Reflecting colours from the fatty layer of the precorneal film have been studied using mat filter (grease-proof paper, parchment paper, tracing paper) in front of the slit lamp mirror, maximally open light slit in a half-lit room, and magnification x 15. The palpebral fissure was narrowed until occurrence of red interference colour (2000 A). In 206 normal eyes the fatty layer was 102 +/- 3nm (+/- SEM), or about 0.1 micron, independent of age, sex and BUT (break up time). Maximum on awakening. Coefficient of variation 12.7 per cent. An increased fatty layer was noticed in cases of blepharitis (129 +/- 8 nm), in 91 per cent wearing hard contact lenses and 73 per cent wearing soft contact lenses. The fatty layer was likewise seen to be augmented in patients with acute infectious conjunctivitis (193 +/- 3 nm), chronic infectious conjunctivitis (164 +/- 7 nm), and in all states complicated by bacterial infection. The fatty layer is normal in allergic and chronic simple conjunctivitis. Silicone oil was found to effect reduction of the fatty layer.
The break up time (B.U.T.) of the precorneal film has been studied before and after application of 34 different vehicles. The material examined comprised 646 eyes. Maximum increase of the B.U.T. was obtained with 2% methyl cellulose (four times) and 10% polyvinyl alchohol (seven times). These vehicles in the usually employed concentrations, fat-free ointment (polyethylene glycol), acetyl cysteine and polysaccharide (dextran) affected a less pronounced prolongation. The B.U.T. was reduced four or five times by fatty, anhydrous ointments and by silicone oil, about two or three times by emulsions and oils, and twice by 0.01% benzalkonium chloride. The clinical significance of the B.U.T. alterations is discussed.
The effect of sodium hyaluronate eye drops in the treatment of severe keratoconjunctivitis sicca (KCS) was evaluated in a double masked crossover trial, comparing the effect of a 0.1% solution, a 0.2% solution and placebo in 20 patients. We found significantly decreased rose bengal staining and increased break-up time following 0.2% treatment compared to placebo. No significant difference was found in the Schirmer values and the cornea sensitivity. The patients significantly preferred sodium hyaluronate treatment. We conclude that sodium hyaluronate eye drops seem to be a valuable new agent in the management of KCS.
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