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PubMed2004

Cluster analysis of patients with ocular surface disease, blepharitis, and dry eye.

OBJECTIVE: To develop a classification system for blepharitis and dry eye based on a classification-tree model of a large group of subjects who were given a variety of objective physiologic tests. METHODS: We evaluated 513 subjects, some healthy and some with blepharitis and dry eye,with tests for tear volume, tear flow, and tear turnover and the Schirmer test for dry eye. Meibomian gland function was evaluated by meibomian gland lipid expression for lipid volume and lipid viscosity, evaporation, and eyelid transillumination for meibomian gland drop out. We subjected these data to cluster analysis and formulated a classification tree. MAIN OUTCOME MEASURE: The outcome measure of this study was the statistically valid groups of subjects with and without ocular surface symptoms identified by their physiologic characteristics. RESULTS: Cluster analysis most successfully grouped subjects by initially dividing them into 2 groups based on the presence or absence of gland drop out and then by lipid viscosity and volume, Schirmer test results, and evaporation. The analysis created 9 categories. This division created an objective classification system that was found to have clinical relevance. Normal subjects were distributed across several groups. CONCLUSIONS: Using a classification tree, blepharitis and dry eye can be classified with objective physiologic tests into clinically relevant groups that have common characteristics. The analysis establishes the central role of meibomian gland dysfunction in blepharitis and demonstrates the diverse characteristics of the normal population.

Adult↗
PubMed1991

Blepharitis--a diagnostic and therapeutic challenge. A report on 407 consecutive cases.

Over the last few years the number of patients with chronic bilateral blepharitis has increased dramatically. From January 1985 until the end of 1989, a total of 407 patients with this diagnosis underwent ophthalmological and dermatological investigations at our out-patient clinic. Keratoconjunctivitis sicca (KCS) in conjunction with blepharitis occurred in 14.5% of the patient population who also suffered from acne rosacea. A comparison of the spectrum of microorganisms that have previously been isolated from affected sites with data obtained in the present study revealed that the range of microorganisms associated with this chronic localized inflammation has apparently shifted in recent years. The prevalence of Staphylococcus aureus, which was considerable in the pre-antibiotic era, has markedly decreased, although a distinct entity of staphylococcal blepharitis seems to remain, either alone or in combination with seborrheic blepharitis (62.8% of our patients). The clinical picture, microbiological findings and therapy for this condition are presented.

Adolescent↗
PubMed1990

Ketoconazole in the treatment of blepharitis.

A double masked, placebo controlled clinical trial, of topical 2% ketoconazole cream with lid hygiene, for the treatment of seborrhoeic and mixed seborrhoeic/staphylococcal blepharitis was conducted. Forty patients with symptomatic blepharitis, 20 randomly allocated to ketoconazole, 20 to placebo were entered. Treatment efficacy was assessed by improvement of symptoms using visual analogue scales, appearance of the eyelids and reduction in numbers of pityrosporum yeasts on the eyelids. Both groups showed a similar reduction in symptoms, and signs of inflammation. The overall clinical impression in the ketoconazole group was better at week five than in the placebo group. Sixty nine per cent were either normal or markedly improved, as compared to 42% in the placebo group, although this was not statistically significant (p less than 0.1, one-sided Mann-Whitney). Pityrosporum numbers were reduced significantly in both groups during the treatment period. Ketoconazole was no better than placebo at improving the symptoms of blepharitis. More ketoconazole treated patients had normal or markedly improved lids after treatment than the placebo group. Pityrosporum yeasts may play a role in blepharitis, and treatment with an antifungal has some advantages over conventional therapy.

Adult↗
PubMed2001

[FK 506 ointment 0.1 % - A new therapeutic option for atopic blepharitis. Clinical trial with 14 patients].

BACKGROUND: Severe atopic blepharitis is difficult to treat, as topical steroids offer only a limited therapeutic benefit with increasing side effects by time. Topical FK 506 was found to be efficient and safe for treatment of atopic dermatitis in dermatologic studies. The use of topical FK 506 in atopic blepharitis has not been reported so far. PATIENTS AND METHODS: Fourteen patients with severe atopic blepharitis were treated with topical FK 506 0.1 %. The ointment was applied twice daily on the eye lids. Ophthalmologic examinations were scheduled at two weeks, two months and five months after onset of treatment. A score was defined for the skin of the lid (edema, erythema, lichenification, oozing, excoriation and crusting) and for the eye lid margin (erythema, thickening, crusting) respectively. Every patient graded pruritus on a visual analogue scale. RESULTS: The mean skin score prior to treatment was 25.6 +/- 5.8, after two weeks 7.9 +/- 4.8 (p < 0.001), after two months 5.8 +/- 5.0 (p < 0.001) and after five months 5.3 +/- 5.3 (p < 0.001). The mean score for the eye lid margin prior to treatment was 12.3 +/- 4.0, after two weeks 4.6 +/- 2.7 (p < 0.001), after two months 3.8 +/- 2.4 (p < 0.001) and after five months 4.3 +/- 2.6 (p < 0.001). The mean score for pruritus prior to treatment was 8.1 +/- 1.3, after two weeks 2.0 +/- 1.4 (p < 0.001), after two months 1.3 +/- 0.8 (p < 0.001) and after five months 0.8 +/- 0.7 (p < 0.001). All patients assessed the overall situation under therapy as markedly improved. CONCLUSIONS: Topical FK 506 0.1 % ointment turns out to be an excellent therapeutic option for treatment of severe atopic blepharitis. Long-term efficacy and safety have to be evaluated in long-term follow-up studies.

