Abstract
The ocular surface is altered in kerato-conjunctivitis sicca, a disorder of aqueous tear production. Many of the factors leading to these surface changes are now more clearly understood and are discussed in this paper.
Similar content being viewed by others
Article PDF
References
Dilly PN and Mackie IA : Surface changes in the anaesthetic conjunctiva in man with special reference to the production of mucus from a non-goblet cell source. Br J Ophthalmol 1981, 65: 833–42.
Dilly PN : Contribution of the epithelium to the stability of the tear film. Trans Ophthalmol Soc UK 1985, 104: 381–9.
Kessing SV : Mucous gland system of the conjunctiva. A quantitative normal anatomical study. Ada Ophthalmol 1968, 95: 1–33.
Allansmith MR, Greiner JV, Baird RS : Number of inflammatory cells in the normal conjunctiva. Am J Ophthalmol 1978, 86: 250–9.
Mengher LS : Tear assessment in the dry eye. D Phil Thesis. In preparation. University of Oxford.
Bron AJ, Mengher LS, Davey CO . The normal conjunctiva and its response to inflammation. Trans Ophthalmol Soc UK 1985, 104: 424–35.
Norn MS : Conjunctivo-cytologic studies. In External Eye. Methods of Examination. Copenhagen. Scriptor. 1974, 142–64.
Speek AJ, van Agtmaal EJ, Saowakontha S, Schreurs WHP, van Haeringen NJ : Fluorometric determination or retinol in human tear fluid using high performance liquid chromatography. Curr. Eye Res 1986, 5: 841–5.
Chao CCW and Butala SM : Isolation and preliminary characterisation of tear prealbumin from human ocular mucus. Curr Eye Res 1986, 5: 895–901.
Tseng SCG, Hirst LW, Farazdaghi M, Green WR : Goblet cell density and vascularization during conjunctival transdifferentiation. Invest Ophthalmol Vis Sci 1984, 25: 1168–76.
Friedenwald JS : Growth pressure and metaplasia of conjunctival and corneal epithelium. Doc Ophthalmol 1951, 5-6: 184–90.
Tseng SCG, Hirst LW, Farazdaghi M, Maumenee AE, Green WR : Retardation of conjunctival trans-differentiation by topical retinoids (abstract-2) Invest Ophthalmol Vis Sci (suppl) 1984, 25: 76–8.
Farazdaghi M, Liu SH, Rider AA, Lutty GA, Pren-dergast RA, Tseng SCG : Reversal of conjunctival trans-differentiation by retinoids (abstract-4). Invest Ophthalmol Vis Sci (suppl) 1984, 25: 76–8.
Gilbard JP, Rossi SR, Gray KL : A new rabbit model for keratoconjunctivitis sicca. Invest Ophthalmol Vis Sci 1987, 28: 225–8.
Gilbard JP, Rossi SR, Gray KL, Hanninen LA, Kenyon KR : Tear film osmolarity and ocular surface disease in two rabbit models for keratoconjunctivitis sicca. Invest Ophthalmol Vis Sci 1988, 29: 374–8.
Moore JC and Tiffany JM : Human ocular mucus. Origins and preliminary characterisation. Exp Eye Res 1979, 29: 291–301.
Huang AJW and Tseng SCG : Development of monoclonal antibodies to rabbit ocular mucin. Invest Ophthalmol Vis Sci 1987, 28: 1483–91.
Kaura R and Tiffany JM : The role of mucus glycoproteins in the tear film. In: Holly FJ, ed. The preocular tear film in health, disease and contact lens wear. Lubbock, TX: Dry Eye Institute, 1986, 728–32.
Hamano H and Kaufman HE : Physiology of the cornea and contact lens applications. Publisher Churchill-Livingstone, 1986.
Bron AJ : Prospects for the dry eye. Duke-Elder lecture. Trans Ophthalmol Soc UK 1985, 104: 801–26.
Allen M, Wright P, Reid L : The human lacrimal gland. A histochemical and organ culture study of the secretory cell. Arch Ophthalmol 1972, 88: 493–7.
Holly FJ and Lemp MA : Wettability and wetting of the corneal epithelium. Exp Eye Res 1971, 11: 239–50.
Cope C, Dilly PN, Kaura R, Tiffany JM : Wettability of the corneal surface: a reappraisal. Curr Eye Res 1986, 5: 777–85
Tiffany JM : Measurement of wettability of the corneal surface (abstract). 28th meeting of the Association for Eye Research, Belgium. Sept. 16-19, 1987. Published in Ophthalmic Res 1988, 20: 61–98.
