Cornea in Measles

1. Introduction.- 1.1. Blinding eye complications after measles: 'Post-Measles-Blindness".- 1.2. Pathogenesis of Post-Measles-Blindness.- 1.3. Lack of knowledge about the cornea in early measles.- 1.4. Purpose and content of the present study.- 2. Review of literature.- 2.1. The epidemiology of measles.- 2.2. The extra- and intracellular morphology of the measles virus.- 2.3. The pathogenesis of the measles infection.- 2.4 Ocular signs and complications in measles.- 2.4.1. The conjunctivitis of infection.- 2.4.2. The conjunctivitis in prodromal measles.- 2.4.3. The epithelial keratitis in measles.- 2.4.4. Corneal ulcers, a complication of measles.- 2.5. Depression of serumproteins, cell-mediated immunity and serum retinol in malnutrition.- 2.6. Traditional ocular medicines.- 2.7. Statistics on Post-Measles-Blindness.- 3. Patients and Methods.- 3.1. Places and time.- 3.2. The patients: diagnosis of measles and treatment.- 3.3. Ophthalmological examination.- 3.4. The significance of vital staining of the conjunctiva with Lissamine Green or Rose Bengal.- 3.5 Assessment of the nutritional status.- 3.6. Biopsies and specimens for pathology, electronmicroscopy and immunofluorescence.- 3.7. Representativeness of the patient samples.- 4. Clinical description of ocular signs and corneal complications of measles.- 4.1. Ocular involvement in measles.- 4.1.1. Subepithelial conjunctivitis.- 4.1.2. Epithelial conjunctivokeratitis.- 4.2. "Exaggerated signs" and early corneal complications.- 4.2.1. Central corneal macro-erosions.- 4.2.2. Exposure ulcers.- 4.3. The prophylactic value of tetracycline eye-ointment 1% and Vitamin A 200.000 iU.- 4.3.1. Measles keratitis.- 4.3.2. Corneal erosions and exposure ulcers.- 4.4 Late ocular complications.- 5. Immunofluorescence-, light- and electronmicroscopy of conjunctival biopsies and corneal specimens.- 5.1. Immunofluorescence of conjunctival biopsies.- 5.1.1. Technique.- 5.1.2. Results of the immunofluorescence tests on 5 conjunctival biopsies.- 5.2. Light- and electronmicroscopy of conjunctival biopsies.- 5.2.1. Techniques.- 5.2.2. Light microscopy of conjunctival biopsies.- 5.2.3. Electronmicroscopy of conjunctival biopsies.- 5.3. Light- and electronmicroscopy of corneal specimens.- 5.4. Discussion.- 6. The nutritional status of the children with measles-keratitis and corneal complications.- 6.1. Measles-keratitis and age, sex, and history of immunization.- 6.2. Measles-keratitis and nutritional status.- 6.3 The nutritional status of 10 children with early corneal Complications.- 6.4. Nutritional status of patients with late corneal complications.- 6.5. Discussion.- 7. Discussion and conclusion.- 7.1. The pathogenesis of Post-Measles-Blindness.- 7.1.1. Measles.- 7.1.2. Corneal ulcers and collagenase.- 7.1.3. Malnutrition.- 7.1.4. Vitamin A deficiency.- 7.2. The prevention of Post-Measles-Blindness.- 7.2.1. Measles-vaccination.- 7.2.2. Topical treatment of the cornea.- 7.2.3. Improvement of the nutritional status.- 7.3 The measles-keratitis in immunosuppression.- 7.4. Measles and herpes simplex keratitis.- 7.5. Conclusion.- References.- Summary.- Samenvatting.- Resume.- Acknowledgements.- Colour plates.- Curriculum vitae.