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Eye Infections Might Seem Like A Minor Complaint, But In Some Cases They Can Cause Blindness And Even Death

When you think of eye infections, what comes to mind? Puffy, swollen bruised feeling eyelids that get glued together with gunk overnight? That feeling of having grit in your eye that can't be cleaned away? Eye infections may seem like a relatively minor—if unsightly and inconvenient—complaint, but they can also be far more serious.

Take the deadly outbreak of antibiotic resistant bacteria Burkholderia cepacia in 2023-24, for example.

Between January 2023 and February 2024, contaminated brands of lubricating eye gel were linked to the infection of at least 52 patients. One person died and at least 25 others suffered serious infections.

The outbreak has now subsided and products are back on the shelves but it isn't the first time that medicinal products have led to outbreaks of B cepacia.

The bacteria is an opportunistic pathogen known to pose a significant risk to people with cystic fibrosis, chronic lung conditions and weakened immune systems. The infection likely progresses from the mucous membranes of the eyelids to the lungs where it leads to pneumonia and septicaemia causing death in days.

But it's not just B cepacia that can threaten our health. Something as simple as rubbing our eyes can introduce pathogens leading to infection, blindness and, in the worst case, death.

Bacteria account for up to 70% of eye infections and globally over 6 million people have blindness or moderate visual impairment from ocular infection. Contact lens wearers are at increased risk.

The eye is a unique structure. It converts light energy to chemical and then electrical energy, which is transmitted to the brain and converted to a picture. The eye uses about 6 million cones and 120 million rods which detect color and light.

Eye cells have no ability to regenerate so, once damaged or injured, cannot be repaired or replaced. The body tries its best to preserve the eyes by encasing them in a bony protective frame and limiting exposure having eyelids to defend against the environmental damage and ensure the eyes are kept lubricated.

Despite our bodies' best efforts to shield the eyes from harm, there are a number of common eye infections that can result from introducing potential pathogens into the eyes.

Conjunctivitis

The outer-most layer of the eye, the sclera, bears the brunt of exposure and to help protect it, it is lined by a thin moist membrane called the conjunctiva.

The conjunctiva is highly vascularised, which means it has lots of blood vessels. When microbes enter the eye, it is this layer that mounts an immune response causing blood vessels to dilate in the conjunctiva. This results in "pink eye", a common form of conjunctivitis. Conjunctivitis can be caused by bacteria, allergens or viruses and typically heals by itself.

Blepharitis

Blepharitis is an inflammation of the eyelid and usually affects both sides. It can cause itchy eyes and dandruff-like flakes. It's most commonly caused by Staphylococcus bacteria, or the dysfunction of the glands of the eyelids. It can be treated by cleaning the eyes regularly.

Stye

A stye (also called hordeolum) is a painful infection of the upper or lower eyelid. Internal styes are caused by infection of an oil-producing gland inside the eyelid, whereas external styes develop at the base of the eyelash because of an infection of the hair follicle. Both are caused by bacteria, typically the S aureus form of the Staphylococcus species.

Styes can be treated by holding a clean flannel soaked in warm water against the affected eye for five to ten minutes, three or four times a day. Do not try to burst styes—this could spread the infection.

Keratitis

Keratitis is the inflammation of the cornea, the transparent part of the eye that light passes through. The cornea is part of the eye's main barrier against dirt, germs, and disease. Severe keratitis can cause ulcers, damage to the eye and even blindness.

The most common type is bacterial keratitis; however, it can also be caused by amoeba, which can migrate to other parts of the body—including the brain—and cause infection and even death.

Noninfectious keratitis is most commonly caused by wearing contact lenses for too long, especially while sleeping. This can cause scratches, dryness and soreness of the cornea, which leads to inflammation.

Uveitis

Uveitis is inflammation of the middle layer of the eye. Although relatively rare, it is a serious condition and usually results from viral infections such as herpes simplex, herpes zoster or trauma. Depending on where the inflammation is in the eye, the symptoms can be anything from redness, pain and floaters to blurred vision and partial blindness.

Exogenous endophthalmitis

This is a rare but serious infection caused by eye surgery complications, penetrating ocular trauma (being stabbed in the eye with a sharp object) or foreign bodies in the eye. Foreign bodies can be anything from dirt and dust to small projectiles such as shards of metal from drilling, explosives or soil from farm machinery and many other sources.

