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Background: Dupilumab-associated conjunctivitis in patients with atopic dermatitis (AD) is not fully characterized., Objective: The aim of the study was to characterize the incidence of bacterial and nonbacterial conjunctivitis among patients with AD who initiated dupilumab., Methods: Pooling longitudinal claims data from 2 US databases, we identified AD patients who newly filled either dupilumab or methotrexate, mycophenolate or cyclosporine, between March 2017 and January 2020. Outcomes were conjunctivitis and its subtypes, bacterial, allergic, and keratoconjunctivitis. Patient follow-up lasted 6 months and 1:1 propensity score (PS) matching-controlled confounding., Results: Within 6 months of treatment initiation, the incidence of conjunctivitis was 6.6% in 3744 dupilumab initiators; bacterial conjunctivitis, 1.5%; allergic conjunctivitis, 2.2%; keratoconjunctivitis, 0.8%; and conjunctivitis requiring ophthalmic medication, 2.7%. After PS matching, dupilumab doubled the risk of conjunctivitis compared with methotrexate (relative risk [RR] 2.12; 1.56-2.91), mycophenolate (RR = 2.43; 1.32-4.47), or cyclosporine (RR = 1.83; 1.05-3.20). Risk of bacterial conjunctivitis was 1.6- to 4.0-fold increased with wide confidence intervals, and allergic conjunctivitis was increased 2.7- to 7-fold. There was no increased risk of keratoconjunctivitis. Patients with comorbid asthma had a further increased risk of conjunctivitis., Conclusions: One in 15 patients treated with dupilumab developed conjunctivitis driven by bacterial and allergic conjunctivitis and not keratoconjunctivitis. This risk was further increased with comorbid asthma., Competing Interests: R.W. has received funding from UCB pharma for work unrelated to the topic of this study and has worked as a consultant to Aetion. J.F.M. is a consultant and/or investigator for Merck, AbbVie, Dermavant, Eli Lilly, Novartis, Janssen, UCB, Celgene, Sanofi, Regeneron, Arena, Sun Pharma, Biogen, Pfizer, EMD, Sorono, Avotres, and Leo Pharma. J.I.S. is advisor/speaker/consultant for AbbVie, Afyx, Arena, Asana, BioMX, Bluefin, Bodewell, Boehringer Ingelheim, Celgene, Dermavant, Dermira, Eli Lilly, Galderma, GlaxoSmithKline, Incyte, Kiniksa, Leo, Luna, Menlo, Novartis, Pfizer, RAPT, Regeneron, and Sanofi; speaker for Eli Lilly, Pfizer, Regeneron, and Sanofi; and institution received grants from Galderma. A.M. is an advisor/consultant for Pfizer, Hims and Hers, Digital Diagnostics, Concert, Lilly, and AbbVie. S.S. is the principal investigator of investigator-initiated grants to the Brigham and Women's Hospital from the FDA, NIH, PCORI, and Boehringer Ingelheim unrelated to the topic of this study. He is a consultant to Aetion, a software manufacturer of which he owns equity. His interests were declared, reviewed, and approved by the Brigham and Women's Hospital and Partners HealthCare System in accordance with their institutional compliance policies. The other authors have no funding or conflicts of interest to declare., (Copyright © 2022 American Contact Dermatitis Society. All Rights Reserved.)

Importance: Acute infectious conjunctivitis is characterized by ocular redness and discharge, and is a common clinical entity. Evidence-based tools to aid the clinical diagnosis of viral vs bacterial conjunctivitis are lacking and may contribute to overprescribing of topical antibiotics., Objective: To determine the relative prevalence of viral vs bacterial conjunctivitis in adults and children, and to determine which symptoms or signs are suggestive of a viral vs bacterial etiology., Data Sources: A MEDLINE search (January 1946-March 2022) yielded 1891 articles. Included articles were rated using a quality score based on a modified Rational Clinical Examination grading system. Methodological quality levels 1 through 4 required a microbiological reference standard for diagnosis, whereas quality level 5 (the lowest quality) used a clinical reference standard for diagnosis., Study Selection: Consecutive series of patients presenting with acute infectious conjunctivitis and case series of viral or bacterial conjunctivitis alone. Thirty-two studies were included in a meta-analysis to determine prevalence and diagnostic accuracy measures; 27 used a microbiological reference standard for diagnosis and 5 used a clinical reference standard for diagnosis., Results: In studies involving children (5 studies; 881 patients; mean age, 4.7 years [age range, 1 month-18 years]), the prevalence of bacterial conjunctivitis was higher than viral conjunctivitis (71% vs 16%, respectively, P = .01). In the only study of adults (n = 207 patients; mean age, 25.7 years), the prevalence of viral conjunctivitis was higher than bacterial conjunctivitis (78% vs 16%, respectively, P < .001). For the primary analysis of level 1 (n = 6) and level 2 (n = 5) studies (1725 patients total), the clinical findings that best distinguished a viral etiology for conjunctivitis from a bacterial etiology included pharyngitis (sensitivity range, 0.55-0.58; specificity range, 0.89-0.94; positive likelihood ratio [LR] range, 5.4-9.9), preauricular lymphadenopathy (sensitivity range, 0.17-0.31; specificity range, 0.93-0.94; positive LR range, 2.5-5.6), and contact with another person with red eye (sensitivity, 0.18 [95% CI, 0.14-0.22]; specificity, 0.93 [95% CI, 0.90-0.95]; positive LR, 2.5 [95% CI, 1.6-3.7]). Mucopurulent ocular discharge (sensitivity, 0.76 [95% CI, 0.60-0.87); specificity, 0.66 [95% CI, 0.58-0.73]; positive LR, 2.1 [95% CI, 1.7-2.6]) and otitis media (sensitivity, 0.24 [95% CI, 0.20-0.29]; specificity, 0.91 [95% CI, 0.85-0.94]; positive LR, 2.5 [95% CI, 1.5-4.4]) were associated with the presence of bacterial conjunctivitis., Conclusions and Relevance: In this review, bacterial conjunctivitis was more common than viral conjunctivitis in children and viral conjunctivitis was more common than bacterial conjunctivitis in adults, although the prevalence estimates were based on limited evidence. Symptoms and signs associated with a higher likelihood of viral conjunctivitis in adults and children included concomitant pharyngitis, an enlarged preauricular node, and contact with another person with red eye, and signs associated with a higher likelihood of bacterial conjunctivitis included the presence of mucopurulent discharge and otitis media, but no single symptom or sign differentiated the 2 conditions with high certainty.

