Experiences in treating patients for blepharitis.
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Adult↗
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Results for “Blepharitis”
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Conjunctivitis, blepro-conjunctivitis and melbomian blepharitis; therapeutic trial by diathermo-coagulation of the mebomian orifices.
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Conjunctivitis↗
Cytodiagnosis of orbital and blepharal tumors.
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Adenocarcinoma↗
[Cytodiagnosis of orbital and blepharal tumors].
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Cytodiagnosis↗
Tear lactoferrin levels in chronic meibomitis associated with acne rosacea.
PURPOSE: To determine tear lactoferrin levels in patients with chronic diffuse meibomitis associated with acne rosacea and to investigate their role in the development and perpetuation of some inflammatory ocular surface complications. METHODS: In this non-randomized, controlled trial performed in a tertiary care center, eight patients with biopsy-proven acne rosacea and blepharitis, and ten patients with seborrheic blepharitis not associated with acne rosacea formed the study groups and ten normal patients were used as controls. Schirmer I test results, tear break-up time and radial immunodiffusion (Lactoplate) tests on tear samples of the three groups were compared. RESULTS: Compared to controls, tear lactoferrin concentrations were lower in both the acne rosacea and seborrheic blepharitis groups. However, this decrease was significant in only the seborrheic blepharitis group (p = 0.026). One patient in the acne rosacea group, with the lowest measurement, developed bacterial keratitis. CONCLUSIONS: Though within the normal range, tear lactoferrin levels in patients with acne rosacea and seborrheic blepharitis were lower than controls. Low concentrations of lactoferrin may play a role in the ocular surface inflammatory components associated with these diseases.
Adolescent↗
Keratoconjunctivitis sicca associated with meibomian secretion polar lipid abnormality.
OBJECTIVE: To determine whether an association between keratoconjunctivitis sicca (KCS) and meibomian gland lipids exists in patients with chronic blepharitis. METHODS: Meibomian gland lipids were collected from normal patients and those with chronic blepharitis. Some of the chronic blepharitis patients had an ocular surface abnormality with apparent aqueous deficiency similar to KCS. Lipids were separated by thin-layer chromatography and polar lipids were further separated by high-pressure liquid chromatography with detection by UV absorbance. Lipids were identified by retention time with comparison with standards and by gas chromatography and mass spectroscopy. RESULTS: A strong association between specific lipids and KCS signs was observed only with the polar lipids. Low levels of 2 phospholipids, identified as phosphatidylethanolamine and sphingomyelin, were significantly (P < .05) associated with ocular surface abnormalities that were consistent with KCS. CONCLUSIONS: Evaporative KCS syndrome (rather than tear insufficiency) in many individuals may be the result of polar lipid abnormalities. We believe that the 2 associated phospholipids identified in the patients with chronic blepharitis act as important structural components in the polar phase of the tear film lipid layer. We suggest that a deficiency in these lipids results in a poorly structured polar phase that in turn affects the nonpolar phase. Ultimately water transmission through the tear film lipid layer increases, thus resulting in evaporative KCS. These results should aid in development of tear film substitutes directed toward specific abnormalities.
Blepharitis↗
Use of macrolides and tetracyclines for chronic inflammatory diseases.
OBJECTIVE: To review the efficacy of macrolides and tetracyclines in several chronic inflammatory conditions. DATA SOURCES: Searches of MEDLINE (1966-March 2004) and an extensive bibliography search were undertaken. Key terms included acne, blepharitis, cardiovascular disease, cystic fibrosis, periodontitis, rosacea, and rheumatoid arthritis. STUDY SELECTION AND DATA EXTRACTION: Data were obtained primarily from randomized placebo-controlled trials upon which key recommendations are based. DATA SYNTHESIS: Antibiotics are often prescribed for months or even years for treatment of chronic inflammatory conditions such as acne, blepharitis, cardiovascular disease, cystic fibrosis, periodontitis, rosacea, and rheumatoid arthritis. Randomized controlled trials have shown that azithromycin is useful in the management of cystic fibrosis and the tetracyclines are beneficial in the management of rheumatoid arthritis, acne, blepharitis, and periodontitis. Several large, randomized controlled trials have failed to show any benefit of macrolides in the secondary prevention of cardiovascular disease. No randomized placebo-controlled clinical trials have been performed to assess the efficacy of macrolides or tetracyclines in patients with rosacea. CONCLUSIONS: The use of tetracyclines and macrolides for rosacea is based primarily on anecdotal reports or open-label trials. Limited clinical trials support the use of tetracyclines or macrolides in acne, blepharitis, periodontitis, rheumatoid arthritis, and cystic fibrosis. Trials to date do not support the use of antibiotics for secondary prevention of cardiovascular disease.