Dacryocystitis

Dacryocystitis is the inflammation of the nasolacrimal sac, which drains tears away from the eye into the nose. This condition can be acute, chronic or acquired at birth. Most cases are caused by Streptococcus pneumoniae and Staphylococcus aureus bacteria.

The condition mainly affects newborns and those over 40. Seventy-five percent of cases are women and it's most commonly found in white adults. It can lead to the stagnation of tears, creating a breeding ground for microbes.

Careful with contacts

Proper eye hygiene reduces the risk of all these conditions—and this is even more important for contact lens wearers.

Appropriate hygienic cleaning of lenses is paramount. Non-sterile water, spit and other fluids can transfer potentially dangerous microbes into the eye—a warm, moist environment that makes an ideal breeding ground for bacteria—leading to localized infection, blindness or progress to a more serious systemic infection or death.

Any persistent and painful redness or swelling of eyes should be checked by a registered health professional.

This article is republished from The Conversation under a Creative Commons license. Read the original article.

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New NIH Grant Aims To Combat Sight Damage From Diabetes

DETROIT — Fu-Shin Yu, Ph.D., professor of ophthalmology, visual and anatomical sciences in the Wayne State University School of Medicine, received an award from the National Eye Institute of the National Institutes of Health for his study aiming to reverse the adverse effects of diabetes on eyesight.

The five-year grant for $2,167,882 will benefit Yu's research "Role of Programmed Cell Death Pathways in Bacterial Keratitis," Which will investigate biological processes that contribute to defects in immune response in the eyes of those with diabetes and identify methods to reverse them. 

"The cornea, located at the front of the eye, is our focus," said Yu. "We aim to understand why diabetic patients are more suspectable to keratitis, or corneal infection. Why does the disease progress faster in these patients, and why are they more resistant to treatments? Diabetic patients are about 30% more likely to experience corneal infections."

Yu's research group uses mouse models of both type 1 and type 2 diabetes, along with Pseudomonas aeruginosa as a model pathogen. In May 2023, the Centers for Disease Control and Prevention (CDC) confirmed 81 cases of a drug-resistant Pseudomonas aeruginosa strain across 18 states, resulting in four deaths, 14 cases of vision loss and four cases of enucleation. This underscores the urgent need to better understand the mechanisms underlying the increased susceptibility and severity of bacterial keratitis in diabetic patients.

Diabetic patients can have a higher incidence of infection, with higher disease severity and an increased resistance to some treatments, resulting in increased susceptibility to the rapid progression of microbial keratitis in the corneas of those affected by diabetes.

"We found evidence that mice are more susceptible to corneal infections," said Yu. "Our approach involves analyzing samples from the mice's infected corneas with similar severity. We look at the RNA sequences in the samples and compare the progression of the infection and identify the pathways, or biological processes. By comparing normal pathways to diabetic pathways, we can explore potential treatment avenues."

The CDC reported that in 2018, approximately 34.2 million people in the United States — roughly 10.5% of the nation's population — had diabetes.

"The loss of sight can be debilitating, and diabetes, which contributes to sight loss, is a condition that affects countless individuals," said Ezemenari M Obasi, Ph.D., vice president for research at Wayne State University. "Dr. Yu and other Wayne State researchers are addressing many issues that may have a significant impact on people's lives now and in the future. It is an excellent example of how Wayne State University is playing a unique and influential role in Detroit and beyond by advancing the health and well-being of our communities."

The grant number for this National Eye Institute of the National Institutes of Health award is R01EY035785.

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Wayne State University is one of the nation's pre-eminent public research institutions in an urban setting. Through its multidisciplinary approach to research and education, and its ongoing collaboration with government, industry and other institutions, the university seeks to enhance economic growth and improve the quality of life in the city of Detroit, the state of Michigan and throughout the world. For more information about research at Wayne State University, visit research.Wayne.Edu.

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Claris Bio's Journey Toward Treating Neurotrophic Keratitis

David Hutton, Managing Editor of Ophthalmology Times sat down with Claris Bio CEO, Clarke Atwell, to discuss the company's path toward developing treatment for neurotrophic keratitis.

David Hutton, Managing Editor of Ophthalmology Times sat down with Claris Bio CEO, Clarke Atwell, to discuss the company's path toward developing treatment for neurotrophic keratitis.

