muramidase and Keratoconjunctivitis

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

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

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

A degeneration of the tear gland leads to reduced lysozyme concentrations in the tear fluid. Tear lysozyme concentrations are generally determined by enzymatic methods. Lysozyme determination by radial immunodiffusion has some advantages above the enzymatic assays, and laboratory facilities are not required. The enzymatic properties of lysozyme that favoured its choice as a parameter for tear gland function, influenced to some extent the results of the radial immunodiffusion assay. Therefore we looked among the proteins originating from the lacrimal gland for alternative parameters of tear gland function. In 94 tear samples obtained from a heterogeneous group, ranging from persons with normal lacrimal gland function to severe kerato-conjunctivitis sicca patients, a high degree of correlation was found between lysozyme concentration and that of lactoferrin as well as tear-specific prealbumin. This indicates that the latter two proteins can be used as alternatives for lysozyme in tear gland function tests.

Topics: Electrophoresis, Polyacrylamide Gel; Humans; Immunodiffusion; Keratoconjunctivitis; Lactoferrin; Lactoglobulins; Muramidase; Prealbumin; Serum Albumin; Tears

Topics: Adult; Biopsy; Drug Administration Schedule; Female; Humans; Keratoconjunctivitis; Middle Aged; Muramidase; Prednisone; Salivary Glands; Sjogren's Syndrome; Tears

Radial immunodiffusion was tested as an alternative for the agar diffusion assay for lysozyme in tear fluid. The influence of interactions between lysozyme and agarose or filter paper, used for sample collection, on the results of the immunodiffusion test was investigated. In 100 tear samples from 50 healthy volunteers and average lysozyme concentration of 1.9 g/l was found. Lysozyme values obtained by both methods in the tear fluid of a group of 78 volunteers, ranging from healthy individuals to severe keratoconjunctivitis sicca patients were compared. A lower limit of normal at 1.1 g/l was found by the radial immunodiffusion assay.

Topics: Diffusion; Filtration; Humans; Immunodiffusion; Keratoconjunctivitis; Muramidase; Sepharose; Tears

The accuracy of lysozyme concentration determination by the method of measuring lysis diameter in agarose gel slabs containing Micrococcus lysodeikticus bacteria uniformly suspended throughout the gel was determined for various methods of tear sample collection. The effects of storage of lysozyme solution samples at subzero temperatures for several days was also examined. It was found that a power rather than the suggested exponential dependence between the lysozyme concentration and lysis diameter provides the most accurate fit and thus should be used for interpolation. Storing samples frozen in glass capillaries lowered the lysozyme concentration in a predictable manner. When Weck-Cel sponges were used to collect the samples the lysozyme concentration was greatly diminished in a nonlinear manner because of internal adsorption. The relative loss (cause by adsorption) depended on the actual lysozyme concentration as well as on the sample volume/sponge weight ratio. Storing samples absorbed by such sponges in a frozen state further altered the results in an unpredictable way. The observation that smaller tear samples for a given sponge size yielded lower apparent values for lysozyme concentration casts doubt on findings that have reported lower lysozyme concentration in the tears of keratoconjunctivitis sicca patients, where either cellulose sponges or filter paper discs were used for tear collection.

Topics: Freezing; Humans; Keratoconjunctivitis; Microbiological Techniques; Micrococcus; Muramidase; Tears

Topics: Adult; Aged; Bromhexine; Female; Humans; Keratoconjunctivitis; Male; Middle Aged; Muramidase; Sjogren's Syndrome; Tears

Unstimulated basal tears and stimulated tears were collected from normal controls, keratoconjunctivitis sicca (KCS) patients, and contact lens (CL) wearers. Basal tear volume (Periopaper) and reflex tear volume (Schirmer Strip) were measured and tears eluted from their respective strip with a TMED-acetic acid buffer. Lactoferrin and lysozyme concentrations were measured in the eluates. Concentration of lysozyme in basal tears was: 65 +/- 43 mg% in normals; 44 +/- 26 mg% in KCS, and 81 +/- 50 mg% in CL wearers. Concentration of lysozyme in reflex tears was: 160 +/- 73 mg% in normals, 74 +/- 41 mg% in KCS, and 186 +/- 83 mg% in CL wearers. Concentration of lactoferrin in basal tears was 137 +/- 102 mg% in normals, 154 +/- 82 mg% in KCS, and 157 +/- 80 mg% in CL wearers. Concentrations of lactoferrin in reflex tears was: 327 +/- 187 mg% in normals; 171 +/- 69 mg% in KCS, and 302 +/- 160 mg% in CL wearers. The lactoferrin concentration in all tear samples was consistently higher (1.6-3.5 times) than lysozyme. In basal tears, lactoferrin concentrations were not significantly different in the three groups. In reflex tears, however, lactoferrin was significantly lower in KCS than normal or CL wearers. The concentration of lysozyme in both basal and reflex tears was significantly lower in the KCS when compared to normal or CL wearers. Lysozyme and lactoferrin concentrations in both basal and reflex tears were similar in CL wearers and normal controls. The sampling and elution of basal and reflex tears as described appears to be a feasible technique for analysis of lysozyme and lactoferrin concentrations by the electroimmunodiffusion technique and has potential diagnostic value.

