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The number and distribution of mitotic epithelial cells in the ocular surface during homeostasis and in response to abrasion of the mammalian cornea were determined. Normal rats and those receiving a 3 mm diameter centrally located epithelial defect, received an intraperitoneal injection of colchicine 6 h prior to sacrifice. Mitosis in the basal epithelium during homeostasis was comparable in magnitude across the ocular surface epithelium, with the exception of a few mitotic figures in the midline. Thirty percent of the mitotic figures were in the basal layer (layer 1), and 70% were in layer 2; the cells in layer 2 were often noted to retain connection to the basal lamina by cytoplasmic stalks. Mitosis was rarely noted in the regenerating epithelium. However, summation of M phase cells in both the basal and suprabasal epithelium adjacent to the wound showed increases of 3- and 5-fold at 30 and 36 h after abrasion, respectively, from levels at homeostasis and the time of injury. In striking contrast to homeostatic epithelium, 80% of the mitotic cells were located in layer 1 of the corneal epithelium, with normal distribution observed by 72 h. Mitosis in the limbus and conjunctiva was increased 3-fold at 30 h and 24 h, respectively, from values at homeostasis and the time of debridement. These results, using rigorous statistical analysis and precise topographic assessment, showed that mitosis is not impeded - but rather often accelerated - following denuding of the corneal epithelium and that the spatial distribution of mitotic cells is correlated with wounding. The data revealed that re-epithelialization of the corneal epithelium is not dependent on mitosis in the regenerating epithelium, but rather in the adjacent unwounded epithelium of the cornea, with most cells being located in the basal layer until re-epithelialization is completed. Mitotic cells in the limbus and conjunctiva may be related to replenishment of ocular surface epithelial cells used in the repair process rather than directly supplying the abraded surface.

To determine the influence of endogenous opioid modulation on reepithelialization of the human cornea.Eight-millimeter-diameter epithelial defects were created with a trephine and mechanical scraping in the center of human corneas. Resurfacing was studied in organ culture. The size of the defect, the number of specimens with complete reepithelialization, and rate of closure were evaluated using topical fluorescein and morphometric analysis. The influence of opioid receptor blockade was studied using the potent and long-acting opioid antagonist, naltrexone (NTX; 10(-6) M), and the effects of excess (10(-6) M) opioid growth factor (OGF), [Met5]enkephalin, also were determined. The modulatory activity of NTX and OGF on DNA synthesis was evaluated by monitoring the labeling index (LI) using radioactive thymidine. The presence and location of OGF and its receptor (OGFr) were ascertained by immunocytochemistry 1 hour and 24 hours after abrasion.NTX accelerated the wound-healing process, with 21% to 89% less defect than controls observed from 24 to 96 hours. At 72 hours, 62% of the subjects in the NTX group had complete closure of the corneal defects, in contrast to only 19% of the control specimens. All epithelial abrasions were resurfaced in the NTX group between 96 and 120 hours, whereas all controls were not closed until 168 hours. The rate of healing in the NTX group was 1.06 mm2/h compared to a rate of 0.68 mm2/h in the control group. OGF delayed corneal wound healing, with 24% to 260% more defect recorded than in control specimens at day 7. The healing rate of the OGF group was 0.42 mm2/h compared to 0.82 mm2/h for control subjects. The corneal epithelium adjacent to the wound had an LI that was 152% greater than control specimens, whereas OGF decreased the LI of this region by 75%. OGF and OGFr were detected in the epithelium bordering the damaged region at 1 hour, and both peptide and receptor were noted in the regenerating epithelium at 24 hours.These results indicate that an endogenous opioid is present and functions as a tonically active, receptor-mediated, negative growth factor during reepithelialization of the abraded human cornea.

To determine the fate of ocular surface epithelial cells in response to corneal injury, epithelial cells undergoing DNA synthesis were labeled at discrete time points following abrasion. A 3-mm diameter epithelial defect was made in the center of the rat cornea. One hour prior to sacrifice, animals received an intraperitoneal injection of [3H]-thymidine. DNA synthesis in the regenerating epithelium was of low abundance (2%). The undamaged corneal epithelium had a labeling index (LI) that was markedly elevated from unwounded specimens in the first 48 h after abrasion. The LIs of suprabasal cells were increased at 24 h and 36 h; these cells were believed to be displaced basal epithelial cells. Basal and suprabasal cells of the limbus and conjunctiva exhibited increases in LIs from unwounded subjects at singular timepoints (within 24 h of injury). These results, using rigorous statistical analysis, show that DNA synthesis is not impeded--but rather often accelerated--following denuding of the corneal epithelium. Re-epithelialization is not dependent on DNA synthesis in the regenerating region, but appears to be related to an increase in DNA synthesis (along with centripetal migration) in the adjacent, undamaged epithelium. The increase in DNA synthesis occurring in the limbus and conjunctiva does not directly supply cells to the regenerating region within the 72 h required for epithelial restitution, but is conjectured to serve in replenishing ocular surface epithelial cells used in the repair process.

Medication classes historically used in the management of glaucoma include beta blockers, miotics, sympathomimetics and carbonic anhydrase inhibitors. Because topically applied medications are more site specific, they are preferred in the treatment of glaucoma. Compared with oral medications, topical agents are associated with a decreased incidence of systemic side effects. With topical administration, conjunctival and localized skin allergic reactions are relatively common, whereas severe reactions, including death, are rare. Recently introduced topical agents for glaucoma therapy include dorzolamide and brinzolamide, the first topical carbonic anhydrase inhibitors; brimonidine and apraclonidine, more ocular-specific alpha agonists; and latanoprost, a prostaglandin analog, which is a new class of glaucoma medication. Latanoprost has the unique side effect of increasing iris pigmentation. Like their predecessors, the newer agents lower intraocular pressure by a statistically significant degree. Preservation of visual field, the more substantial patient-oriented end point, continues to be studied.

