaesthetised with ketamine and xylazin. In 12 rabbits, the right eye was fit with the high Dk Lotrafilcon A silicone hydrogel lens. In the other 12 rabbits, the right eye was fit with the low Dk Vifilcon A hydrogel lens, whereas the left eyes were kept as control eyes. Thereafter, the lens-fitted eyes had partial tarsorrhaphy that left a central gap of approximately 4 mm in length. After 24 h the eyelids were opened and the lenses removed. Central corneal thickness was measured using an ultrasonic pachymeter (Mentor O&O-Advent). RESULTS: Central corneal oedema induced by Vifilcon A lens was significantly higher than that with the Lotrafilcon A lens (p < 0.0001). The oedema of the fellow eyes paired with the Vifilcon A lens-wearing eyes was also higher than that of the fellow eyes paired with the Lotrafilcon A lens-wearing eyes (p < 0.01). CONCLUSIONS: The Lotrafilcon A lens induced significantly less corneal oedema than the Vifilcon A lens. Corneal oedema of the fellow eyes appears to be influenced by the swelling of the contralateral lens-wearing eyes. The oedema of the fellow control eye was significantly lower when there was less oedema in the contralateral eye wearing a high Dk silicone hydrogel lens. This may be a sympathetic physiological response. The presence of silicone in the high Dk hydrogel lens may suppress corneal oedema in the lens-wearing eye, thus affecting the fellow eye.

The effects of chronic smoking on the ocular surface and tear characteristics: a clinical, histological and biochemical study.

PURPOSE: To investigate the effects of chronic smoking on the ocular surface and tear characteristics. METHODS: The Schirmer I-test, tear film break-up time, rose Bengal staining scores, impression cytology, tear lysozyme concentration, eye irritation symptoms, and eye irritation indices were determined for 44 eyes in 44 healthy, chronic smokers who had smoked six or more cigarettes per day for the previous year. Thirty-seven eyes in 37 healthy, non-smokers were assessed in the same masked manner for comparison. Cytological specimens were obtained from the temporal interpalpebral bulbar conjunctiva by 'impression' technique. Goblet cells were counted in the specimens obtained and squamous metaplasia was graded following epithelial cell morphology assessment. RESULTS: In chronic smokers, we found decreased tear film break-up time (p=0.022) and tear lysozyme concentration (p=0.013), and increased Schirmer I-test values (p=0.047), squamous metaplasia scores (p=0.016), eye irritation scores (p<0.001) and eye irritation indices (p=0.013), as compared with the control group. There were no statistically significant differences in goblet cell counts (p=0.710) or rose Bengal staining scores (p=0.827). CONCLUSION: These findings suggest that chronic smoking has a negative effect on the ocular surface and affects some tear characteristics. The chronic ocular irritative effects of cigarette smoking may lead to defects in ocular surface defence.