Acute effects of chlorobutanol- or benzalkonium chloride-containing artificial tears on the surface features of rabbit corneal epithelial cells

Changes in Ocular Surface Characteristics after Switching from Benzalkonium Chloride-Preserved Latanoprost to Preservative-Free Tafluprost or Benzalkonium Chloride-Preserved Tafluprost

Purpose

The aim of the present study was to examine the effects of switching from Latanoprost ophthalmic solution containing a preservative to preservative-free Tafluprost ophthalmic solution or Tafluprost containing a preservative on ocular surfaces.

Materials and Methods

Forty patients (40 eyes) with glaucoma (mean age: 62.0 ± 10.9 years) using Latanoprost with preservative for six months or longer were assigned either to a Tafluprost-containing-preservative group (20 eyes) or preservative-free-Tafluprost group (20 eyes). The intraocular pressure, corneal epithelial barrier function (fluorescein uptake concentration with fluorophotometer FL-500), superficial punctate keratopathy (AD classification), and tear film breakup time (TBUT) were assessed before switching and at 12 weeks after switching.

Results

No significant differences in intraocular pressure were noted after switching in either group. Corneal epithelial barrier function was improved significantly after switching in both the Tafluprost-containing-preservative and the preservative-free-Tafluprost groups. There were no significant differences in AD scores after switching in the Tafluprost-containing-preservative group, but significant improvements were noted in the preservative-free-Tafluprost group. No significant differences in TBUT were noted in the Tafluprost-containing-preservative or preservative-free-Tafluprost groups after switching.

Conclusion

After switching from preservative Latanoprost to Tafluprost containing-preservative or preservative-free Tafluprost, corneal epithelial barrier function was improved while the intraocular pressure reduction was retained.

Frog saliva-induced toxic keratopathy: a case report

Corneal toxicity due to exposure to many chemicals and medications have been described in the literature. We present a case of toxic keratopathy by corneal exposure to salivary secretion of a frog. A 40-year-old male patient reported a sudden splash of frog saliva in his right eye while he was examining it at a close distance. Corneal punctate epitheliopathy and stromal oedema and Descemet folds were the initial clinical findings, which completely recovered on the 2nd control day of topical dexamethasone and ofloxacin treatment. We aimed to show the toxic effects of animal-derived secretions on the cornea as a rare cause of toxic keratopathy.

Preservative use in topical glaucoma medications

Benzalkonium chloride (BAK) is the principal preservative employed in topical ocular hypotensive medications, although alternative compounds recently have begun to be employed or examined. Individual clinical trials have shown that exposure to BAK concentrations contained in ophthalmic solutions does not produce adverse sequelae in the majority of glaucoma patients, but concerns continue with regard to its long-term use. These concerns have resulted from an extensive research effort, including preclinical studies with in vitro and in vivo models, as well as recent clinical investigations dedicated specifically to this issue. The aim of this systematic literature review of both preclinical and clinical data was to determine the relevance of these findings to clinical practice. Most preclinical studies reported negative effects of BAK exposure, but with few exceptions, BAK concentrations and exposure times greatly exceeded those likely to be experienced by patients, given the normal physiological dilution by the tear film. In addition, consistent evidence of BAK-related toxicity did not emerge from our review of dedicated clinical investigations. Thus, taken together, current evidence supports the safety of BAK for most glaucoma patients, although subpopulations with abnormal tearing may benefit from alternative preservative compounds or preservative-free formulations. Further studies to identify these populations are needed.

Further assessment of the size, shape and surface features of superficial cells of the bovine corneal epithelium, using scanning electron microscopy

PURPOSE

To qualitatively and quantitatively assess the size and shape of the surface cells of the bovine corneal epithelium as assessed by scanning electron microscopy.

