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LACRIMAL GLAND, TEAR FILM, AND DRY EYE SYNDROMES Basic Science and Clinical Relevance
ADVANCES IN EXPERIMENTAL MEDICINE AND BIOLOGY
Editorial Board:
NATHAN BACK, State University of New York at Buffalo
IRUN R. COHEN, The Weizmann Institute of Science
DAVID KRITCHEVSKY, Wistar Instilute
ABEL LAJTHA, N. S. Kline Instilute for Psychiatric Research
RODOLFO PAOLETTI, University of Milan
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Edited by Peter Vaupel, Rolf Zander, and Duane F. Bruley
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Edited by Samuel Sideman and Rafael Beyar
Volume 347 IMMUNOBIOLOGY OF PROTEINS AND PEPTIDES VII: Unwanted Immune Responses
Edited by M. Zouhair Atassi
Volume 348 ADVANCES IN NUTRITION AND CANCER
Edited by Vincenzo Zappia, Marco Salvatore, and Fulvio Della Ragione
Volume 349 ANTIMICROBIAL SUSCEPTIBILITY TESTING: Critical Issues for the 90s
Edited by James A. Poupard, Lori R. Walsh, and Bruce Kleger
Volume 350 LACRIMAL GLAND, TEAR FILM, AND DRY EYE SYNDROMES: Basic Science and Clinical Relevance
Edited by David A. Sullivan
Volume 351 THE CHEMOKINES: Biology of the Inflammatory Peptide Supergene Family II
Edited by 1. J. D. Lindley, J. Westwick, and S. Kunkel
A Continuation Order Plan is available for this series. A continuation order will bring delivery of each new volume immediately upon publication. Volumes are billed only upon actual shipment. For further information please contact the publisher.
LACRIMAL GLAND, TEAR FILM, AND DRY EYE SYNDROMES Basic Science and Clinical Relevance
Edited by
David A. Sullivan Schepens Eye Research Institute and Harvard Medical School Boston, Massachusetts
Associate Editors
B. Britt Bromberg University of New Orleans, New Orleans, Louisiana
Michele M. Cripps Louisiana State University Medical Center, New Orleans, Louisiana
Assistant Editors
Darlene A. Dartt Schepens Eye Research Institute and Harvard Medical School, Boston, Massachusetts
Donald L. MacKeen Georgetown University Medical Center, Washington, D. c.
Austin K. Mircheff University of Southern California School of Medicine, Los Angeles, California
Paul C. Montgomery Wayne State University Medical School, Detroit, Michigan
Kazuo Tsubota Ichikawa General Hospital and Tokyo Dental College, Chiba, Japan
Benjamin Walcott State University of New York at Stony Brook, Stony Brook, New York
SPRINGER SCIENCE+BUSINESS MEDIA, LLC
Library of Congress Cataloging in Publication Data
Lacrimal gland, tear film, and dry eye syndromes: basic science and clinical relevance / edited by David A Sullivan; associate editors, A Britt Bromberg, Michele M. Cripps; assistant editors, Darlene A Dartt ... ret al.].
p. cm.-{Advances in experimental medicine and biology; v. 350) "Proceedings of an International Conference on the Lacrimal Gland, Tear Film, and
Dry Eye Syndromes: Basic Science and Clinical Relevance, held November 14-17, 1992, in Southampton, Bermuda"-T.p. verso.
Includes bibliographical references and index. ISBN 978-1-4613-6025-4 ISBN 978-1-4615-2417-5 (eBook) DOI 10.1007/978-1-4615-2417-5 1. Lacrimal apparatus--Physiology----Congresses. 2. Tears--Congresses. 3. Dry eye
syndromes--Congresses. 4. Sjogren's syndrome-Congresses. I. Sullivan, David A II. International Conference on the Lacrimal Gland, Tear Film, and Dry Eye Syndromes: Basic Science and Clinical Relevance (1992: Southampton, Bermuda Islands) III. Series.
