Year : 1983 | Volume
: 31 | Issue : 5 | Page : 563--565
Tear glucose in ocular inflammations and its enzymatic lysis as a possible therapeutic adjunct in treatment of ocular infections
GK Sharma, SG Kabra, PK Sharma, LK Nepalia, Shashi Bharadwaj, Arun Mehra
Departments of Ophthalmology, Anatomy and Biochemistry, J.L.N. Medical College, Ajmer, India
G K Sharma
Department of Ophthalmology, J.L.N. Medical College, Ajmer
|How to cite this article:|
Sharma G K, Kabra S G, Sharma P K, Nepalia L K, Bharadwaj S, Mehra A. Tear glucose in ocular inflammations and its enzymatic lysis as a possible therapeutic adjunct in treatment of ocular infections.Indian J Ophthalmol 1983;31:563-565
|How to cite this URL:|
Sharma G K, Kabra S G, Sharma P K, Nepalia L K, Bharadwaj S, Mehra A. Tear glucose in ocular inflammations and its enzymatic lysis as a possible therapeutic adjunct in treatment of ocular infections. Indian J Ophthalmol [serial online] 1983 [cited 2020 Jan 20 ];31:563-565
Available from: http://www.ijo.in/text.asp?1983/31/5/563/36589
The glucose is diffusible but nonionized constituent of lacrimal fluid. Since the pioneering work of Ridley  , several workers have attempted to quantitatively correlate the level of tear glucose with that of blood in diabetic states. Last year, we presented an extensive work on tear glucose levels in normals and in diabetics which showed that tear glucose levels reflect blood glucose levels and diagnosis of chemical and uncontrolled diabetes can be easily made by simple estimation of tear glucose levels  . Later, the factors other than diabetes that cause an increase in tear glucose levels were studied. Tapszto et al  ., reported that tear glucose levels are increased by about twice or thrice the normal value in-inflammatory eye disease. The present study is an attempt to comprehensively evaluate the same and to elucidate the effect of glucose oxidase when used topically in lowering tear glucose levels.
Material and Methods
The subject matter of the study comprised of 25 cases each of acute conjunctivitis and corneal ulcers.
Tear samples were collected by a capillary tube after inhalation of spirit of ammonia. Simultaneous fasting blood and tear samples were collected during acute phase and after clinical cure. Glucose was estimated by King and Asatoor  method for true sugar in 0.05 ml of the samples.
Bacteriological culture was carried out in all cases of conjunctivitis and corneal ulcers at the commencement of treatment and after clinical cure.
The effect of 0.1% aqueous solution of glucose oxidase, pH 7.0, was evaluated on tear glucose levels of 35 normal subjects of either sex. After the collection of fasting tear samples, one drop of 0.l% aqueous solution of glucose oxidase was instilled in conjunctival sac. Tears were collected after 1/2, 1, 2, 4 and 6 hours and the glucose estimated.
Results of blood and tear glucose levels during and after inflammation of conjunctiva and cornea [Table 1] reveal that the increase in tear glucose levels during acute phase shows a statistically significant fall after the control of inflammation.
Isolation of pathogenic organisms revealed wide variation in the level of tear glucose [Table 2].
Statistical analysis of the results of topical instillation of 0. 1 % glucose oxidase solution on fasting tear glucose level upto a period of 6 hours [Table 3] shows that tear glucose level starts lowering after 1/2 hour and the maximum effect is after 1 hour, thereafter a gradual restoration brings it to near fasting levels after 6 hours.
It has been demonstrated in the present study that glucose, a constituent of tears, tends to rise with inflammation of conjunctiva and cornea. In conjunctivitis and corneal ulcers, the two conditions studied, the tear glucose was found to show a statistically significant rise (p  al., attributed this increase to the fact that tears are not only a product of glandular secretion, but also contain plasma components that have diffused through the blood vessels of conjunctiva in inflammatory diseases.
A study of causative pathogens, revealed the variation in tear glucose levels according to the type of infection. Glucose utilizing organisms are likely to decrease the raised tear glucose levels due to inflammation. The two contradictory factors viz., the inflammation tending to increase and the glucose-utilizing pathogens, if present, tending to decrease it, explains the wide variations in tear glucose levels observed in present study in association with the different organisms isolated by bacteriological culture.
Glucose oxidase is used as a food preservative by virtue of its hydrolytic properties (Underkofler 5 ). It has been unequivocally demonstrated in the present study that instillation of glucose oxidase effectively lowers the glucose level of tears. A 0. 1 % solution of glucose oxidase has not only been found to be safe but also of sufficient strength (unreported animal, and in vitro experiments) to achieve a sustained reduction. This finding assumes a great significance in the light of our previous work2.and several others demonstrating a rise in tear glucose levels pare pasu with the diabetic state. It is suggested, that glucose oxidase instillations (0.1 % aqueous solution every 2 hours) be employed as a preventive measure before ocular surgery in a suspected case of diabetes. Further, the use of 0.1 % glucose oxidase instillation as an adjunct in antibacterial therapy may prove beneficiary. Further study in this direction is in progress.
A study of tear glucose in 25 cases of acute conjunctivitis and corneal ulcer revealed a significant rise in its level in proportion to the grade and acuteness of inflammation. Type of pathogenic organisms varied the concentration. Instillation of 0.1 % glucose oxidase has been demonstrated to be a safe measure to lower the tear glucose; its preventive and therapeutic value suggested.
|1||Ridley, F., Brit. J. Exp. Path., 11, 217, 1930.|
|2||Gaur, M.S., Sharma, G.K., Kabra, S.G., Sharma, P.K., and Nepalia, L.K., Paper read at 40th All Indian Ophthalmology Conference at Udaipur, 1980.|
|3||Tapaszto, I., and Boross, F., Int. Clinic Ophthal., 13/1, 123, 1973.|
|4||King, C.J., Microanalysis in Medical Biochemistry, 2nd Edition, Churchil, London, 1954.|