Audio Transcript

Editor's note: This transcript has been edited for clarity.

David Hutton:

I'm David Hutton of Ophthalmology Times. Welcome to the latest installment of EyePod, the Ophthalmology Times Podcast. I'm joined today by Clarke Atwell, founding CEO and board member of Claris Bio. Thank you so much for joining us. Tell us a little bit about your company.'

Clarke Atwell:

Thank you, David, thank you for the opportunity. Our company is a young company, we just recently emerged from stealth. Our founding technology comes from Harvard from Dr. Reza Dana and Sunil Chauhan's lab. And early, well, about four or five years ago, they were experimenting with mesenchymal stem cells, and they were seeing a salubrious effect on the surface of the cornea. And they were obviously intrigued by the activity othe cells but we're concerned that the cells themselves would not be a viable way forward for the treatment of diseases, given CMC difficulties and also dosing difficulties. So they went in and started silencing the proteins in the secretome that was being produced, and when they silenced HGF, that was the Aha! Moment when the salubrious effects of the cells went away. So we closed our Series A in 2020. And with our partnership with a company in Japan called Kringle, we brought in our Series A and they brought in GMP material, we were able to submit our IND and are currently in our pivotal trial in Neurotrophic keratitis.Your company's lead program is CSB-001 for patients with neurotrophic keratitis. Can you give us an update on it and its current status?Yes, so it has been a while but we have completed enrollment in our trial. We have 131 patients, and we expect to have our top line data out in the summer of this year.

David Hutton:

And ultimately, what could this mean for ophthalmologists and the patients they treat?

Clarke Atwell:

Well, we see a lot of effects. So the activity of the drug, HGF, is a drug that modulates inflammation, it accelerates wound healing. Especially when we look at proliferation of epithelial cells, endothelial cells, nerve cells, and stromal cells. It also prevents, in animal models at least, prevents the formation of fibrosis, both fibrosis that is currently forming, but also fibrosis that has recently been formed. So we hopefully can regress scars. So we see many different indications potentially for the product. In neurotrophic keratitis, specifically, we're fortunate that our drug is very easy to use,. Patients will be able to keep it at room temperature, it's preservative free, and can be instilled in single doses and blow-fill-seal. The safety profile that we've seen from the product, we're very, very happy with. Obviously, we're masked to the AE rate right now in the study, but the overall safety profile is very positive. And so we see that the drug could potentially be used in more neurotrophic keratitis patients, because of its ease to use, ease to formulate, but also, more patients would be amenable to stay on the therapy because of the side effect profile.

David Hutton:

And what are the next steps for this program? Of course, you've kind of alluded to it, but could you maybe walk us through the timeline and how you see this unfolding.

Clarke Atwell:

So with positive data, and in the summer, we would begin another pivotal trial. This trial will be slightly different in that it will be slightly larger and will include both the US and European sites. We will also be studying BID versus QID. The study currently is QID. So we'll be looking at a different pathology in the next trial. And that trial should read out in the middle of 2026. We hoped then to submit for a BLA and look for approval early 2027.And does Claris have any other therapies currently in development?So we currently see HGF as sort of a Swiss army knife with multiple potential indications. So currently, we are enrolling a open label study in scar regression. So patients who have recently had a scar form in the surface of their eye within 5 millimeters of their pupil. We've enrolled 6 patients to date. Our target is 20 patients. We believe we will have top line data from that open label study in the same period as the NK. We've opened a trial and will begin enrolling in limbal stem cell deficiency. Currently there are no therapies, pharmaceutical agents to treat limbal stem cell deficiency. We believe that our drug might have a positive effect in that area. And that data will be towards the middle or late part of the summer.

David Hutton:

And lastly, what are your goals and outlook for Claris over the next year 2?

Clarke Atwell:

Well, given positive data, we're very excited to get the next NK trials started we've already started manufacture of drug for that and we'll be ready to go into the clinic. We're opening the regulatory files in Europe so that we can file in Europe and open up sites in Europe. And then given that we might have positive data from our either the limbal stem cell or the scar reversal, we're also looking to start a randomized control trial, after discussions with the FDA in either one of those indications.

David Hutton:

Thanks for listening to this episode of EyePod by Ophthalmology Times. If there are topics you would like to hear about, let us know. You can also stay connected with us on Twitter, LinkedIn or Instagram. We'll see you next time.

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