tretinoin and Keratoconjunctivitis

In a prospective, double-masked clinical study, the authors evaluated the efficacy and safety of topically applied tretinoin ophthalmic ointment (0.01%) versus placebo in the treatment of squamous metaplasia associated with various ocular surface disorders involving dry eyes. Study parameters consisted of graded symptoms and signs, and serial impression cytologies. A total of 161 patients were enrolled in the study. Of these patients, 116 who had a minimum of 4 to 8 months of follow-up qualified for final statistical analysis. These patients were classified into two major groups: (1) keratoconjunctivitis sicca (KCS) and (2) conjunctival cicatricial diseases (Stevens-Johnson syndrome, inactive pemphigoid, radiation-induced dry eye, drug-induced pseudopemphigoid, and toxic epidermal necrolysis). An analysis of adjusted mean changes for KCS patients showed no statistically significant differences between active drug and placebo. A similar analysis of patients with conjunctival cicatricial diseases indicated a statistically significant (P less than 0.05) reversal of conjunctival keratinization in the temporal bulbar site after treatment with active drug, however, clinical symptoms and signs showed no significant improvement with active drug relative to placebo. Side effects were limited to blepharoconjunctivitis and were reversible upon tapering or stopping the drug.

Topics: Administration, Topical; Adolescent; Adult; Aged; Aged, 80 and over; Conjunctiva; Conjunctival Diseases; Double-Blind Method; Epithelium; Female; Follow-Up Studies; Humans; Keratoconjunctivitis; Keratoconjunctivitis Sicca; Male; Metaplasia; Middle Aged; Multicenter Studies as Topic; Prospective Studies; Random Allocation; Tretinoin

To test the efficacy of topically applied tretinoin eyedrops (0.01%, twice daily, in a solution of peanut oil) in the treatment of squamous metaplasia of the conjunctival epithelium associated with dry-eye, the authors evaluated the impression cytology (IPC) of a total of 31 patients. The cytological findings were classified into four different stages with an overall range from 0 to 9 points. The average period of treatment was 12 weeks. The patients were classified into three groups: (1) Those with mucin deficiency (Mucin less than - greater than; n = 19), (2) those with Keratoconjunctivitis sicca (KSC; n = 6), and (3) a control group in whom pure peanut oil was used (n = 6). The IPC showed a considerable improvement of squamous metaplasia in the mucin less than - greater than group, by an average of 4.3 points (from 6.2 points before treatment to 1.9 points). No changes were seen in the IPC of the KCS patients or the control group. The results of this study show a good effect of tretinoin eyedrops in patients with a significant decrease in or loss of goblet cells seen in the IPC, a decreased break-up time and with no severe aqueous deficiency of tear film. These patients seem to have a "primary" mucin deficiency induced by the decrease in or loss of goblet cells. There is no indication for tretinoin treatment in patients with aqueous deficiency involving major or accessory lacrimal glands. The results of other previous and recent studies on tretinoin treatment are discussed.

Topics: Adult; Conjunctiva; Female; Humans; Keratoconjunctivitis; Keratoconjunctivitis Sicca; Male; Metaplasia; Ophthalmic Solutions; Tretinoin

Despite the diverse causes of dry-eye disorders, the ocular surface epithelia in these diseases all undergo squamous metaplasia, manifested by loss of goblet cells, mucin deficiency, and keratinization. These changes account for tearfilm instability, which leads to various ocular symptoms and corneal complications. This article reviews research in the use of topical tretinoin to treat severe dry-eye disorders. To classify squamous metaplasia into stages, a modified impression cytology technique was used to monitor the therapeutic effect of topical tretinoin ointment (0.01% or 0.1%, w/w) in 22 patients. This population had severe dry-eye disorders, including keratoconjunctivitis sicca, Stevens-Johnson syndrome, inactive ocular pemphigoid, drug-induced pseudopemphigoid, and surgery- or radiation-induced dry eyes. After treatment, clinical improvements were correlated with the reversal of squamous metaplasia as evidenced by the impression cytology technique. Tretinoin may also be effective in treating conjunctival keratinization without dry eyes, as illustrated by a case study. This may represent the first reported attempt to treat ocular surface disorders by reversing diseased epithelium.

