Development Of Corneal Ulcers Research Articles

Topical Insulin Treatment for Neurotrophic Corneal Ulcer with Persistent Epithelial Defect

Background: Neurotrophic keratitis (NK) is a degenerative corneal disease caused by impairment of corneal sensory innervation. It is characterized by decreased or absent corneal sensation, leading to epithelial breakdown, impairment of healing, and ultimately to the development of corneal ulceration, melting, and perforation. We described a case of neurotrophic ulcer with persistent epithelial defect and its remarkable healing response to insulin eye drop treatment. Case Presentation: A 62-year-old male patient was referred to our hospital for the management of stage III NK in the left eye. The condition started 6 months ago; the patient developed a sudden onset of left eye diminution of vision, red eye, and tearing. The patient sought an ophthalmic consultation and was diagnosed with herpes simplex keratitis. On examination, visual acuity OS was hand motion (HM), severe conjunctival injection, deep corneal vascularization, corneal opacity with stromal infiltration, epithelial defect about 3.5 x 6 mm, stromal thinning, Descemet membrane folds and loss of corneal sensation by cotton wisp test. The patient was treated with topical insulin eye drops for 6 weeks and showed substantial ulcer healing and reepithelization of the epithelial defect. Conclusion: Insulin drops have been shown to substantially promote persistent epithelial defect healing in the case of neurotrophic ulcers. Therefore, topical insulin use can potentially help in the treatment of refractory neurotrophic keratitis. Further studies with large case numbers and long follow-ups should be the main focus of future research.

Retrospective assessment of ophthalmic disease development in domestic dogs and cats when hospitalised with tick paralysis caused by Ixodes holocyclus.

To investigate the incidence and predisposing factors leading to the development of corneal ulcers and the loss of a palpebral reflex in hospitalised canine and feline patients with tick paralysis (TP). A total of 102 dogs and 100 cats retrospectively were assessed from previously hospitalised patients. A retrospective cohort study was performed on 102 different canine and 100 different feline patients who were hospitalised for TP from October 2020-January 2022. Patient data were collected, and logistic regression was conducted to determine factors affecting the palpebral reflex and the development of corneal ulcers. Corneal ulcers occurred in 23/102 (22.5%) dogs during hospitalisation and were strongly associated with an incomplete palpebral reflex ipsilaterally during hospitalisation (P < 0.001), hospitalisation ≥3 days (P = 0.004), mechanical ventilation ≥3 days (P = 0.015) or a tick location cranial to C1 (P = 0.003). An incomplete palpebral reflex during hospitalisation was observed in 29/102 (28.4%) dogs and was significantly associated with decreasing patient weight (P = 0.018), increasing days hospitalised (P = 0.001), having a tick found cranial to C1 (P = 0.004), highest recorded GP grade (P = 0.01), highest recorded RP grade (P = 0.005), use of amoxycillin-clavulanic acid during hospitalisation (P = 0.002) and use of piperacillin/tazobactam during hospitalisation (P = 0.003). There was a significant association between the loss of a complete palpebral reflex and mortality during hospitalisation in dogs (OR = 4.5, P = 0.029). Corneal ulcers occurred in 10/100 (10.0%) cats during hospitalisation, and was significantly more likely to occur to an eye if an incomplete palpebral reflex was observed ipsilaterally during hospitalisation (OR = 20.1, P < 0.0001) and with increasing patient age (P = 0.019). The absence of a complete palpebral reflex during hospitalisation was observed in 18/10 (18.0%) cats and was significantly associated with increasing days hospitalised (P = 0.034). There was no significant association between the loss of a complete palpebral reflex and mortality during hospitalisation in cats. The frequency of corneal ulcers and loss of palpebral reflexes were significant in dogs and cats hospitalised by TP, with many factors contributing to the risk of these developing.