Acne Vulgaris↗
[Discoid lupus erythematosus involving the eyelids: 4 cases].
BACKGROUND: Discoid lupus erythematosus is a chronic skin disease frequently involving the face, scalp and ears. Palpebral lesions are rare. We report 4 cases of this uncommon localization. In one case, palpebral lesions were the sole manifestation of the discoid lupus erythematosus. CASE REPORTS: Four patients aged between 26 and 45 Years had lesions of the lower eyelid as erythematous, infiltrated and scaly plaques. One patient, without diagnosis despite 2 skin biopsies of lesion, presented with a 2-Year history of blepharitis in the absence of any other cutaneous abnormality. In one case, chronic blepharitis has been present for 4 Years and associated with inflammatory arthralgia. Alopecia occurred 4 Years after the onset of blepharitis and led to the diagnosis of discoid lupus erythematosus. In 2 cases, blepharitis was associated with typical cutaneous lesions of discoid lupus erythematosus. Antimalaria drugs were very effective in 3 cases. In one patient the antimalaria drug failed, but thalidomide was effective. DISCUSSION: The location of lesions on the eyelids in the absence of any other cutaneous abnormality is rare and can easily lead to the misdiagnosis of discoid lupus erythematosus. Most Authors mention a predilection of the lesions to the inferior portion of the eyelid, more specifically to the external third. The involvement of the eyelids with permanent scarring and severe eye impairment is explained by the long duration of the disease without diagnostic and appropriate treatment. Clinical examination is highly consistent with discoid lupus erythematosus: the lesions typically present as well-circumscribed, erythematous plaques with telangiectasia and scales and atrophy in long-standing disease. Antimalaria drugs are remarkably effective.
Adult↗
Acquired external punctal stenosis: etiology and associated findings.
UNLABELLED: PURPOSE; To investigate the underlying causes of acquired external punctal stenosis (AEPS) and assess the associated tear drainage problems. DESIGN: Prospective, noncomparative observational case series. METHODS: Seventy-eight eyes of 52 patients with symptomatic AEPS were prospectively assessed by or under supervision of a consultant oculoplastic surgeon from June 1999 to October 2002. The severity of the stenosis was graded on clinical examination. Associated findings from ophthalmic examination, diagnostic probing, and irrigation were recorded. The chi(2) test with 95% confidence interval (CI) and the Fisher exact test were used for statistical analysis. RESULTS: The age range was 39 to 90 years (mean, 69.4 years). Acquired external punctal stenosis was due to chronic blepharitis in 35 eyes (45%), unknown etiology in 21 eyes (27%), ectropion in 18 eyes (23%), and related to drugs in 4 eyes (5%). Associated canalicular stenosis and common canalicular stenosis with obstruction (at the level of the internal punctum) was found in 36 eyes (46%) with AEPS. Nasolacrimal duct stenosis (5 eyes) or obstruction (2 eyes) was found in 8.5%. The number of patients with associated canalicular and common canalicular stenosis increased with increasing age (95% Confidence Interval [CI] = 0.03-0.04, P =.03) and duration of symptoms (95% CI = 0.02-0.03, P =.02). The number of patients with associated nasolacrimal duct stenosis and obstruction increased with increasing age (95% CI = 0.000- 0.001, P =.001) and in AEPS with unknown etiology (95% CI = 0.004-0.006, P =.003). CONCLUSIONS: Chronic blepharitis is a common cause of AEPS even after treating the blepharitis, but in a significant number of patients there is no apparent etiology. Associated upper and lower tear drainage stenosis should be considered in the preoperative evaluation and surgical plan for AEPS.
Adult↗
Minocycline effect on meibomian gland lipids in meibomianitis patients.