Holly FJ : Formation and stability of the tear film. Int Ophthalmol Clin 1973, 13: 73–96.
Benedetto DA, Shah DO, Kaufman HE : The instilled fluid dynamics and surface chemistry of polymers in the pre-ocular tear film. Invest Ophthalmol 1975, 14: 887–92.
Nasu M, Matsubara, Yamamoto H : Post-mortem prevalence of lymphocytic infiltration of the lacri-mal gland: A comparative study in autoimmune and non-autoimmune diseases. J Pathol 1984, 143: 11–15.
Mishima S, Kubota Z, Farris RL : Tear flow dynamics in normal and in keratoconjunctivitis sicca cases: in Solanes MP, ed. XXI Concilium Ophthalmologicum, Mexico DF. 8-14 March 1970. Amsterdam. Excerpta Medica. 1971, part II: 1801–5.
van Bijesterveld OP : Diagnostic tests in sicca syndrome. Arch Ophthalmol 1969, 82: 10–14.
Farris RL, Gilbard JP, Stuchell RN, Mandel ID : Diagnostic tests in keratoconjunctivitis sicca. TCLAO J 1983, 9: 23–8.
Scherz W, Doane MG, Dohlman CH : Tear volume in normal eyes and keratoconjunctivitis sicca. Albrecht v. Graefes Arch Klin Exp Ophthamol 1974, 192: 151–60.
Klein M : The lacrimal strip and precorneal tear film in cases of Sjögren's syndrome. Br J Ophthalmol 1949, 33: 387–8.
Lamberts DW : Keratoconjunctivitis sicca. In Smolin G and Thoft RA, eds. The Cornea. Boston. Little Brown and Co 1987, 387–104.
Lamberts DW, Foster CS, Perry HD : Schirmer test after topical anaesthetesia and tear meniscus height in normal eyes. Arch Ophthalmol 1979, 97: 1082–5.
von Bahr G : Konnte der flussigkeitsabgang durch die cornea von physiologischer bedeutung sein? Acta Ophthalmol 1941, 19: 125–34.
Mastmann GJ, Baldes EJ, Henderson JW : The total osmotic pressure of tears in normals and various pathological conditions. Arch Ophthalmol 1961, 61: 509–13.
Gilbard JP, Farris RL, Santamaria J : Osmolarity of tear microvolumes in keratoconjunctivitis sicca. Arch Ophthalmol 1978, 96: 677–81.
Gilbard JP, Carter JB, Sang DN, Refojo MF, Hanninen LA, Kenyon KR : Morphologic effect of hyperosmolarity on rabbit corneal epithelium. Ophthalmol 1984, 91: 1205–12.
Verges C, Refojo MF, Gilbard JP, Kenyon KR : Effect of hyperosmolarity on conjunctival goblet cells density in vivo (abstract 8) Invest Ophthalmol Vis Sci (suppl). 1984, 25: 190–2.
Hardman-Lea S, MengherLS, Davey CC, Bron AJ : Rose bengal and fluoresceinstainingin the assessment of keratoconjunctivitis sicca (abstract). 27th meeting of the Association for Eye Research. Oxford, England. Sept 14-18th 1986, Published in Ophthalmol Res 1987, 19: 19–20.
Seal DV : The effect of ageing and disease on tear constituents. Trans Ophthalmol Soc UK 1985, 104: 355–62.
Mackie IA and Seal DV : Diagnostic implications of tear protein profiles. Br J Ophthalmol 1984, 68: 321–4.
Norn MS : Desiccation of the precorneal film: I corneal wetting time. Acta Ophthalmol 1969, 47: 856–80.
Lemp MA, Dohlman CH, Holly FJ : Corneal desiccation despite normal tear volume. Ann Ophthalmol 1970, 2: 258–84.
Lemp MA and Hamill JR : Factors affecting tear film break up in normal eyes. Arch Ophthalmol 1973, 89: 103–5.
Vanley GT, Leopold HI, Gregg TH : Interpretation of tear film break up. Arch Ophthalmol 1977, 95: 445–8.
Mengher LS, Bron AJ, Tonge SR, Gilbert DJ : A non-invasive instrument for clinical assessment of the pre-corneal tear film stability. Curr Eye Res 1985, 4: 1–7.
Mengher LS, Pandher KS, Bron AJ : Non-invasive tear film break up time; Sensitivity and Specificity. Acta Ophthalmol 1986, 64: 441–4.
Abdel-Khalek LMR, Williamson J, Lee WR : Morphological changes in the human conjunctival epithelium II. In keratoconjunctivitis sicca. Br J Ophthalmol 1978, 62: 800–6.
