Conjunctival Follicles Research Articles

Computer Vision Identification of Trachomatous Inflammation-Follicular Using Deep Learning.

Trachoma surveys are used to estimate the prevalence of trachomatous inflammation-follicular (TF) to guide mass antibiotic distribution. These surveys currently rely on human graders, introducing a significant resource burden and potential for human error. This study describes the development and evaluation of machine learning models intended to reduce cost and improve reliability of these surveys. Fifty-six thousand seven hundred twenty-five everted eyelid photographs were obtained from 11,358 children of age 0 to 9 years in a single trachoma-endemic region of Ethiopia over a 3-year period. Expert graders reviewed all images from each examination to determine the estimated number of tarsal conjunctival follicles and the degree of trachomatous inflammation-intense. The median estimate of the 3 grader groups was used as the ground truth to train a MobileNetV3 large deep convolutional neural network to detect cases with TF. The classification model predicted a TF prevalence of 32%, which was not significantly different from the human consensus estimate (30%; 95% confidence interval of difference, -2 to +4%). The model had an area under the receiver operating characteristic curve of 0.943, F1 score of 0.923, 88% accuracy, 83% sensitivity, and 91% specificity. The area under the receiver operating characteristic curve increased to 0.995 when interpreting nonborderline cases of TF. Deep convolutional neural network models performed well at classifying TF and detecting the number of follicles evident in conjunctival photographs. Implementation of similar models may enable accurate, efficient, large-scale trachoma screening. Further validation in diverse populations with varying TF prevalence is needed before implementation at scale.

The 2023 outbreak of viral conjunctivitis: Clinical features and treatment patterns from five states in India

Background: In July 2023, an outbreak of viral conjunctivitis swept across India. A knowledge of clinical features and outcome of treatment helps in the management of future outbreaks. Aim: The aim of this study was to report the clinical presentation, treatment, and outcome in patients affected during the outbreak of viral conjunctivitis. Setting and Design: This was a multicentric retrospective case series. Materials and Methods: This study reviewed the medical records of all consecutive patients diagnosed with viral conjunctivitis between July 1, 2023, and August 10, 2023, in five centers across India. Results: Of the 793 patients, 525 (66.2%) were male and 268 (33.8%) were female, with a mean age of 34.1 ± 19.0 years. The mean symptom duration was 2.6 ± 2.1 days with bilateral disease in 591 (74.5%) patients. The common ocular signs were conjunctival congestion (793, 100%), lid edema (479, 60.4%), follicles (607, 76.5%), and conjunctival hemorrhages (339, 42.7%). Artificial tears were used in 730 (92.1%) patients, antibiotic eye drops in 661 (83.4%) patients, and steroid eye drops in 428 (54.0%). The time to resolution was the least in patients who had been treated with only artificial tears (4.61 ± 2.24 days) and was maximum in patients who had been treated with topical steroids (6.5 ± 2.51 days), and the difference was significant (P < 0.001). Conclusion: The presence of conjunctival hemorrhages indicated acute hemorrhagic conjunctivitis. Although many patients were treated with topical antibiotics, it was unnecessary, as the shortest resolution time was found in patients who had been received supportive therapy with artificial tear eye drops and not topical antibiotics or steroids.

Safety and Efficacy of the Rho-Kinase Inhibitor (Ripasudil) in Bleb Needling after Trabeculectomy: A Prospective Multicenter Study.

Ripasudil, a rho-associated protein kinase inhibitor ophthalmic solution, shows a protective effect in preventing excessive scarring in vitro. This study aims to evaluate the safety and efficacy of ripasudil for glaucoma patients submitted to the needling procedure. In this prospective, multicenter, single-arm study, we included 20 eyes of 20 patients with glaucoma who underwent the needling procedure without antimetabolites. All patients administered ripasudil after needling for three months. The primary endpoint of this study was the safety of ripasudil in patients, and the secondary endpoint was the change in IOP at 12 weeks after the needling procedure. No serious complications were found in the patients. One eye experienced pruritus and conjunctival follicle, while another eye had conjunctival follicle. These complications were transient and resolved quickly after discontinuation of ripasudil. The mean preoperative IOP was 14.6 ± 4.6 mmHg, which decreased to 11.0 ± 4.7 mmHg (p = 0.0062) at 1 week postoperatively. The IOP reduction effect continued to 12 weeks (11.8 ± 3.1 mmHg; p = 0.0448). The administration of the ROCK inhibitor, ripasudil, after the needling procedure is safe and effective in maintaining IOP for 12 weeks.