DNLM: 1. Lacrimal Apparatus--congresses. 2. Tears-physiology-rongresses. 3. Dry Eye Syndromes-diagnosis-rongresses. 4. Dry Eye Syndromes-therapycongresses. WI AD559 v.350 1994 / WW 208 L1453 1994] QPI88.T41A4 1994 612.8'47-dc20 DNLM/DLC for Library of Congress
94-2222 CIP
Proceedings of an International Conference on the Lacrimal Gland, Tear Film, and Dry Eye Syndromes: Basic Science and Clinical Relevance, held November 14-17, 1992, in Southampton, Bermuda
ISBN 978-1-4613-6025-4
© 1994 Springer Science+Business Media New York Originally published by Plenum Press in 1994 Softcover reprint of the hardcover 15t edition 1994
All rights reserved
No part of this book may be reproduced, stored in a retrieval system, or transmitted in any form or by any means, electronic, mechanical, photocopying, microfilming, recording, or otherwise, without written permission from the Publisher
DEDICATION
We dedicate this book to Drs. Mathea R. Allansmith, Stella Y. Botelho, Frank Flynn,
Frank J. Holly, Mogens S. Nom and O. Paul van Bijsterveld for their pioneering efforts and
outstanding achievements in basic and clinical research on the lacrimal gland, tear film and
dry eye syndromes.
The Editors
v
ACKNOWLEDGMENTS
We would like to express our sincere appreciation to the following companies, whose generous financial contributions significantly offset the educational expenses and publication costs associated with the International Conference on the Lacrimal Gland, Tear Film and Dry Eye Syndromes: Basic Science and Clinical Relevance.
ALCON OPHTHALMIC Alcon Laboratories, Inc., 6201 South Freeway, Fort Worth, Texas 76134-2099
SANDOZ PHARMACEUTICAL CORPORATION 3525 Lake Trail, Kenner, Louisiana 70065
LACRIMEDICS, INC. 190 North Arrowhead Avenue, Suite #B, Rialto, California 92376
DR. MANN PHARMA Brunsblitteler Damm 165, Postfach 20 04 56, D-W-lOOO Berlin, Germany
IOLAB CORPORATION 500 lolab Drive, Claremont, CA 91711
CIBA VISION OPHTHALMICS 11460 John's Creek Parkway, Duluth, Georgia 30136
ALLERGAN, INC. 2525 Dupont Ave., Irvine, CA 92715
ROSS LABORATORIES 625 Cleveland Avenue, Columbus, Ohio 43215
SANTEN PHARMACEUTICAL COMPANY, LTD. 9-19, Shimoshinjo 3-chome, Higashi Yodogawa-ku, Osaka 533, Japan
vii
ALCON FOUNDATION P.O. Box 6600, Fort Worth, Texas 76115
PFIZER INC. Consumer Health Care Division, 235 East 42nd Street, New York City, NY 10017-5755
BAUSCH & LOMB Pharmaceutical Division, 8500 Hidden River Parkway, Tampa, Florida 33637
EAGLE VISION 6263 Poplar Avenue, Suite 650, Memphis, Tennessee 38119
ROHTO PHARMACEUTICAL COMPANY, LTD. Product Development Department, 8-1, Tatsumi-nishi l-chome, Ikuno-ku, Osaka 544, Japan
MACKEEN CONSULTANTS LTD. 4903 Sangamore Road, Bethesda, Maryland 20816
STORZ INTERNATIONAL Pharmaceuticals Division, 3365 Tree Court Industrial Blvd., St. Louis, Missouri 63122
viii
TELIOS PHARMACEUTICALS, INC. 2909 Science Park Rd., San Diego, California 92121
PREFACE
During the past decade a significant international research effort has been directed
towards understanding the composition and regulation of the preocular tear film. This effort has been motivated by the recognition that the tear film plays an essential role in maintaining
corneal and conjunctival integrity, protecting against microbial challenge and preserving
visual acuity. In addition, research has been stimulated by the knowledge that alteration or
deficiency of the tear film, which occurs in countless individuals throughout the world, may lead to desiccation of the ocular surface, ulceration and perforation of the cornea, an increased incidence of infectious disease, and potentially, pronounced visual disability and blindness.7
To promote further progress in this field of vision research, the International Conference on the Lacrimal Gland, Tear Film and Dry Eye Syndromes: Basic Science and Clinical Relevance was held in the Southampton Princess Resort in Bermuda from November 14 to
17, 1992. This meeting was designed to assess critically the current knowledge and 'state of
the art' research on the structure and function of lacrimal tissue and tears in both health and
disease. The goal of this conference was to provide an international exchange of information
that would be of value to basic scientists involved in eye research, to physicians in the
ophthalmological community, and to pharmaceutical companies with an interest in the treatment of lacrimal gland, tear film or ocular surface disorders (e.g. Sjogren's syndrome).