This case report discusses the rare association of cerebral abscess related to conjunctivitis in an otherwise healthy child. A 6 year old boy presented with conjunctivitis was treated with topical antibiotics and resolved after a week. Conjunctival swab cultures grew MRSA. A month later he developed status epileptics and CT scans revealed a large cerebral abscess. He was treated with intravenous antibiotics which covered for MRSA, along with an incision and drainage for the cerebral abscess. Pus cultures grew MRSA. The patient recovered well with no disturbance in visual acuity or visual field. On post-operative follow ups, he had no other neurological deficit apart from a slight limp.

Purpose: To investigate latent conjunctival Chlamydia trachomatis (CT) and Bacteroides fragilis (BF) infections as potential risk factors for posttrabeculectomy bleb failure., Patients and Methods: This retrospective observational study included 50 primary open-angle glaucoma eyes of 50 patients who were submitted to trabeculectomy without cytostatics from September 2010 to June 2011 and were followed up for at least a year. Preoperatively, conjunctival scrapings were taken and their specimens subjected to polymerase chain reaction, direct fluorescent assay and cell culture testing for CT, and culture for BF on blood agar medium. Serum CT-specific IgG and IgA and tear interleukin (IL)-1β and IL-8 concentrations were measured with enzyme-linked immunosorbent assay. We defined bleb failure as intraocular pressure >21 mm Hg with antiglaucoma medications, resulting from reduced bleb filtration capacity due to bleb fibrosis, fistula obstruction, flattened bleb, or encapsulated bleb, and no earlier than 2 weeks after surgery. At the time of the reintervention, a scleroconjunctival biopsy was obtained for histopathology (including direct fluorescent assay testing for CT). Eyes were divided into a failure group and a nonfailure group, depending on whether they developed bleb failure (required reintervention) or not within a follow-up year., Results: In the failure group (n=18), the frequencies of detection of CT and BF in conjunctival specimens were 27.8% and 66.7%, respectively, versus 0% and 9.4% in the nonfailure group (n=32). CT and BF were detected in 11.1% and 11.1%, respectively, of scleroconjunctival biopsies. IgG and IgA seropositivity to CT was found in 66.7% and 33.3%, respectively, of the failure group patients, versus 9.4% and 0% of the nonfailure group patients. Tear IL-1β and IL-8 levels were markedly elevated in the failure group (468.83±80.43 and 107.89±15.11 pg/mL, respectively) versus the nonfailure group (22.34±5.43 and 9.34±2.83 pg/mL, respectively)., Conclusion: Being a contributor to low-grade conjunctival inflammation, latent conjunctival CT, and BF infections in primary open-angle glaucoma patients represent risk factors for posttrabeculectomy bleb failure.

Importance: Conjunctivitis is a common problem., Objective: To examine the diagnosis, management, and treatment of conjunctivitis, including various antibiotics and alternatives to antibiotic use in infectious conjunctivitis and use of antihistamines and mast cell stabilizers in allergic conjunctivitis., Evidence Review: A search of the literature published through March 2013, using PubMed, the ISI Web of Knowledge database, and the Cochrane Library was performed. Eligible articles were selected after review of titles, abstracts, and references., Findings: Viral conjunctivitis is the most common overall cause of infectious conjunctivitis and usually does not require treatment; the signs and symptoms at presentation are variable. Bacterial conjunctivitis is the second most common cause of infectious conjunctivitis, with most uncomplicated cases resolving in 1 to 2 weeks. Mattering and adherence of the eyelids on waking, lack of itching, and absence of a history of conjunctivitis are the strongest factors associated with bacterial conjunctivitis. Topical antibiotics decrease the duration of bacterial conjunctivitis and allow earlier return to school or work. Conjunctivitis secondary to sexually transmitted diseases such as chlamydia and gonorrhea requires systemic treatment in addition to topical antibiotic therapy. Allergic conjunctivitis is encountered in up to 40% of the population, but only a small proportion of these individuals seek medical help; itching is the most consistent sign in allergic conjunctivitis, and treatment consists of topical antihistamines and mast cell inhibitors., Conclusions and Relevance: The majority of cases in bacterial conjunctivitis are self-limiting and no treatment is necessary in uncomplicated cases. However, conjunctivitis caused by gonorrhea or chlamydia and conjunctivitis in contact lens wearers should be treated with antibiotics. Treatment for viral conjunctivitis is supportive. Treatment with antihistamines and mast cell stabilizers alleviates the symptoms of allergic conjunctivitis.