Efficacy of the topical antihistamine olopatadine in dogs with experimentally induced allergic conjunctivitis

AbstractObjectiveThe objective of the study was to evaluate the efficacy of a once a day, over the counter antihistamine eye drop, 0.7% olopatadine hydrochloride, in treating or preventing experimentally induced allergic conjunctivitis in dogs.Animals studiedTwelve systemically healthy pet dogs with no known history of allergies or atopic dermatitis, and in the past 12 months had no known ocular abnormalities.ProceduresDogs were randomly assigned to two groups: “Treatment” which received topical 0.7% olopatadine hydrochloride and “Control” which received artificial tears. Dogs received the antihistamine eye drops before (Phase 1) or after (Phase 2) receiving a compounded ophthalmic histamine solution to induce clinical signs of allergic conjunctivitis. Conjunctival hyperemia, chemosis, follicles, ocular discharge, and ocular pruritus were graded, and photographs were used to document changes. Schirmer tear test values, fluorescein staining, and intraocular pressures were monitored throughout.ResultsIn both Phase 1 and Phase 2, conjunctival scores increased 10 min after histamine administration (p < .05). There was no difference between maximum overall conjunctival scores between treatment and control groups in either phase or when comparing treatment groups of Phase 1 to Phase 2 (p > .05). However, treatment groups in Phase 2 did have a higher maximum conjunctival chemosis score and spent more time at their maximum chemosis score when compared to Phase 1 (p < .05).ConclusionOlopatadine may be beneficial as prophylaxis to reduce the degree and duration of clinical signs of allergic conjunctivitis.

Intense Pulsed Light Attenuates Oxidative Stress in Perennial Allergic Conjunctivitis.

Objective: To assess the effects of intense pulsed light (IPL) on oxidative stress (OS) in perennial allergic conjunctivitis (PAC). Background: IPL treatment has been proven effective for dry eye disease (DED). However, we have observed that, after IPL treatment, some patients with DED combined with allergic conjunctivitis (AC), an immune response condition in which excessive OS causes and exacerbates inflammatory damage, not only show an improvement in eye dryness, but also their AC-related eye itching is relieved. The mechanism by which IPL inhibits allergic reactions is not clear. Methods: Five patients with moderate-to-severe PAC were given two IPL treatments on the periorbital skin with a 2-week interval. Visual analog scale (VAS) scores and signs of AC, including eye redness and conjunctival follicles, were assessed before the first treatment (day 1) and 2 weeks after the second treatment (day 30). Tears were also collected at the same time, and lipid oxidation (LPO) metabolite analysis was performed using liquid chromatography tandem mass spectrometry (LC-MS/MS) to investigate the effects of IPL on OS response. Results: The average VAS score significantly decreased with treatment (30.2 for day 1, 10.6 for day 30; p < 0.001). The general signs of PAC showed no difference (p > 0.05). LPO metabolite analysis revealed that 17,18-diHETE, which is an oxidation product of eicosapentaenoic acid, and 13-OXoODE, which is an oxidation product of linoleic acid, are significantly downregulated after IPL treatment. Conclusions: The photothermal effect of IPL attenuates OS in PAC, and this seems to be one of the mechanisms by which IPL treatment improves PAC. Clinical Trial Registration number: ChiCTR1900022202.