The objective of this research was to determine the effect of oral minocycline on the meibomian gland nonpolar and free fatty acid lipids of chronic blepharitis patients. Patients--seborrheic blepharitis (SBBL), acne rosacea (AR) without ocular involvement, and acne rosacea with meibomianitis (AR-MKC). Minocycline treatment--50mg orally for 2 weeks followed by 100mg to the end of 3 months; this was followed by 3 more months with no treatment. Meibomian gland secretions (meibum) were collected before treatment, at the end of the 3 months on treatment, and 3 months after stopping treatment. Lipids were separated and analyzed for wax and sterol esters, triglycerides, diglycerides, free cholesterol and free fatty acids. Data were analyzed statistically by ANOVA. Minocycline treatment resulted in decreased diglycerides and free fatty acids in the group AR-MKC, which continued into the second 3 months (off treatment) and was significant. Cholesterol decreased, but triglycerides initially decreased with treatment and then increased when treatment in the group was discontinued (second 3 months); these results, however, were not significant. Thus, minocycline has its greatest effect on lipid types, which result from degradation (lipase) reactions, suggesting a lipase inhibition effect and/or direct effect on ocular flora. This minocycline effect continues even after treatment is discontinued, suggesting a more lasting effect on ocular microflora. Minocycline may be most effective when the treatment period is longer than 3 months. These results give insight into disease mechanisms associated with chronic blepharitis.
Analysis of Variance↗
Antiproteolytic activities found in human tears.
Human tears were found to inhibit the thiol-dependent protease, papain. Inhibitory activity in normal tears was compared with that in patients with blepharitis, infectious and allergic conjunctivitis, and herpes simplex. Activities lower than normal were found in some patients with infectious conjunctivitis and blepharitis. Higher than normal activities were found in patients with herpes simplex and allergic conjunctivitis. Differences from normal values were found to be statistically significant in allergic conjunctivitis and blepharitis by analyses of sample medians, means, and geometric means. A function of this inhibitor in external ocular inflammations is suggested.
Blepharitis↗
Model for ocular tear film function.
Blepharitis patients have a number of disturbances in their tear film associated with meibomian gland dysfunction that affect evaporation and tear osmolarity. We tested a series of 156 consecutive patients, with a presumed diagnosis of blepharitis, dry eye, or allergic disease, and a series of 72 normals. We compared their tear film characteristics using tear osmolarity, tear volume, tear production (fluorophotometric and Schirmer test), tear turnover (decay constant), tear evaporation, and meibomian gland function evaluated by gland drop-out, expressed lipid viscosity, and volume. Of the 156 patients tested, we found 37 had dry eye, 10 had only allergic disease, 73 had meibomian gland dysfunction and dry eye, and 36 had only meibomian gland dysfunction. We created a model of the relative influence some of these factors had on each other using their correlation coefficients. The highest correlations for osmolarity were Schirmer test (-0.44), lipid volume low (-0.44), lipid viscosity high (0.39), gland drop-out (0.39), and tear evaporation (0.36). With regression analysis we accounted for 47% of the total variation in osmolarity, but only 17% of the variation in tear evaporation. We also present our classification system for blepharitis and dry eye patients based on our measurable physiologic parameters.
Blepharitis↗
Comparative evaluation of efficacy and safety of ciprofloxacin and norfloxacin ophthalmic solutions.
The efficacy and safety of ciprofloxacin ophthalmic solution 0.3% and norfloxacin ophthalmic solution 0.3% in the treatment of bacterial conjunctivitis and blepharitis were compared in a double masked randomised study. A total of 131 patients, 65 treated with ciprofloxacin (42 with conjunctivitis and 23 with blepharitis) and 66 treated with norfloxacin (39 with conjunctivitis and 27 with blepharitis) were enrolled in the study at five centres in France. In the efficacy population, pathogens were eradicated or reduced in 96% (24/25) of patients in the ciprofloxacin group and 89% (24/27) in the norfloxacin group. There was no difference between treatments with regard to eradication of particular pathogens. In the efficacy population, clinical cure or improvement was seen in 96% of the patients (24/25 in the ciprofloxacin group and 26/27 in the norfloxacin group). There were no significant differences between ciprofloxacin and norfloxacin with respect to improvements in four symptoms or ten clinical signs. No serious treatment-related adverse events were reported and both ciprofloxacin and norfloxacin were well tolerated.