METHODS

After quality-control measures on recent postmortem bovine eyes obtained from a slaughterhouse, the ocular surface was aggressively washed with 0.97% saline and then fixed for scanning electron microscopy (SEM) by a dropwise application, in 37 degrees C moist chamber, of a 2% glutaraldehyde solution (in 80 mM cacodylate, pH 7.2 to 7.4). A set of images were taken from the central region of the surface of the corneal epithelium. The cell areas, perimeter and dimensions of 25 to 30 cells from 18 different samples were measured with a digitiser pad or rule, and number of bordering cells (sides) counted manually. Cell shape was assessed by comparing the longer and shorter dimensions (LS ratio) and calculation of the figure coefficient (FC, 4PiA/P2 ).

RESULTS

With the washing protocol, surface cells were evident that displayed a range of electron reflexes (light, medium and dark) and that were decorated with microplicae and some crater-like features. These features were generally not evident if the surface was only rinsed with saline. The cell surface areas ranged from 58 to 6444 microm2 (mean 1748 +/- 1169 microm2), and increased as the number of sides increases. Cells with a higher number of sides (n=10) tended to be more rounded (LS ratio averaging 1.24) while cells with small number of sides (n=3) were more elongated (LS ratio 1.94). Shape (FC) values ranged from 0.379 to 0.967, and increased as the number of cell sides increases. Assessment of cell shape in relation to the number of cell sides identified only a small proportion of surface cells with unusually low FC values.

CONCLUSIONS

With an appropriate preparative procedure (aggressive washing with saline), bovine corneal epithelial surface (squamous) cells can be shown to have a similar appearance by SEM to that previously observed for rabbit and human corneas. The cell sizes are however substantially greater than those seen in rabbits, presumably because of the much larger corneal diameter (c. 28 mm vs. 13 mm). Based on detailed analysis of cell size and shape, the results indicate that the squamous cells have reasonably predictable characteristics.

Quantitative Analysis of Ring-Shaped (Crater-Like) Features at the Tear Film–Epithelial Interface of the Rabbit Cornea as Assessed by Scanning Electron Microscopy

PURPOSE

To develop a method for the quantitative analyses of the ring-shaped features usually observed on the surface of mammalian corneal epithelial cells.

METHODS

The corneas of 10 young adult female albino rabbits were prepared for scanning electron microscopy (SEM) by fixation in 2% glutaraldehyde in 80 mM cacodylate buffer (pH 7.2 to 7.4, 320 to 340 mOsm/kg) and single images taken at 1000x of the central region of the corneal epithelial surface. On enlarged prints at 5000x final magnification, cell-cell borders were marked as were the outlines of the ring-shaped features. Cell areas and the dimensions of the ring-shaped features were measured and the cell characteristics in terms of electron reflex (light, medium, and dark) as well as the number of apices (sides) also noted.

RESULTS

The ring-shaped features had an overall density of 2.5/100 microm2, or an average of 6.5/cell. With the corneal epithelial cells being small and light in appearance (median area 36 microm2), medium in size and appearance (median area 151 microm2), or larger and darker (median area 476 microm2), the number of features/cell was very strongly associated with both the cell type (p < 0.001) and the cell area (p < 0.001). The ring-shaped features could be between 0.65 and 5.5 microm in diameter, but sizes more than 3 microm were most unusual. Ring-shaped features of light cells were smallest (median diameter 1.35 microm), slightly larger on medium cells (1.55 microm), and largest on the dark cells (1.90 microm).

CONCLUSIONS

The ring-like features seen on SEM photomicrographs of rabbits (also known as craters or holes) are reproducible in terms of their overall density per unit surface area as well as their diameter. Such methods should be useful for objective analysis of these features after various treatments of the ocular surface.

Validity of Fluorexon Disodium Versus Sodium Fluorescein for Use in Goldmann Tonometry

PURPOSE

To evaluate the safety, validity, and comfort of 0.35% fluorexon disodium and 0.4% benoxinate (Flura-Safe) compared with the gold standard of 0.25% sodium fluorescein and 0.4% benoxinate for Goldmann applanation tonometry (GAT).

