External Ocular Infections Research Articles

Ciprofloxacin as Treatment for Conjunctivitis

The authors studied the bactericidal action and therapeutic effectiveness of ciprofloxacin in treating external ocular infections (bacterial conjunctivitis and bac-terial blepharoconjunctivitis). 108 ambulatory patients with clinical signs of con-junctivitis and blepharoconjunctivitis were enrolled in the study. All subjects under-went a conjunctival swab before starting therapy and at 10 days, to identify the causative bacteria and their susceptibility to ciprofloxacin, following routine micro-biological methods. The reported therapeutic success rate (95%) and bacteriological analysis confirmed the effectiveness of ciprofloxacin in subjects with bacterial con-junctivitis and bacterial blepharoconjunctivitis. In vitro tests conducted 10 days after treatment confirmed the in vivo therapeutic effectiveness, even for those infections characterized by a difficult etiological identification which interferes with specific antibiotic therapy.

Is the cystatin-like domain of TSL functionally active in external ocular infections and during the normal diurnal cycle?

Purpose. To test whether the cystatin-like functional domain in tear specific lipocalin (TSL) is functionally active in tears during the normal diurnal cycle and during external ocular infections. Methods. Capillary tube collected reflex (RTF), open (OTF) and closed (CTF) eye tear samples were recovered from six normals and semi-quantitatively western blot assayed for cystatin C and TSL. CTF samples were immunoprecipitated with antibodies raised against TSL, cystatin C and other antiproteases and screened for the co-precipitation of proteases by casein and gelatin zymography. OTF samples recovered from individuals with viral, fungal and bacterial keratitis were similarly screened for TSL-bound proteases. Human tissue was subjected to immunohistochemical study. Results. Western blot analysis reveals a progressive increase in cystatin C in going from RTF to OTF to CTF samples (∼3, 7 and 30 ng μl −1, respectively). In contrast, the concentration of TSL remains constant (∼1500 ng μl −1). Immunocytochemistry data show staining of the apical surface of the human conjunctiva and some intra-cellular staining for cystatin C, but not for cystatin A. Zymography confirms earlier data that CTF contains exceptionally high levels of proteases bound to a wide range of specific inhibitors. However, only trace amounts of proteases are complexed with cystatin C and no protease can be detected bound to TSL in either the pathological or CTF samples. Conclusion. Although TSL contains a functional cystatin-like domain, it is not physiologically active during the normal diurnal cycle or during external ocular infections. Reactive proteases in CTF are most likely controlled by the presence of excess levels of more reactive cystatins, especially cystatin C, which accumulates during prolonged eye closure. Immunohistochemical data suggest that the apical conjunctiva may be a contributing source for the accumulating cystatin C.

Clinical evaluation of bioadhesive ophthalmic drug inserts (BODI ®) for the treatment of external ocular infections in dogs

In the case of external ocular diseases such as conjunctivitis, keratoconjunctivitis sicca (KCS) and superficial corneal ulcers, topical administration of eyedrops containing an antibacterial agent is often prescribed. Numerous daily instillations of eyedrops over several days are required for successful treatment, often leading to bad compliance. In addition, the reflex lachrymation following instillation promotes rapid elimination of the drug from the corneal surface. To overcome the disadvantage of repeated instillations, a soluble bioadhesive ophthalmic drug insert (BODI ®) to be placed in the lower cul de sac of the eye was developed. The clinical efficacy, after deposition of one insert and a classical eyedrop treatment (Tiacil ®, Virbac Laboratories), was investigated in dogs presenting conjunctivitis, superficial corneal ulcer or keratoconjunctivitis sicca (KCS). Similar total clinical recovery results were obtained after 3 and 7 days for both treatments. BODI can therefore advantageously be prescribed for the treatment of external ophthalmic diseases, by reducing the treatment to a single application and therefore improving compliance compared to classical eyedrop treatment.

Changes in the diurnal pattern of the distribution of gelatinases and associated proteins in normal and pathological tear fluids: evidence that the PMN cell is a major source of MMP activity in tear fluid.

