Immunohistochemical findings in prosthesis-associated giant papillary conjunctivitis
ABSTRACT To identify functional subsets of inflammatory cells and expression of cytokines in the conjunctiva of patients with ocular prosthesis-associated giant papillary conjunctivitis (P-GPC).
Specific immunohistochemical staining using monoclonal antibodies was performed on biopsy specimens obtained from superior tarsal conjunctiva of 18 patients with P-GPC. The prosthetic eyes were taken as the study group, whereas their fellow eyes were used as matched controls.
In normal conjunctiva, mast cells (MCs) were located only in the substantia propria (SP), whereas in P-GPC eyes MCs were also notable in the epithelium in five specimens. Tryptase-chymase-positive MCs (MC(TC)) were predominant both in P-GPC (79%) and in fellow (72%) eyes. MC(TC), CD4(+) lymphocyte, CD8(+) lymphocyte and eosinophil numbers were higher in P-GPC specimens compared with the fellow eyes (P = 0.005, 0.074, 0.012 and 0.025, respectively). Eosinophils were detected in 58.8% of P-GPC specimens and 16.7% of control specimens (P = 0.053). The number of inflammatory cells expressing eotaxin and interleukin (IL)-4 was higher in P-GPC group (P = 0.050 and 0.048, respectively). Nine out of 17 giant papillary conjunctivitis specimens (52.9%) showed eotaxin and IL-4 immunoreactivity, which was considerably higher than the fellow eyes (16.7%) (P = 0.064).
These findings suggest that P-GPC is an allergic disease of the eye associated with increased numbers of MC, eosinophils and lymphocytes in the conjunctiva and a remarkable expression of IL-4 and eotaxin both by the conjunctival epithelium and by the inflammatory cells in the SP.
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ABSTRACT: Mucoid discharge associated with prosthetic eye wear can be a distressing condition that affects the quality of life of people who have lost an eye. Discharge is the second highest concern of experienced prosthetic eye wearers after health of the companion eye and is prevalent in anophthalmic populations. Specific causes of mucoid discharge such as infections and environmental allergens are well understood, but non-specific causes are unknown and an evidence based protocol for managing non-specific discharge is lacking. Current management is based on prosthesis removal and cleaning, and professional re-polishing of the prosthesis. Tear protein deposits accumulate on prosthetic eyes. These deposits mediate the response of the socket to prosthetic eye wear and their influence (good and bad) is determined by differing cleaning regimes and standards of surface finish. This paper proposes a three-phase model that describes the response of the socket to prosthetic eye wear. The phases are: An initial period of wear of a new (or newly-polished) prosthesis when homeostasis is being established (or re-established) within the socket; a second period (equilibrium phase) where beneficial surface deposits have built up on the prosthesis and wear is safe and comfortable, and a third period (breakdown phase) where there is an increasing likelihood of harm from continued wear. The proposed model provides a rationale for a personal cleaning regime to manage non-specific mucoid discharge. Professional care of prosthetic eyes is also important for the management of discharge and evidence for effective surface finishing is reported in this study. Taken together, the proposed regimes for personal and professional care comprise a protocol for managing discharge associated with prosthetic eye wear. The protocol describes prosthetic eye cleaning methods and frequency, and suggests minimum standards for professional polishing. If confirmed, the protocol has the potential to resolve the current varied and contradictory opinions about the management of discharge, and to clarify advice given to patients about how to personally care for their prosthetic eyes.Medical Hypotheses 05/2013; 81(2). DOI:10.1016/j.mehy.2013.04.024 · 1.15 Impact Factor
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ABSTRACT: The aim of this review is to summarize causes of pain and discomfort in the anophthalmic socket and to aid the clinician in evaluating anophthalmic patients.Current Opinion in Ophthalmology 05/2014; DOI:10.1097/ICU.0000000000000069 · 2.64 Impact Factor
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ABSTRACT: PurposeThe aim of this study was to investigate the inflammatory response of the anophthalmic socket to prosthetic eye wear. Methods One hundred and two prosthetic eye wearers were recruited for this observational study. Photographic grading scales were used to measure the severity of conjunctival inflammation and the extent and intensity of stained deposits on the prosthetic eyes. Tear volume was measured with the phenol red thread test. For mucoid discharge, visual analogue scales were used to assess frequency of occurrence, colour, volume and viscosity. For the prostheses, assessments were made of weight, shape, wearing time and frequency of cleaning. ResultsAnophthalmic sockets had more severe conjunctival inflammation than their companion eyes (p = 0.0001). The difference in inflammation between the companion eye and the anophthalmic socket was associated with discharge volume (p = 0.01) and discharge viscosity (p = 0.007) with greater difference in inflammation being associated with higher levels of discharge volume and viscosity. A greater difference in inflammation was also associated with less surface deposition (p = 0.009). No evidence of associations was found between difference in conjunctival inflammation and the other variables. Conclusions Recently developed grading scales for measuring inflammation in anophthalmic sockets and deposits on prosthetic eyes were used for the first time in this study. It is recommended that in clinical practice, inflammation grades for both socket and companion eye conjunctivae be compared, when determining if prosthesis-induced inflammation is present. The finding that more discharge was associated with more conjunctival inflammation is logical but the finding that less inflammation was associated with more deposits is counter-intuitive to those familiar with the contact lens literature. The apparently benign nature of at least some deposits on the prostheses raises questions about the maintenance of prosthetic eyes. We conclude that the simple presence of deposits is unlikely to be linked with inflammation of the conjunctiva in wearers of prostheses, who like those in this study, cleaned their prostheses regularly but not frequently.Clinical and Experimental Optometry 01/2013; 96(4). DOI:10.1111/cxo.12004 · 1.26 Impact Factor