Adenoviral Keratoconjunctivitis in Korea: Serotypes and Clinical Characteristics

Purpose: Human adenoviruses are a major cause of epidemic keratoconjunctivitis. Of over 60 genotypes, subgroup D is associated with epidemic keratoconjunctivitis. There are, however, no data regarding the genotypes of conjunctivitis-causing adenoviruses in Korea. The purpose of this study was to determine the types of adenoviruses causing epidemic keratoconjunctivitis and clinical manifestations in Korea.Methods: From November 2016 to September 2017, 20 conjunctival swab specimens were collected from patients who were clinically suspected to have adenoviral keratoconjunctivitis. Nucleic acids were extracted using a QIAamp Viral mini kit and processed on the QIAcube platform. Genotyping targeted for adenovirus capsid hexon genes was performed by using the polymerase chain reaction and sequencing techniques. Patient ages ranged from 18 days to 69 years (median, 37 years).Results: Of 20 collected specimens, 17 (85.0%) were genotyped. Three samples were not amplified with our primer sets. Eleven samples (64.7%) were adenovirus type 8, five (29.4%) were type 37, and one was type 64. All 17 genotyped patients showed conjunctival injections (100%) and follicles (100%), and 12 (84.6%) showed pseudomembrane formation. In case of patients genotyped type 8, most of them showed corneal manifestations and involvement of cornea by type 37 showed filamentary keratitis.Conclusions: This study showed that the polymerase chain reaction and direct sequencing for adenovirus hexon genes of conjunctival swab samples were effective techniques for genotyping the adenoviruses that cause epidemic keratoconjunctivitis. The most common causes of adenoviral keratoconjunctivitis in Korea were adenovirus types 8 and 37 in this period of time. Conjunctival injection, follicle formation, and pseudomembrane formation were the major manifestations of adenovirus types 8 and 37 infections.

Study of ocular manifestations and humoral immune response in eyes of dogs with leishmaniasis.

Ocular manifestations in dogs with leishmaniasis are frequent and complications in affected tissues can lead to blindness. Immune processes play a very important role in the pathogenesis of ocular inflammation. Therefore, the immunology of ocular manifestations in dogs with leishmaniasis remains complex and poorly understood. Estimation and characterisation of ocular and periocular manifestations in dogs naturally infected with Leishmania infantum and investigation of the production site of specific anti-Leishmania infantum IgG. The present investigation used 53 confirmed dogs infected with Leishmania infantum, presenting ocular and periocular lesions, and 10 control non-infected dogs. Complete macroscopic ophthalmic examination of eyelids and globes was performed. Both total and anti-Leishmania infantum IgG antibodies were studied in sera and aqueous humour (AH) of all dogs by ELISA technique. A Goldmann-Witmer coefficient (C value) was calculated. The main ophthalmological findings were keratoconjunctivitis (71.7%; 38/53), hyperplasia of conjunctival lymphoid follicles (54.7%; 29/53), blepharitis (50.9%; 27/53) and uveitis (20.7%; 11/53). Ocular production of anti-Leishmania infantum IgG was detected in 73.6% (39/53) of infected dogs. There was no correlation between the antibody levels in AH and sera of the same dog. The mean anti-Leishmania infantum IgG in AH was higher in uveitis, followed by lesions affecting only the adnexa (p < 0.0001). The highest mean C values were observed for uveitis, conjunctivitis and keratitis. Our findings suggest that production of anti-Leishmania IgG in dogs infected with Leishmania infantum with ocular manifestations begin in situ and follows by a transfer of antibodies from the bloodstream to the AH.

Conjunctival Trichodiscoma of the Lower Eyelid

Trichodiscomas are benign tumors of the skin which develop around a hair follicle. They usually present on the face, neck, or trunk region. The authors report a rare case of a 63-year-old man who presented with a tumor on the left lower eyelid that was histologically proven to be a trichodiscoma of conjunctival origin.Trichodiscomas are benign tumors of the skin appendage which develop around a hair follicle. Although conjunctival hair follicles are rudimentary and do not give rise to hair, rarely a benign proliferation of these cells can result in trichodiscoma of the conjunctiva.

Clinical case: severe course of adenoviral conjunctivitis with a hemorrhagic component complicated by a toxic-allergic reaction against a pregnancy

One of the manifestations of adenovirus keratoconjunctivitis – extensive subconjunctival hemorrhages – is the characteristic of rather rare hemorrhagic form of conjunctivitis of severe course. Patients, especially pregnant women, with clinical manifestations of adenoviral conjunctivitis of severe course with a hemorrhagic component complicated by a toxic-allergic reaction, require close attention not only from ophthalmologists. It is necessary to conduct a comprehensive examination, including: general blood test, coagulogram, consultation of the therapist. Clinical signs of deterioration, in the early days of the disease, against the backdrop of treatment, is a clinical feature of the course of adenovirus infection, which should be informed to the patient. The use of a complex approach using the domestic non-toxic inducer of interferon formation of Poludan (polyA:polyU complex) in instillations and injections, supplemented by scraping-massage with a glass rod of the tarsal conjunctiva, facilitating the elimination of adenovirus from conjunctival follicles, quickly and effectively reversed the phenomenon of severe AVC. The appointment of corticosteroid therapy, regardless of the severity of the toxic-allergic reaction, is shown no earlier than 7 days after the manifestation of the disease.