Background: Infestation by Demodex spp. in the palpebral edge follicles in humans is common. However, these mites are not routinely diagnosed in patients with or without ocular pathologies in Chile and their relevance is unclear. One of the eye diseases most related to infestation by Demodex spp. is blepharitis, a chronic inflammation of the eyelid margin with intermittent exacerbations, which is very common in ophthalmic practice. Its management is prolonged treatment, which is often ineffective, leading to relapses and frustration of patient and treating physician. Blepharitis can be typed by its etiology into various types, one of them is caused by Demodex folliculorum and another species, D. brevis., Objective: The overall objective was to detect the presence and estimate the rate of infestation of Demodex spp. in healthy subjects and in patients with ocular pathology such as blepharitis, bacterial conjunctivitis, chalazion, and stye., Patients and Methods: Samples of tabs from both lower eyelids of ophthalmologically healthy patients (23) and patients with ocular pathologies (9) were mounted in immersion oil as described in literature, then visualized with a 10x objective and confirmed with 40x objective., Results: Detection rates of eggs, nymphs or adults of Demodex spp. in patients with and without ophthalmological problems were above and below 0.5 mites per tab, respectively. D.folliculorum was the species most frequently found., Discussion: The results are consistent with the international literature on both the rate of infestation as the predominant species., Conclusion: This paper is the first study in Chile on this subject and represents a significant contribution to ophthalmic clinical diagnosis and treatment of patients with this disease.

Background: Pathological origin of primary acquired nasolacrimal duct obstruction (PANDO) is considered as inflammation of unknown causes; however, specific predisposing factors have not been fully addressed to date., Methods: In an institutional setting, background factors of 45 patients with PANDO were compared to those in 67 control subjects. The control subjects were persons with senile cataract, representing the non-pathological general population. The evaluated background factors were inflammatory medical histories (infectious conjunctivitis and allergic conjunctivitis and/or rhinitis), previously reported factors (POAG and topical timolol), and a novel factor proposed in the current study (exposure to swimming pool). Data were extracted from the patients through interview based on a standardized questionnaire as well as from their clinical records., Results: After adjustment for age and gender, a history of infectious conjunctivitis was more common in the PANDO group than in the control group (55.6 % vs 32.8 %, P = 0.0027), and regular attendance to indoor swimming pools was also more common in the PANDO group (33.3 % vs 0 %, P < 0.0001). Furthermore, when age- and gender- matched subjects were selected, a history of conjunctivitis and swimming pool exposure were independently associated with the development of PANDO (P = 0.022 and P < 0.0001 respectively). On the other hand, the frequencies of histories of POAG, topical timolol, and allergic conjunctivitis and/or rhinitis were similar between the two groups., Conclusions: Histories of infectious conjunctivitis and swimming pool exposure could be associated with the development of PANDO, although the pathogenesis of this condition has been considered as inflammation of unknown causes.

Purpose: To assess the safety and feasibility of a moxifloxacin-loaded punctum plug (MP) in 2 groups of cataract patients., Methods: Two prospective, single-arm, Phase I studies were conducted with 20 cataract patients (10 per study) at the Singapore National Eye Center. After cataract surgery, the MP was inserted into the punctum, and follow-up assessments were conducted at 1 h, 24 h, and on days 3, 7, 10, 20, and 30. Study endpoints included MP retention, ease of placement, and moxifloxacin concentrations in the tear fluid. Moxifloxacin concentrations were targeted to be ≥250 ng/mL through 7 days, with detectable levels through day 10. After the course of therapy, the plug would resorb and be absent from the punctum by day 30. Slit lamp evaluations were performed, and intraocular pressure measurements were performed on days 1, 3, 7, 10, 20, and 30. Patients were queried for the presence or absence of several ocular sensations in the operative eye. Due to the variability in tear film antibiotic concentrations observed in the first study, a second study was conducted with more stringent concomitant drop administration and tear sample collection criteria., Results: MP retention in the punctum was 95% (19/20) through day 10, and all plugs were absent at day 30. Average moxifloxacin concentrations in the tear film ranged from 155 to 785 ng/mL for Study 1 and 2,465 to 3,236 ng/mL for Study 2 through day 7. These values were above the target of 250 ng/mL for all time points except for day 1 of Study 1. For both studies, moxifloxacin concentrations in the tear film were above detectable levels at day 10. The plugs were well tolerated, and there were no adverse events as defined by the protocol, and no ocular complaints or findings other than normal post-cataract symptoms., Conclusions: The MP delivered and maintained moxifloxacin tear fluid concentrations at therapeutic levels above the MIC(90) values for common susceptible conjunctivitis pathogens for 7 days (Study 2). The MP also exhibited a favorable safety and tolerability profile and, hence, may be a viable alternative to topical antibiotic drops for the treatment of bacterial conjunctivitis.