Proportion and characteristics of lacrimal drainage pathway disease and keratopathy in non-infectious corneal perforation using lacrimal syringing test

AbstractLacrimal drainage pathway disease-associated keratopathy (LDAK) has been associated with corneal perforation, which arises from both infectious and non-infectious corneal disorders. However, patients with corneal perforation are often not routinely tested for LDAK, and the potential risk posed by LDAK in the development of corneal ulcers has not been investigated in detail. This study aimed to assess the proportion and characteristics of LDAK in patients with non-infectious corneal perforation using lacrimal syringing test. This study enrolled 56 patients with corneal perforation treated at Saitama Medical University Hospital between January 2016 and September 2022. The causes of corneal perforation were trauma (n = 17, 30%), infection (n = 19, 34%), non-infection (n = 16, 29%), and unknown (n = 4, 7%). A lacrimal syringing test was performed on 12 patients with non-infectious corneal perforation and 4 with an unknown diagnosis. Among the 16 patients with non-infectious corneal perforation, 13 (81%) had lacrimal drainage disease, but only 3 (19%) patients had lacrimal puncta, as revealed by slit-lamp examinations. The primary bacterial species identified in lacrimal obstructive disease and lacrimal canaliculitis were Staphylococcus spp. and Actinomycetes spp. respectively. Lower temporal and peripheral corneal perforations were common. All patients underwent lacrimal surgery, and 6 (38%) were treated for corneal perforation without corneal surgery. Interestingly, several patients with LDAK who did not exhibit any lacrimal duct obstruction on slit-lamp examination. The study findings demonstrate the significance of the lacrimal syringing test for assessing LDAK in patients with corneal perforation, indicating LDAK as a potential cause of corneal perforation.

Solving an eye condition by looking to the rear

Solving an eye condition by looking to the rear

Risk factors for corneal ulcers: a population-based matched case–control study in Nepal

Background/aimsWe aimed to examine risk factors for corneal ulcer in a rural and peri-urban setting in Nepal.MethodsThis population-based matched case–control study was nested in a cluster randomised trial in 24...

English

BACKGROUND Significant causes of corneal blindness worldwide are ocular trauma and corneal ulceration that are often under reported. They may be responsible for 1.5 - 2.0 million new cases of monocular blindness every year. Corneal ulceration in developing countries has only recently been recognised as a silent epidemic. Infectious keratitis is one of the leading causes of blindness but in most cases these infections represent preventable or treatable ophthalmic diseases. Important predisposing factors related to corneal ulcers are trauma, chronic ocular surface disease, contact lens usage, ocular surgery, corneal anaesthetics abuse, diabetes mellitus, vitamin deficiency and immuno-deficiencies. This work is proposed to study the prevalence, clinical and lab diagnosis and management of suppurative corneal ulcer. We wanted to study the socio-demographic profile, microbiological investigation and treatment outcome of patients with corneal ulcer. METHODS This is a prospective study conducted among patients presenting with corneal ulcer at a tertiary level Government Medical College, Ajmer, Rajasthan. RESULTS Trauma comes out as a major predisposing factor for the development of corneal ulcer. 18.1 % of the study subjects had bacterial corneal ulcer and 37.7 % had fungal ulcer. More than half of the patients showed good prognosis on follow up. There was good response in most of patients, 51.2 % improved in first week which increased to 57.4 % at the time of second follow up. The most common bacterial species responsible for corneal ulcer was found to be staphylococcus followed by pseudomonas. CONCLUSIONS Bacteria and fungi are a frequent cause of ulcerative keratitis. Microbiological work up is an essential tool in the diagnosis of these infections which should not be under-rated. Timely administration of species-specific treatment certainly results in early resolution of keratitis followed by satisfactory visual outcome. Late or inappropriate treatment worsens the condition resulting in corneal perforation and increased morbidity. KEYWORDS Prospective, Corneal Ulcer, Bacterial, Fungal, Infectious

Ophthalmic effects of petroleum dispersant exposure on common murres (Uria aalge): An experimental study