The significance of meibomian gland changes in asymptomatic children

PurposeTo evaluate meibomian gland morphology and function in children without ocular discomfort. MethodA total of 266 eyes of 266 children without signs or symptoms of ocular surface dysfunction were enrolled. Morphology of meibomian glands (MG) and non-invasive break-up time (BUT) was assessed by noncontact meibography. Based on lipid layer thickness (LLT) of the tear film measurements, 66 children were chosen to be assessed by meibomian glands yielding liquid secretion (MGYLS). ResultsBased on the presence of physiologic conjunctival follicles (PCF), participants were divided into normal or PCF groups. The distortion and deficiency of MG function was significantly higher in PCF group (P = 0.002, 0.007, respectively). Five different gland duct shapes (vertical, tortuous, overriding, hooked, U-shaped) were observed. MG deficiency was positively correlated with age (R = 0.362, P < 0.001). Distortion and the number of MG showed no correlation with age (P > 0.05). However, distortion and deficiency of MG were negatively correlated with LLT (P < 0.001, P < 0.01). ConclusionChildren with PCF had significantly more MG distortion and deficiency which was associated with LLT. These results prompt future studies to determine if changes in MG morphology are congenital or acquired.

Clinical signs of trachoma are prevalent among Solomon Islanders who have no persistent markers of prior infection with Chlamydia trachomatis

Background: The low population-prevalence of trachomatous trichiasis and high prevalence of trachomatous inflammation–follicular (TF) provide contradictory estimates of the magnitude of the public health threat from trachoma in the Solomon Islands. Improved characterisation of the biology of trachoma in the region may support policy makers as they decide what interventions are required. Here, age-specific profiles of anti-Pgp3 antibodies and conjunctival scarring were examined to determine whether there is evidence of ongoing transmission and pathology from ocular Chlamydia trachomatis (Ct) infection. Methods: A total of 1511 individuals aged ≥1 year were enrolled from randomly selected households in 13 villages in which &gt;10% of children aged 1–9 years had TF prior to a single round of azithromycin mass drug administration undertaken six months previously. Blood was collected to be screened for antibodies to the Ct antigen Pgp3. Tarsal conjunctival photographs were collected for analysis of scarring severity. Results: Anti-Pgp3 seropositivity was 18% in 1–9 year olds, sharply increasing around the age of sexual debut to reach 69% in those over 25 years. Anti-Pgp3 seropositivity did not increase significantly between the ages of 1–9 years and was not associated with TF (p=0.581) or scarring in children (p=0.472). Conjunctival scars were visible in 13.1% of photographs. Mild (p&lt;0.0001) but not severe (p=0.149) scars increased in prevalence with age. Conclusions: Neither conjunctival scars nor lymphoid follicles were associated with antibodies to Ct, suggesting that they are unlikely to be a direct result of ocular Ct infection. Clinical signs of trachoma were prevalent in this population but were not indicative of the underlying rates of Ct infection. The current World Health Organization guidelines for trachoma elimination indicated that this population should receive intervention with mass distribution of antibiotics, but the data presented here suggest that this may not have been appropriate.

P08.04 Pathogenicity of plasmid positive and negativechlamydia trachomatisin a macaque model of ocular and genital tract diseases

