Corneal Sensitivity In Patients Research Articles

Kératopathie centrale toxique et fibromyalgie : à propos d’un cas

A patient with fibromyalgia after laser refractive surgery presented bilateral diffuse lamellar keratitis complicated by central toxic keratopathy. A 51-year-old patient, followed for fibromyalgia, consulted for visual loss 1 week after laser in situ keratomileusis. Slit lamp examination revealed stromal infiltrate in both eyes into the flap interface. Confocal microscopy showed an infiltration of inflammatory cells into the anterior stroma and the flap interface. Intensive topical corticosteroid treatment was used and the left eye was treated with flap lifting and interface irrigation. The corneal infiltrates decreased very slowly, and the left eye developed postoperative hyperopia. Diagnosis of central toxic keratopathy was discussed. Visual acuity, highly volatile, was limited to 7/10 (right eye) and 6/10 (left eye). Diffuse lamellar keratitis (DLK) is a sterile inflammation after laser in situ keratomileusis. Central toxic keratopathy is characterized by noninflammatory central corneal opacification with a significant hyperopic shift. The cause of central toxic keratopathy is unknown. Fibromyalgia is a widespread, chronic pain disorder that includes a complex constellation of somatic and emotional symptoms. Patients often complain of dry eye sensations. Recent studies have highlighted a reduced corneal sensitivity in patients with fibromyalgia. There could be a relation between fibromyalgia, diffuse lamellar keratitis, and central toxic keratopathy. Some precautions may be used before LASIK in patients with fibromyalgia.

Reduced corneal sensitivity in patients with primary Sjögren’s syndrome

Reduced corneal sensitivity in patients with primary Sjögren’s syndrome

Vogt-Koyanagi-Harada Disease Associated with Bilateral Tonic Pupils in a Pregnant Patient

Purpose: We report a case of bilateral tonic pupils and decreased corneal sensitivity in a patient with Vogt-Koyanagi-Harada (VKH) disease during pregnancy. Case summary: A 33-year-old Korean woman in the sixth month of pregnancy presented with visual impairment in both eyes. Her best corrected visual acuity was 0.2 in the right eye and 0.125 in the left. Slit-lamp examination revealed cells in the anterior chamber and serous retinal detachments in both eyes. The patient was treated with topical corticosteroid in both eyes and posterior subtenon injection of triamcinolone acetonide in the left eye. The serous retinal detachment resolved completely at 2 months in the left eye and at 3 months in the right. As pigmentation of the retina developed, VKH disease was confirmed. The patient complained of photophobia, and both pupils were found to be enlarged to 8 mm without dilation. Light reflex was absent and near reflex was suppressed and slow. After instillation of 0.125% pilocarpine, the pupils were constricted to 3.5 mm and were diagnosed as tonic pupils. Though the patient's corrected visual acuity improved to 0.8 in the right eye and 1.0 in the left at 6 months, her pupils remained unchanged. Corneal sensitivity was decreased. Conclusions: Tonic pupils may be complicated with VKH disease even during pregnancy. We recommend examinations of the pupils and corneal sensitivity in patients with VKH disease, especially those complaining of photophobia.

Decreased Corneal Sensitivity in Patients with Dry Eye

To explore changes in corneal sensitivity that develop in patients with dry eye and the relationship between sensibility and severity of the dry eye disease. Experiments were performed in 44 patients with dry eye and 42 healthy individuals. Corneal sensitivity was measured with the Belmonte noncontact gas esthesiometer. Mechanical (air jets at flow rates from 0 to 200 mL/min, reaching the corneal surface at 34 degrees C), thermal (cold or warm air at subthreshold flow rates changing corneal basal temperature +/-1 degrees C), and chemical stimuli (air containing 0% to 50% CO2 at subthreshold flow rate and temperature at the cornea of 34 degrees C) were applied to the center of the cornea to determine the sensitivity threshold for each stimulus modality. The clinical state of the ocular surface was also explored, measuring the fluorescein tear break-up time, the degree of corneal staining with fluorescein and Lissamine green, and tear production with the Schirmer test. Both in control subjects and patients with dry eye, the corneal thresholds for mechanical, chemical, and thermal stimulation increased with age. Moreover, the thresholds for the three modalities of stimuli were significantly higher in patients with dry eye than in control subjects. In both groups, individual mechanical, chemical, and thermal thresholds correlated significantly. Also, high thresholds in patients with dry eye correlated with the intensity of fluorescein and Lissamine green corneal staining but not with the results of the Schirmer test. Patients with dry eye exhibit corneal hypoesthesia after mechanical, thermal, and chemical stimulation that appears to be related to damage to the corneal sensory innervation.

Corneal sensitivity in patients with leprosy and in controls.

In a quantitative prospective study the corneal sensation in patients with leprosy was compared with age matched controls. The patients with leprosy were classified as paucibacillary and multibacillary and were divided in three groups: (1) patients without clinically detectable eye pathology; (2) patients with lagophthalmos, (3) patients with signs of iridocyclitis. The corneal sensitivity was assessed with the Cochet and Bonnet aesthesiometer. There was a significant decrease in corneal sensitivity in multibacillary patients without clinically detectable eye pathology and in patients with lagophthalmos or iritis when compared with controls. A significant correlation between the loss of power of the orbicularis oculi muscle and the degree of corneal sensation loss could not be established. No significant decrease in corneal sensitivity was found in paucibacillary patients without eye pathology compared with the control group. The results of this study showed that loss of corneal sensation can occur while there is no clinically detectable eye pathology, at least in multibacillary patients. Regular checkups of the corneal sensation should, therefore, be part of the routine control of leprosy patients. Health education on eye care and early warning signs should be encouraged.

Immunofluorescent Staining and Corneal Sensitivity in Patients Suspected of Having Herpes Simplex Keratitis

We examined immunofluorescent staining and corneal sensitivity in 25 control subjects (25 eyes) with normal corneas, six patients (eight eyes) with possible herpes simplex keratitis, and 44 patients (48 eyes) with corneal lesions (recurrent erosion, superficial punctate keratitis, marginal ulcer, and follicular keratoconjunctivitis) in whom herpes simplex keratitis was not suspected. On immunofluorescent staining, all 25 control subjects had negative reactions, all eight eyes suspected of having herpes simplex keratitis had positive reactions, and 11 (23%) of the 48 eyes not suspected of having herpes simplex keratitis had positive reactions; the remaining 37 eyes had negative reactions. Of the 11 eyes not suspected of having herpes simplex keratitis but that had positive reactions on immunofluorescent staining, nine had recurrent erosions and the remaining two eyes had superficial punctate keratitis. Of the eight eyes with possible herpes simplex keratitis, seven (88%) had decreased corneal sensitivity. Of the 11 eyes not suspected of having herpes simplex keratitis but that had positive reactions on immunofluorescent staining, eight (73%) had decreased corneal sensitivity. Of the 37 eyes not suspected of having herpes simplex keratitis that had negative reactions on immunofluorescent staining, 11 (30%) had decreased corneal sensitivity.

Corneal Sensitivity in Nephropathic Cystinosis

We measured corneal sensitivity in 14 patients with infantile nephropathic cystinosis and in 13 age-matched controls. All patients with cystinosis had the pathognomonic anterior segment findings of crystal deposition within conjunctiva and cornea. Transcutaneous stimulation of the supraorbital nerve and surface electromyographic recording of the orbicularis oculi muscle performed on four patients showed a normal afferent limb to the blink reflex. The corneal sensitivity in patients with cystinosis was 3.18 g/mm2; in the control subjects it was 0.43 g/mm2. This difference was statistically significant (P less than .001).