Design and evaluation of ocular hydrogel containing combination of ofloxacin and dexamethasone for the treatment of conjunctivitis

Abstract Conjunctivitis is an inflammation of the conjunctiva, which covers the white part of the eyeball. It can be caused by allergies, bacterial or viral infection. In situ hydrogels are three-dimensional hydrophilic cross-linked network of polymers. In situ hydrogel provided better therapeutic index when compared to conventional treatment. The present work describes the formulation and evaluation of ofloxacin and dexamethasone based on the concept of pH triggered in situ gelation. Carbopol 934p was used as the gelling agent in combination with HPMC, as a viscosity-enhancing agent, benzalkonium chloride as preservative, sodium chloride as tonicity adjusting agent. The prepared formulations were liquid at the low pH and underwent rapid transition into viscous gel at the pH of the tear fluid. Formulations were evaluated for various rheological, in vitro and in vivo release characteristics. Infrared spectroscopy studies showed that there were no interactions between the drug and polymers. Viscosity of the prepared hydrogels lies in the optimum range and drug was released up to 85 % as the end of 13 h. The prepared in situ hydrogel was sterile, non-irritant to the eye. The present study indicated that it is possible to develop safe and physiologically effective in situ hydrogel which is patient compliant.

Surto de conjuntivite aguda no período de 2017-2018 em Recife, Brasil / Outbreak of acute conjunctivitis in the period 2017-2018 in Recife, Brazil

RESUMO Objetivo: Avaliar o perfil clínico, epidemiológico e o impacto econômico do surto de conjuntivite no período 2017-2018 no município de Recife-PE. Métodos: Estudo transversal com base na análise de prontuários de pacientes com diagnóstico de conjuntivite, atendidos na emergência da Fundação Altino Ventura entre dezembro/2017 e março/2018. Os dados coletados incluíram manifestações oculares no exame, complicações subsequentes, manejo e dias de licença médica. Resultados: Dos 12.712 pacientes atendidos na FAV entre dezembro de 2017 e março de 2018, 6.359 (50,0%) foram diagnosticados com conjuntivite, dos quais 3.543 pacientes (55,7%) foram atendimentos únicos. A média de idade dos pacientes ao atendimento foi de 29,5 ± 14,1 anos (variação, 1-85 anos), com distribuição semelhante entre os sexos (2.288 casos [50,1%] masculino; 2.282 casos [49,9%] feminino). O diagnóstico mais comum foi conjuntivite sem pseudomembrana (5.645 casos [88,8%]). Hiperemia conjuntival (6.278 casos [98,7%]) e reação folicular (6.255 casos [98,4%]) foram os achados mais frequentes ao exame. A complicação mais frequente foi pseudomembrana (1.062 casos [16,7%]). Os colírios lubrificantes (4.308 [67,7%]) e os colírios de associação antibiótico com corticoide (2.033 [32%]) foram os mais prescritos no tratamento. A média de dias de atestado médico foi de 4,8 ± 2,9 dias (variação, 1- 47 dias) e a perda de produtividade estimada em R$1.159.329,14. Conclusão: O surto de conjuntivite em Pernambuco foi responsável por metade das consultas em um pronto-socorro oftalmológico. Surtos de conjuntivite podem causar um impacto econômico, uma vez que afeta principalmente adultos jovens em idade produtiva. As características clínicas observadas sugerem um surto de conjuntivite de etiologia viral.

Abstract Purpose: To evaluate the epidemiological and clinical profile and economic impact of the acute conjunctivitis outbreak in the period of 2017-2018 in Recife-PE. Methods: Cross-sectional study based on the analysis of medical records of patients diagnosed with conjunctivitis at the emergency room of the Altino Ventura Foundation (FAV) between December 2017 and March 2018. The collected data included ocular manifestations at examination, subsequent complications, management, and days of sick leave. Results: Out of 12,712 patients assisted at FAV from December 2017 to March 2018, 6,359 (50.0%) were diagnosed with conjunctivitis. The mean age of patients was 29.5 ± 14.1 years (range, 01-85 years), with similar distribution between sex (2,288 50.1% male; 2,282 49.9% female). The most common diagnosis was non-pseudomembranous conjunctivitis (5,645 cases 88.8%). Conjunctival hyperemia (6,278 cases 98.7%) and follicular reaction (6,255 cases 98.4%) were the most frequent ocular findings. The most common complication was pseudomembrane in 1,062 cases (16.7%). Lubricants (4,308 67.7%) and antibiotic associated to corticosteroid eyedrops (2,033 32.0%) were the most prescribed medications. The average days of sick leave per patient was 4.8 ± 2.9 days (range, 1- 47 days) and the productivity loss estimated in R$1.159.329,14. Conclusion: The conjunctivitis outbreak in Pernambuco, Brazil was responsible for half of the consultations in an ophthalmic emergency room. Conjunctivitis outbreaks may cause an economic impact as it mostly affects young adults in their productive ages and take in average a 5-day sick leave. The clinical characteristics observed suggest an outbreak of conjunctivitis of viral etiology.