Introduction Previous studies demonstrated that a Chlamydia trachomatis plasmid negative ocular strain (A/P-) resulted in attenuation of infection and pathology, paired with immune stimulation that produced protective immunity in a monkey ocular model. Expanding upon these findings, we assessed a plasmid negative genital strain (D/P-) in the pigtailed macaque model of chlamydial reproductive tract infection. Infection and pathology were compared to a plasmid positive genital strain (D/P+). Methods Groups of six macaques were cervically challenged with C. trachomatis D/P+ or D/P-. All animals were followed for infection, circulating antibody, local immunity, and tissue inflammation. Upon spontaneous clearance of cervical infection, each animal underwent repeated challenges with matched strains to drive upper reproductive tract disease. The same strains were similarly compared in the macaque ocular infection model. Results Similar rates and duration of chlamydial genital infection were documented in both the P+ and P- challenged macaques. Likewise serum and local antibodies were similar. Tissue inflammation graded by gross observation during laparoscopic procedures and by tissue histology yielded no discernible patterns to disease pathology between P+ and P- strains. Because A/P+ and A/P- ocular strains in macaques exhibited dramatic differences in infectivity and pathology in the eye, we ocularly challenged animals with D/P+ and D/P-. Unexpectedly, no differences in infectivity or pathology were observed between the D/P+ and D/P- strains; each produced similar infection kinetics with ocular disease characterised by conjunctival hyperemia and follicle formation. Conclusions Unlike the ocular strain, the plasmid negative genital strain is not attenuated in either genital or ocular macaque infection models. This suggests that genetic determinants unrelated to the plasmid play a dominant role in the pathogenesis of urogenital strains. Disclosure of interest statement This research was supported by NIH Contract Numbers HHSN266200700013C and HHSN272201400016C, and by the Office of Research Infrastructure Programs (ORIP) of the National Institutes of Health through Grant Number P51 OD010425 Washington National Primate Research Centre. No pharmaceutical grants were received in the development of this study.

Involvement of Chemokines and a CD4-Positive T Cell Subset in the Development of Conjunctival Secondary Lymphoid Follicles in an Atopic Keratoconjunctivitis Mouse Model

Background: Massive B cell lymphoid hyperplasia and its associated factors may play a role in exacerbating inflammation in allergic disorders. We here investigated the chemokines and CD4-positive T cell subset involved in the development of secondary lymphoid follicles (iCALT) in conjunctival tissues in an atopic keratoconjunctivitis mouse model (AKC mouse). Methods: NC/Nga mice were divided into three groups: AKC (percutaneous sensitization and instillation of crude house dust mite antigen), AD (percutaneous sensitization only) and C (untreated control). Pathological changes in the conjunctival tissues of each group were investigated using histological and immunohistochemical detection of CD4 and CD20. Furthermore, tissue sections of iCALT (AKC-iCALT subgroup) and conjunctiva without iCALT (AKC-conjunctiva subgroup) were obtained from AKC mice using laser-assisted microdissection. mRNA expression of chemokine and T cell subset-related transcription factors were compared between the AKC-iCALT and AKC-conjunctiva subgroups using polymerase chain reaction (PCR) array and real-time reverse transcription-PCR (RT-PCR) methods. Results: iCALT with central aggregation of CD20-positive B cells and CD4-positive T cell infiltration surrounding B cells was observed in the palpebral conjunctival tissue of the AKC group, but not in that of the AD and C groups. Chemokine and T cell subset-related transcription factor expression was confirmed using real-time RT-PCR, with significant increases in Ccl5, Ccl17, Cxl20, Cxcl3, Ccr7, Foxp3 and T-bet mRNA expression in the AKC-iCALT subgroup compared with those in the AKC-conjunctiva subgroup. Conclusions: We concluded that CCL5, CCL17 and CCL20, as well as T-bet- and Foxp3-positive lymphocytes may be iCALT-related factors and that iCALT-related chemokines are worth evaluating as biomarkers.

Bilaterale vaskularisierte disziforme Hornhautnarbe herpetischer Genese bei einem Kind

Bilateral keratitis is rare and can have various causes. For a good outcome after treatment, the correct diagnosis is decisive. A 15-year-old boy presented to our clinic with recurrent keratoconjunctivitis and progressive loss of vision in both eyes since 6 years. The best corrected visual acuity was 0.1 in the right eye and 1/12 in the left eye. Slit-lamp examination verified keratitis disciformis with strongly vascularized corneal stromal scars without conjunctival follicles on both sides. Based on the clinical diagnosis, antiviral treatment was initiated. Best corrected visual acuity 8 weeks later increased to 0.4 in the right eye and 0.8 in the left eye and the corneal edema decreased in both eyes. Due to noncompliance the patient returned with a perforated corneal ulcer of the left eye, where an á chaud penetrating keratoplasty had to be performed. Herpes simplex virus is one of the most common causes of keratitis and has different manifestations. In the treatment of keratitis disciformis the use of topical steroids is mandatory as there is an active immunological process. The use of systemic and local antiviral treatment is necessary at the same time in order to avoid reactivation of viral replication. Bilateral keratitis is relatively frequent in children. Herpetic keratitis is now well treatable if the various manifestations of the disease are recognized early and an appropriate therapy is adjusted accordingly.