The aim of this case-control study was to evaluate and compare the bacterial microflora from the conjunctival sac of dogs with atopic dermatitis and healthy dogs. Twenty-one atopic dogs without clinical and/or cytopathological signs of bacterial blepharoconjunctivitis and 21 breed-matched healthy dogs were enrolled. Under topical anaesthesia, the inferior conjunctival sac of one eye was scraped twice. Material was collected with a Kimura spatula, spread over a slide and stained with a Diff Quick(®) -type stain (Medion Diagnostics GmbH, Düdingen, Switzerland) for cytological examination. An area of 0.5 cm(2) was examined at ×1000 magnification, and the types and numbers of cells and bacteria were recorded. A bacterial swab was collected and inoculated into culture media for the growth of aerobic bacteria. Before sampling, each atopic dog was evaluated for severity of cutaneous lesions, pruritus and conjunctival inflammation. Significant differences were observed between atopic and healthy dogs for the presence of bacteria on cytology (P = 0.015), keratinized (P = 0.001) and nonkeratinized epithelial cells (P = 0.013), eosinophils (P = 0.019) and lymphocytes (P = 0.008). Bacteria were recovered from 12 atopic dogs and three healthy dogs (P = 0.004). Staphylococcus pseudintermedius was the most commonly isolated species in atopic dogs (seven of 12). In atopic dogs, no significant relation was found between conjunctival bacterial colonization (on cytology and culture) and the severity of any of the clinical parameters. This study suggests differences in conjunctival bacterial colonization and cytological features between atopic and healthy dogs., (© 2011 The Authors. Veterinary Dermatology. © 2011 ESVD and ACVD.)

Aim: Following the previous study observing keratoconjunctivitis sicca (KCS) after treated follicular conjunctivitis of chlamydial etiology from the years 1999-2002, at this time the authors would like to point out the possible connection between KCS appearance and Chlamydia pneumoniae infection., Material: In the Department of Ophthalmology, during the period of 12 months (in the years 2009 - 2010), there were treated 11 adult patients (6 women and 5 men) in the age of 28 - 81 years (median, 50 years) with follicular conjunctivitis lasting on average 2.5 years and caused by Chlamydia pneumoniae, and simultaneously were diagnosed the symptoms of KCS, out of the total number of 37 examined patients with similar clinical findings., Methods: The diagnosis of chlamydial infection in clinical symptoms of follicular conjunctivitis and simultaneous signs of KCS was established partly according to the serologic positivity of chlamydial genus (anti-LPS) and/or species (anti-Ch. pneumoniae and anti-Ch. trachomatis) IgG, IgM, and IgA antibodies together with simultaneous anti-cHSP60 IgG positivity, further using conjunctival prints examined by means of indirect immunofluorescence method using specific monoclonal antibodies; in conjunctival smears and peripheral leucocytes was tested also the presence of Chlamydia pneumoniae DNA. The main subjective complaints of the patients were burning sensation, sticking, or foreign-body sensation; the itching and lacrimation were less common. Among clinical signs dominated the hyperemia and the edema of the lower fornix; the tortuosity of the vessels and the follicles were not always present. The KCS diagnosis was confirmed by Bengal rose staining., Results: In 10 patients, the positive IgA and/or IgM anti-Ch. pneumoniae antibodies were detected. Simultaneously, the positive anti-cHSP60 IgG were confirmed, out of them medium- and high-positive findings were in 7 patients, and anti-LSP antibodies IgA and/or IgM in 8 of them. Positive smears were found in 6 patients. In 2 persons of this group of treated patients, the general serologic findings were not significant, but the Chlamydia pneumoniae infection was confirmed by Chlamydia pneumoniae DNA positivity in peripheral leucocytes; in these 2 patients, the symptoms lasted for one half of the year. As the side findings were the confirmations of active Chlamydia trachomatis infection in other 4 patients of the whole group. The patients with Chlamydia pneumoniae infection were treated systemically by macrolide antibiotic azithromycine for 12 days. After the treatment, above all else the clinical signs of conjunctival inflammation disappeared, but remained KCS symptoms, which were disappearing only slowly. The optimal supporting therapies were lubricant drops with different concentration of sodium hyaluronide without preservatives. Control microbiological examinations during 6 months after the treatment termination confirmed negative smears findings, but the antibody levels were not decreased significantly., Conclusion: This study confirmed the possible connection between the KCS and Chlamydia pneumoniae infection in simultaneous clinical signs of follicular conjunctivitis. Along with that the study pointed out the necessity of simultaneous evaluating of the microbial findings and clinical symptoms to consider the systemic antibiotic treatment.