Conjuntivite e COVID-19 / Conjunctivitis and COVID-19

RESUMO Apresentamos um caso de conjuntivite por SARS-CoV-2 em mulher de 55 anos, com hiperemia e sensação de corpo estranho em ambos os olhos. O exame oftalmológico revelou conjuntivite. A paciente apresentou reação em cadeia da polimerase de SARS-CoV-2 detectável em swab conjuntival e nasal. O tratamento foi realizado com colírio de ciprofloxacina, corticoide e trometamol por 5 dias. Após o sétimo dia de evolução, houve melhora importante da conjuntivite, e foi repetido swab conjuntival, com resultado não detectável.

ABSTRACT We present a case of SARS-CoV-2 conjunctivitis in a 55-year-old female patient, with hyperemia and foreign body sensation in both eyes. The eye examination revealed conjunctivitis. She had detectable SARS-CoV-2 by polymerase chain reaction on conjunctival and nasal swabs. She was treated with ciprofloxacin eye drops, corticosteroids and trometamol for 5 days. After the seventh day of evolution, there was a significant improvement in conjunctivitis, and repeated conjunctival swab was negative.

Conjuntivitis cicatrizal recalcitrante: Tratamiento de nueve pacientes con rituximab / Recalcitrant cicatrizing conjunctivitis. Treatment of nine patients with rituximab

La conjuntivitis cicatrizal es la consecuencia de distintas enfermedades oculares. Entre ellas, las más graves son el penfigoide cicatrizal y el síndrome de Stevens-Johnson crónico. El tratamiento de estas enfermedades con corticoides e inmunosupresores es habitualmente exitoso, pero unos pocos pacientes siguen un curso recalcitrante. En los últimos años se introdujo el uso de rituximab, asociado o no a gammaglobulina endovenosa, en forma abierta, para el control de la inflamación conjuntival. Describimos aquí el tratamiento de siete pacientes con penfigoide y dos con Stevens-Johnson recalcitrante, con rituximab. Ocho recibieron también gammaglobulina y todos alcanzaron la remisión de la actividad. Tres recayeron y recibieron dos o tres nuevos cursos de la medicación con mejoría sintomática. El rituximab probó ser una droga efectiva para el tratamiento de la conjuntivitis cicatrizal crónica recalcitrante.

Cicatrizing conjunctivitis is the final consequence of several diseases. The most severe among them are cicatricial pemphigoid and chronic Stevens-Johnson syndrome. Systemic immunosuppressive drugs and steroids are usually an effective approach to these diseases. However, a few patients follow a recalcitrant course unremitting to usual therapy. We describe the treatment with rituximab of seven patients with cicatricial pemphigoid and two with chronic Stevens-Johnson syndrome. Eight of them also received gammaglobulin and all achieved clinical remission. Three relapsed and required two or three new courses of rituximab with good control of disease activity. Rituximab proved to be an efficacious drug for chronic recalcitrant cicatrizing conjunctivitis.

Successful Treatment with Chronic Conjunctivitis: Removal of Tarsoconjunctival Crypt

No abstract available.

effect of olopatadine 0.1% ophthalmic solution on ocular and nasal symptoms in patients with seasonal allergic rhino- conjunctivitis

To evaluate the effect of olopatadine 0.1% ophthalmic solution twice daily on ocular and nasal symptoms in patients with seasonal allergic rhino-conjunctivitis. This study was conducted at the Ophthalmology and ear, nose and throat [ENT] clinics on patients with seasonal allergic rhino-conjunctivitis during spring and early summer seasons [March to end of June] in 2010 at Princess Haya Al Hussein hospital in the south of Jordan and in 2011 at Prince Rashid Bin Al Hassan hospital in the north of Jordan. The patients were divided randomly into 2 groups; group A [50 patients] received Olopatadine 0.1% ophthalmic solution [Patanol] twice daily, group B [51 patients] received placebo in the form of balanced salt solution. All patients attended ENT and Ophthalmology clinics weekly for 2 visits; they were reviewed regarding the improvement of ocular symptoms [itching, redness and lacrimation] and nasal symptoms [sneezing, itchy nose and runny nose]. In those patients who received Olopatadine 0.1% ophthalmic solution, after two weeks 98%, 98% and 90% of them showed satisfactory improvement according to a scale of 1 to 5 marked by the patients for itching, lacrimation and redness respectively compared to 14%, 12% and 6% in group B respectively [P-value <0.05]. Regarding nasal symptoms 90%, 84% and 78% of patients in group A showed satisfactory improvement regarding sneezing, running nose and nasal itching respectively compared to 8%, 16% and 10% in group B [P-value <0.05]. The treatment of ocular allergy positively impacts nasal symptoms. The use of ocular solution of Olopatadine 0.1% ophthalmic solution twice daily has an excellent effect on ocular symptoms and good effect on nasal symptoms, this effect was more significant at two weeks of treatment. Olopatadine 0.1% ophthalmic solution is a well-tolerated drug and may be considered as a primary treatment for patients with seasonal allergic rhino-conjunctivitis