The safety of chemical dispersants used during oil spill responses is largely unknown in birds. We captured common murres in Monterey Bay, CA and exposed them to Corexit EC9500a, crude oil, or a combination in artificial seawater. We performed ophthalmic examinations and measured intraocular pressures and tear production before and after exposure. Loglinear analysis found that exposure to oil or dispersant was related to the development of conjunctivitis and corneal ulcers. Odds ratios for birds exposed to oil or dispersant were positive and significant for the development of conjunctivitis, while odds ratios for the development of corneal ulcers were positive and significant only for birds exposed to a high concentration of oil. Ocular exposure to dispersants and petroleum in seabirds may cause conjunctivitis and may play a role in the development of corneal ulcers. These results have implications for policymakers who develop protocols for the use of dispersants during marine oil spills.

ДИРОФИЛЯРИОЗ ПРИДАТОЧНОГО АППАРАТА ГЛАЗА И ОРБИТЫ

Background: Floppy eyelid syndrome is a rare disorder characterized by tarsal atonia, common spontaneous eversion of the upper eyelids in conjunction with chronic papillary conjunctivitis. Floppy eyelid syndrome is a frequent cause of recurrent keratitis of different severity up to corneal ulceration. Aim: To assess tear production, tear film and status of cornea in patients with floppy eyelid syndrome. Materials and methods: We examined 8 women aged 47–81 years (median 59 years) with clinical signs of floppy eyelid syndrome. For functional assessment, Schirmer and Norn tests were used. Results: All patients had dry eye syndrome due to increased evaporation and fluid loss from the ocular surface in combination with meibomian gland dysfunction. In all cases, keratitis of varied severity was diagnosed: pitted corneal erosions in 7 patients, severe keratitis on 1 patient. In this patient, untimely diagnosis of floppy eyelid syndrome and inadequate treatment resulted in the development of purulent corneal ulcer, endophthalmitis and subsequent eye enucleation. In all patients, medical treatment involved artificial tear, night gauze bandage and therapeutic eye gels. Conclusion: In patients with floppy eye syndrome, early diagnosis and timely treatment may prevent the development of corneal ulcer.

Evaluation of risk factors for development of corneal ulcer after nonocular surgery in dogs: 14 cases (2009–2011)

To evaluate the prevalence of and risk factors for development of corneal ulcers after nonocular surgery performed with general anesthesia in dogs. Retrospective case-control study. 14 dogs with development of corneal ulcers after nonocular surgery and 718 control dogs. Medical records of dogs evaluated at the Veterinary Medical Teaching Hospital of Seoul National University from January 2009 to June 2011 were reviewed for assessment of risk factors for development of corneal ulcers. Among the 732 reviewed cases, 14 (1.9%) dogs of 6 breeds developed a corneal ulcer after nonocular surgery. Duration of anesthesia was significantly longer in dogs with ulcers than dogs without ulcers. The number of medications received and procedures performed were also significantly higher in dogs with ulcers than dogs without ulcers. Dogs with a small skull (OR, 8.59; 95% confidence interval [CI], 1.04 to 70.90) and dogs that received neurosurgery (OR, 21.12; 95% CI, 5.77 to 77.25) were more susceptible to development of corneal ulcers. Also, postoperative application of a fentanyl patch was a risk factor for development of corneal ulcers (OR, 4.53; 95% CI, 1.05 to 19.60). Several risk factors were identified for development of corneal ulcers after nonocular surgery was performed with general anesthesia in dogs. Perioperative eye protection strategies and postoperative ophthalmic examination are needed to reduce the occurrence of corneal ulcers and their progression, especially for high-risk dogs and procedures.

