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The epithelial response in keratitis sicca and keratitis herpetica (an experimental and clinical study)

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Summary

The results of the histochemical stainings are summarised in Table 3a and b.

The histological examination of the dry eyes shows the thickening and keratinisation of the superficial flattened cell layer of the corneal and con-junctival epithelium. There is generalised hypertrophy of the epithelium but in some places hydropic degeneration of the cells and atrophy is seen. The cells are irregularly arranged, sometimes forming a “rosette”. There is intercellular and intracellular oedema of the epithelium.

A large number of Teng cells (Teng & Katzin, 1953; Teng, 1961, 1962) are seen in the corneal epithelium. These cells participate in the regeneration of the basement membrane of the epithelium. This membrane becomes irregular and wavy in keratitis sicca.

In the basal and middle layers of the corneal epithelium and the deeper layers of the conjunctiva increased RNA activity is found.

The histochemical stainings demonstrate intranuclear keratinisation and denaturation of DNA. These nuclei stain positive with alcian blue and PAS stains; negative or faintly positive with the Feulgen reaction; show ortho-chromasia instead of the metachromasia with toluidine blue metachromatic staining and give a positive reaction for the keratin.

The activity of the acid phosphatase is increased in the epithelium.

The cells of the corneal and conjunctival epithelium show intracytoplasmic deposits of heterogenous material composed of 0.1 μ elementary particles. These deposits show positive reactions for -SH groups and glycoproteins. This material presents an isotropic and anisotropic zones. Its density is variable and pleomorphic which progressively increases towards the superficial layers. These characteristics correspond to those of keratohyalin.

The superficial keratinised layers of the corneal and conjunctival epithelium are disposed in lamellar fashion and give positive stainings for -SH groups and -S-S- bridges.

In addition to the changes of keratinisation, progressive atrophy of the goblet cells is seen in the conjunctiva. These cells may entirely disappear in some areas. The submucosa shows subacute inflammatory cell infiltration and hyperaemia. In some cases it is found fragmented. Quite often a fibrinous deposit can be seen on the conjunctival surface.

Slight oedema of the superficial layers of the corneal stroma is found which explains the feable stainings for mucopolysaccharides.

Before discussing the implications of the histochemical and histological findings in relation to the clinical observations in keratoconjunctivitis sicca, we ought to take into account the results of electron microscopy. Discussion of the overall findings, therefore, follows in the section ‘General discussion and conclusions’'.

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  1. P. C. Maudgal

    Present address: Dept. of Ophthalmology, University Hospital-St. Rafaël, 7 Kapucijnenvoer, 3000, Louvain, Belgium

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This paper was originally submitted as a Doctor's Thesis to the Department of Ophthalmology, University of Leuven (Faculty of Medicine) in 1976.

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Maudgal, P.C. The epithelial response in keratitis sicca and keratitis herpetica (an experimental and clinical study). Doc Ophthalmol 45, 223–327 (1978). https://doi.org/10.1007/BF00161670

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