To help achieve this objective, over 180 scientists, physicians and industry representatives from Australia, Brazil, Canada, Denmark, England, Finland, France, Germany, Israel, India, Italy, Japan, The Netherlands, Poland, Scotland, Spain and the United States registered as active participants in this conference. In addition, this volume,
which contains summaries of the conference's keynote, oral and poster presentations, was
created to provide an educational foundation and scientific reference for tear film research.
The editors would like to thank the following individuals, whose scientific, administrative, or technical advice and/or assistance helped make the International Conference on the Lacrimal Gland, Tear Film, and Dry Eye Syndromes: Basis Science and
Clinical Relevance, as well as this book, a reality: Mark B. Abelson, M.D., Mathea R.
Allansmith, M.D., Gillian Alexander, Alan Bergl, Anthony J. Bron, M.D., Marshall G.
ix
Doane, Ph.D., Mary Gallagher, Michelle George, Jeffrey P. Gilbard, M.D., Jack V. Greiner, Ph.D., O.D., D.O., Louane E. Hann, Zhiyan Huang, M.D., Jan Jorrin, Ilya Kagansky, Robin S. Kelleher, Ph.D., Aize Kijlstra, Ph.D., Kevin J. Klein, Ross William Lambert, Ph.D., Carole Lanigan, Kathleen Lavin, Myca Mooshian, 1. Daniel Nelson, M.D., Stephen C. Pflugfelder, M.D., Miguel F. Refojo, Ph.D., Margaret Rocco, Bernard Rossignol, Ph.D., Elcio H. Sato, M.D., Kendyl Schaefer, Amy G. Sullivan, Benjamin D. Sullivan, Rose M. Sullivan, Marva Trott, Janice Ubels, John L. Ubels, Ph.D., and L. Alexandra Wickham.
David A. Sullivan
x
CONTENTS
KEYNOTE ADDRESS
Regulation of Tear Secretion. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1 D.A. Dartt
LACRIMAL GLAND: ANATOMY AND INNERVATION
The Anatomy and Innervation of Lacrimal Glands. . . . . . . . . . . . . . . . . . . . . . . . . 11 B. Walcott, R.H. Cameron, and P.R. Brink
Light and Electron Microscopic Morphology of Accessory Lacrimal Glands. . . . . . . . 19 P. Seifert, M. Spitznas, F. Koch, and A. Cusumano
Immunohistochemistry and Protein Secretion in the Rat Lacrimal Gland: A Morphophysiological Study. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 25
J. Singh, E. Adeghate, S. Burrows, F.C. Howarth, and R.M. Williams
Carbonic Anhydrase and Acinar Cell Heterogeneity in Rat and Rabbit Lacrimal Glands. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 31
B.B. Bromberg, C.W. Hanemann, M.H. Welch, R.W. Beuerman, and S. Githens
Basement Membrane Modulation of Stimulated Secretion by Lacrimal Acinar Cells. . . 37 G.W. Laurie, J.D. Glass, and R.A. Ogle
Galactose-Binding Sites in the Acinar Cells of the Human Accessory Lacrimal Gland. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. 45
W. Breipohl, M. Spitznas, F. Sinowatz, O. Leip, W. Naib-Majani, and A. Cusumano
xi
Thoughts on the Ductules of the Aging Human Lacrimal Gland. . . . . . . . . . . . . . . .. 49 O.G. Stasior and J.L. Roen
The Parenchyma Accompanying Major Extraglandular Ducts within the Rat Lacrimal Cord. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 53
M. Lorber
Protein Secretion and the Identification of Neurotransmitters in the Isolated Pig Lacrimal Gland. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 57
J. Singh, E. Adeghate, S. Burrows, F.e. Howarth, and T. Donath
Anti-Muscarinic Acetylcholine Receptor-Like Immunoreactivity in Lacrimal Glands. .. 61 B. Walcott, R. Cameron, E. Grine, E. Roemer, M. Pastor and P.R. Brink
Innervation and Mast Cells of the Rat Lacrimal Gland: The Effects of Age. . . . . . . 67 R.M. Williams, J. Singh, and K.A. Sharkey
Immunogold Localization of Prolactin in Acinar Cells of Lacrimal Gland. . . . . . . . . . 75 R.L. Wood, K.-H. Park, J.P. Gierow, and A.K. Mircheff
LACRIMAL GLAND: ELECTROPHYSIOLOGY, WATER AND ION TRANSPORT
