[Staphylococcus-associated blepharokeratoconjunctivitis. Clinical findings, pathogenesis and therapy].

BACKGROUND

Staphylococci represent an important source of external infections of the eye. In addition to acute staphylococcal conjunctivitis a spectrum of subacute or chronic disease may be found. According to Valenton und Okumoto, with this staphylococci-associated blepharo-kerato-conjunctivitis in culture-positive cases S. aureus is found in 31% and S. epidermidis in 69% of smears. Microbiallergic and toxic mechanisms are the underlying etiology.

PATIENTS

We report on a series of 38 patients with "red eye" that were seen between 1992 and 1994 in the external disease clinic at the Department of Ophthalmology, University of Heidelberg.

RESULTS

There were 17 female and 21 male patients. The mean age was 53 +/- 20 years. The patient's complaints included recurrent red eyes with discomfort and pain. Clinically, a squamous blepharitis (63%) and conjunctivitis (87%) were present. Upon biomicroscopic evaluation, a corneal involvement could be found in 80% of cases. In 66% of cases conjunctival swabs were positive for staphylococci.

DISCUSSION

The blepharitis may be squamous or ulcerative. The underlying cause is a dermal irritation by staphylococcal toxins. As early as 1937, Thygeson and Allan postulated a toxin-induced skin irritation by a "dermonecrotic factor." In chronic cases a papillary conjunctivitis caused by a toxin reaction can be observed. Histologically, no lymph follicles or eosinophils are present. Several types of keratitis and corneal involvement are found. An epithelial keratitis is caused by toxic mechanisms. Marginal infiltrates and ulcers indicate an antigen-antibody reaction. Phlyctenulae indicate a delayed immune reaction (Gell and Coombs type IV). Complications include vascular pannus, corneal scarring, and rarely corneal melting and ulcers. Therapy depends on the severity of the inflammation and the underlying pathomechanism. This includes reduction of toxin-producing organisms by hygiene of the lid margins and application of topical disinfectants and antibiotics. With immunological phenomena topical steroids are required.