METHODS

This was a double-masked, randomized, crossover clinical trial. Subjects received either the standard or study formulation for GAT on visit 1 and the other formulation 1 week later. At each visit, tonometer mire quality, adequacy of fluorescence, ease of intraocular pressure (IOP) measurements, the IOP value, and anesthetizing efficacy of the formulation were assessed. Subjects graded general comfort, soreness and irritation, and burning and stinging of each formulation at 1 and 5 minutes after drop instillation.

RESULTS

Sixty-seven subjects completed the study. The mean IOP was 13.9 +/- 2.7 with fluorexon and 13.9 +/- 2.8 mm Hg with fluorescein OD and 14.0 +/- 2.8 with fluorexon and 13.9 +/- 2.5 mm Hg with fluorescein OS. The measurements with the 2 formulations were highly correlated for OD and OS, and the differences between the 2 measurements were not clinically significant. There was also no significant difference between the 2 drops in mire clarity, adequacy of fluorescence, or corneal anesthesia. However, fluorexon was statistically more comfortable (P = 0.039) and caused less stinging and burning (P = 0.014) at 1 minute versus the fluorescein formulation.

CONCLUSION

Not only was the new fluorexon product accurate and effective in GAT, it was also statistically more comfortable and had a less stinging and burning effect at 1 minute after drop instillation than the traditional fluorescein formulation. Because fluorexon is less likely to stain soft contact lenses, this may be the dye-anesthetic formulation of choice for practices that routinely perform GAT.

The corneal epithelial surface in the eyes of vertebrates: Environmental and evolutionary influences on structure and function

The smooth optical surface of the cornea is maintained by a tear film, which adheres to a variety of microprojections. These microprojections increase the cell surface area and are thought to improve the movement of oxygen, nutrients, and metabolic products across the outer cell membranes. However, little is known of these structural adaptations in vertebrates inhabiting different environments. This field emission scanning electron microscopic study examined the cell density and surface structure of corneal epithelial cells across 51 representative species of all vertebrate classes from a large range of habitats (aquatic, amphibious, terrestrial, and aerial). In particular, we wished to extend the range of vertebrates to include agnathans and some uniquely Australian species, such as the Australian lungfish (Neoceratodus forsteri), the Australian galah (Eolophus roseicapillus), the Australian koala (Phascolarctos cinereus), and the rat-tailed dunnart (Sminthopsis crassicaudata). Epithelial cell densities ranged from 28,860 +/- 9,214 cells mm(-2) in the flathead sole Hippoglossoides elassodon (a marine teleost) to 2,126 +/- 713 cells mm(-2) in the Australian koala (a terrestrial mammal), which may indicate a reduction in osmotic stress across the corneal surface. A similar reduction in cell density occurred from marine to estuarine to freshwater species. The structure and occurrence of microholes, microplicae, microridges, and microvilli are also described with respect to the demands placed on the cornea in different environments. All species that spend significant periods out of an aquatic environment possess microvilli and/or microplicae. These include all of our species of Mammalia, Aves, Reptilia, Amphibia, and even one species of Teleostei (Australian lungfish). Well-developed microridges occur only in teleosts in high osmolarity environments such as marine or estuarine habitats. Clear interspecific differences in corneal surface structure suggest a degree of adaptive plasticity, in addition to some phylogenetic trends.

Atomic force microscopy analysis of normal and photoablated porcine corneas

We showed the capabilities and accuracy of atomic force microscopy (AFM) techniques for imaging and analyzing the corneal epithelium and the photoablated corneal stroma. Eight normal porcine corneas, half of which were ablated using a scanning-spot excimer laser, were examined. All the corneas were imaged in balanced salt solution after fixation in glutaraldehyde. In the normal untreated corneas we observed the epithelial surface showing the typical polygonal cells and presenting numerous microprojections. The superficial epithelial cells were classified in three types as a result of the anterior-surface roughness measurements. AFM images of the photoablated corneal specimens showed undulations and granule-like features on the ablated stromal surface, specific to 193-nm ArF laser irradiation. Nevertheless, the quantitative analysis confirmed the precision of excimer laser surgery in removing sub-micrometric amounts of tissue. AFM showed to be a high-resolved imaging tool for the scanning of both native as well as photoablated corneal specimens. Also, this technique permits precise topographic analysis of the corneal plane, in the nanometric scale, of which smoothness is an important physical characteristic and necessary to achieve an optimal optical quality of the eye.

