Marginal ulceration of the cornea.

Chignell, A H; Easty, D L; Chesterton, J R; Thomsitt, J

doi:10.1136/bjo.54.7.433

Cited by 20 publications

(3 citation statements)

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“…It may be difficult using clinical signs to reliably distinguish between the corneal infiltrate caused by infection and an infiltrate caused by a hypersensitivity response, although the management differs significantly. Pain, suppurative discharge, an epithelial defect of >2 mm, and an anterior chamber reaction are suggestive of a bacterial keratitis,13 while a marginal corneal infiltrate with only a minimal epithelial defect or a punctate keratopathy is typical of the sterile keratitis associated with staphylococcal blepharitis 14. The mechanisms leading to corneal infiltration differ between the two conditions.…”

Section: Discussionmentioning

confidence: 99%

Corneal infiltration after recurrent corneal epithelial erosion

Ionides

Tuft

Ferguson

et al. 1997

British Journal of Ophthalmology

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Aims-To describe the clinical features of patients with a history of recurrent corneal epithelial erosion who develop acute corneal infiltration. Methods-The records were reviewed of patients who had previously been examined and treated for recurrent corneal epithelial erosion and who presented again with signs suggestive of a microbial keratitis. Results-11 patients were described; one patient presented with similar signs on two occasions. There was typically a paracentral epithelial defect >2 mm in diameter with an associated stromal infiltrate and an intense anterior uveitis. Three patients had a hypopyon, and four developed a subepithelial ring infiltrate. Samples were taken for microscopy and bacterial culture, with a positive isolate from two of 12 episodes (16%). Treatment with topical antibiotics and topical corticosteroid resulted in rapid reepithelialisation and a reduction of inflammation. There was good visual outcome for all eyes, with a recurrence or symptoms of epithelial erosion in only one eye after a mean follow up period of 18 months. Conclusions-Corneal infiltrates are an uncommon complication of recurrent corneal epithelial erosion. Despite the intensity of the infiltration the majority are culture negative using established techniques. There is typically rapid resolution and a good visual outcome, with a tendency for the episode to mark the end of further symptoms of epithelial erosion. (Br J Ophthalmol 1997;81:537-540) Recurrent corneal erosion (RCE) can develop after mechanical injury, as a complication of chronic ocular surface disease, or as a result of inherited dystrophies of the epithelial basement membrane or stroma.

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Section: Discussionmentioning

confidence: 99%

Corneal infiltration after recurrent corneal epithelial erosion

Ionides

Tuft

Ferguson

et al. 1997

British Journal of Ophthalmology

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“…It is a type III hypersensitivity reaction to staphylococcal antigens or toxins that results in complement activation and influx of polymorphonuclear leukocytes and mononuclear cells that form the infiltrate (7). It is a type III hypersensitivity reaction to staphylococcal antigens or toxins that results in complement activation and influx of polymorphonuclear leukocytes and mononuclear cells that form the infiltrate (7).…”