Demodex-AssociatedBacillusProteins Induce an Aberrant Wound Healing Response in a Corneal Epithelial Cell Line: Possible Implications for Corneal Ulcer Formation in Ocular Rosacea

The aim of the work presented here was to establish the response of a corneal epithelial cell line (hTCEpi) to protein extracted from a bacterium (Bacillus oleronius) previously isolated from a Demodex mite from a rosacea patient. The response of the corneal epithelial cell line to Bacillus proteins was measured in terms of alterations in cell migration and invasiveness. Changes in the expression of metalloproteinase genes and proteins were also assessed. The results indicated increased cell migration (14.5-fold, P = 0.001) as measured using 8-μm PET inserts (BD Falcon) in a transwell assay and invasiveness (1.7-fold, P = 0.003) as measured using 8-μm Matrigel (BD Biocoat) invasion inserts in a 24-well plate assay format, following exposure to the Bacillus proteins. Cells exposed to the Bacillus protein showed a dose-dependent increase in expression of genes coding for matrix metalloprotease (MMP)-3 (61-fold) and MPP-9 (301-fold). This dose-dependent increase in gene expression was also reflected in elevated levels of MMP-9 protein (1.34-fold, P = 0.033) and increased matrix metalloprotease activity (1.96-fold, P = 0.043) being present in the culture supernatant. Cells also displayed reduced levels of β-integrin (1.25-fold, P = 0.01), indicative of increased motility and elevated levels of vinculin (2.7-fold, P = 0.0009), suggesting altered motility. The results indicate that exposure of corneal epithelial cells to Bacillus proteins results in an aberrant wound healing response as visualized using a scratch wound assay. These results suggest a possible link between the high density of Demodex mites on the eyelashes of ocular rosacea patients and the development of corneal ulcers.

Perforating Corneal Ulceration in a Patient with Lung Metastatic Adenocarcinoma Treated with Gefitinib: A Case Report

We present a case of a sixty-year-old female who presented with sudden onset of painless loss of vision in one eye due to a perforated corneal ulcer, following three months of treatment with gefitinib, a selective epidermal growth factor receptor (EGFR) tyrosine kinase inhibitor for metastatic adenocarcinoma of the lung with confirmed EGFR gene mutation. The eye did not show any sign of infection or inflammation and had no associated lid problems to account for the development of corneal ulceration. The patient went on to have a corneal graft surgery but postoperatively developed corneal graft melt. This paper aims to raise awareness among ophthalmologists and oncologists of the probable association between gefitinib and corneal ulceration.

Conjunctival flap covering for treatment of refractory corneal ulcer

Objective To evaluate conjunctival flap covering for treatment of refractory corneal ulcer.Methods Eight-four cases of corneal ulcer that were ineffective by treatment of medicine had undergone conjunctival flap covering treatment. No perforated corneal ulcer was included. Results 80 cases were successful, the cure rate was 95. 24%. Conjunctival flap shrunk and underwent secondary surgery in 4 eyes, in which one case had secondary glaucoma, and iridectomy was applicated. Conclusion Bubar conjunctival flap covering can effectively control the development of corneal ulcers, save the eye, and give chance for further sight restoring. Key words: corneal ulcer, refractory; conjunctival flap coverage surgery

Corneal Ulcers Associated With Aerosolized Crack Cocaine Use

We report 4 cases of corneal ulcers associated with drug abuse. The pathogenesis of these ulcers and management of these patients are also reviewed. Review of all cases of corneal ulcers associated with drug abuse seen at our institution from July 2006 to December 2006. Four patients with corneal ulcers associated with crack cocaine use were reviewed. All corneal ulcers were cultured, and the patients were admitted to the hospital for intensive topical antibiotic treatment. Each patient received comprehensive health care, including medical and substance abuse consultations. Streptococcal organisms were found in 3 cases and Capnocytophaga and Brevibacterium casei in 1 patient. The infections responded to antibiotic treatment. Two patients needed a lateral tarsorrhaphy for persistent epithelial defects. Aerosolized crack cocaine use can be associated with the development of corneal ulcers. Drug abuse provides additional challenges for management. Not only treatment of their infections but also the overall poor health of the patients and increased risk of noncompliance need to be addressed. Comprehensive care may provide the patient the opportunity to discontinue their substance abuse, improve their overall health, and prevent future corneal complications.