Subcellular Organization of Ion Transporters in Lacrimal Acinar Cells: Secretagogue-Induced Dynamics . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 79
A.K. Mircheff, Ross W. Lambert, Robert W. Lambert, e.A. Maves, J.P. Gierow and R.L. Wood
Effect of Acetylcholine on the Membrane Conductance of the Intralobular Duct Cells of the Rat Exorbital Lacrimal Gland. . . . . . . . . . . . . . . . . . . . . . . . . . . . . 87
Y. Saito and S. Kuwahara
The Circadian Rhythm of Lacrimal Secretion and Its Parameters, Determined in a Group of Healthy Individuals, and Its Potential Diagnostic and Therapeutic Significance . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 93
A. Romano, A. Peisich, and B. Madjarov
Effects of Dihydrotestosterone and Prolactin on Lacrimal Gland Function. . . . . . . . . 99 D.W. Warren, A.M. Azzarolo, L. Becker, K. Bjerrum, R.L. Kaswan, and
A.K. Mircheff
A Na:H Exchanger Subtype Mediates Volume Regulation in Bovine Corneal
Epithelial Cells. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. 105 P. Reinach, V. Ganapathy, and V. Torres-Zamorano
xii
Endocytosis and Exocytosis in Rabbit Lacrimal Gland Acinar Cells. . . . . . . . . . . . . 111 J.P. Gierow, R.L. Wood, and AK. Mircheff
LACRIMAL GLAND: SIGNAL TRANSDUCTION AND PROTEIN SECRETION
The Inositol Phosphate-Calcium Signalling System in Lacrimal Gland Cells. . . . . . . 115 J.W. Putney, Jr., and G. St. J. Bird
Characterization of Rat Lacrimal Gland Protein Kinase C: Effects of Phorbol Esters and PKC Inhibitors on Histone Kinase Activity and Labelled Protein Discharge . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 121
D. Zoukhri, P. Mauduit, and B. Rossignol
Inhibition of Lacrimal Function by Selective Opiate Agonists . . . . . . . . . . . . . . . . . 127 M.M. Cripps and DJ. Bennett
Second Messenger Modulation of IgG Secretion from Chicken Lacrimal Gland. . . . . 133 R.H. Cameron, B. Walcott, S.F. Fan, M. Pastor, E. Roemer, E. Grine, and
P.R. Brink
Identification of Sigma Receptors in Lacrimocytes and Their Therapeutic Implication in Dry Eye Syndrome. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 141
R.D. Schoenwald, C.F. Barfknecht, S. Shirolkar, E. Xia, and C.C. Ignace
Role of Protein Kinase C in a I-Adrenergic and Cholinergic Agonist Stimulated
Protein Secretion. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 147 R.R. Hodges, D.M. Dicker, and D.A Dartt
The Role of Membrane Channels in IgG Secretion by Plasma Cells in the Chicken Lacrimal Gland. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. 151
P.R. Brink, B. Walcott, E. Roemer, R. Cameron, and M. Pastor
Binding Characteristics, Immunocytochemical Location and Hormonal Regulation of Androgen Receptors in Lacrimal Tissue. . . . . . . . . . . . . . . . . . . . . . . . . .. 157
F.J. Rocha, R.S. Kelleher, J.A Edwards, J.D.O. Pena, M. Ono, and D.A Sullivan
LACRIMAL GLAND: IMMUNOLOGY
Regulation of Lacrimal Gland Immune Responses ........................ , 161 P.C. Montgomery, N.L. O'Sullivan, L.B. Martin, C.A Skandera,
J.V. Peppard, and AG. Pockley
xiii
The Lacrimal Antibody Response to Viral and Chlamydial Infections. . . . . . . . . . .. 169 M.G. Friedman
Neural-Endocrine Control of Secretory Component Synthesis by Lacrimal Gland Acinar Cells: Specificity, Temporal Characteristics and Molecular Basis. . . .. 175
R.W. Lambert, R.S. Kelleher, L.A. Wickham, J. Gao and D.A. Sullivan
Lymphocyte Adhesive Interaction with Lacrimal Gland Acinar Epithelium Involves Carbohydrate Recognition. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. 181
N.L. O'Sullivan, R. Raja, and P.e. Montgomery
Subclass Expression of IgA in Lacrimal Glands of Patients with Sjogren's Syndrome. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 185
M. Ono, K. Yoshino, K. Tsubota and I. Saito