Topics: Contact Lenses; Humans; Keratoconjunctivitis; Lactoferrin; Lactoglobulins; Muramidase; Reflex; Tears; Xerophthalmia

This paper is concerned with the recognition of the dry eye when the clinical diagnosis is in doubt and other external eye diseases may be present. Papillary conjunctivitis is common to the dry eye as well as other pathological conditions and confuses the diagnosis. We have correlated the factors involved in the assessment for dryness. We have shown that particulate matter in the unstained tear film is associated with low tear lysozyme concentration. Tear flow and tear lysozyme are not necessarily interrelated, but a low lysozyme concentration (tear lysozyme ratio < 1.0) is associated with keratoconjunctivitis sicca. The Schirmer I test can produce false positive results, and we have suggested a modification to overcome this. This modified test will detect the eye with severely depleted lysozyme secretion, but it is unreliable for detecting the eye with moderately depleted secretion. We find that its lowest normal limit should be considered as 6 mm.

Topics: Adult; Aged; Clinical Enzyme Tests; Diagnosis, Differential; Humans; Keratoconjunctivitis; Middle Aged; Muramidase; Tears; Xerophthalmia

Topics: Adult; Age Factors; Aged; Biological Assay; Humans; Infant, Newborn; Keratoconjunctivitis; Muramidase; Tears

We have developed a method for assaying the concentration of tear lysozyme using eluates of tear fluid collected on filter paper discs. Specimens can be stored and transported to remote laboratories for assay. We have shown that the 'indirect' or eluate method gives statistically comparable results to the 'direct' method using fresh, neat tear fluid.

Topics: Adolescent; Adult; Aged; Antibodies, Bacterial; Biological Assay; Child; Humans; Keratoconjunctivitis; Middle Aged; Muramidase; Specimen Handling; Tears; Transportation; Xerophthalmia

Topics: Adolescent; Adult; Aged; Humans; Keratoconjunctivitis; Middle Aged; Muramidase; Sjogren's Syndrome; Tears

Topics: Humans; Keratoconjunctivitis; Muramidase; Sjogren's Syndrome; Syndrome; Tears

Comparative studies of the lysozyme test (LT) and the Schirmer tear test (STT) revealed that the LT was not reliable in the diagnosis of kerato-conjunctivitis sicca (KCS) in dogs and cats. This is in contrast to its successful use in human patients. No M. lysodeikticus lysating substrates were detectable in the tear fluid of the normal cat.

Topics: Animals; Cat Diseases; Cats; Dog Diseases; Dogs; Keratoconjunctivitis; Micrococcus; Muramidase; Tears

An accurate method of assaying the tear lysozyme concentration in units of activity/mul has been developed. Normal physiological levels which vary with age have been determined. It has been demonstrated that measurement of the volume of tear fluid collected and assay with a calibrated standard are essential for the accurate determination of the precise concentration of lysozyme in the tear fluid. Tear lyozyme concentration can be used as an index of lacrimal gland function, and in the diagnosis of the sicca syndrome and associated conditions. We believe that this method of tear lyozyme assay has important applications in drug toxicity states in humans (for example, practolol toxicity) and also in animal drug toxicity studies.

Topics: Adult; Aged; Biological Assay; Humans; Keratoconjunctivitis; Lacrimal Apparatus; Micrococcus; Middle Aged; Muramidase; Tears

Topics: Agar; Bacteriological Techniques; Culture Media; Humans; Keratoconjunctivitis; Methods; Micrococcus; Muramidase

Topics: Biopsy; Conjunctiva; Eye Diseases; Hexosamines; Humans; Keratoconjunctivitis; Lacrimal Apparatus; Lacrimal Duct Obstruction; Methods; Mucus; Muramidase; Necrosis; Pemphigus; Proteins; Radiography; Reflex; Rose Bengal; Secretory Rate; Staining and Labeling; Tears

Topics: Adult; Agar; Aged; Bacteriolysis; Biological Assay; Diffusion; Evaluation Studies as Topic; Female; Humans; Keratoconjunctivitis; Male; Micrococcus; Middle Aged; Muramidase; Rose Bengal; Tears

Topics: Conjunctivitis; Corneal Ulcer; Eye Diseases; Humans; Hypersensitivity; Keratoconjunctivitis; Muramidase; Tears

Topics: Autoimmune Diseases; Conjunctiva; Estradiol; Humans; Keratoconjunctivitis; Microscopy, Electron; Muramidase; Rose Bengal; Xerophthalmia

Topics: Adult; Age Factors; Aged; Humans; Immunodiffusion; Keratoconjunctivitis; Lysosomes; Methods; Middle Aged; Muramidase; Rose Bengal; Staining and Labeling

Topics: Adenosine Triphosphatases; Carbonic Anhydrases; Cytochromes; Drug Therapy; Eye; Eye Diseases; Humans; Hyaluronoglucosaminidase; Keratoconjunctivitis; Muramidase; Peptide Hydrolases

Topics: Anti-Bacterial Agents; Atropine; Conjunctivitis; Humans; Idoxuridine; Iodine; Keratitis; Keratitis, Dendritic; Keratoconjunctivitis; Muramidase; Therapeutics

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