Prevention of naturally occurring infectious bovine keratoconjunctivitis with a recombinant Moraxella bovis pilin– Moraxella bovis cytotoxin–ISCOM matrix adjuvanted vaccine

To evaluate the efficacy of a recombinant Moraxella bovis pilin– M. bovis cytotoxin subunit vaccine to prevent naturally occurring infectious bovine keratoconjunctivitis (IBK; pinkeye), a randomized, blinded, controlled field trial was conducted during summer 2005 in a northern California herd of beef cattle. One hundred and one steers were vaccinated with ISCOM matrix (adjuvant control), recombinant M. bovis cytotoxin carboxy terminus + ISCOM matrix (MbxA), or recombinant M. bovis pilin–cytotoxin carboxy terminus + ISCOM matrix (pilin–MbxA); calves received secondary vaccinations 21 days later. Calves were examined once weekly for 18 weeks for the development of corneal ulcers associated with IBK. Overall, the pilin–MbxA vaccinated group had the lowest overall cumulative proportion of ulcerated calves. Calves that received MbxA, whether alone or with pilin had significantly higher M. bovis cytotoxin serum neutralizing titers as compared to control calves. Results of ocular cultures suggested that vaccination with an M. bovis antigen affected organism type isolated from an ulcer: M. bovis was cultured more often from the eyes of control calves than from the eyes of calves vaccinated with MbxA and pilin–MbxA. In addition, vaccination of calves with MbxA and pilin–MbxA resulted in a higher prevalence of Moraxella bovoculi sp. nov. in ocular cultures. While no significant difference was observed between a cytotoxin versus pilin + cytotoxin vaccine against IBK, the reduced cumulative proportion of IBK in the pilin–cytotoxin vaccinated calves suggests it may provide an advantage over a cytotoxin vaccine alone. Efficacy of an M. bovis vaccine may be reduced in herds where IBK is associated with M. bovoculi sp. nov.

Corneal Ulcers in Two Children Wearing Paragon Corneal Refractive Therapy Lenses

To report the development of corneal ulcers in two children wearing Paragon Corneal Refractive Therapy (CRT) lenses. Two case reports of children who developed corneal ulcers when fit with Paragon CRT contact lenses, which were worn nightly, are discussed. Each patient presented with a bacterial corneal ulcer after wearing CRT contact lenses for less than 6 months. In the first patient, Pseudomonas aeruginosa was identified as the causative organism. In the second patient, Haemophilus influenza was cultured from the ulcer. Both patients were treated with intensive, fortified antibiotics with rapid resolution of the corneal ulcers and preservation of vision. No surgical intervention was required. Paragon CRT lenses have been approved for use in patients of all ages. When used in children, these lenses may present unique problems. The absolute incidence of bacterial corneal ulcers in patients with CRT lenses are unknown. Severe caution should be used before prescribing CRT lenses for children and informed consent should include potential sight-threatening corneal ulcers.

Contact lens–related corneal ulcers in compliant patients

Purpose To report a case series of contact lens–related corneal ulcers in compliant patients with no apparent predisposing factors. Design Retrospective case series. Methods Charts of 70 patients with contact lens–related corneal ulcers from July 1999 to June 2002 were reviewed. Lens care hygiene and method of disinfection, as well as frequency of lens replacement, were recorded. Only patients who followed recommended guidelines for contact lens wear were included in the study. Results Of the 70 patients, 21 (30%) developed corneal ulcers despite being compliant with the guidelines for contact lens wear. All patients used multipurpose solutions for cleaning, disinfecting, and storing daily wear soft contact lenses. Conclusion Standard lens care hygiene does not seem to be sufficient in preventing the development of corneal ulcers in patients using conventional and frequent replacement daily wear soft contact lenses.

Systemic disorders associated with peripheral corneal ulceration.

