258 THE INDIAN MEDICAL GAZETTE [June, 1944

NOTE ON THE TREATMENT OF ANGULAR CONJUNCTIVITIS WITH RIBOFLAVIN

By 0. P. VERMA, m.b.5 b.s.

Field Worker attached to the Nutrition Research Laboratories

(Nutrition Research Laboratories, I. R. F. A., Coonoor, S. India)

The successful treatment by riboflavin of a number of cases of superficial keratitis was des- cribed in two previous papers (Aykroyd and Verma, 1942; Verma, 1942). In the course of this work it was observed that a number of

patients with superficial keratitis, associated with angular stomatitis and other signs of riboflavin deficiency, were also suffering from angular conjunctivitis, and that the latter condi- tion tended to clear up on the administration of riboflavin. Further investigations on the effect of riboflavin therapy in cases showing angular conjunctivitis were then undertaken. These

investigations were interrupted by Army service, and since it will probably be some time before the work can be resumed, the preliminary observations are here recorded.

Angular conjunctivitis and the Morax-

Axenfeld bacillus.?This diplo-bacillus was

described in 1896 by Morax and Axenfeld simultaneously (Duke-Elder, 1938). It is found in abundance in smears from cases of angular conjunctivitis. It is a saprophyte and is said to produce conjunctivitis by excreting an

exogenous protein-dissolving ferment, which acts by macerating the epithelium. The specific treatment of angular conjunctivitis associated with this bacillus is by drops of zinc sulphate solution, which banishes the symptoms rapidly- The action of zinc, according to Duke-Elder

(loc. ext.), is not a bactericidal one, for the

diplo-bacillus grows well in a culture-medium

containing zinc; the zinc acts by inhibiting the proteolytic ferment secreted by the bacillus and so rendering it impotent.

Effect of riboflavin therapy.?Smears from cases of angular conjunctivitis associated with signs of riboflavin deficiency showed abundant Morax-Axenfeld bacilli (MAB). On treatment by the administration of riboflavin, the angular con- junctivitis disappeared and the smears became negative. No local treatment was given. Twenty cases were treated, 12 males and 8 females. Of

these, 2 showed superficial keratitis and 14 had other sigrts of riboflavin deficiency, i.e. angular stomatitis and sore and fissured tongue. Some of the male patients showed an eczematous con- dition of the skin of the scrotum, characteristic of riboflavin deficiency. In only 3 cases was

angular conjunctivitis present without other

signs of riboflavin deficiency. Some typical cases are described below :? '

(1) F. 30. Complained of photophobia, itching* burning, watering and discharge from the eyes for a

period of 6 weeks. Examination showed angular con- junctivitis and superficial keratitis. Conjunctival smears were highly positive for MAB. Three mgm. of

riboflavin were given by intramuscular injection daily for 7 days. All symptoms and signs disappeared, and the conjunctival smear became negative.

(2) F. 11. This patient complained of pain, watering and itching in both eyes for 10 months. She had xerosis conjunctivae, angular conjunctivitis, corneal '

stipplingangular stomatitis and fissured tongue. The conjunctival smear was positive for MAB. After the intramuscular injection of 4 mgm. of riboflavin daily for 5 days the eye symptoms and signs cleared up, and the smear became negative. .

(3) F. 30. Had angular conjunctivitis, superficial keratitis and angular stomatitis. Duration over 3

weeks. Treatment with riboflavin, 5 mgm. daily _

f?r

8 days by mouth, was followed by relief of eye sigo3

(Concluded on opposite page)

With r (.Continued from previous page)

thp lsaPPearance of MAB, previously present, from

^smear. aQ(j

26. Complained of itching, burning, watering sUfj Pantophobia, in both eyes. Stated that he had

Wiutp from recurring attacks for 3 years, in the

c?nj r ft'onths. This patient had blepharitis, angular

aW fkCtlvitis> angular stomatitis and fissured tongue,

The S^n ^ie scr?tum was itchy, rough and scaly.

Axenf c,jnjunc5tival smear showed numerous Morax-

flavin /i bacilli. He was treated by injection of ribo-

Ocuj ' fflgm. daily intramuscularly for 11 days. The

becati S!Sns and symptoms disappeared, and the smear beCaCv!e negative. Simultaneously the scrotal skin

(5?1? smooth and the angular stomatitis disappeared. Water .24. Complained of burning, itching and

tivitjlng *n ^ie eyes ^or ^ months. Angular conjunc- The an.^ well-marked angular stomatitis were present, the nC0Dju.nctival smear was highly positive for MAB, 7 (]?, r8anism being separated in pure culture. After

cularfS treatment with riboflavin (3 mgm. intramus-

appc ^ each day) the eye signs and symptoms dis-

(6) ^' anc* no bacilli could be found in the smears, recui. )

? ^is case angular conjunctivitis had signs G(j after a month of treatment with zinc. No

juncti ?

i riboflavin deficiency were present. The con-

the 0 smear was highly positive for MAB, and

eo'ganism was grown in pure culture. Treatment ,

5 nigv!6 40 mgm. of riboflavin gi^en orally and of 3 daily by intramuscular injection over a period and thWee^S" The angular conjunctivitis disappeared,

^ "e smear became negative.

preP a series of bacteriological experiments

flav.lllllnary evidence was obtained that ribo-

thp ̂ A/r an inhibitory effect on the growth of

^rork d bacillus in vitro. Further

.' however, necessary for conclusive results. pr

n?ular conjunctivitis associated with the

to bence ^ie Morax-Axenfeld bacillus appears \yi

? a common condition in many countries,

show r riboflavin therapy is of value in cases

defiV-ln? no obvious evidence of riboflavin

gre Clency requires further investigation. In the

signs maj.ority cases observed in this series s of riboflavin deficiency were present.

p Summary fullases of angular conjunctivitis were success- Bef^ ̂ rea^ed by the administration of riboflavin, jyj

?re treatment, smears showed numerous

tre ,ax~Axenfeld bacilli which disappeared after

othe -nt' mai?rity cases, ocular and r signs of riboflavin deficiency were present. Ay REFERENCES

-^Royd, "W, R and Indian Med. Gaz., 77, 1.

P- (1942). C1qoo\LDer' W. S. Textbook of Ophthalmology,

'? Vol. 2. Henry Kimpton, Ver>^ London.

P. (1942). Indian Med. Gaz., 77, 471.