Section: Case Reportmentioning

confidence: 99%

Ring Infiltrate in Staphylococcal Keratitis

et al. 2013

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Smear and culture tests of corneal scrapings from a patient with a ring infiltrate confirmed significant growth of a Staphylococcus species resistant to fluoroquinolones. Because of nonresponse to medical management, the patient underwent therapeutic penetrating keratoplasty. Staphylococcal infection of the cornea may appear as a ring-like infiltrate that is recalcitrant to medical management. CASE REPORTA 66-year-old man presented with complaints of sudden diminution of vision in his left eye for 4 days. He had undergone left eye punctoplasty for lower lid punctal stenosis in the past and was receiving treatment for chronic meibomitis. He also had a history of recurrent uveitis and secondary glaucoma in this eye. At the time of presentation, he was using loteprednol etabonate (0.5%) and brimonidine tartrate (0.2%) eyedrops twice daily.During presentation, his visual acuity was limited to hand movement close to the face. Corneal examination revealed a large epithelial defect measuring 8.0 by 7.5 mm. A stromal ring infiltrate corresponding to the dimensions of the epithelial defect was present ( Fig. 1a and b). It was approximately 1.5 mm wide and away from the limbus with associated surrounding stromal edema. The anterior chamber showed a hypopyon measuring 2 mm in height. While staining with 10% potassium hydroxide with calcofluor white did not show any organism, Gram staining showed plenty of polymorphonuclear cells and Gram-positive cocci in groups.The patient was put on fortified cefazolin (5%) and gatifloxacin (0.3%) eyedrops applied once an hour. Culture grew a Staphylococcus species (other than Staphylococcus aureus) that was significant (consistent with the direct microscopy result and confluent growth in two solid media) and sensitive to vancomycin, cefazolin, and methicillin. Hence, the application of 5% cefazolin eyedrops was continued.On subsequent follow-up, a persistent epithelial defect with a size of Ͼ8 mm in all dimensions, a deep stromal ring infiltrate, and a hypopyon remained the same. Loteprednol etabonate eyedrops applied four times daily were added on day 5 after presentation to control the inflammatory component, along with intensive lubrication. They were tapered off over a period of 4 weeks. A repeat corneal scraping 26 days after presentation revealed no organisms in a direct smear test by Gram staining and staining with 10% potassium hydroxide plus calcofluor white or in culture. Finally, with the failure of resolution of clinical signs and symptoms, the patient was given the option of left eye therapeutic penetrating keratoplasty.Culture of the corneal tissue for bacteria, fungi, and Acanthamoeba did not grow any organism. The histopathology evaluation of the corneal tissue showed a completely denuded epithelium with a continuous Bowman's membrane. The stroma showed diffuse loss of fibrokeratocytic nuclei (Fig. 1c and d). The peripheral stroma showed the presence of plump myofibroblastic cells. The central and paracentral corneal stroma showed patchy stromal necrosis with eosinophili...

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“…A condition known as peripheral infiltrates or catarrhal ulcer can also arise at the peripheral superficial cornea and is thought to reflect hypersensitivity or a toxic response to bacteria, 2 with the presence of S. aureus having been detected at the lid margin in eyes affected by this condition. [3][4][5] The various clinical features of ocular disease caused by S. aureus likely result from complex interactions among factors released from bacteria as well as humoral factors such as plasminogen and cellular components such as corneal fibroblasts and infiltrated inflammatory cells of the host.…”

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confidence: 99%

Plasminogen-Dependent Collagenolytic Properties ofStaphylococcus aureusin Collagen Gel Cultures of Human Corneal Fibroblasts

Sugioka

Kodama-Takahshi

Sato

et al. 2018

Invest. Ophthalmol. Vis. Sci.

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PURPOSE. Staphylococcus aureus is a common cause of corneal ulceration, and staphylokinase (SAK) produced by this bacterium is a plasminogen activator. To investigate the pathogenesis of corneal ulceration induced by S. aureus, we examined the effects of bacterial culture broth and SAK on collagen degradation in a culture model in which human corneal fibroblasts are embedded in a collagen gel. METHODS. Corneal fibroblasts embedded in collagen were exposed to S. aureus culture broth or SAK. Collagen degradation was assessed by measurement of hydroxyproline in acid hydrolysates of culture supernatants. Expression of pro-matrix metalloproteinase-1 (pro-MMP-1) was detected by immunoblot analysis as well as reverse transcription and real-time polymerase chain reaction analysis. RESULTS. Both S. aureus culture broth and SAK markedly increased collagen degradation in the presence of corneal fibroblasts and plasminogen. This effect of the culture broth was dependent on cell number to a greater extent than was that of SAK. Whereas the culture broth also increased the expression of pro-MMP-1 in corneal fibroblasts at both mRNA and protein levels, SAK did not. CONCLUSIONS. Our results suggest that S. aureus may promote collagen degradation both by upregulating pro-MMP1 expression in corneal fibroblasts, with pro-MMP-1 then being converted to active MMP-1 by plasmin, and by directing plasmin activity toward collagen in a SAK-dependent manner.

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Marginal ulceration of the cornea.

Cited by 20 publications

References 0 publications

Corneal infiltration after recurrent corneal epithelial erosion

Corneal infiltration after recurrent corneal epithelial erosion

Ring Infiltrate in Staphylococcal Keratitis

Plasminogen-Dependent Collagenolytic Properties ofStaphylococcus aureusin Collagen Gel Cultures of Human Corneal Fibroblasts

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