Peripheral ulcerative keratitis may be associated with a variety of autoimmune diseases. In some diseases, corneal involvement occurs after the systemic disease has been present for many years, whereas in others, it may be the first manifestation. Regardless of the time of presentation, the development of corneal ulceration in the setting of systemic autoimmune disease may represent progression of a potentially life threatening disease. The relatively rare incidence of these diseases has limited publications over the past year to a few case series that have further characterized the natural history of the diseases associated with peripheral ulcerative keratitis. Current laboratory research has been directed at describing the antigenic targets within the cornea of the abnormal immune response in these patients and also the mechanism of keratolysis that results in ulceration.

An excess of topical calcium and magnesium reverses the therapeutic effect of citrate on the development of corneal ulcers after alkali injury.

Our purpose was to determine whether chelation of Ca2+ and Mg2+ is the mechanism by which sodium citrate inhibits corneal ulceration in the alkali-injured rabbit eye. The right eyes of 60 albino rabbits (2-2.5 kg) were alkali-injured by filling a 12-mm-diameter plastic well placed on the corneal surface with 0.4 ml of 1 N NaOH. After 35 s the alkali was aspirated, and the well was rinsed with physiological saline. Animals were randomly distributed to three treatment groups of equal size. Two drops of the following topical medications were administered on the hour (14 times per day) for 35 days: physiological saline, 10% citrate in saline, and 346 mM Ca2+, 346 mM Mg2+, and 10% citrate in saline. During the experiment, significantly fewer ulcerations occurred in the citrate-treated eyes (five of 20, 25%) than in the saline-treated eyes (13 of 20, 65%) or in the calcium-magnesium-citrate-treated eyes (15 of 20, 75%). When ulcerations did develop in the citrate group, they occurred significantly later and were less severe than those in the saline and calcium-magnesium-citrate groups. There was a significant increase in the number of eyes with signs of band keratopathy and translucent areas in the calcium-magnesium-citrate group when compared with the other two groups. As in previous studies, sodium citrate significantly inhibited the development of corneal ulcers after alkali injury. The annullment of the favorable effect of citrate on ulceration in the alkali-injured eye by the addition of calcium and magnesium shows that the mechanism of action of citrate is the chelation of these divalent cations.

Platelet-activating factor induces collagenase expression in corneal epithelial cells.

Platelet-activating factor (PAF), a potent lipid mediator involved in inflammatory and immune responses, accumulates rapidly in response to injury in a variety of tissues, including the corneal epithelium. However, the precise role of this compound in the cascade of events following insult has not been defined. Here we examined the effect of PAF on gene expression in the epithelial cells of rabbit corneas in organ culture. We found that incubation with 100 nM methylcarbamoyl PAF, a nonhydrolyzable analog of PAF, produced rapid transient 2.8- and 3.5-fold increases in the expression of c-fos and c-jun, respectively, at 1 hr, followed by increased expression of the collagenase type I gene beginning at 3 hr and peaking at 14-fold by 8 hr. Addition of the protein-synthesis-inhibitor cycloheximide superinduced c-fos and c-jun, strongly potentiating the PAF effect, but inhibited the induction of collagenase type I expression, suggesting the existence of a transcriptional factor linking the two events. BN-50730, a selective antagonist of intracellular PAF-binding sites, blocked the expression of the immediate-early genes as well as the increase in collagenase type I mRNA. Our results suggest that one of the functions of PAF may be to enhance the breakdown of the extracellular matrix as a part of the remodeling process during corneal wound healing after injury. Pathologically, a PAF-induced overproduction of collagenase may be a factor in the development of corneal ulcers, as well as other pathophysiological conditions such as cartilage destruction in arthritis. If so, inhibitors of this signal-transduction pathway may be useful as tools for further investigation and, eventually, as therapeutic agents to treat such disorders.

Microvascular submandibular gland transfer for the management of xerophthalmia; an experimental study

Free submandibular salivary gland transfer was investigated as a method of treatment for xerophthalmia. Xerophthalmia was created in rabbits by surgical removal of the lacrimal gland and the incidence of corneal ulceration was seen to correlate with the decrease in tear secretion. Microvascular transfer of the submandibular salivary gland to drain saliva into the conjunctival fornix prevented the development of corneal ulceration in 63% of the cases.