The matrix metalloproteases (MMP) play critical roles in modulating apoptosis, angiogenesis, cell migration, wound healing, tissue remodeling and inflammation in all connective tissues. Two extracellular MMPs, both type IV gelatinases, MMP-2 and MMP-9 (gelatinase A and B), as well as their respective inhibitors TIMP-1, TIMP-2 and TIMP-3 have been detected in the human cornea. MMP-9 is localized in the epithelium while MMP-2 is expressed preferentially by stromal keratocytes, and to a lesser extent, in the epithelium with expression of both enzymes up-regulated during wound healing.1 MMPs, principally pro-MMP-9 and associated complexes, have been detected in human tear fluid in the open eye condition. Active MMP-9 is presumed to be derived principally from the epithelium. Increased levels of enzyme and a shift in the pattern of distribution from proenzyme to the active MMP-9 species, along with the emergence of pro-MMP-2 and active MMP-2, has been observed in tear fluid in a wide range of pathological conditions. These conditions include external ocular infections, corneal wound healing secondary to LASIK, sterile corneal ulcers, dry eye syndrome, active keratoconus, ocular rosacea and sterile corneal melts.2–4 This study was designed to examine the origins and the nature of gelatinolytic species and associated proteins present in normal and pathological tear fluid during open and closed eye phases of the diurnal cycle.

Antiviral prophylaxis with twice daily topical cidofovir protects against challenge in the adenovirus type 5/New Zealand rabbit ocular model

Adenoviral ocular infections are the most common external ocular infections world wide and there is no approved treatment. Topical cidofovir has been shown to be effective in vitro, in animal models and in case studies for the treatment of adenoviral ocular infections. Prophylaxis to prevent transmission within households and to reduce community epidemics remains an important public health goal. The current study examined whether antiviral prophylaxis with cidofovir, twice daily dosing, would restrict viral replication following a large challenge inoculum of adenovirus type 5 (Ad5) in the New Zealand white rabbit ocular model. The results showed that antiviral prophylaxis with 1 and 0.5% cidofovir significantly reduced mean daily Ad5 ocular titers (days 0–5), the number of Ad5 positive cultures/total (days 1–14), serial Ad5 positive cultures/total (days 1, 2, 3, 4, 5, 7), and the number of eyes with Ad5 replication beyond day 0 (1% cidofovir only). Antiviral prophylaxis appears to be an effective strategy to reduce and restrict adenovirus replication experimentally.

Co-occurring Adenoviral Keratitis and Hemorrhagic Cystitis

Adenoviruses are ubiquitous viruses, commonly causing ocular infections. They are also known to cause multisystem infections. External ocular infections caused by adenovirus are most often due to contaminated secretions. We report a patient in whom genitourinary symptoms developed and subsided along with ocular symptoms. Adenovirus was isolated on ocular culture. This is the first reported case of concurrent adenoviral keratitis and hemorrhagic cystitis. Eliciting a history of genitourinary and respiratory symptoms is important in patients with ocular adenoviral infections.

Fluoroquinolones for the eye.

Two fluoroquinolone antibiotics, ciprofloxacin (Ciloxan-Alcon) and ofloxacin (Exocin-Allergan), are available in the UK as topical preparations for the eye. Ciprofloxacin eyedrops are licensed for the treatment of "corneal ulcers and superficial infections of the eye", and ofloxacin eyedrops for "external ocular infections (such as conjunctivitis and keratoconjunctivitis)". In the UK chloramphenicol is commonly recommended as the drug of first choice for the treatment of superficial bacterial eye infections. Do fluoroquinolone preparations offer any advantage over this or other established drugs?

Topically Administered Norfloxacin Compared with Topically Administered Gentamicin for the Treatment of External Ocular Bacterial Infections

In this double-masked study, we randomly assigned 488 patients with clinical signs of acute bacterial conjunctivitis or blepharitis, or both, to treatment with either norfloxacin ophthalmic solution 0.3% (245) or gentamicin ophthalmic solution 0.3% (243) for one week. Of the patients with positive cultures, 71% (85 of 120) of the norfloxacin-treated patients and 65% (86 of 133) of the gentamicin-treated patients were clinically cured. An additional 25% (30 of 120) of norfloxacin-treated patients and 32% (43 of 133) of gentamicin-treated patients were clinically improved. On the basis of posttreatment cultures, 89% of all cultured bacteria were eradicated (146 of 179 organisms) or suppressed (14 of 179 organisms) after treatment with norfloxacin. The condition of five norfloxacin-treated patients did not clinically improve, compared with the condition of eight gentamicin-treated patients. Both antibiotics had similar efficacy against gram-positive and against gram-negative organisms. One norfloxacin-treated patient and two gentamicin-treated patients withdrew from the study because of local intolerance. Norfloxacin appears to be an effective and relatively safe agent for the treatment of bacterial infections of the eyelids or conjunctiva, or both. In this study, norfloxacin was clinically and microbiologically similar in activity to gentamicin.