Directed conjunctival biopsy and impact of histologic sectioning methodology on the diagnosis of ocular sarcoidosis

BackgroundSarcoidosis is an idiopathic, multi-system, granulomatous disease with well-described ocular manifestations. However, other uveitic etiologies can manifest in a similar fashion, and ocular disease may precede systemic manifestations. Definitive diagnosis requires histologic confirmation of non-caseating granulomatous inflammation. This study reports the diagnostic yield of directed biopsy of conjunctival follicles in patients with uveitis suspected to be secondary to sarcoidosis, and compares an institutional standard tissue sectioning method to a multi-plane technique.ResultsA retrospective analysis was performed of all patients who underwent directed conjunctival biopsy for suspected ocular sarcoidosis. A total of eight patients were identified; all were females. Directed conjunctival biopsy was positive in three of seven patients using standard histologic processing method, a yield of 43%. Using the multi-plane technique increased the cumulative yield to 63%.ConclusionsDirected conjunctival biopsy is a minimally invasive, cost-effective, and moderately high yield method of diagnosing ocular sarcoidosis. Using a multi-plane sectioning method may increase biopsy yield when standard sectioning techniques are negative.

Artificial tears alone versus 0.45% ketorolac tromethamine with artificial tears for the treatment of acute viral conjunctivitis.

To evaluate the effects of preservative-free 0.45% ketorolac tromethamine and artificial tears (carboxymethylcellulose) compared with those of preservative-free artificial tears alone on the symptoms and signs of acute viral conjunctivitis. This was a randomized, double-masked clinical trial that included 50 patients who were diagnosed with acute viral conjunctivitis and distributed into two groups (Group 0: artificial tears and Group 1: 0.45% ketorolac tromethamine + carboxymethylcellulose). The patients were instructed to use the medication 4 times daily. Signs (conjunctival hyperemia, chemosis, follicles, and secretion) and symptoms (general ocular discomfort, itching, foreign body sensation, tearing, redness, and swelling of the eyelids) were scored at baseline and on the third and seventh days of treatment using a standardized questionnaire and slitlamp anterior segment examination. Both groups showed an improvement in the signs and symptoms of conjunctivitis in their follow-up visits. There was no significant difference in symptom and sign scores between Group 0 and Group 1 in the study visits (p>0.05). The frequency of side effects during treatment was similar between groups (p>0.05). Our findings indicate that 0.45% ketorolac tromethamine was not superior to the use of artificial tears in relieving the signs and symptoms of viral conjunctivitis.

Interferon for Ocular Surface Squamous Neoplasia in 81 Cases

To assess the efficacy of interferon alpha-2b (IFNα2b) in the management of ocular surface squamous neoplasia (OSSN). This is a retrospective, nonrandomized interventional case series study of 80 patients with 81 tumors treated with IFNα2b eye drops and/or injection combined with surgical excision when necessary. The main outcome measure was complete response or partial response based on the American Joint Committee on Cancer classification. The OSSN was classified as Tis (n = 10, 12%), T1 (n = 13, 16%), T2 (n = 6, 7%), T3 (n = 51, 63%), and T4 (n = 1, 1%). IFNα2b was used as immunotherapy alone (n = 22, 27%) or combined with surgery (n = 59, 73%). Overall (n = 81), complete response was achieved in 90% Tis, in 100% T1, in 100% T2, in 94% T3, and in 100% T4. Specifically for immunotherapy (n = 22), IFNα2b alone achieved complete response in 75% (3/4) Tis, in 100% (8/8) T1, and in 70% (7/10) T3. Planned IFNα2b plus surgery (n = 59) achieved control in 100% (6/6) Tis, in 100% (5/5) T1, in 100% (6/6) T2, in 100% (41/41) T3, and in 100% (1/1) T4. Tumor recurrence was noted in 5% (4/81) of cases over a median follow-up of 1 year. Ocular side effects included conjunctival hyperemia (n = 4, 5%), ocular irritation (n = 3, 4%), superficial punctate keratitis (n = 3, 4%), and conjunctival follicles (n = 1, 1%). Systemic side effects included postinjection flu-like syndrome for 1 day (n = 7, 9%). IFNα2b, when appropriately combined with surgical excision for OSSN, provides complete control in 95% of cases overall, specifically in 90% Tis, in 100% T1, in 100% T2, in 94% T3, and in 100% T4.