Management of filamentary keratitis associated with aqueous-deficient dry eye

PURPOSE

To review the incidence, underlying pathophysiology, and clinical features of filamentary keratitis and to identify evidence-based best-practice strategies for managing filamentary keratitis.

METHODS

A comprehensive review of published literature was undertaken. Recommendations for best-practice management strategies were based on the available evidence. Three cases are presented to illustrate the clinical findings and management of patients with chronic filamentary keratitis.

RESULTS

Although the evidence base is limited by the absence of well-designed studies, current evidence indicates the following: (1) Aqueous-deficient dry eye (keratoconjunctivitis sicca) is the most common ocular condition associated with filamentary keratitis. (2) Current best-practice management of filamentary keratitis involves treating the underlying dry eye and specific treatments for the corneal filaments. Proposed treatments include nonpreserved lubricants, topical steroidal and nonsteroidal anti-inflammatory agents, and punctal plugs for aqueous-deficient dry eye as well as mechanical removal of filaments, hypertonic saline, mucolytic agents, and bandage contact lenses for the filaments. (3) Filamentary keratitis can be induced or exacerbated by contact lens wear and ocular surgical procedures such as cataract surgery and corneal graft surgery. Pre- and postoperative ocular surface management strategies should be considered in the surgical planning of patients with, or who are susceptible to, filamentary keratitis. Filamentary keratitis can also be induced and/or exacerbated by chronic use of ocular and/or systemic medications, and alternate medications or additional measures to manage the tear film and ocular surface may be required in these cases.

CONCLUSIONS

Filamentary keratitis can be a chronic, recurrent, and debilitating condition. With a systemic approach to diagnosis and management, the condition can be effectively controlled and the incidence and severity of recurrences minimized.

Impact of brief exposure to balanced salts solution or cetylpyridinium chloride on the surface appearance of the rabbit corneal epithelium--a scanning electron microscopy study

PURPOSE

To examine the surface of pre-corneal mucous layer by scanning electron microscopy (SEM) with the view to assessing whether it was an amorphous, fibrous or porous structure.

METHODS

Healthy female albino rabbits (2 kg) were euthanised at 15.00 h and the corneal surface immediately fixed with buffered glutaraldehyde fixative pH 7.2 to 7.4 at 35 degrees C, carefully rinsed with balanced salts solution (BSS) and then fixed, or treated with the same fixative containing 0.05 to 0.25% w/v cetylpyridinium chloride (CPC). The corneas were critical point dried and gold-palladium coated, prior to examination at 1000x or 15000x magnification.

RESULTS

Buffered glutaraldehyde fixation resulted in an SEM image of polygonal cells, with very contrasting electron reflexes (light, medium and dark) and distinct cell surface microplicae and large crater-like features (average diameter 2.8 +/- 0.9 microm). Along the cell-cell borders was a distinct line (referred to as "caulking"), perhaps composed of mucous. Rinsing of the corneal surface with BSS just before fixation reduced the cell contrast, the surface was then covered with very short strands or small clumps of presumed mucus, the cell-cell border features were changed, but the crater-like features were largely unchanged (average diameter 2.5 +/- 0.7 microm). Fixation in the presence of 0.05% or 0.1% CPC resulted in the appearance of very short fine strands and occasional coarse mucous strands or even small plaques of mucous on the cell surfaces. The microplicae and craters were still often evident. Fixation with 0.2 or 0.25% CPC however yielded a surface with a uniform grey reflex that included numerous ultramicroscopic debris particles (average diameter of 72 nm) and was punctuated by numerous pores. No microplicae or craters were evident. The average pore diameter was 70 nm, their density averaged 59/5 microm(2), but a radial distribution analysis indicated no substantial pattern.