Topics: Administration, Topical; Adolescent; Eye Diseases; Female; Humans; Keratoconjunctivitis; Keratoconjunctivitis Sicca; Pemphigoid, Benign Mucous Membrane; Postoperative Complications; Radiotherapy; Skin Diseases, Vesiculobullous; Stevens-Johnson Syndrome; Tretinoin

We have demonstrated the clinical efficacy of topical all-trans retinoic acid ointment in the treatment of four severe cases of the following dry eye disorders: Keratoconjunctivitis sicca, Stevens-Johnson syndrome, drug-induced pseudopemphigoid, surgery-induced dry eye. In all four cases, impression cytology confirmed that improvements in symptoms, visual acuity, keratopathy, and Schirmer test resulted from reversal of the process of squamous metaplasia. This treatment represents the first nonsurgical approach with action directed specifically at the diseased ocular surface epithelia.

Topics: Administration, Topical; Adult; Aged; Conjunctiva; Cornea; Female; Humans; Keratoconjunctivitis; Male; Metaplasia; Pemphigoid, Bullous; Stevens-Johnson Syndrome; Tretinoin; Xerophthalmia

Topical all trans retinoic acid (tretinoin) 0.1 per cent has been used to treat eight patients with squamous metaplasia and keratinisation of the conjunctiva. In four patients the changes followed Stevens-Johnson syndrome, one patient had chronic atopic kerato conjunctivitis, one had persistent epithelial erosions following sarcoid related kerato conjunctivitis sicca complicated by preservative induced epithelial toxicity, one had a recurrent Bowen like epithelial dysplasia and one had an unclassifiable primary ocular surface disorder. Improvement in symptoms and signs were noted in all patients but local irritation developed in some and the optimum dosage remains to be determined. Problems of formulation and stability of the preparation need to be solved before topical retinoid therapy can be more widely used.

Topics: Administration, Topical; Adolescent; Adult; Aged; Antineoplastic Agents; Conjunctiva; Conjunctival Diseases; Female; Humans; Keratoconjunctivitis; Male; Metaplasia; Middle Aged; Tretinoin

We evaluated the clinical efficacy of treating various dry-eye disorders using 0.01% and 0.1% (weight/weight) topical all-trans retinoic acid ointment. Twenty-two patients were selected and classified into four major groups: keratoconjunctivitis sicca (6 patients; 11 eyes), Stevens-Johnson syndrome (9 patients; 17 eyes), ocular pemphigoid or drug-induced pseudopemphigoid (3 patients; 6 eyes), and surgery or radiation-induced dry eye (4 patients; 4 eyes), based on the criterion that they remained symptomatic even under maximum tolerable conventional medical and/or surgical therapies. The results indicated that squamous metaplasia with mucin deficiency secondary to goblet cell loss and keratinization may be the basis for the development of clinical symptoms and morbidities, as these epithelial abnormalities were invariably present before treatment. After treatment, all patients demonstrated clinical improvements in symptoms, visual acuity, rose Bengal staining, or Schirmer test. Most importantly, this topical vitamin A treatment caused the reversal of squamous metaplasia as evidenced by impression cytology. Therefore, this treatment may represent the first nonsurgical attempt to treat these disorders by reversing diseased ocular surface epithelium.

Topics: Administration, Topical; Adolescent; Adult; Aged; Child; Child, Preschool; Eye; Female; Humans; Keratoconjunctivitis; Lacrimal Apparatus Diseases; Male; Metaplasia; Middle Aged; Ointments; Pemphigoid, Benign Mucous Membrane; Postoperative Complications; Radiotherapy; Stevens-Johnson Syndrome; Tretinoin; Visual Acuity; Xerophthalmia