The fate of ocular surface epithelial cells in response to injury of the cornea was examined. Corneal epithelial cells were labeled during DNA synthesis with [3H]thymidine 1 h prior to wounding. A 3-mm diameter epithelial defect was made in the center of the rat cornea, with the basement membrane remaining intact. Within 12 h of abrasion, labeled cells were detected in the regenerating surface. At 18 h, there was a 2.7- and 17-fold increase of labeled basal and suprabasal cells, respectively, in the epithelium adjacent to the wound, and at 24 and 30 h there was an excessive number of cell layers (up to 7) at the margin of the abrasion. Re-epithelialization progressed as a gradient of cell layers that became diminished towards the center of the wound. Completion of layers 1, 2, 3, and 4 were recorded at 24, 30, 36, and 72 h, respectively. No changes in the labeling index of the limbus or conjunctiva were noted. These results suggest that processes of centripetal and vertical migration, as well as events related to cell division, in the uninjured corneal surface are not impeded by wounding of the corneal epithelium. However, wound healing appears to require cells with a basal phenotype, presumably because of this cell type's migratory capability.

A 90-year-old woman was referred to us with a 1-month history of progressively worsening blepharoconjunctivitis. She had a complete acquired ankyloblepharon of the right lids, which resulted in the appearance of a right upper lid abscess on computed tomography.Blepharotomy with separation and debridement of the lid margins was performed.Cultures were positive only for herpes simplex virus, type II.Herpes simplex blepharoconjunctivitis may take many clinical forms. Our patient's severe manifestations led to the clinical and radiologic appearance of preseptal cellulitis with a right upper lid abscess.

We report the light and electron microscopic findings from two eyes treated with argon laser peripheral iridoplasty (ALPI) for bilateral angle-closure glaucoma. The patient, a 45-year-old man, died from complications of acquired immunodeficiency syndrome 16 days following ALPI. Ocular pathologic findings included contraction furrow formation and proliferation of fibroblast-like cells, accompanied by collagen deposition on the iris surface, denaturation of stromal collagen, and coagulative necrosis of blood vessels within the anterior two thirds of the iris stroma. These findings suggest that heat shrinkage of collagen may be responsible for the short-term response to ALPI, and that contraction of the fibroblastic membrane may be responsible for its long-term effects. Additionally, the presence of coagulative necrosis of iris blood vessels suggests that overt treatment may result in iris necrosis. To our knowledge this is the first report of the histopathology of ALPI.

Renal cell carcinoma (RCC) is a tumor of middle-aged men that metastasizes to the lung, liver, and bone. Few cases of RCC metastatic to the orbit have been reported. When this tumor spreads to the orbit, the orbital metastasis is likely to be the first indication of the cancer. We report the case of a 53-year-old man with widespread metastatic RCC whose first sign of disease was a metastatic orbital tumor. External and ocular examination and computed tomographic and histopathologic findings are described. The clinical characteristics, treatment, and prognosis of metastatic RCC are discussed.

We report the use of a symblepharon ring in the treatment of seven cases of flat anterior chamber (six cases of total iridocorneal touch, and one of corneallens touch) secondary to overfiltration or to bleb leak. In all cases, the anterior chamber reformed within 24 hours after the symblepharon ring was used. Advantages of using the ring are: (a) it permits testing of visual acuity, tonometry, and intraocular examination without removing it; (b) it does not require suturing to the conjunctiva; (c) it does not disturb the corneal epithelium; (d) it may be available at institutions lacking other shells; and (e) it is cost-effective.

There have been numerous reports of subconjunctival dislocation of the lens resulting from nonsurgical trauma. This paper is the first to describe such a dislocation following surgical trauma (unplanned extracapsular cataract extraction).

Chloroquine retinopathy is a well-documented toxic manifestation of a commonly used systemic medication. The major retinal findings are those of macular retinal pigment epithelial changes, narrowed retinal vessels, and scotomatous visual field defects. The fluorescein angiographic findings are those of a retinal pigment epithelial transmission defect that takes on a bull's-eye configuration. We present a patient who had taken chloroquine for two years while in the military service. Two years after discharge, he was examined and reported to have a mild granular appearance to the macula. Over a period of nine years, progressive decreased central acuity prompted repeated fluorescein angiograms, which revealed a progressive bull's-eye maculopathy compatible with chloroquine retinopathy. Evaluation of offspring failed to reveal any evidence of a hereditary macular dystrophy. To our knowledge, this is the first reported case of delayed onset and progression of chloroquine maculopathy documented by fluorescein angiography.

A 70-year-old man had a rapid growth of a pigmented eyelid lesion, previously stationary for at least 50 years. Because of the suspicion of malignant melanoma, the lesion which resembled a cutaneous horn was excised. Histologic examination demonstrated a benign epithelial tumor, inverted follicular keratosis.

Proton NMR relaxation times T1 and T2 were determined for normal lenses excised from sexually mature animals from seven different species. Lenses were immersed in physiological buffer during measurements, and suppression methods were employed to null the buffer signal. This enabled selective analysis of lenticular water. Observed relaxation times were correlated with protein and water content. At 37 degrees C and 1.89 Tesla, single-exponential spin-lattice relaxation was observed, but spin-spin relaxation was found to be double-exponential. It was shown that the short-T2 fraction is proportional to protein concentration; this fraction was attributed to water bound to protein. The long-T2 fraction was attributed to free lenticular water. The amounts of free and bound water thus obtained were used in the spin-lattice relaxation rate equation for rapid exchange in a two-component system to calculate the magnitudes of the two corresponding T1 relaxation components.