CONCLUSIONS

The pre-corneal mucous layer can be dispersed, by careful rinsing with a divalent cation containing solution, into small fibrils or clumps, but the cell surface craters are unaffected. After precipitation with a low concentrations of a polycation, some coarse fibrils are also formed. The use of high concentrations of a polycation in the fixative transforms the more superficial aspects of the pre-corneal mucous layer into a pore-like gel. The crater-like features therefore do not appear to be mucous, but the pore-like structure may be indicative of the organisation of the mucous layer on the surface of the living eye.

Ocular tolerance of preservatives and alternatives

Eye drops are multiple dosage forms protected against microbial contamination by means of preservatives. However, the ocular tolerance of these chemicals can vary and this may result in adverse toxic or allergic reactions. This overview presents the pharmacopoeial requirements for the preservation of eye drops, the factors affecting ocular tolerance as well as the adverse external ocular effects induced by preservatives. The alternatives to the use of preservatives are also discussed, including the recent progress in eye drops packaging.

Corneal toxicity secondary to inadvertent use of benzalkonium chloride preserved viscoelastic material in cataract surgery

AIMS

To study the long term toxic effects of intraocular benzalkonium chloride (BAC).

METHODS

19 patients exposed to intraocular BAC preserved viscoelastic during cataract surgery in February 1999 developed severe striate keratopathy immediately postoperatively. 16 patients, including two who underwent penetrating keratoplasty, were studied in the period April to June 2000. Ocular symptoms, visual acuity, biomicroscopy, intraocular pressure, dilated funduscopy, specular endothelial microscopy, and corneal pachymetry findings were recorded. The corneal and iris specimens of the two patients who underwent keratoplasty were studied by light, transmission, and scanning electron microscopy.

RESULTS

Six males and 10 females, aged 64-98 years, were studied 14-16 months postoperatively. All patients were symptomatic. 12 patients had best corrected visual acuity of 6/12 or better and four patients of between 6/18 and 6/60. Five patients had corneal epithelial oedema and 11 had Descemet's membrane folds. The central corneal thickness, 620 (SD 71) microm, in affected eyes was significantly higher (p<0.005, two tailed paired t test) than that of the contralateral eyes, 563 (SD 48) microm. The endothelial cell density was significantly lower (p<0.0001, two tailed paired t test) in affected eyes: 830 (SD 280) cells/mm2 v 2017 (SD 446) cells/mm2. The mean average cell area was significantly higher in the BAC treated eyes: 1317 (SD 385) microm2 v 521 (SD 132) microm2. There was no significant difference in the coefficient of variation of cell size between the two eyes (p=0.3, two tailed paired t test). Two corneal specimens displayed morphological features of bullous keratopathy and other non-specific abnormalities. Extracellular melanosomes were present in a portion of the iris of one case.

CONCLUSION

BAC is toxic to the corneal endothelium when used intraocularly, leading to severe striate keratopathy. This cleared in most cases but left varying degrees of residual stromal thickening in all eyes. If penetrating keratoplasty is required the results are excellent.

Dry eye: an update on clinical diagnosis, management and promising new treatments

Dry eye conditions are prevalent with one in four to five patients presenting to eye care practitioners having dry eye signs and/or symptoms. An intimate relationship exists between the ocular surface and the tear film. The cycle of tear film instability and ocular surface damage characteristic of dry eye conditions suggests that dry eye represents a dysfunction of an integrated ocular surface-lacrimal gland unit. Therefore, dry eye is a multifactorial condition and an approach based on clinical subtypes is required for diagnosis and management. There is increasing evidence that inflammation is a contributing and exacerbating factor in dry eye conditions and anti-inflammatory or immunomodulatory therapy for chronic dry eye conditions may facilitate ocular surface healing. Other promising new treatments for dry eye include new generation artificial tear polymers and preservative systems, secretagogues, topical androgen supplements and surgical techniques for ocular surface reconstruction.

The conjunctival epithelium in dry eye subtypes: effect of preserved and non-preserved topical treatments

PURPOSE

To determine the effect of topical treatments on the conjunctiva in dry eye.