Influence of the Endocrine Environment on Herpes Virus Infection in Rat Lacrimal Gland Acinar Cells. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 189
Z. Huang, R.W. Lambert, L.A. Wickham, and D.A. Sullivan
Sialodacryoadenitis Virus Infection of Rat Lacrimal Gland Acinar Cells. . . . . . . . . . 193 L.A. Wickham, Z. Huang, R.W. Lambert, and D.A. Sullivan
MOLECULAR BIOLOGICAL APPROACHES TO THE STUDY OF THE LACRIMAL GLAND AND TEAR FILM
Growth Factor and Receptor Messenger RNA Production in Human Lacrimal Gland Tissue. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. 197
S.E. Wilson
Human Lacrimal Gland Secretes Proteins Belonging to the Group of Hydrophobic Molecule Transporters . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. 205
A.M.F. Gachon
Transcription of Message for Tumor Necrosis Factor-Alpha by Lacrimal Gland is Regulated by Corneal Wounding. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 211
H.W. Thompson, R.W. Beuerman, J. Cook, L.W. Underwood, and D.H. Nguyen
Androgen Regulation of Secretory Component rnRNA Levels in the Rat Lacrimal Gland. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. 219
J. Gao, R.W. Lambert, L.A. Wickham, and D.A. Sullivan
xiv
Vasoactive Intestinal Peptide Induces Primary Response Gene Expression in Lacrimal Gland ......................................... " 225
M.M. Cripps, H.W. Thompson, and R.W. Beuerman
TEAR FILM COMPOSITION AND BIOPHYSICAL PROPERTIES
Composition and Biophysical Properties of the Tear Film: Knowledge and Uncertainty. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. 231
J.M. Tiffany
Structure and Function of the Tear Film. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. 239 P.N. Dilly
Ocular Surface Changes Induced by Repeated Impression Cytology. . . . . . . . . . . .. 249 M. Rolando, V. Brezzo, and G. Calabria
Developmental Appearance of a Component of the Glycocalyx of the Ocular Surface
Epithelium in the Rat. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. 255 H. Watanabe, A.S. Tisdale, SJ. Spurr-Michaud, and I.K. Gipson
Mixing of the Tear Film under the Eyelids. . . . . . . . . . . . . . . . . . . . . . . . . . . . .. 263 D.M. Maurice
Viscoelastic Properties of Human Tears and Polymer Solutions. . . . . . . . . . . . . . .. 267 J.M. Tiffany
Effect of Age on Human Tear Film Evaporation in Normals ................ " 271
A. Tomlinson and C. Giesbrecht
Advances in Ocular Tribology . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. 275 F.J. Holly and T.F. Holly
Effect of Systemic Ingestion of Vitamin and Trace Element Dietary Supplements on
the Stability of the Pre-Corneal Tear Film in Normal Subjects. . . . . . . . . . .. 285 S. Patel, C. Ferrier, and J. Plaskow
Patterns of Cytokeratin Expression in Impression Cytology Specimens from Normal Human Conjunctival Epithelium. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. 289
K.L. Krenzer and T.F. Freddo
Increase in Tear Film Lipid Layer Thickness Following Treatment of Meibomian Gland Dysfunction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. 293
D.R. Korb and J.V. Greiner
xv
TEAR PROTEINS AND GROWTH FACTORS
Analysis and Function of the Human Tear Proteins. . . . . . . . . . . . . . . . . . . . . . .. 299 A. Kijlstra and A. Kuizenga
Tear Protein Composition and the Effects of Stimulus. . . . . . . . . . . . . . . . . . . . .. 309 R.J. Fullard and D. Tucker
Growth Factors in Human Tear Ruid and in Lacrimal Glands. . . . . . . . . . . . . . . .. 315 G.-B. van Setten, G.S. Schultz, and S. Macauley
Re-Examination of the Origin of Human Tear LDH . . . . . . . . . . . . . . . . . . . . . . .. 321 T. Tsubai and M. Murai
Tear Proteins and Enzymes in the Chimpanzee. . . . . . . . . . . . . . . . . . . . . . . . . .. 327 N.J. van Haeringen, V.M.W. Bodelier, and P.S.J. Klaver
