Microbial keratitis

Efron, Nathan

doi:10.1016/b978-0-7020-4269-0.00025-0

Cited by 2 publications

(6 citation statements)

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Section: Clinical Signs (Classical)mentioning

confidence: 99%

“…The term ‘loss of function’ was probably intended to infer a loss of function ‘of the affected tissue’. For example, in a serious case of microbial keratitis, where the central cornea is involved, the loss of function would manifest as reduced vision of the affected eye . When considering the contact lens‐wearing eye as a combined system, two key manifestations of ‘loss of function’ are apparent – a forced reduction in wearing time on a given day and discontinuance of lens wear.…”

Section: Clinical Signs (Classical)mentioning

confidence: 99%

“…If a patient presents with serious microbial keratitis, the five cardinal signs of inflammation are readily apparent: the limbus and conjunctiva are hyperaemic (rubor), patients might report that their eyes feel hot and the tissues around the eye will feel warm (calor); there will be evidence of corneal oedema, conjunctival chemosis and swelling of the eyelids (tumor), the eye will be painful (dolor) and if the central cornea is affected, there will be loss of vision (functio laesa). 6 During uncomplicated contact lens wear, perhaps only two of these five clinical signs of inflammation may be apparentlimbal redness (rubor) and end of day discomfort (dolor). More sophisticated clinical techniques would be required to verify calor, tumor and functio laesa.…”

Section: Clinical Signs (Classical)mentioning

confidence: 99%

“…For example, in a serious case of microbial keratitis, where the central cornea is involved, the loss of function would manifest as reduced vision of the affected eye. 6 When considering the contact lens-wearing eye as a combined system, two key manifestations of 'loss of function' are apparenta forced reduction in wearing time on a given day and discontinuance of lens wear. Thus, the act of removing a contact lens from the eye toward the end of the day due to discomfort can be construed as a 'loss of function'.…”

Section: Functio Laesa (Loss Of Function)mentioning

confidence: 99%

“…At the outset, I need to introduce an important point of clarification: I am not referring here to frank, overt inflammatory reactions to contact lens wear, such as papillary conjunctivitis, superior limbic keratoconjunctivitis, microbial keratitis or even the various forms of corneal infiltrative events . The proposition I am advancing is that normal, asymptomatic, problem‐free contact lens wear (aside from ‘end of day discomfort’, which all lens wearers experience) is intrinsically inflammatory.…”

mentioning

confidence: 99%

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Contact lens wear is intrinsically inflammatory

Efron

2017

Clinical and Experimental Optometry

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Eye-care practitioners typically associate ocular inflammation during contact lens wear with serious complications such as microbial keratitis; however, more subtle mechanisms may be at play. This paper tests the notion that contact lens wear is intrinsically inflammatory by exploring whether uncomplicated contact lens wear meets the classical, clinical definition of inflammation -rubor (redness), calor (heat), tumor (swelling), dolor (pain) and functio laesa (loss of function) -as well as the contemporary, sub-clinical definition of inflammation (cellular and biochemical reactions). It is demonstrated that all of these clinical and sub-clinical criteria are met with hydrogel lens wear and most are met with silicone hydrogel lens wear, indicating that uncomplicated contact lens wear is intrinsically inflammatory. Consideration of both traditional and contemporary thinking about the role of inflammation in the human body leads to the perhaps surprising conclusion that the chronic, low grade, sub-clinical inflammatory status of the anterior eye during contact lens wear, which may be termed 'para-inflammation', is a positive, protective phenomenon, whereby up-regulation of the immune system, in a non-damaging way, maintains the eye in a state of 'heightened alert', ready to ward off any extrinsic noxious challenge. Characterisation of this inflammatory status may lead to the development of lens engineering or pharmacological strategies to modulate contact lens-induced inflammation, so as to render lens wear more safe and comfortable.Key words: conjunctiva, cornea, contact lens wear, inflammation, para-inflammationThe topic that I have chosen to present in this H Barry Collin Research Medal Lecture a is a question that has been niggling away at the back of my mind throughout my career. To illustrate this, I draw your attention to a paper I published in 1985 entitled 'Is contact lens-induced corneal oedema inflammatory?' 1 and a follow-up editorial published over a quarter of a century later entitled 'Is contact lens wear inflammatory?' 2 Although the title of the present paper gives away the conclusion that I have ultimately reached, the thought process that has evolved over the past 30 years, supported by emerging evidence rooted in clinical practice and fundamental vision science, is a story worth telling.The notion that inflammation is an intrinsic component of normal, asymptomatic contact lens wear has emerged in part because it has not been possible to otherwise explain some of the most fundamental problems relating to contact lens wear -in particular discomfort, which invariably worsens toward the end of the day.3 If it can be established that contact lens wear is inflammatory, this would open up the door for the exploration of a raft of engineering solutions by way of lens material formulations and designs, as well as pharmacological strategies that can modulate the inflammatory response. At the outset, I need to introduce an important point of clarification: I am not referring here to frank, overt inflammato...

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Section: Clinical Signs (Classical)mentioning

confidence: 99%

Section: Clinical Signs (Classical)mentioning

confidence: 99%

Section: Clinical Signs (Classical)mentioning

confidence: 99%

Section: Functio Laesa (Loss Of Function)mentioning

confidence: 99%

mentioning

confidence: 99%

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Contact lens wear is intrinsically inflammatory

Efron

2017

Clinical and Experimental Optometry

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Biomimetic Functional Surfaces towards Bactericidal Soft Contact Lenses

Mao

2020

Micromachines

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The surface with high-aspect-ratio nanostructure is observed to possess the bactericidal properties, where the physical interaction between high-aspect-ratio nanostructure could exert sufficient pressure on the cell membrane eventually lead to cell lysis. Recent studies in the interaction mechanism and reverse engineering have transferred the bactericidal capability to artificial surface, but the biomimetic surfaces mimicking the topographical patterns on natural resources possess different geometrical parameters and surface properties. The review attempts to highlight the recent progress in bactericidal nanostructured surfaces to analyze the prominent influence factors and cell rupture mechanism. A holistic approach was utilized, integrating interaction mechanisms, material characterization, and fabrication techniques to establish inclusive insights into the topographical effect and mechano-bactericidal applications. The experimental work presented in the hydrogel material field provides support for the feasibility of potentially broadening applications in soft contact lenses.

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Microbial keratitis

Cited by 2 publications

References 62 publications

Contact lens wear is intrinsically inflammatory

Contact lens wear is intrinsically inflammatory

Biomimetic Functional Surfaces towards Bactericidal Soft Contact Lenses

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