Ofloxacin compared with chloramphenicol in the management of external ocular infection.

The safety and efficacy of 0.3% ofloxacin in treating bacterial ocular infections was compared with that of 0.5% chloramphenicol in a parallel-group, randomised clinical trial at five sites. Clinical and microbiological improvement rates were studied in 84 culture-positive patients. Patients with suspected bacterial ocular infections were evaluated for clinical improvement and were included in drug safety and comfort analyses. Clinical improvement did not differ significantly between drug treatments. All patients completing the study (79 assigned ofloxacin, and 74 chloramphenicol) showed clinical improvement. Clinical improvement in the culture-positive groups was 100% (41/41) after ofloxacin treatment, and 95% (41/43) after chloramphenicol treatment. Microbiological improvement rates were similar for the two drugs: 85% (33/39) improved with ofloxacin, and 88% (38/43) improved with chloramphenicol. Both drugs were well tolerated. Adverse reactions possibly due to the study medication occurred in 1% (1/89) of those who received ofloxacin, and in 4% (4/93) of those who received chloramphenicol.

Nocardia Asteroides Infection Following Scleral Buckling

We report a case of delayed external ocular Nocardia asteroides infection following scleral buckling for rhegmatogenous detachment. Surgical removal of the exoplant material allowed isolation and identification of the organism. Topical and systemic antibiotic therapy following exoplant removal yielded a favorable result.

Sustained Gentamicin Release by Presoaked Medicated Bandage Contact Lenses

Current therapeutic regimens for external ocular infections require instillation of antibiotics up to every quarter of an hour in concentrations higher than those commercially available. As an alternative to topically applied gentamicin eye drops, the possibility of sustained gentamicin release by bandage contact lenses was investigated. Ten hydrogel bandage contact lenses (61.4% HEMA and 38.6% water content) were soaked overnight in a 0.5% solution of sterile, unpreserved, commercially available gentamicin, and fitted thereafter on ten eyes of healthy adult volunteers. Gentamicin concentrations in the tear film were determined 10, 30, and 60 minutes, and 4, 8, 24, 48, 72, and 96 hours after fitting, using agar diffusion bioassay. Bactericidal concentrations (>1.6 µg/ml) were found up to 3 days after contact lens fitting in all subjects. No toxic topical or systemic effects were seen.

Keratopathy in a Family with the Ectrodactyly-Ectodermal Dysplasia-clefting Syndrome

Four members of a family with the ectrodactyly-ectodermal dysplasiaclefting (EEC) syndrome and associated keratopathy are presented. The main features of this syndrome include lobster-claw deformities of the hands and feet, abnormalities of the hair and teeth, cleft lip and palate, nasolacrimal abnormalities, and a progressive keratopathy ranging in severity from an asymptomatic pannus to bilateral dense corneal scarring and neovascularization. Despite congenital limb abnormalities, the major functional disability of three of these patients stems from severe photophobia and decreased visual acuity secondary to the corneal disease. Treatment with cycloplegics, topical steroids, and bandage soft contact lenses was unsuccessful. The EEC syndrome is transmitted in an autosomal dominant manner. The spectrum of keratopathy demonstrated in this family can be explained by the different ages of the patients, by variation in gene penetrance and expressivity and by differing durations and severity of dacryocystitis and related keratoconjunctivitis. The etiology of the keratopathy appears to be primarily a manifestation of the underlying ectodermal dysplasia with probable contributions from associated tearfilm abnormalities and external ocular infection.

Lysozyme Content of Tears in Some External Eye Infections

We estimated tear flow and lysozyme content in 130 eyes with external ocular infections during the active infection and after recovery and compared these findings to those for 286 normal eyes. We found an exact correlation between the rate of tear secretion in eyes with external infections and the enzyme content of the tears. The greater the flow of tears, the greater was the decrease in the enzyme content of the tears.

Ocular Microbial Flora in Immunodeficient Patients

The eyes of 20 patients with primary immunodeficiency syndromes were examined, and microbial cultures of their lids and conjunctivae were made. Nine patients had a history of recurrent external ocular infections, and six of these had active blepharitis or blepharoconjunctivitis at the time of examination. A single pathogenic bacterium was isolated from the lids and conjunctivae of six patients with a history of infection; a mixture of two possible pathogens was cultured from eyes of three other patients. Three of the nine patients with infections had impaired B-cell and intact T-cell immunity, whereas three patients had impaired B cell and T-cell immunity. Two patients had chronic granulomatous disease in which a defect in phagocytosis was the predominant immunologic abnormality, and one patient (with mucocutaneous candidiasis) had intact B- and T-cell function at the time of testing. Although the immunodeficient patients had a higher incidence of lid or conjunctival infection than 20 age-matched controls, the microbial flora of the lids and conjunctivae did not differ between the two groups.