Comparisons of Tear Proteins in the Cow, Horse, Dog and Rabbit. . . . . . . . . . . .. 331 H.J. Davidson, G.L. Blanchard, and P.C. Montgomery
Tear Protein G Originates from Denatured Tear Specific Prealburnin as Revealed by Anti-TSP Antibody. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. 335
J. Baguet, V. Claudon-Eyl, and A.M. Gachon
Tear Lactoferrin Levels and Ocular Bacterial Rora in HIV Positive Patients. . . . . . .. 339 S.E. Comerie-Smith, J. Nunez, M. Hosmer, and R.L. Farris
Vitronectin in Human Tears--Protection Against Closed Eye Induced Inflammatory Damage. . . .. . .. . .. . . . . .. . .. . . . . .. . . . . . . . .. . .. . . . ... . . .. 345
R.A. Sack, A. Underwood, K.O. Tan, and C. Morris
Mucopolysaccharide Degrading Enzymes (MPDE) in the Tear Fluid: A New Diagnostic Test for Rapid Detection of Acute Ocular Infections. . . . . . . . . .. 351
A. Romano
Tear Immunoglobulins and Lysozyme Levels in Corneal Ulcers. . . . . . . . . . . . . . .. 355 H. Lal and A.K. Khurana
Mucus and Pseudomonas aeruginosa Adherence to the Cornea. . . . . . . . . . . . . . . 359 S.M.J. Fleiszig, T.S. Zaidi, and G.B. Pier
Measurement of Human Tear Lysozyme Using a Novel Synthetic Substrate. . . . . . .. 363 M.D. Sherman, V. Cevallos, R. Gabriel, C. Dawson, and R.S. Stephens
xvi
Retrospective Use of Frozen Schinner Strips for the Measurement of Tear Lysozyme. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 367
M.D. Sherman, J.P. Whitcher, and T.E. Daniels
Rapid Measurement of Selected Tear Proteins in Health and Disease Using the Touch Tear Microassay System. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. 371
G.N. Foulks, K Baratz, and P. Ferrone
TEAR FILM: PHARMACOLOGICAL APPROACHES AND EFFECTS
The Tear Film: Pharmacological Approaches and Effects. . . . . . . . . . . . . . . . . . . .. 377 J.P. Gilbard
Influence of Various Pharmaceutical Agents on Tear Flow as Assessed by Fluorophotometry . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. 385
MJ. Gobbels and M. Spitznas
Neural Stimulation of Conjunctival Goblet Cell Mucous Secretion in Rats. . . . . . . .. 393 T.L. Kessler and D.A. Dartt
Bioavailability of Prednisolone in Rabbits: Comparison of a High-Viscosity Gel and an Aqueous Suspension-Single- and Repeated Applications, . . . . . . . . . . .. 399
S. Johansen, E. Rask-Pedersen, and J.U. Prause
TEAR FILM AND CONTACT LENS INTERACTIONS
Tear Film--Contact Lens Interactions ............................... , . 403 D.R. Korb
Electrophoretic Patterns of Human Denatured Tear Proteins and Glycoproteins from Normal Subjects and Soft Contact Lens Wearers. . . . . . . . . . . . . . . . . . . . 411
V. Claudon-Eyl and J. Baguet
The Refractive Index of Tears in Normals and Soft Lens Wearers. . . . . . . . . . . . . .. 417 S. Patel, L. Anderson, and K. Cairney
The Role of Tear Deposits on Hydrogel Contact Lenses Induced Bacterial Keratitis: Pseudomonas aeruginosa Abhesives . . . . . . . . . . . . . . . . . . . . . . . . . . . . 421
M. Portoles and M.F. Refojo
The Closed-Eye Challenge. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. 427 B.A. Holden, KO. Tan, and R.A. Sack
xvii
ARTIFICIAL TEARS
Dry Eye Therapy: Evaluation of Current Directions and Clinical Trials. . . . . . . . . . .. 431 M.B. Abelson and E. Knight
Artificial Tear Issues. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. 437 M.J. Sibley
Evaluation of Effects of a Physiologic Artificial Tear on the Corneal Epithelial Barrier: Electrical Resistance and Carboxyfluorescein Penneability . . . . . . . . . . . . .. 441
J.L. Ubels, K.K. Williams, D.L. Bernal, and H.F. Edelhauser
Evaluation of a Physiological Tear Substitute in Patients with Keratoconjunctivitis Sicca. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. 453