Unilateral conjunctival ulcer due to Stenotrophomonas maltophilia infection.

We report a case of unilateral conjunctival ulcer due to Stenotrophomonas maltophilia infection in an immunocompetent individual. A 44-year-old male presented with complaints of pain and yellowish discharge in the right eye for one week. Patient underwent complete ophthalmic evaluation and relevant laboratory investigations. Anterior segment examination revealed localized conjunctival and episcleral congestion with conjunctival ulceration on the bulbar conjunctiva in the right eye. Gram's stain revealed gram-negative bacilli. Culture and sensitivity revealed S. maltophilia and responded well to topical moxifloxacin with systemic co-trimoxazole therapy.

[Bacterial agents in patients with conjunctivitis in Labbafinejad hospital in 2006]

Conjunctivitis, one of the most prevalent eye complications, is usually self limited but may result in optical disorders. Classification is based on the cause including bacterial, viral, fungal, allergic or chemical. Considering antimicrobial resistance, determining the exact cause may lead to improved medical therapy. In this descriptive-analytic survey, 92 patients with conjunctivitis, who attended Shaheed Labbafi Nezhad medical center were enrolled. Samples were accurately collected by the physician working in the center and were transported in a sterile condition to the Laboratory of Pediatric Infectious Research Center of Mofid hospital. Determination of mycobacteria, aerobic and anaerobic bacteria was accomplished using standard methods. Data was analyzed using SPSS 13. Samples were obtained from 49 men [61.4%] and 43 women [38.6%], [median age 36.2]. 85% of patients with bacterial conjunctivitis had mucoplurant discharge as a main symptom. 45[58.5%] cultures were positive. Aerobic organisms were isolated from 40 patients [57.1%] and anaerobic ones from 5 [7.1%], of which 4 were mixed with aerobes. No mycobacterium was found. The most common aerobic organism cultured was staphylococcus epidermidis [30%] and the other aerobic ones were: Staphylococcus aureus [12.9%], E coli [7.1%], Bacillus cereus [5.7%], Moraxella catarrhalis [4.3%], Diphteroid [4.3%], Acientobacter baumanii [2.9%], Citrobacter fraundii [2.9%], Staphylococcus oricularis [1.4%], Streptococcus viridans [1.4%], Bacillus subtilis [1.4%], Pseudomonas aeruginosa [1.4%], and Proteus mirabilis [1.4%]. Anaerobic organisms cultured were Peptostreptococcus [4.3%] and Bacteroides fragilis [2.9%]. Since various organisms are responsible for bacterial conjunctivitis, therapeutic strategies should be based on the results of microbiological investigations

Tratamiento de la gonorrea en adolescentes y adultos / Gonorrhea treatment in adolescents and adults

La gonorrea continúa siendo una enfermedad frecuente. En Chile 70 porciento de las cepas de neisseria gonorrhoeae son resistentes a penicilina y mantienen 100 porciento de sensibilidad a cefalosporinas de tercera generación y ciprofloxacina. Se revisan los esquemas terapéuticos propuestos para las infecciones gonocóccicas uretrales, cervicales, rectales, faríngeas, conjuntivales, forma diseminada, endocarditis y meningitis. Además se comentan las exigencias del tratamiento en la mujer embarazada, en pacientes infectados por virus de inmunodeficiencia humana, en casos de coexistencia con chlamydia trachomatis y en pacientes alérgicos a b lactámicos

Estudo clínico comparativo entre cetirizina e placebo no tratamento de pacientes com rinite alérgica perene / Comparative clinical study between cetirizine and placebo in the treatment of patients with perennial allergic rhinitis

