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LACRIMAL GLAND, TEAR FILM, AND DRY EYE SYNDROMES Basic Science and Clinical Relevance

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Page 1: LACRIMAL GLAND, TEAR FILM, AND DRY EYE SYNDROMES978-1-4615-2417-5/1.pdfon the Lacrimal Gland, Tear Film and Dry Eye Syndromes: Basic Science and Clinical Relevance was held in the

LACRIMAL GLAND, TEAR FILM, AND DRY EYE SYNDROMES Basic Science and Clinical Relevance

Page 2: LACRIMAL GLAND, TEAR FILM, AND DRY EYE SYNDROMES978-1-4615-2417-5/1.pdfon the Lacrimal Gland, Tear Film and Dry Eye Syndromes: Basic Science and Clinical Relevance was held in the

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

Recent Volumes in this Series

Volume 343 CURRENT DIRECTIONS IN INSULIN-LIKE GROWTH FACTOR RESEARCH

Edited by Derek LeRoith and Mohan K. Raizada

Volume 344 MECHANISMS OF PLATELET ACTIVATION AND CONTROL

Edited by Kalwant S. Authi, Steve P. Watson, and Vijay V. Kakkar

Volume 345 OXYGEN TRANSPORT TO TISSUE XV

Edited by Peter Vaupel, Rolf Zander, and Duane F. Bruley

Volume 346 INTERACTIVE PHENOMENA IN THE CARDIAC SYSTEM

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.

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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

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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

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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

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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

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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

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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

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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

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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

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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

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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

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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

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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

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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

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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

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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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