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Sander Keijser, Jaap A. van Best, Allegonda Van der Lelij, Martine J. Jager; Reflex and Steady State Tears in Patients with Latent Stromal Herpetic Keratitis. Invest. Ophthalmol. Vis. Sci. 2002;43(1):87-91.
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purpose. To compare tear production in patients with stromal herpetic keratitis
with that in healthy control subjects.
methods. After instillation of 2 μL fluorescein into both eyes, the
tear-fluorescein concentration was measured by fluorophotometry. During
the first 10 minutes, steady state tear turnover (TTO-1) was
determined. After a nasal alcohol stimulus to induce reflex tears, a
second steady state tear turnover (TTO-2) was obtained during 15
minutes. The index of reflex lacrimation (IRL) was calculated as the
percentage decrease in tear fluorescein concentration directly after
the stimulus. TTO-1, TTO-2, and IRL were determined in the patients’
affected eyes (n = 12), in the patients’ healthy
contralateral eyes, if possible (n = 9), and in one eye
of healthy control subjects (n = 24).
results. The TTO-1 in the affected and healthy eyes of patients was
approximately two times lower than the TTO-1 in eyes of healthy control
subjects (P = 0.012 and P =
0.024, respectively) and almost equal to the TTO-2 in eyes of healthy
control subjects (P = 0.32 and P = 0.40). There were no significant differences in
the values of TTO-1, IRL, and TTO-2 between affected and healthy eyes
of patients (P > 0.5). IRL and TTO-2 did not
differ significantly among the three groups (P >
conclusions. Both eyes of the patients were dry. The dryness could be due to a
defective reflex lacrimation under physiological conditions that can
still be induced by nonphysiological nasal excitation. The cause of
this may be demyelination of both trigeminal root entry zones as a
result of a unilateral eye infection by the herpes virus. Another
possibility is that dryness predisposes to herpetic infection or
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