muramidase and Blepharitis

Diagnosis of a dry eye is facilitated by prompt recognition of pertinent signs and symptoms and by utilisation of those office and laboratory procedures which help to confirm the diagnosis. Prior knowledge of those systemic diseases associated with keratoconjunctivitis sicca (KCS) alert the practitioner to a possible dry eye state. Conversely, a diagnosis of KCS may prompt recognition of a hitherto unsuspected systemic disease. In this review, I will discuss the signs and symptoms of KCS, its association with various systemic conditions, as well as the tests and procedures that contribute to its diagnosis.

Topics: Adolescent; Adult; Blepharitis; Child; Cornea; Dysautonomia, Familial; Epithelium; Erythema Multiforme; Humans; Keratoconjunctivitis; Lactoferrin; Muramidase; Osmolar Concentration; Pemphigoid, Benign Mucous Membrane; Rose Bengal; Sarcoidosis; Sjogren's Syndrome; Tears

To evaluate changes in symptoms, objective tests, and signs after medical treatment of subjects with evaporative-type dry eye disease (EDE) caused by Meibomian gland dysfunction (MGD), and to analyze correlations among symptoms, signs and test results in the worse eyes (W-eyes) of the subjects.. Prospective clinical study of 21 symptomatic subjects with EDE caused by MGD. Subjects who were diagnosed with EDE in a first visit were treated for 6 weeks and re-evaluated in a second visit. The differences between initial and second visits were evaluated. Correlations among clinical symptoms, signs, and test results were performed using the data of the W-eyes. Variables evaluated included: dry eye symptoms, best corrected visual acuity (BCVA), contrast sensitivity, conjunctival hyperemia, phenol red thread test, tear break-up time (TBUT), tear meniscus height (TMH), corneal fluorescein and conjunctival rose Bengal staining, tear lysozyme concentration, Schirmer test, and lid margin assessment.. All items evaluated improved after treatment, but only conjunctival hyperemia and TMH improved significantly. TBUT and lid margin changes improved, but still remained abnormal. There were significant correlations among symptoms questionnaires and some clinical tests (TBUT, conjunctival hyperemia, TMH, and conjunctival rose Bengal staining).. Despite the instability of the tear film and lid margin alterations that continued after treatment, subjects with MGD improved symptomatically. The low degree of correlations among W-eye signs, symptoms, and tests reflects the independency of symptoms and signs in this complex pathology.

Topics: Adult; Aged; Blepharitis; Contrast Sensitivity; Cross-Sectional Studies; Dry Eye Syndromes; Female; Fluorescent Dyes; Humans; Hyperemia; Male; Meibomian Glands; Middle Aged; Muramidase; Ophthalmic Solutions; Prospective Studies; Rose Bengal; Surveys and Questionnaires; Tears; Visual Acuity

Despite the high frequency and clinical relevance of blepharitis-associated dry-eye syndrome, no agreement exists about whether diagnostic tests should be performed with or without topical anesthesia. The aim of this study was to compare the influence of topical anesthesia on the mean values of Schirmer's test, tear lysozyme, tear lactoferrin, and tear osmolarity in patients suffering from blepharitis-associated dry eye syndrome.. The authors compared the mean values of Schirmer's test, tear osmolarity, tear lysozyme (turbidimetric assay), and tear lactoferrin (radial immunodiffusion) before and after topical anesthesia in the following groups: 56 normal subjects (group 1), 62 blepharitis patients (group 2), and 15 patients with blepharitis-associated dry eye syndrome (group 3). All clinical and laboratory tests were performed by masked observers.. In group I, mean values of Schirmer's test decreased 24.8% (p < 0.01) when performed after application of topical anesthesia. The other tests were not significantly modified. In groups 2 and 3, significant differences were seen in Schirmer's test (25.33% and 24.19% respectively, p < 0.001) and the lysozyme determination (14.00% and 13.22% respectively, p < 0.01). Differences between the normal subjects (group I) and the patient groups increased when the tests were performed after application of topical anesthesia reaching statistical significance in group 3 for all the tests.. Performing diagnostic tests after topical anesthesia instillation could be useful in detecting dry eye associated with blepharitis.

Topics: Adrenergic alpha-Agonists; Adult; Anesthesia, Local; Anesthetics, Local; Blepharitis; Drug Combinations; Dry Eye Syndromes; Female; Humans; Lactoferrin; Male; Middle Aged; Muramidase; Naphazoline; Ophthalmic Solutions; Osmolar Concentration; Tears; Tetracaine

Seventeen patients with cystic fibrosis and 17 age-, race-, and sex-matched controls were examined under standardized conditions. Testing included slit-lamp biomicroscopy, fluorescein staining, rose bengal staining, Schirmer's basic tear test, tear film break-up time, tear pH, tear lysozyme, tear protein, lid and conjunctival cultures, and conjunctival impression cytology. Cystic fibrosis patients showed a statistically significant increase in the incidence of fluorescein staining and clinical blepharitis, as well as significantly decreased Schirmer testing and tear lysozyme. Ocular surface abnormalities in these patients may be attributable to aqueous and lipid tear film deficiencies. Cystic fibrosis patients showed normal conjunctival epithelial cell morphology, grew no pathogenic organisms, and had a decreased incidence of conjunctival bacterial colonization.