J.D. Nelson, M.M. Drake, J.T. Brewer, Jr., and M. Tuley
A Scanning Electron Micrographic Comparison of the Effects of Two PreservativeFree Artificial Tear Solutions on the Corneal Epithelium as Compared to a Phosphate Buffered Saline and a 0.02% Benzalkonium Chloride Control. . .. 459
K. Schaefer, M.A. George, M.B. Abelson, and C. Garofalo
A Unique Therapeutic Artificial Tear Fonnulation . . . . . . . . . . . . . . . . . . . . . . . .. 465 J.P. Gilbard and S.R. Rossi
DRY EYE SYNDROMES: PATHOGENESIS AND DIAGNOSIS
Non-Sjogren Dry Eye: Pathogenesis, Diagnosis and Animal Models. . . . . . . . . . . .. 471 A.J. Bron
Abnonnalities of the Structure of the Superficial Lipid Layer on the In Vivo Dry-Eye Tear Film . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. 489
M.G. Doane
Tear Osmolarity - a New Gold Standard? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. 495 R.L. Farris
Micropachometric Differentiation of Dry Eye Syndromes. . . . . . . . . . . . . . . . . . . .. 505 H.W. Roth and D.L. MacKeen
Decreased Tear Secretion in Chernobyl Children: External Eye Disorders in Children Subjected to Long-Tenn Low-Dose Radiation. . . . . . . . . . . . . . . . . . . . . .. 513
D. Gamus, Z. Weschler, S. Greenberg, and A. Romano
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Lacrimal Dysfunction in Pediatric Acquired Immunodeficiency Syndrome. . . . . . . .. 517 R.A. Neves, D. de Freitas, E. Sato, C. Oliveira, and R. Belfort, Jr.
Keratoconjunctivitis Sicca in HIY -1 Infected Female Patients. . . . . . . . . . . . . . . . .. 521
J.A. Lucca, J.S. Kung, and R.L. Farris
The Increase of the Blink Interval in Ophthalmic Procedures. . . . . . . . . . . . . . . . .. 525 H. Takano, E. Takamura, K. Yoshino, and K. Tsubota
Changes in Tear Ion Concentrations in Dry-Eye Disorders. . . . . . . . . . . . . . . . . . . 529 J.P. Gilbard and S.R. Rossi
Quantitative Cellular Evaluation of Conjunctival Squamous Metaplasia in the Dry
Eye Patient. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. 535 E. Takamura, H. Takano, K. Yoshino, K. Negoro, K. Tsubota, and
T. Kobayashi
Topical Anesthetic Induced Pain as a Diagnostic Tool for Keratoconjunctivitis Sicca (KCS) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. 539
H.H. Stolze, A. Yolprecht, and U. Welter
Lacrimation Kinetics as Determined by a Schirmer-Type Technique. . . . . . . . . . . .. 543 F.J. Holly
A Precise Method of Using Rose Bengal in the Evaluation of Dry Eye and the Detection of Changes in Its Severity. . . . . . . . . . . . . . . . . . . . . . . . . . . .. 549
M.A. George, M.B. Abelson, K. Schaefer, M. Mooshian, and D. Weintraub
DRY EYE SYNDROMES: TREATMENT AND CLINICAL TRIALS
Dry Eye Syndromes: Treatment and Clinical Trials. . . . . . . . . . . . . . . . . . . . . . . .. 553 M.A. Lemp
Keratoprosthesis in End-Stage Dry Eye. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. 561 C.H. Dohlman and M. Doane
Amylase in Mare Lacrimale in Patients with Submandibular Salivary Gland
Transplantation to the Lacrimal Basin . . . . . . . . . . . . . . . . . . . . . . . . . . .. 565 J. Murube, M.G. Marcos, and R. Javate
A Subjective Approach to the Treatment of Dry Eye Syndrome. . . . . . . . . . . . . . . . 571 R.S. Herrick
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Simulation of Lacrimal Gland Output: a Tear Jet for Replacing Eye Moisture in Sjogren's Syndrome. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 577
J.H. Bertera
Characteristics of a Canine Model of KCS: Effective Treatment with Topical Cyclosporine . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 583
R.L. Kaswan
Treatment of Severe Eye Dryness and Problematic Eye Lesions with Enriched Bovine Colostrum Lactoserum . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 595