Administration, Topical↗
PubMed1995

Placebo controlled trial of fusidic acid gel and oxytetracycline for recurrent blepharitis and rosacea.

A prospective, randomised, double blind, partial crossover, placebo controlled trial has been conducted to compare the performance of topical fusidic acid gel (Fucithalmic) and oral oxytetracycline as treatment for symptomatic chronic blepharitis. Treatment success was judged both by a reduction in symptoms and clinical examination before and after therapy. Seventy five per cent of patients with blepharitis and associated rosacea were symptomatically improved by fusidic acid gel and 50% by oxytetracycline, but fewer (35%) appeared to benefit from the combination. Patients with chronic blepharitis of other aetiologies did not respond to fusidic acid gel but 25% did benefit from oxytetracycline and 30% from the combination. Our results demonstrate the need to investigate patients with blepharitis for concomitant rosacea as they respond well to targeted therapy.

Blepharitis↗
PubMedDate not supplied

Comparative evaluation of the short-term bactericidal potential of a steroid-antibiotic combination versus steroid in the treatment of chronic bacterial blepharitis and conjunctivitis.

The effects of four days' treatment with topical Maxitrol (neomycin sulphate 3500 IU/mL, polymyxin-B sulphate 6000 IU/mL with dexamethasone 0.1%) were compared with those of Maxidex (dexamethasone 0.1% alone) in a double-masked study in 111 patients with bacterial blepharitis or conjunctivitis, 95 of whom were evaluable for efficacy. The majority of patients (N = 80) had chronic blepharitis. Maxitrol treatment resulted in a significantly greater reduction (90%) in bacterial counts and bacterial eradication (50%) compared with Maxidex (34% and 17% respectively). Maxitrol treatment also produced a significantly greater reduction in conjunctival discharge than did Maxidex, while the treatments were equally effective in alleviating other ocular signs and symptoms. It was concluded that use of a fixed dose combination steroid-antibiotic product was more effective for bacterial control and therapeutic efficacy in the treatment of chronic blepharitis and conjunctivitis patients than treatment with steroid alone. However, in the long-term treatment of chronic blepharitis the well-known toxic problems of neomycin sulphate have to be taken into account.

Administration, Topical↗
PubMed1999

[Blepharitis due to Demodex: myth or reality?].

PURPOSE: Demodex folliculorum has been incriminated in the development of blepharitis although much controversy persists. Certain authors suggest that Demodex is a direct pathogen in chronic palpebral conditions while others consider the saprophyte to be innocuous to skin. METHODS: We conducted a prospective study of eyelashes in 100 persons, searching for Demodex folliculorum and chronic blepharitis. Microscopy in immersion oil after storage in a moist chamber was performed. RESULTS: The incidence of Demodex folliculorum was very high in patients with blepharitis compared with normal controls. Incidence increased with age. Harmless cuffs around the base of the eyelashes was found in 4% with Demodex irradior. CONCLUSION: Demodex should be considered as the cause of chronic blepharitis. Anti-Demodex treatment is indicated when the parasite is found.

Adult↗
PubMed1992

Giant papillary conjunctivitis and meibomian gland dysfunction blepharitis.

In this prospective pilot study we saw 42 consecutive giant papillary conjunctivitis (GPC) patients (80 eyes), all of whom were found to have some meibomian gland dysfunction blepharitis. Severity of GPC at presentation correlated with severity of meibomian gland dysfunction blepharitis (Kendall's tau b averaged 0.246 across the adjusted statistical analyses). Thirty-two patients (63 eyes) were refit after treating meibomian gland dysfunction blepharitis. Twenty-eight of these patients (55 eyes; 87%) continue to wear contact lenses, maintaining an improvement in GPC (mean follow-up 21 months; range 11-36 months). We hypothesize that meibomian gland dysfunction blepharitis may play a role in the pathogenesis of GPC and suggest that a large, controlled, multi-observer study be performed to further investigate this possible association.

Adolescent↗
PubMed2005

[Demodex as an etiological factor in chronic blepharitis].

PURPOSE: To present and account the results of newest experimental and clinical investigations on the role of Demodex folliculorum and Demodex brevis in the etiology of chronic blepharitis. MATERIAL AND METHODS: A review of literature concerning the role of Demodex in the etiology of chronic blepharitis was done. RESULTS: It has been established that: (1) Demodex folliculorum and Demodex brevis occur among humans worldwide. (2) With age the prevalence of eyelids demodicidosis rises. (3) In the course of chronic blepharitis infection of Demodex folliculorum and Demodex brevis is often observed. CONCLUSIONS: Demodex is an etiological factor in chronic blepharitis.

