The Cornea in Measles

ISBN-13: 9789400986794 / Angielski / Miękka / 2011 / 128 str.

N. W. H. M. Dekkers

Opis

The need to study the corneal complications of measles was not very obvious. Everyone knew of the (kerato) conjunctivitis of measles and considered it to be an innocuous feature of the disease. Every medical worker in developing countries knew that measles in under- or malnourished children runs a very serious course leading to, e. g., corneal The latter are seen frequently that medical workers in complications. developing countries are in the habit of speaking of post-measles blind ness. The aspect of the cornea in post-measles blindness is reminiscent of the keratomalacia in vitamine A deficiency and kwashiorkor. It was suggested that in measles the last reserves of vitamine A are exhausted, thereby precipitating the keratomalacia. The virological origin of measles keratitis has been more or less neglected in literature up till now. This study provides clinical and laboratory data concerning the kerato conjunctivitis of measles, gathered from a number of hospitalized children in a rural area of Kenya. The merits of this monograph is that it gives a careful description of the clinical course of measles keratoconjunctivitis and that it emphasizes the role of the virus-infection in addition to protein deficiency and vitamine A-deficiency in the etiology of post-measles blind ness. The possible roles of exposure in semi-comatose patients and of the application of traditional autochthone medicine are mentioned. Measles is no longer seen in developed countries but will still be encountered in the developing countries."

Spis treści

1. Introduction.- 1.1. Blinding eye complications after measles: ‘Post-Measles-Blindness”.- 1.2. Pathogenesis of Post-Measles-Blindness.- 1.3. Lack of knowledge about the cornea in early measles.- 1.4. Purpose and content of the present study.- 2. Review of literature.- 2.1. The epidemiology of measles.- 2.2. The extra- and intracellular morphology of the measles virus.- 2.3. The pathogenesis of the measles infection.- 2.4 Ocular signs and complications in measles.- 2.4.1. The conjunctivitis of infection.- 2.4.2. The conjunctivitis in prodromal measles.- 2.4.3. The epithelial keratitis in measles.- 2.4.4. Corneal ulcers, a complication of measles.- 2.5. Depression of serumproteins, cell-mediated immunity and serum retinol in malnutrition.- 2.6. Traditional ocular medicines.- 2.7. Statistics on Post-Measles-Blindness.- 3. Patients and Methods.- 3.1. Places and time.- 3.2. The patients: diagnosis of measles and treatment.- 3.3. Ophthalmological examination.- 3.4. The significance of vital staining of the conjunctiva with Lissamine Green or Rose Bengal.- 3.5 Assessment of the nutritional status.- 3.6. Biopsies and specimens for pathology, electronmicroscopy and immunofluorescence.- 3.7. Representativeness of the patient samples.- 4. Clinical description of ocular signs and corneal complications of measles.- 4.1. Ocular involvement in measles.- 4.1.1. Subepithelial conjunctivitis.- 4.1.2. Epithelial conjunctivokeratitis.- 4.2. “Exaggerated signs” and early corneal complications.- 4.2.1. Central corneal macro-erosions.- 4.2.2. Exposure ulcers.- 4.3. The prophylactic value of tetracycline eye-ointment 1% and Vitamin A 200.000 iU.- 4.3.1. Measles keratitis.- 4.3.2. Corneal erosions and exposure ulcers.- 4.4 Late ocular complications.- 5. Immunofluorescence-, light- and electronmicroscopy of conjunctival biopsies and corneal specimens.- 5.1. Immunofluorescence of conjunctival biopsies.- 5.1.1. Technique.- 5.1.2. Results of the immunofluorescence tests on 5 conjunctival biopsies.- 5.2. Light- and electronmicroscopy of conjunctival biopsies.- 5.2.1. Techniques.- 5.2.2. Light microscopy of conjunctival biopsies.- 5.2.3. Electronmicroscopy of conjunctival biopsies.- 5.3. Light- and electronmicroscopy of corneal specimens.- 5.4. Discussion.- 6. The nutritional status of the children with measles-keratitis and corneal complications.- 6.1. Measles-keratitis and age, sex, and history of immunization.- 6.2. Measles-keratitis and nutritional status.- 6.3 The nutritional status of 10 children with early corneal Complications.- 6.4. Nutritional status of patients with late corneal complications.- 6.5. Discussion.- 7. Discussion and conclusion.- 7.1. The pathogenesis of Post-Measles-Blindness.- 7.1.1. Measles.- 7.1.2. Corneal ulcers and collagenase.- 7.1.3. Malnutrition.- 7.1.4. Vitamin A deficiency.- 7.2. The prevention of Post-Measles-Blindness.- 7.2.1. Measles-vaccination.- 7.2.2. Topical treatment of the cornea.- 7.2.3. Improvement of the nutritional status.- 7.3 The measles-keratitis in immunosuppression.- 7.4. Measles and herpes simplex keratitis.- 7.5. Conclusion.- References.- Summary.- Samenvatting.- Résumé.- Acknowledgements.- Colour plates.- Curriculum vitae.