Serious occurrences in the natural history of advanced climatic keratopathy.

BACKGROUND: Climatic or chronic actinic keratopathy is an important corneal degeneration occurring after prolonged climatic exposure. The advanced stages of disease are confined generally to tropical or arid localities (including the Arctic) with high levels of sunlight. After many years of disease evolution, the advent of stage 3 keratopathy often presages a rapid downhill course. The instability of advanced climatic keratopathy has received little attention. METHODS: Eighteen patients with advanced climatic keratopathy are described from the Transvaal region in South Africa and from Saudi Arabia. Patients with rapid disease progression, spontaneous sterile ulceration, and secondary microbial keratitis are described. RESULTS: The rapid progression characteristic of stage 3 climatic keratopathy is illustrated. Severe, focal, sterile ulceration of the devitalized corneal degeneration may be common. Secondary infection may occur, leading to rapid dissolution of the climatic keratopathy material. Corneal perforation may ensue. The occurrence of yellow or brown fragments of the climatic keratopathy within or adjacent to the corneal inflammatory infiltrate indicates the predisposing cause of the infection, as usually also with examination of the opposite eye. CONCLUSIONS: These observations emphasize the inherent instability of advanced climatic keratopathy, which frequently takes a relentless downhill course. In rural populations of the developing world, climatic keratopathy is an important cause of blindness. Disease pathogenesis, treatment, and prevention deserve greater study.

Lacrimal testing. Age as a factor in Jones testing.

PURPOSE: A modified Jones test is used to assess whether lacrimal transit time varies with age. METHODS: The right eyes of 101 control subjects and 18 patients suspected of having lacrimal system abnormalities were tested with one drop of 2% sodium fluorescein solution. A cotton applicator was placed in the nose next to the inferior turbinate and participants were asked to lean forward. Dye passage was assessed every 3 minutes for 24 minutes. RESULTS: The results were assessed by age. In control subjects, there seemed to be a natural break in the distribution of the data at the age of 45 to 50 years. In control subjects younger than 45 years of age, 10/11 (91%) passed dye in 6 minutes or less (median = 3 minutes), whereas in those 45 years of age and older, 79/90 (84%) passed dye in 12 minutes or less (median = 6 minutes). The results were statistically significant (P = 0.0091). In contrast, patients with symptoms of epiphora due to a nasolacrimal duct obstruction had lacrimal transit times in excess of the above limits. CONCLUSION: This study confirms that the lacrimal transit time slows with age. The modification of the Jones test presented here requires a cutoff of 6 minutes in patients younger than 45 years of age and 12 minutes in patients 45 years of age and older.