Faculty Bibliography

Conjunctival cultures and scrapings for cytological examination were done in 852 cases of chronic conjunctivitis. Bacteria were recovered in 464. Of these, Staphylococcus sp were isolated in 91%; their etiologic importance over normal flora is questionable. Important cytological findings included atypical epithelium (three cases), Halberstaedter-Prowazek inclusion bodies (two), and eosinophils (104). Epithelial degenerative changes were common (585 cases). Crystals (105) and microorganisms (283) were other frequent findings. Active infection seems to be an uncommon cause of chronic conjunctivitis. Cultures are important in avoiding unnecessary antibiotic therapy when no organism is present. Cytological examination can be a helpful diagnostic adjunct in selected cases and is to be recommended especially in chronic follicular conjunctivitis, possible drug toxicity or allergy, dry eye states, and other atypical clinical presentations.

Three cases of retained contact lenses leading to focal papillary conjunctivitis of the upper lids reminiscent of the more diffuse changes of lens or suture-induced giant papillary conjunctivitis are reported. One silicone and two cabufocon lenses were responsible. Corneal changes occurred in two of the three cases. Secondary infection with Staphylococcus aureus was found in one patient. In two, conjunctival cytology suggested a hypersensitivity mechanism. In all three patients the simple removal of the retained lens was sufficient to reverse pathology. The focal nature of the papillary changes observed in these patients as well as in those cases occurring post-operatively from exposed suture edges would point towards an important direct mechanical etiologic factor in addition to the proposed hypersensitivity basis for the similar diffuse upper lid papillary hypertrophy characteristic of giant papillary conjunctivitis.

In 84% of 700 consecutive cases of untreated acute conjunctivitis subjected to conjunctival cultures and scrapings, a presumptive etiologic diagnosis could be made based on standard microbiologic and cytologic criteria. Of these 583 cases, 264 were bacterial, 245 were viral, 51 were allergic, and 17 were chlamydial. In 75% of the cases, clinical impressions were consistent with laboratory findings. On the basis of these results, laboratory workup is recommended in (1) follicular conjunctivitis to differentiate viral from chlamydial processes, (2) purulent conjunctivitis to identify pathogens and decide on appropriate antimicrobial therapy based on sensitivity data, and (3) those cases in which the clinical picture is not sufficiently distinctive to suggest an etiologic diagnosis.

Xeroderma pigmentosum is a hereditary precancerous dermatosis caused by a defect in DNA repair-replication after damage induced by exposure to ultraviolet light. The clinical course is characterized by progressive hyperpigmentation and atrophy of the skin with tumorigenesis, basal and squamous cell carcinomas being most common. Ocular involvement occurs in up to 80% of cases, with recurrent infection, neoplasia, and atrophy of the lids, conjunctiva, and cornea the most common findings. Two cases of xeroderma pigmentosum and their ophthalmic findings are described.

A case of bilateral necrotizing scleritis due to Aspergillus oryzae is reported. The patient was a former addict of intravenous narcotics treated five years previously for meningitis due to the same organism. A seeding focus in the thoracic spine was eventually found. The patient responded well to combined local and systemic therapy with amphotericin B, flucytosine, and natamycin. This represents, to the best of our knowledge, both the first reported case of ocular disease due to this species of Aspergillus and of isolated scleral, nonintraocular involvement in endogenous oculomycosis.

During a 30-year period, causative organisms were identified on Gram's stain and culture in 547 of 677 cases of infectious corneal ulcers. Even if no organisms were seen on Gram's stain, culture results were often positive. Staphylococcus was the most common isolate; Moraxella, Pseudomonas, and Streptococcus pneumoniae were the next most frequent pathogens. Only 1% of cases were fungal. Of some help in identifying the causative organism were locations, presence or absence of hypopyon, and perforation of the ulcer. Most marginal lesions were a result of staphylococcal infection; central lesions were more likely to be Gram-negative ulcers. Fungal ulcers were identified by laboratory workup and not by clinical characteristics. Moraxella infection was observed almost exclusively in malnourished patients. Pseudomnas ulcers were often seen in patients with large body burns or patients receiving respiratory assistance. Gentamicin and neomycin were the most effective treatments.

Twenty-five consecutive cases of adult inclusion conjunctivitis were studied. Diagnosis was based on the finding of typical Halberstaedter-Prowazek inclusion bodies on conjunctival scrapings. Corneal involvement was common (20/25 patients); most frequent was superficial epithelial keratitis (15/25). Other changes seen included subepithelial nummular keratitis (6/25), marginal keratitis (2/25), (4/25). There seemed to be a predilection for involvement of the upper half of the cornea. Conjunctival scarring occurred in one patient only. Associated genitourinary symptoms were spontaneously reported in three patients only; however, on careful questioning, an additional 12 patients were found to have a history of urethritis or cervicitis. A comparison with viral follicular conjunctivitis is made. The location and pattern of keratopathy, associated genitourinary complaints, mucopurulent nature of discharge, and lack of response to standard topical therapy would seem to suggest chlamydial cause. Conjunctival scrapings are very helpful in differential diagnosis between viral and chlamydial conjunctivitis.

One hundred seventy-one cases of neonatal conjunctivitis seen at Bellevue Hospital during the period 1950--1976 were reviewed. An overall incidence of 3.0 cases per 1,000 live births was found. A comparison of the rates of neonatal conjunctivitis with silver nitrate and tetracycline prophylaxis revealed a 100% increase in the rate overall, as well as the rate of gonococcal conjunctivitis with tetracycline. Using conjunctival cultures and cytology, a diagnosis could be established in 73% of the cases, with 41% being bacterial and 32% chlamydial. Staphylococcus was the single most common organism recovered; gonococcus was relatively rare.