External Infections of the Eye: Bacterial, Viral, and Mycotic

ABSTRACT This, the second edition of External Infections of the Eye, fills an important void in ophthalmology. It begins with a series of beautiful illustrations of a variety of corneal and external ocular infections. Each clinical plate is accompanied by pictures of cytologic appearance and by pictures of the organisms on culture. The more common entities are stressed, but even esoteric and rare infections such as those caused by leprosy are pictured, their cytology documented, and their culture characteristics discussed in adequate detail. Lesions due to the mycoses as well as Chlamydia are documented, as are those caused by the common viruses.The second part of the book concisely summarizes both the microbiological properties of the causative agents as well as the common forms of therapy. The final portion of the book deals with the practical aspects. In a straightforward how-to fashion, the text illustrates the exact methods and materials for

Treatment of External Ocular <i>Candida</i> Infections with 5-FIuorocytosine

15 patients who suffered from severe and prolonged external Candida ocular infections and who had not responded to Mycostatin and/or Amphotericin B treatment, were successfully treated with 5-Fluorocytosine administered topically or combined topical-orally. In all patients, a cure was achieved after a treatment period of approximately 6 months. No side effects were observed and no resistance to the drug developed.

Study of external ocular bacterial infections on rural area

1) 208 patients who had external ocular bacterial infections (conjunctivitis, holdeolum, dacryocystitis) were observed on organismus, sensitivitis test and therapeutic effect from 1972 to 1974 on rural area in Nagano prefecture.2) The most common organismus was Staphylococcus epidermidis (23.1%) Haemophilus influenzae, Staphylococcus aureus, α-Streptococcus and Diplococcus pheumoniae were found in more than 10%. Pseudonomas aeruginosa and Klebsilla were not found. This tendency was seen in the city previously.3) Cases of 2 or more organismus isolated found in 37%, this percentage was higher than previous paper.4) The results of sensitivity test showed the most effective antibiotics were KM and GM.The most effective instillation was KM.

Common external ocular infections.

In the United States, blepharitis marginalis, acute and chronic catarrhal conjunctivitis, lacrimal conjunctivitis, and herpes simplex keratitis make up about 20 percent of eye problems. Sulfonamide ointments or drops are usually used in blepharitis marginalis and lacrimal conjunctivitis and sometimes in catarrhal conjunctivitis, but in herpes simplex keratitis, 5-iodo-2′-deoxyuridine is most effective and corticosteroids are contraindicated.

Ophthalmic use of novobiocin.

The sensitivity of 270 strains of bacteria isolated from 264 patients with external eye infections was tested against novobiocin. There were 136 strains of coagulase negative staphylococci, all of which were sensitive to novobiocin; 100% sensitivity was likewise found in 89 strains of coagulase positive staphylococci, 5 strains of diplococcus pneumoniae, and 15 strains of alpha and beta hemolytic streptococci. Varied results were obtained with other organisms, and 13 strains of Pseudomonas aeruginosa were found uniformly resistant. Thirty patients with various clinical types of external ocular infection were treated with an ointment containing 1 % novobiocin every three hours during the day. Clinical cure resulted in 28; in the two unsuccessful cases the infection was ascribed to either a fungus or a virus. The effectiveness of novobiocin was demonstrated, but the authors advise limiting its use to the more serious eye infections.

Incidence of Coagulase-Positive Staphylococci in external Ocular Infections

The surveys concerning the microflora of external ocular infections in the United States generally indicate that staphylococci are the commonest bacteria encountered.* Therefore, the need commonly arises (for obvious epidemiologic, bacteriologic, and clinical reasons) to differentiate the pathogenic from the nonpathogenic strains. In the past such criteria as hemolysis on blood plates, fermentation of mannitol, pigmentation, and liquefaction of gelatin have been employed. However, it is generally agreed that these characteristics can only serve as presumptive evidence of pathogenicity, since the nonpathogenic strains may also exhibit similar reactions, usually to a slighter degree. Furthermore, the pathogenic strains may vary considerably in their biochemical reactions as well as in the production of pigment. The ability of certain staphylococci to coagulate citrated or oxalated plasma was first described in 1903 by Loeb. 4 Cruickshank 5 and Thygeson, as well as others, maintain that the coagulase test is the most reliable and convenient