METHODS

N = 134 dry eye subjects were diagnosed using a protocol of McMonnies dry eye symptom survey score > 14, fluorescein break up time (FBUT) < 10 s and presence of rose Bengal staining. Differential diagnosis of dry eye subtypes was based on biomicroscopic signs and ocular/medical history. Superficial perilimbal bulbar conjunctival epithelial samples were collected using impression cytology. The nucleo-cytoplasmic ratio (N/C), goblet cell density (GCD) and expression of monoclonal antibodies HLA DR and CD23 were determined. The ocular surface characteristics of untreated subjects, those receiving preserved dry eye treatments and those receiving non-preserved treatments were compared with each other and with controls. Ocular surface characteristics of dry eye subtypes were also examined.

RESULTS

An increase in N/C (p = 0.011), reduction in GCD (p = 0.0001) and increase in expression of HLA DR (p = 0.0001) and CD23 (p = 0.0001) were detected in the untreated group compared to controls. No significant differences were found between the group receiving non-preserved dry eye treatments and untreated dry eye group. The group receiving preserved treatments had a reduced GCD (p = 0.0003) and increased expression of HLA DR (p = 0.0003) and CD23 (p = 0.0001) compared to the group receiving non-preserved treatments. Dry eye subtype specific differences in HLA DR and CD23 expression were noted.

CONCLUSIONS

The conjunctival inflammation and reduced goblet cell density of dry eye is exacerbated by use of preserved topical agents, and is not significantly improved by use of non-preserved artificial tear supplements alone. Therapeutic strategies for dry eye should aim to increase goblet cell density and control ocular surface inflammation.

A comparative SEM study of the vertebrate corneal epithelium

PURPOSE

The anterior surface of the cornea of mammals, including humans, has numerous folds in the anterior epithelial cell membranes in the form of microvilli and microplicae. The role of these surface irregularities may be to increase cell-surface area and therefore aid in intra- and extracellular movement of nutritional and waste products across the cell membranes in addition to stabilizing the corneal tear film. The aim of this study was to investigate and compare the nature of these corneal-surface features in various vertebrate classes residing in different environments.

METHODS

The anterior corneal surfaces of various vertebrates were investigated by using field emission scanning electron microscopy. Cell areas were analyzed by using image-analysis software.

RESULTS

Representative species were examined from all the vertebrate classes, with the exception of the Cephalaspidomorphi. The mean epithelial cell density of aquatic vertebrates (17,602 +/- 9,604 cells/mm2) is greater (p = 0.000018) than that of aerial and terrestrial vertebrate species, including amphibians (3,755 +/- 2,067 cells/ mm2). Similarly, the mean epithelial cell density for the marine vertebrates (22,553 +/- 8,878 cells/mm2) is greater (p = 0.0015) than that of the freshwater and estuarine species (10,529 +/- 5,341 cells/mm2). The anterior corneal surfaces of all species examined were found to show a variety of cell-surface structures. Microvilli are predominant in reptiles, birds, and mammals; microridges appear to be characteristic of the Osteichthyes; and microholes were observed only in the Chondrichthyes.

CONCLUSION

The function of these morphologic variations in surface structure appear to be correlated with the range of ecologic environments (marine, aerial, and terrestrial) occupied by each species, corneal phylogeny, and the demands placed on the cornea to ensure clear vision.

Re-wetting, comfort, lubricant and moisturising solutions for the contact lens wearer

In recent years there have been significant changes in perspective and availability of eyedrops designed to provide comfort to the contact lens wearer. This review addresses the reasons why there is a need for these types of products and considers their potential impact on the corneal and conjunctival surface. The methods of assessment of these solutions are discussed and the range of current products and options for the UK practitioner are detailed.