C. Chaumeil, S. Liotet, and O. Kogbe
The Efficiency of Short-Wave Diathermy and Laser Stimulation of the Lacrimal Gland in the Treatment of Dry Eye Syndrome. . . . . . . . . . . . . . . . . . . . . . 601
T. Ke9ik, I. SWitka-WieQtawska, L. Portacha, and J. Ciszewska
Effect of Collagen Punctal Occlusion on Tear Stability and Volume. . . . . . . . . . . .. 605 S. Patel and D. Grierson
SJOGREN'S SYNDROME: PATHOGENESIS AND DIAGNOSIS
Sjogren's Syndrome: Immunologic and Neuroendocrine Mechanisms. . . . . . . . . . . 609 R.1. Fox and I. Saito
Murine Models of Sjogren's Syndrome. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 623 D.A. Jabs and R.A. Prendergast
Utilization of the Non-Obese Diabetic (NOD) Mouse as an Animal Model for the Study of Secondary Sjogren's Syndrome. . . . . . . . . . . . . . . . . . . . . . . . . 631
M.G. Humphreys-Beher, Y. Hu, Y. Nakagawa, P-L. Wang, and K.R. Purushotham
Expression of Granzyme A and Perforin in Lacrimal Gland of Sjogren's Syndrome. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 637
K. Tsubota, I. Saito, and N. Miyasaka
Epstein-Barr Virus and the Lacrimal Gland Pathology of Sjogren's Syndrome. . . . .. 641 S.C. Pflugfelder, C.A. Crouse, and S.S. Atherton
Sjogren's Syndrome (SS) and Epstein-Barr Virus (EBV) Reactivation. . . . . . . . . . . 647 1. Toda, M. Ono, H. Fujishima, and K. Tsubota
Hypothesis for Autoantigen Presentation and T Cell Activation. . . . . . . . . . . . . . . . 651 A.K. Mircheff, J.P. Gierow, R.L. Wood, R.H. Akashi, and F.M. Hofman
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Gingival Impression: A New Biological Test for Xerostomia in Diagnosis of Sjogren's Syndrome. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 655
S. Liotet, M.J. Wattiaux, and Y. Morin
Sjogren's Syndrome Diagnosis: A Comparison of Conjunctival and Gingival Impressions and Salivary Gland Biopsy. . . . . . . . . . . . . . . . . . . . . . . . . . 661
S. Liotet, O. Kogbe, and M.J. Wattiaux
Correlation of Labial Salivary Gland Biopsies with Ocular and Oral Findings in Patients with Sjogren's Syndrome ............................ " 667
J.P. Whitcher, T.E. Daniels, and M.D. Sherman
A Comparative Study Between Tear Protein Electrophoresis and Accessory Salivary Gland Biopsy in Sjogren's Syndrome. . . . . . . . . . . . . . . . . . . . . . . . . . .. 671
F. Carre, S. Liotet, and M.J. Wattiaux
SJOGREN'S SYNDROME: TREATMENT
Sjogren's Syndrome--Close to Cause and Cure? . . . . . . . . . . . . . . . . . . . . . . . . .. 679 N. Talal
Androgen-induced suppression of autoimmune disease in lacrimal glands of mouse models of Sjogren's syndrome. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. 683
D.A Sullivan, H. Ariga, AC. Vendramini, F.J. Rocha, M. Ono, and E.H. Sato
Effect of Sodium Sucrose-Sulfate on the Ocular Surface of Patients with Keratoconjunctivitis Sicca in Sjogren's Syndrome. . . . . . . . . . . . . . . . . . . 691
J.U. Prause, K. Bjerrum, and S. Johansen
Comparative Efficacy of Androgen Analogues in Suppressing Lacrimal Gland Inflammation in a Mouse Model (MRL/lpr) of Sjogren's Syndrome. . . . . .. 697
F.J. Rocha, E.H. Sato, B.D. Sullivan and D.A. Sullivan
SJOGREN'S SYNDROME ASSOCIATIONS
National Sjogren's Syndrome Association. . . . . . . . . . . . . . . . . . . . . . . . . . . . .. 701 B. Latiff
Sjogren's Syndrome Foundation Inc. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. 705 E.K. Harris
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Advertisement: Lacrimedics, Inc. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. 709
Contributors . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. 711
Index. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. 715
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