muramidase and Keratoconjunctivitis-Sicca

Laboratory tear function tests, such as the lactoferrin and the lysozyme test, reflect the level of tear gland deficiency and are, therefore, very useful for the clinician in the diagnosis of keratoconjunctivitis sicca (KCS). Although these tests do have an excellent discriminatory ability, they should be used in addition to clinical tests, such as the Schirmer-1 test, the tear film break-up time (BUT) and the Rose bengal (Rb) staining test. Schirmer's test, the most commonly used clinical test, measures tear fluid production. The tear film BUT, on the other hand, is the only test which establishes tear film instability. The Rose bengal score is strongly related to secondary damage of the superficial epithelium of the cornea and conjunctiva in patients with KCS. Thus, combining the results of these various tests facilitates the diagnosis of KCS and also the differentiation between Sjögren's KCS and non-Sjögren's KCS.

Topics: Diagnosis, Differential; Humans; Keratoconjunctivitis Sicca; Lacrimal Apparatus; Lactoferrin; Muramidase; Rose Bengal; Tears

To evaluate the concentration of tear lipocalin, lysozyme, and total protein in Sjögren's Syndrome (SS), non-Sjögren's keratoconjunctivitis sicca (KCS), and non-dry-eyed (NDE) individuals.. Seventy-six subjects were recruited for this study: 25 SS subjects; 25 KCS subjects, and 26 NDE individuals. Symptoms were measured with a visual analogue scale. Tear flow was measured by the Schirmer I test without anesthesia. Tears were collected using an eye wash technique. Total tear protein was quantified using the DC Protein Assay Kit. Tear lipocalin and lysozyme were quantified via Western blotting performed on a Phast System.. By definition, the SS and KCS groups both had significantly lower mean Schirmer scores (5.12 +/- 5.96 mm and 7.84 +/- 7.35 mm) compared with the NDE group (23.83 +/- 7.85 mm; p < 0.0001). There was no difference in mean Schirmer scores between SS and KCS groups (p = 0.19). The tear film of the SS group was characterized by significantly reduced (p < 0.0001) total protein and lipocalin concentrations compared with both KCS and NDE groups. No difference between the KCS and NDE groups was found in total protein (p = 0.92) or lipocalin (p = 0.19) concentration. In contrast, the concentration of tear film lysozyme was found to be statistically similar in all three groups examined. No statistically significant correlation was found in any group between mean Schirmer values compared with total protein, lipocalin or lysozyme concentration.. Our data demonstrate a biochemical distinction between the Sjögren's group compared with both KCS and control groups, in that both tear lipocalin and total tear protein were significantly reduced. Although correlations were not found between protein measurements and tear flow, a combination of tests including Schirmer I and quantitation of tear film biomarkers may allow for the identification of SS patients without the need for invasive testing.

Topics: Blotting, Western; Eye Proteins; Female; Humans; Keratoconjunctivitis Sicca; Lipocalins; Male; Middle Aged; Muramidase; Sjogren's Syndrome; Tears

To assess the course of tear gland function of patients with keratoconjunctivitis sicca (KCS) associated with primary (KCS-PSS) or secondary Sjögren's syndrome (KCS-SSS), and of patients with KCS not related to Sjögren's syndrome (KCS-NS).. In 106 patients with dry eye an ophthalmic diagnosis of KCS was made. Subsequent evaluations revealed a diagnosis of KCS-PSS in 31, KCS-SS in 19, and KCS-NS in 56 patients. Follow up assessments have been performed 10-12 years after initial diagnosis.. At baseline and at follow up tear gland function tests were worse in patients with KCS-PSS compared with the other forms of KCS. At follow up in the KCS-SSS patient group the tear gland function variables returned to marginal normal limits. In contrast with expectation, a marked improvement of the tear gland function variables in the KCS-NS patient group was noted.. In KCS-PSS patients tear gland function is characterised by a steady state situation. In KCS-SSS patients the normalisation of tear gland function variables most probably reflects a remission of the underlying disease. In view of the overall improvement in KCS-NS patients the term age related KCS should be avoided.

Topics: Disease Progression; Female; Follow-Up Studies; Humans; Keratoconjunctivitis Sicca; Lacrimal Apparatus; Lactoferrin; Male; Middle Aged; Muramidase; Sjogren's Syndrome; Statistics, Nonparametric; Tears

In this study we examined 85 patients in the range of 25 to 60 years with rheumatoid arthritis (RA) and a control group of 35 persons without any systemic diseases. The 85 patients with RA were split into two groups: first group was made up of 32 patients with keratoconjunctivitis sicca (KCS) and the second of 53 patients without KCS. The aim was to decide whether the simple ocular ferning test has more diagnostic value than the "classical" tests: break-up time (BUT), Schirmer-1-test and concentration of lysozyme in the tear fluid. Therefore, we compared the tests with reference to sensitivity, specificity and prognostic value in the three groups. The results of the ocular ferning test are markedly better than the results of the other tests: sensitivity is 82.2%, specificity 92.5% and prognostic value 86.6%. The corresponding values are: BUT: 51.6%-77.8%-63.1%; Schirmer-1-test: 34.4%-90.8%-73.5%, lysozyme concentration: 73.4%-51.0%-52.7%. The ocular ferning test is an easy, practical, cheap, and reliable completion to the conventional tests; it is also easy on the patients.