Scanning electron microscopy study of the tarsal and orbital conjunctival surfaces compared to peripheral corneal epithelium in pigmented rabbits

The mammalian palpebral conjunctiva has not been systematically evaluated by scanning electron microscopy (SEM). The upper eyelid of female grey rabbits (2 kg) was fixed in its extended conformation at 15.00 h; some corneas were prepared with the same fixative protocol. The corneal epithelium, within 1 mm of the limbus, is a mosaic of small-to-large (average cell area of 693 m2) squamous cells with light, medium or dark appearance due to different densities of cell surface microplicae. The tarsal conjunctiva was a 1.5 to 3 mm wide mosaic of small (average cell area of 86 microm2) non-desquamating polygonal cells having distinctive light and dark appearances due surface microplicae. The orbital portion of the palpebral conjunctiva is also composed of small (average cell area of 87 microm2) non-desquamating polygonal cells but with a uniform medium-grey appearance due to a relatively consistent density of surface microvilli. Several types of intercellular pore-like openings were also present across the palpebral surface but not the corneal epithelial surface. Very small type 1 pores (1.5 to 5 microm diameter) were present at a density of 480 to 760 / mm2 for the tarsal and 80-160 / mm2 for orbital conjunctiva. Slightly larger (2.5 to 18 microm diameter) type 2 pores with distinct borders were present at 120-200 / mm2 across the orbital conjunctiva. Very large (10-109 microm diameter) type 3 (Henle) pores were present at 40 to 280/mm2 especially at the tarsal/orbital transition zone. Type 4 pores (goblet cell orifices) were oval with a peripheral ring of microvilli and were present at 40 to 160/mm2 for tarsal and 800 to 1600/mm2 for orbital conjunctiva. The rabbit palpebral conjunctival surface is thus distinctly different from the peripheral corneal epithelium across which it slides following eyelid closure.

The effect of a shear force on the cell shedding rate of the corneal epithelium

PURPOSE

During blinking the lids apply a shear force to the corneal epithelium. The aim of this study was to determine if a shear force applied to the epithelial surface increases the rate at which cells shed.

METHODS

The shedding rate was studied in perfused whole rabbit eyes, and the effect of a shear force examined by exposing the corneas to a stirred solution. Control corneas were exposed to a static solution. The shedding rate and size of shed cells were measured, and the number of terminally differentiated cells on the corneal surface determined after 6 h of perfusion using ethidium bromide.

RESULTS

Compared with controls, the shear force increased the cell shedding rate from the corneal surface significantly (p < 0.01, paired t-test). The increase was due to small cells with a longest dimension less than 25 microm. The number of terminally differentiated cells on the epithelial surface did not increase.

CONCLUSION

Because of the decrease in size, and the change in appearance of shedding cells, it is proposed that the increase in cell shedding rate was due to an increase in the number of apoptotic cells, and not to an increase in terminally differentiated cells. It is suggested that in the human eye, under adverse conditions, shear forces due to blinking may play a role in creating apoptotic cells.

Evidence for heterogeneity in a small squamous cell type ('light' cells) in the rabbit corneal epithelium--a scanning electron microscope study. Corneal epithelial squamous cells

The rabbit corneal epithelial surface, as viewed by scanning electron microscopy (SEM), is composed of a mosaic of polygonal cells with different appearances (light, medium and dark) with the lighter cells having a characteristically high density of microplicae. From the central zone of the corneal epithelial surface of 16 female New Zealand White rabbits (2 kg), the lighter-appearing cells had an average area of 108 +/- 47 microns2 (n = 567, +/-SD). A subgroup of atypical lighter cells had an average area of 294 +/- 67 microns2 (n = 53) compared to typical light cells of 88 +/- 12 microns (n = 514). These atypical lighter cells had fused microplicae at their periphery (instead of a uniform arrangement of densely packed microplicae), tended to be rounder in shape (as opposed to being angular), could show signs of desquamation and were not decorated with the epithelial craters found on almost all (92%) other light cells. All of these features are suggestive of these atypical lighter cells being the terminal phenotype of the light cells just prior to desquamation from the ocular surface. The observation of the desquamation of lighter cells supports a hypothesis that they constitute a distinct sub-population of cells at the corneal epithelial surface.