Objective: To evaluate the clinical efficacy and safety of tobramycin/dexamethasone (TobraDex ST ; 'ST') ophthalmic suspension 0.3%/0.05% compared to azithromycin (Azasite) ophthalmic solution (1%) in the treatment of moderate to severe blepharitis/blepharoconjunctivitis., Research Design and Methods: The study was a multicenter, randomized, investigator-masked, and active-controlled, 15-day study. Enrolled in the study were 122 adult subjects (at least 18 years of age) diagnosed with moderate to severe blepharitis/blepharoconjunctivitis, defined by a minimum score of at least '1' for one of the lid signs, one of the conjunctival signs, and one of the symptoms in at least one eye and a minimum global score (total signs and symptoms score) of '5' in the same eye. One group of 61 subjects received ST with instructions to dose 1  drop four times daily (QID) for 14 days. The other group of 61 subjects received azithromycin and dosed with 1 drop twice daily (BID) for 2 days followed by once daily (QD) dosing for 12 days. Visits were conducted at Day 1 (baseline), Day 8 and Day 15. The a priori primary outcome parameter of the study was the seven-item global score defined as the total score of lid margin redness, bulbar conjunctival redness, palpebral conjunctival redness, ocular discharge (0-3 scale), and lid swelling, itchy eyelids, and gritty eyes (0-4 scale). The study utilized standardized, validated photograph control scales developed by Ora, Inc. (Andover, MA)., Clinical Trial Registration: The study was registered at ClinicalTrials.gov under the registry number NCT01102244., Results: A statistically significant lower mean global score (p = 0.0002) was observed in subjects treated with ST compared to subjects treated with azithromycin at Day 8. No serious adverse events were reported during the course of the study in either group., Conclusion: ST provides a fast and effective treatment of acute blepharitis compared to azithromycin. Initial therapy with the combination of tobramycin/dexamethasone provides faster inflammation relief than azithromycin for moderate to severe blepharitis/blepharoconjunctivitis.

Background: Periphpral ulcerative keratitis (PUK) is a disorder consisting of a crescent-shaped destructive inflammation of the perilimbal corneal stroma., Case: We present a case of PUK following acute bacterial conjunctivitis in a 60-year-old lady with a history of on-and-off joint pain for two years. After admission to the hospital, she underwent conjunctival resection and was given topical and oral steroids. She was prescribed hydroxychloroquine after confirming the diagnosis of rheumatoid arthritis with a positive RA factor., Conclusion: This report highlights the role of infection as a triggeringagent in the induction of PUK in an otherwise quiescent cornea.

Anthrax is an infectious disease that is not well known by ophthalmologists. In its cutaneous form, it may produce lesions of the eyelids. We report eight cases of palpebral anthrax. All patients presented with a black necrotic eschar and a tegumentary edema, with a history of contact with sick animals. The curative treatment was based on intravenous penicillin G in four cases and amoxicillin-clavulanic acid in the four other cases. The palpebral lesions resolved, leaving no clinical evidence of eyelid abnormalities in six patients. Only two patients developed a cicatricial ectropion and a palpebral symphysis. Although palpebral anthrax is a rare disease in humans, ophthalmologists should be aware of its symptoms and management.

Background: Tuberculous conjunctivitis has been described only rarely during the course of lupus vulgaris. We report a case of hemifacial cutaneous tuberculosis, diagnosed as atypical lupus vulgaris, associated with homolateral fibrosing tuberculous conjunctivitis., Patients and Methods: An 83-year-old woman presented inflammatory conjunctivitis without bullous involvement in the left eye leading to corneal neovascularisation, symblepharons and ptosis. Erythematous and atrophic papules were seen on the left side of the face. Biopsy of the skin and conjunctiva revealed a tuberculoid granulomatous infiltrate. Bacterial culture and PCR were both positive for Mycobacterium tuberculosis., Discussion: This case illustrates the need to consider tuberculosis when faced with an atypical facial eruption and ocular involvement.

Aims: To report circulating and mucosa-deposited anti-basement membrane zone autoantibodies in a series of six ectodermal dysplasia patients with severe bilateral cicatrising conjunctivitis and blindness due to both corneal disease and intractable surface inflammation. We also report clinical improvement with steroid-sparing systemic immunosuppression combined with clearance of bacterial colonisation., Methods: Conjunctival and buccal immunohistopathology, and serological analysis using a panel of epithelial basement membrane zone proteins including the bullous pemphigoid antigen 180 (BP180) were carried out as part of an ocular pemphigoid work-up in each patient. The degree of photophobia, conjunctival inflammation and visual acuity were monitored to evaluate the response to immunosuppression. The mean duration of follow-up was 31 (SD 6) months., Results: Four of the six patients showed positive immunopathology: direct immunofluorescence testing of the conjunctiva in one patient demonstrated linear IgA deposition along the basement membrane zone, and IgG and IgM in the buccal mucosa of another patient. Circulating autoantibodies to BP180 were detected in two other patients. Treatment with systemic immunosuppression, combined with clearance of bacterial colonisation, reduced the severity of photophobia and degree of conjunctival inflammation in 5/6 (83%) patients., Conclusions: Systemic immunosuppression, used as steroid-sparing therapy, combined with clearance of bacterial colonisation can control inflammation and disabling photophobia, and allow improvement in vision, in a subgroup of ectodermal dysplasia patients who have severe cicatrising conjunctivitis which shares clinical and immunopathological features with ocular mucous membrane pemphigoid.

We present a case of bilateral purulent conjunctivitis complicated by ocular perforation of the right eye secondary to fulminant corneal melt in a 29-year-old man. He developed urethritis after a sexual contact with a prostitute 3 weeks previously. Microbiological analyses of conjunctival and urinary cultures were positive for Neisseria gonorrhoeae resistant to penicillins, tetracyclines, and fluoroquinolones. Progression was favorable with a 15-day course of high doses of parenterally administered antibiotics associating imipenem and fosfomycin. Keratoplasty was done after 3 months. This observation is a good example of the problems raised by gonococcal conjunctivitis in adults. Extremely rare in developed countries, it remains widely unrecognized by ophthalmologists. It is a sexually transmitted disease usually resulting from autoinoculation from an infected genital site. The risk of marginal purulent corneal melt, which can lead to fulminant perforation, warrants prompt microbiological analysis and early parenteral antibiotic treatment.