Tiffany JM, Winter N, Bliss G : Tear film stability and tear surface tension. Curr Eye Res (submitted).
Norn MS : Vital staining of cornea and conjunctiva. Acta Ophthalmol (suppl 113) 1972, 39–46.
Lemp MA and Gold JB : An in vivo study of the corneal surface in keratoconjunctivitis sicca. Trans Ophthalmol Soc UK 1985, 104: 436–8.
Sjögren H and Bloch KJ : Keratoconjunctivitis sicca and the Sjögren syndrome. Surv Ophthalmol 1971, 16: 145–59.
Lemp MA, Dohalman CH, Kuwabra T, Holly FJ, Carroll JM : Dry eye secondary to mucus deficiency. Trans Am Acad Ophthalmol Otolarygol 1971, 1223–27.
Ralph RA : Conjunctival goblet cell density in normal subjects and in dry eye syndromes. Invest Ophthalmol Vis Sci 1975, 14: 299–302.
Nelson JD, Havener VR, Cameron JD : Cellulose acetate impressions of the ocular surface: Dry eye states. Arch Ophthalmol 1983, 101: 1869–72.
Nelson JD and Wright JC : Conjunctival goblet cell densities in ocular surface disease. Arch Ophthalmol 1984, 102: 1049–51.
Nelson JD and Wright JC : Impression cytology of the ocular surface in keratoconjunctivitis sicca. In: Holly FJ, ed. The preocular tear film in health, disease and contact lens wear. Lubbock TX: Dry Eye Institute, 1986, 140–56.
Norn MS and Kristensen EB : Benign mucous membrane pemphigoid II. Cytology Acta Ophthalmol 1974, 52: 282–90.
Maumenee AE : Keratitis secondary to keratiniza-tion of the tarsal conjunctiva. Am J Ophthalmol 1956, 41: 477–87.
Egbert PR, Lauber MA, Maurice DM : A simple conjunctival biopsy. Am J Ophthalmol 1977, 84: 798–801.
Nelson JD : Impression cytology. Cornea 1988, 71–81.
Wittpenn JR, Tseng SCG, Sommer A : Detection of early xerophthalmia by impression cytology Arch Ophthalmol 1986, 104: 237–9.
Natadisastra G, Wittpenn JR, West KP, Muhilal RD, Sommer A : Impression cytology for detection of vitamin A deficiency. Arch Ophthalmol 1987, 105: 1224–8.
Sommer A, Tarwotjo I, Hussaini G, Susanto D : Increased mortality in children with mild vitamin A deficiency. Lancet 1983, 2: 585–8.
Sommer A : Mortality associated with mild, untreated xerophthalmia. Trans Am Ophthalmol Soc 1983, 81: 825–53.
Sommer A, Katz J, Tarwotjo I : Increased risk of respiratory disease and diarrhea in children with pre-existing mild vitamin A deficiency Am J Clin Nutr 1984, 40: 1090–5.
Sommer A, Tarwotjo I, Djunaedi E, West KP, Loeden A, Tilden R and The Aceh Study Group: Impact of vitamin A supplementation on childhood mortality. A randomised controlled community trial. Lancet 1986, 1: 1169–73.
Marner K : ‘Snake-like’ appearance of nuclear chromatin in conjunctival epithelial cells from patients with keratoconjunctivitis sicca. Ada Ophthalmol 1980, 58: 849–53.
Marner K, Manthrope R, Prause JU : Snake-like nuclear chromatin in imprints of conjunctival cells from patients with Sjögren's syndrome. In Machteyl, ed. Progressin Rheumatology. Rheumatology Service, Hasharon Hospital, Petan-Tiqva, Israel 1984, Vol. II, 127–30.
Kruse FE, Jaeger W, Gotz ML, Schmitz W : Conjunctival morphology in Sjögren's syndrome and other disorders of the anterior eye. Scand J Rheu-matol 1986 (suppl) 61, 206–14.
Author information
Authors and Affiliations
Rights and permissions
About this article
Cite this article
Bron, A., Mengher, L. The ocular surface in keratoconjunctivitis sicca. Eye 3, 428–437 (1989). https://doi.org/10.1038/eye.1989.64
Issue Date:
DOI: https://doi.org/10.1038/eye.1989.64
This article is cited by
-
Case control study of dry eye and related ocular surface abnormalities in Ibadan, Nigeria
International Ophthalmology (2010)
-
Lacrimal plugs as a therapy for contact lens intolerance
Eye (1996)
-
The viscosity of human tears
International Ophthalmology (1991)