Anti-Infective Agents↗
Pediatric ocular acne rosacea: long-term treatment with systemic antibiotics.
PURPOSE: To report our experience with four cases of pediatric ocular acne rosacea, including responses to long-term systemic treatment. DESIGN: Retrospective interventional case series. METHODS: The medical records of four consecutive cases diagnosed with pediatric ocular acne rosacea over a period of 36 months were reviewed. Diagnostic criteria were meibomian gland dysfunction, blepharitis, lid margin telangiectasia, punctate superficial keratopathy, and conjunctival hyperemia with or without inferior corneal vascularization. RESULTS: The patients, aged between four and 12, were all females with bilateral disease. Meibomitis, blepharitis, conjunctival hyperemia, and punctuate epitheliopathy was evident in each case. Cutaneous involvement was seen in two cases (50%), and limbal vascularization with subepithelial or stromal infiltrates was present in three cases (75%). One case showed corneal ulceration at presentation. All four children received systemic doxycycline or erythromycin for at least 12 months and showed considerable improvement within the first month of therapy. No recurrence was noted within the mean 25.5 months of follow-up. None of the girls experienced any side effects during the long treatment duration. CONCLUSIONS: Ophthalmologists should consider acne rosacea as a potential diagnosis for any child who has any combination of meibomian disease, chronic blepharitis, recurrent chalazia, and chronic symptoms of photophobia, ocular irritation, and redness that does not respond to routine medical treatment. Such patients respond very well to long-term treatment with systemic erythromycin/doxycycline.
Anti-Bacterial Agents↗
Photosensitivity to sulfisoxazole ointment.
A 35-year-old man demonstrated sulfisoxazole diolamine-induced photosensitivity during treatment for staphylococcal blepharitis. This reaction was easily avoided by applying the ointment at bedtime and covering the eyelids during sun-bathing while in therapy. A drug-induced photosensitivity reaction should be considered in cases of staphylococcal blepharitis resistant to or aggravated by eyelid-margin therapy with sulfonamides.
Adult↗
Lysozyme content of tears in normal subjects and in patients with external eye infections.
We studied the lysozyme content of tears in 267 subjects (521 eyes), including 241 healthy subjects, 7 patients (14 eyes) with bilateral blepharitis, 8 patients (12 eyes) with conjunctivitis, and 11 patients (16 eyes) with keratitis. The concentration of lysozyme in the tears rises with age between childhood and maturity. The highest values were seen in the age group of 21-40 years, and a decrease of lysozyme concentration occurred with an increase in age from 30-40 years. The mean lysozyme content of tears was 1,768 micrograms/ml in healthy subjects; no significant differences occurred between the sexes. Patients with blepharitis, conjunctivitis, and keratitis had normal mean lysozyme content of tears. The tears of patients with herpes simplex keratitis had low lysozyme values.
Adolescent↗
Assessment of keratoconjunctivitis sicca in patients with fibromyalgia: results of a prospective study.
Patients with fibromyalgia (FM) often describe the presence of dry eyes and other ocular symptoms. It has been claimed that a subgroup of patients with FM might have features suggestive of primary Sjögren syndrome. In others, such a relationship could not be found. The purpose of the present study was to investigate the association and prevalence of keratoconjunctivitis sicca (KCS) in patients with FM. Among 285 patients with FM, 40 patients reporting sicca symptoms were screened with Schirmer's I test, break-up time and Rose-Bengal score. KCS was diagnosed when two of the selected three tests gave pathological results. A detailed ophthalmological examination was also performed. In 15 patients the diagnosis of KCS could be confirmed. Eighteen of 40 patients had been taking low-dose antidepressants and 7 of them had objective signs of KCS. Eight of 40 patients had signs of chronic blepharitis and 4 of them had KCS. Fourteen patients showed unremarkable test results. Chronic blepharitis and the use of tricyclic antidepressants may play a role in developing KCS. It seems that the rate of KCS does not increase in patients with FM and they probably have objective ocular findings comparable with the normal population.
Adult↗
[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.
Adolescent↗