Background: This study reports the one-year success rate of a new surgical approach to treat symptoms of chronic epiphora and/or mucopurulent discharge refractive to at least six months of medical treatment in patients with permeable lacrimal drainage system (irrigation test)., Design: retrospective chart review analysis., Participants: seventeen consecutive patients referred from a private praxis to an eye clinic to treat, by surgery, symptoms of either chronic epiphora (8/17), mucopurulent discharge (7/17), or both (2/17)., Intervention: Piffaretti's non-laser transpunctal endoscopic diagnostic/surgical lacrimal drainage procedure (17/17), lacrimal punctoplasty (16/17), conjunctivochalasisplasty (5/17), lateral canthoplasty (1/17), and/or both conjunctivochalasisplasty and lateral canthoplasty (3/17). In the majority of these patients (13/17) partial obstructions within the lacrimal canaliculus (3/17), the ductus nasolacrimalis (7/17), or both (3/17) were observed endoscopically and removed with Piffaretti's lacrimal trephines., Main Outcome Measures: patient's self-assessment of symptom improvement one year after surgery., Results: One year after surgery, 88 % (15/18) of patients had a marked improvement of their symptoms, 64 % (11/17) of them even reporting as being symptom free. When conducted (14/17), irrigation always revealed a permeable lacrimal system (test not performed in a lost-to-follow-up and in two symptom-free patients)., Conclusions: Surgery can be an alternative therapeutic option for patients who have a permeable lacrimal drainage system and suffer from chronic epiphora and/or mucopurulent discharge that do not respond to conventional conservative medical therapies.

A 41 year-old Malay man had been treated by general practitioners for bilateral red eyes with profuse discharge of three weeks' duration with no improvement. He then presented to an ophthalmologist who noted profuse purulent discharge, bilateral corneal perforation, lid swelling and chemosis. Culture of the ocular discharge grew Neisseria gonorrhoeae. Treatment with systemic and topical antibiotics prevented microperforations in the right eye from progressing to overt perforation and was able to control disease in the left eye.

Purpose: To report a case of coexistent Chlamydia conjunctivitis and central retinal vein occlusion (CRVO) in which both problems improved significantly after oral doxycyline., Design: Interventional case report., Methods: A healthy 39-year-old man presented with follicular and papillary conjunctivitis, unresponsive to topical antibiotic therapy, and a CRVO. The patient had serum IgG titers of 1:256 to both Chlamydia pneumonia and Chlamydia trachomatous., Results: Treatment with oral doxycyline (100 mg orally twice daily for 2 weeks) resulted in complete resolution of the conjunctivitis and rapid improvement of the CRVO., Conclusions: Because of its ability to cause chronic vascular endothelial infection and localized inflammation, Chlamydia has been implicated in the development of arterial vascular disease. The positive Chlamydia serology, conjunctivitis, CRVO, and excellent response to doxycycline in this patient suggest that Chlamydia may have contributed to his vascular occlusion. Further studies investigating a possible association between Chlamydia and CRVO may be indicated.

A new method for treating chlamydial conjunctivitis consists in injections of ciprofloxacine for intravenous injections, which is injected (1 ml) under the inferior vault of the conjunctiva on novocaine pad (0.5 ml 0.5% solution) and intravenously by drip infusion (99 ml) twice daily for 7-10 days. The treatment led to clinical cure in all patients, no relapses were observed. This method ensures a high therapeutic effect and accelerates the recovery of patients with chlamydial conjunctivitis by 4.6 days. The method is recommended for patients with complicated forms of chlamydial conjunctivitis in severe and protracted cases with concomitant urogenital chlamydial infection and concomitant chronic gastrointestinal diseases, when oral antibiotic therapy is undesirable or precluded.

Background: Ligneous conjunctivitis is a rare form of chronic recurrent pseudomembranous disease and may be associated with systemic membranous pathological changes. Recently ligneous conjunctivitis has been linked to severe type I plasminogen deficiency. We report on a patient with plasminogen deficiency and severe bilateral ligneous conjunctivitis. A new treatment approach and its outcome in this patient are described., Case Report: We present the case of a 9-month-old Turkish girl with massive swelling of the eyelids and hard white pseudomembranes on both lids. The conjunctival smear was positive for Streptococcus pneumoniae. The clinical diagnosis was: ligneous conjunctivitis with superinfection. Histological investigation showed fibrin as major component of the pseudomembranes. The coagulation analyses revealed decreased plasminogen activity (<5%; normal 80-120%) and decreased plasminogen antigen (<0.4 mg/dl; normal 6-25 mg/dl). The failure of surgical therapy led to the attempt at treatment with intravenous lys-plasminogen. A significant improvement of the ocular symptoms occurred; stabilization with no recurrent pseudomembranes could be achieved for 6 months after treatment., Discussion: The initial amelioration of symptoms in our patient after systemic replacement therapy confirms the etiological importance of plasminogen deficiency in the development of ligneous conjunctivitis. Curative treatment of ligneous conjunctivitis is still not available. However, intravenous application of plasminogen offers new possibilities in therapy, although long-term treatment seems necessary.