Topics: Adult; Arthritis, Rheumatoid; Diagnosis, Differential; Female; Fluorescein; Fluoresceins; Humans; Keratoconjunctivitis Sicca; Male; Middle Aged; Muramidase; Prognosis; Surface Properties; Tears

In 35 patients with mild, moderate and severe keratoconjunctivitis sicca, an association was found between treatment effect, break-up time value and Rose bengal score. Neither of these tests, used separately, was successful as a clinically valuable predictor of treatment effect as the scatter, in score points, was too large. Analysed together, however, as in a partial regression analysis, an adequate prediction is possible, which is clinically of some value.

Topics: Adult; Aged; Conjunctiva; Cornea; Female; Gels; Humans; Keratoconjunctivitis Sicca; Male; Middle Aged; Muramidase; Rose Bengal; Tears

The average corneal thickness in a group of patients with KCS did not differ significantly from that in a control group. Within the patient group the corneal thickness decreased with decreasing lysozyme concentrations and also with decreasing Schirmer values, but the correlation was weak in both cases. The average central corneal thickness with severe and very severe KCS was greater than that of patients with mild KCS and the control groups. The average corneal thickness in patients with mild KCS was less than that of the control group, but not significantly so. Because of the comparatively small number of patients with severe KCS, an all over increase in corneal thickness in patients with KCS could not be demonstrated.

Topics: Cornea; Female; Humans; Keratoconjunctivitis Sicca; Male; Middle Aged; Muramidase; Tears

Topics: Animals; Arthritis, Rheumatoid; Bromhexine; Humans; Keratoconjunctivitis Sicca; Muramidase; Rabbits; Saliva; Sjogren's Syndrome; Tears

Topics: Biopsy; Conjunctiva; Diagnosis, Differential; Fluorescein; Fluoresceins; Humans; Keratoconjunctivitis; Keratoconjunctivitis Sicca; Lip; Muramidase; Salivary Glands; Sjogren's Syndrome; Staining and Labeling; Tears; Xerophthalmia

Tear fluid lysozyme concentration, measured by means of the agar diffusion assay, and lactoferrin concentration, measured with radial immunodiffusion using the Lactoplate test, were determined in 112 persons in routine clinical practice. About one third of these persons had symptoms and signs compatible with keratoconjunctivitis sicca. A good correlation was found between these tear proteins in the tear fluid in persons with normal tear function and in those with a tear function disorder. In 8%, false-positive and false-negative results were obtained, but the difference in associated values of lysozyme and lactoferrin concentration was small.

Topics: Adolescent; Adult; Aged; False Negative Reactions; False Positive Reactions; Female; Humans; Immunodiffusion; Keratoconjunctivitis; Keratoconjunctivitis Sicca; Lactoferrin; Lactoglobulins; Male; Middle Aged; Muramidase; Radioimmunoassay; 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; Aged; Aged, 80 and over; Albumins; Female; Humans; Keratoconjunctivitis; Keratoconjunctivitis Sicca; Lactoferrin; Male; Middle Aged; Muramidase; Osmolar Concentration; Tears

The concentrations of tear lysozyme, lactoferrin, ceruloplasmin, IgA, and IgG have been estimated in patients with dry eyes at the same time as semiquantitative bacterial culture was performed of the conjunctivae and lids. Staphylococcal isolations were quantified and biotyped. There was no increased conjunctival colonisation by any particular biotype of Staphylococcus aureus or Staph. epidermidis, and similar numbers of conjunctivae were sterile as in controls (33%); neither were any pathogens such as pneumococci or haemophili isolated. We consider that the conjunctiva of the dry eye, without the lacrimal secretion components of lysozyme and lactoferrin, has an alternative protective antibacterial mechanism which is derived from serum proteins via chronically inflamed vessels.

Topics: Adult; Aged; Ceruloplasmin; Conjunctiva; Eyelids; Humans; Immunoglobulin A; Immunoglobulin G; Keratoconjunctivitis Sicca; Lactoferrin; Middle Aged; Muramidase; Proteins; Staphylococcus aureus; Staphylococcus epidermidis; Tears; Xerophthalmia

Topics: Dry Eye Syndromes; Electrophoresis; Electrophoresis, Paper; Humans; Keratoconjunctivitis; Keratoconjunctivitis Sicca; Lacrimal Apparatus; Muramidase; Proteins; Tears