O estudo teve como objetivo avaliar a tolerabilidade, a eficácia clínica e a segurança do uso da cetirizina (CTZ) no tratamento da rinite alérgica perene. O estudo foi comparativo contra placebo (PLB), duplo-cego, randomizado, cruzado. Os pacientes receberam um período de 15 dias com CTZ (10 mg em dose única di ria), seguido de outro período de 15 dias com PLB, ou vice-versa de acordo com lista de aleatorizaçäo. Setenta e dois pacientes foram admitidos e 52 deles completaram os dois períodos de tratamento previstos. A CTZ mostrou superioridade nos seguintes sintomas de rinite alérgica: coriza, obstruçäo nasal, crises de espirro, prurido nasal e conjuntivite. O sintoma tosse näo foi modificado por qualquer dos tratamentos. Os sinais físicos de rinite alérgica, como coloraçäo da mucosa, hipertrofia de cornetos, secreçäo nasal e inflamaçäo faríngea, mantiveram-se inalterados com os dois tratamentos. O mesmo ocorreu com os sinais vitais: pressäo arterial, frequência cardíaca, frequência respiratória e peso. Durante o período de tratamento com a CTZ foram observados eventos adversos em sete pacientes (12,3 por cento) e no período PLB foram observados eventos adversos em oito pacientes (14 por cento). Os eventos adversos mais frequentes no período de tratamento com CTZ foram sonolência e aumento subjetivo de peso (nÝo confirmado ao exame físico); no período PLB foram tontura, aumento de apetite e cefaléia. Durante o período de tratamento com a CTZ nove pacientes interromperam o tratamento, sendo oito pacientes por abandono ou falta de colaboraçäo do paciente e um por evento adverso (urticária ao frio näo controlada). Durante o período PLB 11 pacientes interromperam o tratamento, sendo dez pacientes por abandono ou falta de colaboraçäo do paciente e um por evento adverso (tontura e calafrios). Concluímos que a CTZ se mostrou clinicamente superior ao PLB em efic cia, proporcionando alívio dos sintomas da rinite alérgica perene e sintomas conjuntivais. A incidência de eventos adversos com CTZ nÝo diferiu da observada com PLB. A cetirizina é um anti-histamínico eficaz e bem tolerado, com posologia cômoda em relaçäo aos anti-histamínicos clássicos, podendo ser utilizada para tratamento da rinite alérgica.

Terapia imunossupressora em penfigóide ocular cicatricial / Immunossupressive therapy in ocular ciciatricial pemphygoid

Penfigóide Ocular Cicatricial é uma doença crônica, progressiva e auto-imune das membranas mucosas. Neste estudo acompanhou-se 15 pacientes submetidos à terapia imunossupressora por um período médio de 13 meses. A resposta ao tratamento foi avaliada em relaçäo à diminuiçäo da atividade inflamatória e parada da progressäo da doença. O diagnóstico foi tardio: 69 por cento dos pacientes apresentaram visäo pior que 20/200 e 86 por cento estavam em estágios avançados da doença no exame inicial. Resposta clínica ao tratamento inicial com Dapsone foi observada na maioria dos pacientes. Em 3 casos foi necessária a substituiçäo por methotrexate. Em um paciente iniciou-se o tratamento com ciclofosfamida devido à intensidade inflamatória do quadro ocular. A imunodepressäo sistêmica é o tratamento de escolha para penfigóide, porém deve ser feita por médicos treinados, já que säo drogas potencialmente letais

Ciprofloxacin ophthalmic preparations in the treatment of chronic chlamydial conjunctivitis

Purpose This was a pilot study of the efficacy and safety of ciprofloxacin ophthalmic preparations in the treatment of chronic chlamydial conjunctivitis. Methods 24 patients, who were positive for Chlamydia trachomatis as shown by direct immunofluorescent monoclonal antibody staining, participated. 4 the first 14 days, one drop of 0.3% ciprofloxacin ophthalmic solution [CILOXAN Eye Drops] was instilled 6 times a day into each affected eye and 0.3 cm of ciprofloxacin ointment [0.3%] was used at bedtime. Treatment, which was continued over the next 14 days, consisted of one drop of the solution into each affected eye four times a day. Results 17 patients had a follow-up bacteriological test. 16 out of the 17 [94%] showed no sign of Chlamydia trachomatis on the direct immunofluorescent monoclonal antibody staining test with 15 [88%] being assessed as cured or improved clinically. Overall, 17 of the 24 participating patients [71%] were considered cured or improved. 6 of the 24 patients experienced adverse events, which were ocular in nature, non-serious, mild and usually resolved without treatment. Conclusion Topical ciprofloxacin appears to be an effective treatment for chlamydial conjunctivitis

Comparative double masked randomised placebo controlled clinical trial of a herbal eye drop preparation in trachoma and conjunctivitis.