Ocular Surface evaluation in children Presenting Ongoing Ocular Allergy

AbstractPurpose to evaluate in a retrospective study ocular surface impairment and tear osmolarity in children presenting ongoing ocular allergy. Tears are necessary for continued health of ocular surface and tear osmolarity is considered a key point for tear film impairment and ocular surface damage.Methods Our retrospective study included 20 children (mean age 11 yo, range 6 to 17 yo) of two groups that presented at ocular consultation of our hospital. Group a, 10 children with ongoing ocular allergy, group b 10 control children who had been tested but finally did not present any sign of allergy or dry eye. All the children underwent a tear osmolarity measure prior to complete ocular consultation to be aware of influencing results by the examination. The tear osmolarity measure was obtained with the Tear Lab Osmolarity System (OcuSense). A complete ocular examination was also performed. So the type of ocular allergy was diagnosed.Results In group a, all the children presented clinical signs of on going ocular allergy with conjunctival redness, follicles and/or papillae. In two cases severe keratitis was present. In group b no ocular signs of conjunctiva anomalies were found. Mean tear osmolarity in group b, was 305mOsm/l and in group a, was 316mOsm/l. Tear osmolarity appeared higher in the ocular allergy group than in the non symptomatic children. Younger children had a higher measure of tear osmolarity.Conclusion In adults 305mOsm/l is a cut‐off value for dry eye. In our study this measure appears similar to adults but could be higher in youngest children. In children with ocular allergy, higher measure of tear osmolarity indicates an ocular surface damage that is underestimated. Tear osmolarity can be useful to manage ocular surface disease in children.

What Is Causing Active Trachoma? The Role of Nonchlamydial Bacterial Pathogens in a Low Prevalence Setting

In low prevalence settings, clinically active follicular trachoma (TF) is often found in the absence of detectable Chlamydia trachomatis. The reasons for this persistent follicular phenotype are not well understood; one possible explanation is that other bacterial species are provoking the inflammatory response. This study investigated the relationship between TF, C. trachomatis, and nonchlamydial bacterial infection. A cross-sectional survey was conducted in a trachoma endemic village in Tanzania. All available children were examined for trachoma and swabs were collected for microbiologic culture (blood and chocolate agar) and C. trachomatis PCR (Amplicor). Four hundred seventy-three children under 10 years of age were recruited for this study. The prevalences of TF and C. trachomatis were 13.7% and 5.3%, respectively, and were not associated. Bacteria were cultured from 305 (64.5%) swab samples; 162 (34.3%) grew a pathogen (with or without a commensal organism) and 143 (30.2%) grew commensal bacteria only. The most common pathogens were Streptococcus pneumoniae and Haemophilus influenzae (type B and non-type B). The presence of bacterial pathogens was associated with TF (odds ratio, 4.68; 95% confidence interval, 2.31-9.50; P < 0.001). In regions with low levels of endemic trachoma, it is possible that much of the TF that is observed is attributable to nonchlamydial bacterial pathogens. It is plausible that individuals who have previously developed a follicular conjunctivitis in response to C. trachomatis may more readily reform conjunctival follicles when challenged with certain other bacterial species.

A Case of Thelazia Callipaeda Recurred At a One-month Interval

Purpose: To report a relapsed case of an intra-conjunctival Thelazia callipaeda infestation within one month. Case summary: A 59-year-old female patient presented with symptoms of itching and a sense of foreign substance in her left eye, which she had been experiencing for several days. Conjunctival hyperemia and follicle multiplication along with ten actively moving worms were identified and were extracted with forceps. The symptoms disappeared until 25 days later, when they recurred and five additional worms were extracted. All of the extracted worms were confirmed to be Thelazia callipaeda and the patient's symptoms disappeared after the final extraction. Conclusions: More than one month of follow-up observation is required for human infection by Thelazia callipaeda due to the post- extraction growth of the larva.