Sjögren's syndrome diagnosis: a comparison of conjunctival and gingival impressions and salivary gland biopsy.

This study reviewed 43 patients with Sjögren's syndrome. All of the patients complained of either dry eye and/or dry mouth. Their clinical records were compared with results of three laboratory diagnostic tests to determine the most sensitive test. Out of 30 patients who complained of both dry eye and dry mouth, 10 had positive conjunctival impressions, 20 had positive gingival impressions and 24 had positive salivary gland biopsies. Of 5 patients who suffered from only dry mouth, 2 had positive conjunctival impressions, 3 had positive gingival impressions and 3 had positive salivary gland biopsies. Of 7 patients with only dry eye complaints, there were 3 positive conjunctival impressions, 5 positive gingival impressions, and 6 positive salivary gland biopsies. Out of 6 healthy controls without complaints of dry eyes/mouth, there were no positive conjunctival impressions, 4 positive gingival impressions, and 5 positive salivary gland biopsies. Gingival impression appears to be nearly as sensitive as salivary gland biopsy in this group of patients suffering from Sjögren's Syndrome.

Factors responsible for tear ferning.

The biochemical agents involved in fern formation on drying tears were investigated by studying the different patterns of ferning of tears from normal and pathological eyes, mucus glycoprotein, saliva, serum, and various salt solutions. We conclude that the ferning phenomenon observed when a drop of tears is allowed to dry at room temperature on a clean microscope slide is to a large extent determined by the electrolyte concentration, especially the ratio of monovalent sodium and potassium ions to divalent calcium and magnesium ions. The presence of a biopolymer is essential, but this need not specifically be mucus as previously thought. The test may therefore be useful clinically in indicating the need for further tear analysis.

Tear electrophoretic changes in Nigerian children after measles.

At the laboratory of the National Centre of Ophthalmology, Paris, tear electrophoresis on cellulose acetate support was studied in 56 Nigerian children--32 during and shortly after measles infection and 24 healthy controls. The controls had a normal pattern, while those with measles had patterns consistent with inflammation, most severe in the first week but showing varying degrees of recovery by the third week. Four weeks after measles all cases suffering from malnutrition had patterns with an additional peak. This was shown on further investigation by electrophoresis on polyacrylamide cellulose gel and immunoelectrophoresis to be due to serum transferrin. The normal protein pattern of tears is shown to be altered during and after measles infection.

A new hypothesis on tear film stability.

Classically, the stability of the lacrimal film is due to the surfacing of the epithelial surface by the mucus produced by the goblet cells. However, there are many objections to this hypothesis. Deducing from electron microscopy of the epithelial cells, which shows vesicles in the superficial layer and glycocalix threads on the microvilli and other clinical facts, we think that the surfacing agent is not mucus but glycocalix. The disappearance of goblet cells during sicca syndrome is not the cause but the result of the dryness. Epithelial cell integrity is essential for the stability of the tear film and therapeutics must aim at regenerating these cells rather than only replacing the lacrimal film by tear substitute.

An interesting use of the study of tear ferning patterns in contactology.

A study of tear ferning patterns in normal and keratoconjunctivitis sicca eyes led to the classification into 4 types by Rolando [1984]. We practised this in our laboratory and observed specific and distinct tear ferning patterns for electrophoretic types 1 and 2 which Liotet et al. [1983] described as abnormal tear proteins modification found in patients who repeatedly and rapidly clog their hydrophilic lenses. In a general way, a study of tear ferning patterns can result in an appreciation of tear quality in contactology.

Post-measles corneal ulceration in children in northern Nigeria: the role of vitamin A, malnutrition and measles.

This work was prompted by the observation that corneal ulceration was apparently more common in young children in the guinea savannah area of northern Nigeria than in children in the tropical rainforest areas of southern Nigeria, where the intake of vitamin A, as the provitamin in red palm oil, is higher. Since corneal ulceration was usually seen in association with measles, a study was carried out to clarify the relationship between nutritional status, measles infection and vitamin A status in young children. The concentration of total retinol was measured in the plasma of well-nourished and malnourished children under three years of age, with or without a clinical record of recent measles. One hundred and twenty children were studied of whom 17 had corneal lesions. Malnutrition and measles were both found to depress the plasma concentrations of retinol and albumin. Measles depressed retinol levels (-20 to -30%) more than did malnutrition (-4 to -12%) while malnutrition had a greater depressing effect on albumin concentration (-23 to -30%) than did measles (-11 to -23%). The results support the hypothesis that corneal ulceration found in association with measles in northern Nigeria, although clinically similar to xerophthalmia, is not simply mediated through an effect of measles on the concentrations of vitamin A in plasma.

Severe ulcerative herpes of mouth and eye following measles.

Malnourished children in the north of Nigeria who had had a severe attack of measles were prone to deep ulcers of the mouth and eyes. Herpes simplex virus was isolated from 17 of 25 of the mouth ulcers which were erosive, slow to heal and caused much suffering and loss of weight. Herpes virus was also identified, either by immunofluorescent staining or viral culture, in the corneal scrapings of the eye ulcers from 16 of 34 children. These ulcers healed slowly in two to six weeks leaving damaging scars which impaired vision and caused blindness in some cases. It is suggested that measles leads to profound depression of cell mediated immunity in malnourished children with the consequence that secondary herpes simplex infections become abnormally severe and erosive.

Investigations into the aqueous humour dynamics in primary pigmentary degeneration of the retina.

40 patients with primary pigmentary degeneration of the retina were investigated for the possible coexistence with glaucoma. 12.5% established primary glaucoma cases and 7.5% suspicious glaucoma cases were found. In primary pigmentary degeneration of the retina with no glaucoma the intraocular pressure and the parameters of Leydhecker's test showed the same distribution as that of the controls selected at random. The intraocular pressure and the tonographic parameters except for CL3-7 were slightly lower on the average in the group with retinitis pigmentosa than in the controls.