A double blind controlled clinical trial has been done with a herbal eye drop preparation in case of trachoma stage III and chronic conjunctivitis of the eyes. In both trachoma and chronic conjunctivitis, the herbal eye drop formulation proved its superiority over placebo. Side-effects (burning sensations) were observed with normal saline which was used as placebo. But no side-effects were observed in the patients of trachoma and conjunctivitis who got the active drug. Both objective and subjective improvements were observed with the herbal eye drop preparation.

Nuevos macrólidos: actividad in vitro de azitromicina, claritromicina, roxitromicina, eritromicina y amoxicilina frente a haemophilus influenzae y streptococcus pneumoniae / New macrolides: in vitro susceptibilities of haemophilus influenzae and streptococcus pneumoniae to azitromycin, clarithromycin, roxithromicyn, erythromycin

Se estudió la susceptibilidad de 100 cepas de Haemophilus influenzae y 20 cepas de S. pneumoniae frente a nuevos macrólidos azitromicina, claritromicina, roxitromicina, antiguos macrólidos (eritromicina) y amoxicilina. Azitromicina fue 8 veces más activa que eritromicina frente a Haemophilus influenzae y 32 veces más que roxitromicina. La CIM 90 de azitromicina fue 1 mcg/ml en tanto que la misma concentración de eritromicina inhibió el 50 por ciento de las cepas, claritromicina 21 por ciento y roxitromicina 3 por ciento respectivamente

Conjuntivite lenhosa: apresentaçäo de um caso / Legenous conjuntivitis: one case

Os autores discutem as várias teorias etiológicas e possibilidades terapêuticas da conjuntivite lenhosa. Apresentam um caso da patologia, e sua evoluçäo favorável com uso de ciclosporina, hialuronidase e cromoglicato dissódico

Atualizaçäo em conjuntivites / Modernization in conjunctivitis

Num estudo laboratorial realizado em pacientes com conjuntivite crônica o agente encontrado em 40 por cento dos casos foi o estáfilococo. 20 por cento dos casos estavam contaminados com Clamidia e os restantes foram divididos entre micro-organismos. Para o diagnóstico da Clamidia o exame mais confiável é a imunofluorescência direta. Na presença de uma conjuntivite crônica o exame clínico deve ser completamentado pela cultura, citologia, exame anótomo patológico e métodos de imunologia

Acción radioprotectora local del factor de crecimiento epidérmico humano recombinante: reporte preliminar / Local radioprotective action of recombinant human epidermal growth factor: preliminary report

La radioterapia es una de las modalidades terapéuticas más empleadas en las neoplasias malignas. Una de las complicaciones más frecuentes es la radiodermitis, que obliga frecuentemente a interrumpir el tratamiento. En este trabajo presentamos una evaluación del efecto del factor de crecimiento epidérmico (EGF) en la prevención de la radiodermitis. Se incluyeron 59 pacientes con diagnóstico histològico de carcinoma de piel, los cuales recibieron 2 Gy diarios de roentgenterapia superficial (80 kV) hasta completar 60 Gy. Los pacientes fueron asignados, al azar, a tres grupos: el primer grupo recibió aplicación tópica del EGF (10 *g/g en crema de sulfadiazina de plata al 1 %) en el área irradiada, dos veces al día durante todo el tiempo de tratamiento; el segundo recibió aplicaciones de la crema de sulfadiazina de plata sin EGF y el tercer grupo no recibió tratamiento local. El porcentaje de aparición de radiodermitis fue de 4 %, 41 % y 64 % en los tres grupos, respectivamente. La diferencia en la frecuencia de aparición de radiodermitis entre el grupo tratado con EGF y los restantes fue estadísticamente significativa (p<0,001). Otro grupo de pacientes -en este caso cinco niños que recibieron radioterapia sobre ojo y órbita-, fue tratado con colirio de kanamicina que contenía, además, EGF humano recombinante (10 *g/ml), aplicando 2 gotas cada 4-6 horas durante todo el período de tratamiento. Solamente uno de estos pacientes presentó conjuntivitis radiógena ligera, a una dosis acumulada de radiaciones de 50 Gy, lo cual se compara favorablemente con la experiencia histórica en que la mayoría de estos pacientes padecen conjuntivitis radiógena. Estos resultados constituyen la primera evidencia clínica de efecto radioprotector del EGF humano recombinante, en la piel y en el epitelio ocular, lo cual tiene importancia práctica en el tratamiento radiante de los tumores malignos