Topics: Adolescent; Adult; Blepharitis; Child; Conjunctiva; Cystic Fibrosis; Data Interpretation, Statistical; Eye; Female; Fluorescent Dyes; Humans; Hydrogen-Ion Concentration; Male; Muramidase; Tears

Topics: Adolescent; Adult; Aged; Aged, 80 and over; Anti-Bacterial Agents; Blepharitis; Child; Eyelid Diseases; Female; Humans; Keratoconjunctivitis; Keratoconjunctivitis Sicca; Male; Meibomian Glands; Middle Aged; Muramidase; Staphylococcal Infections; Tears

Topics: Adult; Blepharitis; Dermatitis, Seborrheic; Eyelid Diseases; Female; Humans; Keratoconjunctivitis; Male; Meibomian Glands; Microbial Sensitivity Tests; Mite Infestations; Muramidase; Propionibacterium acnes; Rosacea; Staphylococcal Infections; Staphylococcus; Tears; Time Factors

An ELISA method is described for measuring the age-related changes of tear lysozyme, lactoferrin, ceruloplasmin, IgA and IgG in normal eyes. The normal levels for these proteins at each age are compared with those from patients with dry and 'questionably dry' eyes, which each have individual profiles, as well as with patients suffering from ocular pemphigoid, chronic non-ulcerative blepharitis and meibomianitis. Results of tear lysozyme assays from patients on various beta-blockers are discussed with the suggested hypothesis that stimulation of beta-receptors per se in the human lacrimal gland is not required for tear protein secretion. The importance of other proteins present in the tear fluid is reviewed.

Topics: Adult; Aged; Aging; Blepharitis; Ceruloplasmin; Eyelid Diseases; Humans; Immunoglobulin A; Immunoglobulin G; Keratoconjunctivitis; Labetalol; Lactoferrin; Middle Aged; Muramidase; Pemphigoid, Bullous; Practolol; Propranolol; Tears; Timolol; Xerophthalmia

Tear lysozyme concentrations were measured on 47 patients with chronic blepharitis and 22 normal control patients. The patients consisted of 26 individuals with various types of chronic blepharitis alone and 21 individuals with chronic blepharitis and clinically-diagnosed keratoconjunctivitis sicca (KCS). The mean lysozyme concentration of blepharitis patients without KCS (4070 micrograms/ml) was not significantly different from normals (3760 micrograms/ml). However, mean lysozyme concentration of the blepharitis patients with KCS (2530 micrograms/ml) was significantly lower than normals or blepharitis patients without KCS (p less than 0.01). It was concluded that tear lysozyme deficiency does not play a significant role in the etiology of chronic blepharitis. However, a large percentage of patients with chronic blepharitis were found to have KCS.

Topics: Adolescent; Adult; Aged; Blepharitis; Child; Child, Preschool; Chronic Disease; Eyelid Diseases; Female; Humans; Infant; Keratoconjunctivitis; Male; Middle Aged; Muramidase; Reference Values; Tears

Concentrations of tear lysozyme, lactoferrin, ceruloplasmin, IgG, and IgA have been measured by enzyme linked immunosorbent assay (ELISA) in patients with chronic non-ulcerative blepharitis and meibomianitis at the same time as the lid and conjunctivae were cultured for bacteria and fungi by a semiquantitative method. A group of normal controls aged 20 to 80 were similarly sampled, when strains of Staphylococcus epidermidis from their eyes and the patients' eyes were biotyped according to Baird-Parker's scheme. 5% of blepharitis cases had increased numbers of Staph. aureus present on the lids, compared with only a scanty growth obtained from 5% of normals. 7% of blepharitis cases had increased numbers of Staph. epidermidis type VI (coagulase-negative, mannitol-fermenting) present compared with a scanty growth obtained from 6% of normals. Isolation rates of other types of Staph. epidermidis did not differ from those in normals; no types were associated with meibomianitis. Tear protein profiles were normal in most patients, and there was no increase in tear IgA or IgG, which is expected with chronic infection. Overall our evidence suggests that in 88% of cases these lid conditions have an inflammatory aetiology not associated with infection. Staphylococcal isolates often found in the eye usually represent a normal commensal rather than pathogenic flora.

Topics: Adult; Aged; Blepharitis; Ceruloplasmin; Eyelid Diseases; Eyelids; Female; Humans; Immunoglobulin A; Immunoglobulin G; Lactoferrin; Malassezia; Male; Meibomian Glands; Middle Aged; Muramidase; Staphylococcus aureus; Staphylococcus epidermidis; Tears

We studied the lysozyme content of tears in 267 subjects (521 eyes), including 241 healthy subjects, 7 patients (14 eyes) with bilateral blepharitis, 8 patients (12 eyes) with conjunctivitis, and 11 patients (16 eyes) with keratitis. The concentration of lysozyme in the tears rises with age between childhood and maturity. The highest values were seen in the age group of 21-40 years, and a decrease of lysozyme concentration occurred with an increase in age from 30-40 years. The mean lysozyme content of tears was 1,768 micrograms/ml in healthy subjects; no significant differences occurred between the sexes. Patients with blepharitis, conjunctivitis, and keratitis had normal mean lysozyme content of tears. The tears of patients with herpes simplex keratitis had low lysozyme values.

Topics: Adolescent; Adult; Age Factors; Aged; Blepharitis; Child; Conjunctivitis; Eye Diseases; Female; Humans; Keratitis; Male; Middle Aged; Muramidase; Tears