Purpose: To report an unusual epibulbar inflammatory process in a patient with human immunodeficiency virus (HIV)., Methods: Case report. A 32-year-old man developed fleshy epibulbar nodules on his right conjunctiva and cornea after being treated for conjunctivitis. A biopsy of the lesions was done, and the specimen was processed for histopathologic examination., Results: The biopsy specimen contained inflammatory cells, including an eosinophilic abscess. The diagnosis was allergic granulomatous nodules., Conclusion: This case illustrates the occurrence of epibulbar allergic granulomatous nodules in an HIV-positive patient.

Purpose: To review reported external ocular manifestations of sarcoidosis and to present bilateral, multilobular, nodular, limbal, corneal nodules as being a unique manifestation of the disease., Patients and Methods: A 16-year-old Saudi girl presented with bilateral, multilobular, solid, limbal nodules, with a vascular supply from the conjunctival vessel, and associated membraneous conjunctivitis and healed trachoma. The Schirmer's test revealed less than 2 mm in both eyes with tear meniscus less than 2 mm. Biopsy of an associated palpebral conjunctival nodule was performed, in addition to a gallium scan, chest X-ray, and a serum angiotensin-converting enzyme (SACE) level., Results: The culture showed beta-hemolytic streptococci. Gallium scan showed intake by both lacrimal glands. Her chest X-ray results were normal, as was the SACE level. Biopsy of the excised conjunctival nodule disclosed a noncaseating granulomatous reaction with epithelioid and giant cells, and chronic inflammatory cell infiltrate confirming a diagnosis of sarcoidosis., Conclusion: A multilobular, nodular, perilimbal mass as a unique manifestation of sarcoidosis is presented. A streptococcal membraneous conjunctivitis and healed trachoma superimposed. A review of sarcoidosis of the external eye is included.

Background: Acute bacterial conjunctivitis, chiefly affecting young children, is generally caused by one of three common pathogens, Haemophilus influenzae, Streptococcus pneumoniae and adenovirus. H. influenzae is the most prevalent causative organism. Some patients presenting initially with conjunctivitis subsequently develop acute otitis media, with H. influenzae the most common etiologic agent of what has been termed the "conjunctivitis-otitis" syndrome. Optimal treatment of acute conjunctivitis would result in a clinical and bacteriologic cure of the conjunctivitis and the prevention of the development of otitis media. Application of topical antimicrobials at 4- to 6-h intervals a day for 1 week to 10 days results in the resolution of the conjunctivitis. However, topical treatment is difficult to administer to toddlers and does not effectively reduce the potential for the development of otitis media. Compared with topical and placebo treatment, oral antibiotics effective against H. influenzae have proved to be most effective in preventing the otitis media associated with conjunctivitis., Conclusion: Acute bacterial conjunctivitis is a common disorder in children < 6 years of age. H. influenzae is the most common etiology of the "conjunctivitis-otitis syndrome." The optimal treatment for this condition is still being studied.

We report an unusual case of bilateral chronic conjunctivitis and corneal scarring in a boy with X-linked hypogammaglobulinaemia (XLH) who did not respond to the usual antibacterial and antiviral therapy. An immunofluorescence test for Chlamydia trachomatis from an eye swab was strongly positive. Within days of commencement of local and systemic tetracycline therapy, he showed marked improvement. Since conjunctival follicle formation, which depends on the presence of a B-cell population, may not occur in XLH, clinical examination in chlamydia conjunctivitis may be misleading and lead to a delay in diagnosis and treatment with resulting corneal complications, unless laboratory evidence of chlamydia infection is specifically sought.

Background: Neisseria meningitidis is a uncommon cause of acute bacterial conjunctivitis. However, its diagnosis has important therapeutic implications., Methods: From December 1993 to January 1984, a prospective study on acute bacterial conjunctivitis was performed at the Hospital Universitario Materno-Infantil Vall d'Hebron. Primary meningococcal conjunctivitis (PMC) was diagnosed in 34 patients. The diagnosis of PMC was made on the basis of consistent clinical manifestations together with isolation of Neisseria meningitidis from conjunctival exudate culture., Results: There were 16 men and 18 women with a mean age of 3.5 +/- 3.3 years. PMC was bilateral in 7 patients and unilateral in 27. Initial therapy for PMC included only topical antibiotics in 24 patients and systemic antibiotic therapy in 10. Ten patients (29.4%) developed invasive meningococcal disease. None of the patients died neither developed ocular sequelae. Forty one percent of the patients who received only topical therapy and none [corrected] of those who received systemic therapy, developed invasive meningococcal disease (p = 0.04)., Conclusions: PMC may represent the portal of entry for invasive meningococcal disease, which occurs in almost a third of patients. Patients with PMC and higher risk of developing invasive meningococcal disease are those treated only with topical antibiotic therapy.

Two groups of six cats were established, one a control group and one infected with feline immunodeficiency virus (FIV) 18 months previously. The cats in both groups were inoculated with Chlamydia psittaci and the clinical progression of the infection was monitored by means of a clinical scoring system for 10 months. Haematological, serological and viral and chlamydial isolation studies were also made. The response of the FIV infected group to treatment with oxytetracycline was monitored in the 11th and 12th months. The FIV infection prolonged the duration of the clinical signs resulting from the infection with C psittaci and led to the development of chronic conjunctivitis. The haematological and antibody responses to C psittaci were comparable in the two groups. However, it was possible to isolate C psittaci from the FIV-infected cats up to day 270, when the treatment began, but only up to day 70 in the control group. In addition, it appeared that the infection with a secondary pathogen may have accelerated the clinical progression of the FIV infection.

To test the efficiency of antimicrobial substances on bacterial conjunctivitis under standardized conditions a reproducible model is needed. As there are no data in the literature concerning this topic we have developed a model of bacterial conjunctivitis in the rabbit eye. Instillation of a suspension of Haemophilus influenzae, Staphylococcus epidermidis or Staphylococcus aureus into the cul-de-sac did not result in any effect. Thus, standardized techniques of conjunctival incision were used additionally. A follow-up was done for a period of 2 weeks (degree of conjunctival hyperemia, microbiology). Radial incision of the conjunctiva with injection of an S. aureus suspension (50 microliters of ATCC 29213; 1.35 x 10(8) cells) was done mimicking a branch injury. This resulted in a purulent conjunctivitis over a period of 1 week and disappeared within 14 days. The swabs were negative on day 7. This is the first model establishing a reproducible purulent conjunctivitis in the rabbit. Using this model antimicrobial substances may be tested under standardized conditions.

Two infants are described in whom identical strains of meningococcus were isolated from both the eyes and the cerebrospinal fluid. This suggests that the eye may be a portal of entry in at least some cases of perinatally acquired neonatal meningococcal disease and has important implications for the management of purulent conjunctivitis in the newborn.

Brazilian purpuric fever (BPF) is a life-threatening pediatric infection that is preceded by conjunctivitis and caused by Haemophilus influenzae biogroup aegyptius. BPF was first recognized during 1984 in the state of Sao Paulo. BPF was not reported in Brazil outside of Sao Paulo and the neighboring state of Parana until December 1989, when children with BPF were identified in the state of Mato Grosso. By April 1990, 10 children with confirmed BPF were identified from six widely separated cities in Mato Grosso. The overall attack rate for the combined population was 6/100,000 children less than 10 years of age. Six (60%) of the 10 children with BPF died. The recognition of BPF in Mato Grosso suggests that the H. influenzae biogroup aegyptius strain responsible for BPF has a wider geographic distribution than previously appreciated or may be capable of spreading.

Two hundred and forty-six patients with signs of acute bacterial conjunctivitis and/or blepharitis were randomised to receive either norfloxacin or chloramphenicol for one week in this double-masked parallel group study. Ninety-two per cent of the norfloxacin-treated patients and 93% of the chloramphenicol-treated patients were rated as either clinically improved or cured at the end of the treatment period. Based upon pre-treatment bacteriological cultures, 31.3% of the patients had significant bacterial infection of the lids and/or conjunctiva. All of these culture-positive patients were rated as either clinically improved or cured. Based upon post-treatment cultures, 72 of 82 strains of Gram-positive and Gram-negative bacteria were eradicated or suppressed following treatment with either norfloxacin or chloramphenicol. However six of 41 strains persisted for norfloxacin and four of 41 for chloramphenicol. Two norfloxacin-treated patients and three chloramphenicol-treated patients had adverse experiences, predominantly ocular discomfort, which required cessation of drug therapy. Norfloxacin appears to be an effective and relatively safe agent for the treatment of bacterial infections of the lids and/or conjunctiva. In this study, norfloxacin was clinically and microbiologically similar in activity to chloramphenicol.

In this study, we report on a case of refractory, unilateral anaerobic conjunctivitis. The predominant anaerobic flora consisted of Prevotella intermedia (formerly Bacteroides intermedius) and Peptostreptococcus micros. By using the technique of restriction endonuclease fingerprinting of genomic DNA, it was shown that the P. intermedia likely originated from the oral cavity. Topically applied antibiotics had failed to suppress the infection in the past. Successful treatment was achieved after systemic administration of metronidazole plus amoxicillin.

The accuracy of the Surecell Chlamydia Test Kit (Kodak Clinical Products, Rochester, N.Y.) in detecting neonatal conjunctival infection caused by Chlamydia trachomatis was determined by comparison of this enzyme immunoassay with the isolation of C. trachomatis in tissue culture. Kodak Surecell is a rapid monoclonal antibody-based membrane capture enzyme immunoassay which can be processed in the office of a physician. The sensitivity and specificity compared to culture in detecting C. trachomatis in conjunctival specimens from infants with conjunctivitis were 93 and 96%, respectively. The test does not require specialized equipment or trained personnel and would be ideal for physicians who see low numbers of infants with possible chlamydial conjunctivitis in their offices.

The ocular findings in three brothers with Bruton's disease are reported. All three boys had purulent conjunctivitis, but the two older brothers also developed marked corneal scarring with visual impairment. Haemophilus influenzae was cultured from conjunctival swabs; it was resistant to neomycin but sensitive to chloramphenicol. Tear analysis showed that the three subjects had normal levels of lysozyme but no detectable IgA.