Animals↗
PubMed2006

[Clinical investigation of chronic blepharitis and evaporative loss dry eye].

OBJECTIVE: To investigate the relationship between chronic blepharitis and evaporative loss dry eye. METHODS: Forty-one patients (82 eyes) were diagnosed as chronic blepharitis from November 2002 to April 2003 in Beijing Tongren Eye Center, of which 22 cases were male and 19 female. All patients' ocular surface was judged by Schirmer I test, tear film break up time (BUT) and Tearscope. Meibomian gland secretion was used for bacteria culture and antibiotic sensitivity test. Thirty patients (60 eyes) of glaucoma, cataract and LASIK before surgery were used as control, which included 16 male and 14 female. Microbiological results of meibomian gland secretion were compared and the statistical difference was evaluated by chi(2) test. RESULTS: Of the blepharitis group, ST value was less than 10 mm in 30 eyes (36.6%), BUT less than 10 s in 56 eyes (68.3%) and tear film tearscope evaluation more than 3 grade in 46 eyes (56.1%). The bacteria spectrum of meibomian secretion in both groups was similar, which included staphylococcus epidermidis, staphylococcus aureus and corynebacterium. However, the bacterium culture positive rate and antibiotic sensitivity showed significant difference (P < 0.05). CONCLUSION: The chronic blepharitis is one of important cause in evaporative loss dry eyes.

Adult↗
PubMed1995

Periocular inflammation in mice with experimental systemic lupus erythematosus. A new experimental blepharitis and its modulation.

Experimental systemic lupus erythematosus (SLE) can be induced in mice by immunization with a human monoclonal anti-DNA Ab, bearing a major Id 16/6Id. Immunized mice initially produce Abs to 16/6Id, DNA and nuclear Ags, and subsequently develop various clinical manifestations including leukopenia and renal immune complex disease. MHC class I Ags play a critical role in the induction and progression of experimental SLE. The present study reports that ocular changes also occur in mice with experimental SLE. The ocular disease is characterized by bilateral subacute and chronic inflammation of the eyelids (blepharitis) with immune complex IgG deposition and hypertrophic meibomian glands. The severity of ocular changes was strain dependent: most severe in 129 mice, less intense in BALB/c animals and only minimal in C3H.SW mice. No blepharitis developed in mice deficient in MHC class I expression. Further, the disease was strongly inhibited in BALB/c mice treated with methimazole, an agent that has been shown to repress transcription of MHC class I. In these cases, there was no IgG deposition and a decreased infiltration of inflammatory cells in the eyelids. These observations thus suggest that, similar to the observation with experimental SLE, MHC class I is critical in the onset of this experimental autoimmune blepharitis. The new experimental eye disease described here provides an animal model for chronic blepharitis in humans, a common condition for which such a model has been sought.

Animals↗
PubMed1994

Clinical diagnosis of recurrent herpes simplex blepharitis in an adult: a case report.

BACKGROUND: Herpes simplex (HSV) blepharitis occurs usually in children as a primary infection. Though primary HSV blepharitis is also observed in adults, recurrent HSV blepharitis involving the same area of the eyelid is unusual in this group. Two clinical types have been identified, one consisting of vesicular type lesions and a second characterized by erosive-ulcerative insults. Presented in this article is a case of an adult with herpes simplex blepharitis (presumed recurrent at the same generalized eyelid region), manifesting erosive-ulcerative lesions. Review of this ocular condition, treatment modalities, and hypothetical modes of transmission is given.

Adult↗
PubMed1993

Relation of cholesterol-stimulated Staphylococcus aureus growth to chronic blepharitis.

PURPOSE: Many types of chronic blepharitis have been believed to be primarily microbial in origin; however, it was proposed that differences and changes in lipid composition of meibomian secretion may be the initiating factor in some of these. It was recently reported that there are two subgroups of normals, those whose meibomian secretions contain high levels of cholesterol esters and those whose secretions contain very low levels of these esters. Thus, these subgroups of normals were defined on the basis of detailed lipid analyses of meibomian secretions from individuals showing no clinical signs of chronic blepharitis. All secretions from patients in the various disease groups contain high levels of these esters. Based on previous observations that in some chronic blepharitis disease groups certain Staphylococcus species were capable of hydrolyzing cholesterol esters, the authors tested the hypothesis that the resulting cholesterol might affect growth of Staphylococcus aureus. METHODS: Staphylococcus aureus growth stimulation in Mueller-Hinton broth by cholesterol was determined by colony forming units. Growth stimulation by cholesterol and other additives was also determined by the optical density 650 nm method. Statistical analyses included analysis of variance and the Student's t test. RESULTS: Cholesterol stimulated Staphylococcus aureus growth was significant during the first 24 hr period (20% increase at 25 microM cholesterol, P < 0.02), and for the total 48 hr period (40% increase at 400 microM cholesterol, P < 0.005) when compared to the respective control. Growth stimulation, determined by OD at 650 nm, in the presence of cholesterol was significantly greater (P < 0.02) than that in the presence of either sitosterol or cholestanol when the sterol concentration was 190 microM. CONCLUSION: These results suggest that the presence and hydrolysis of cholesterol esters of meibomian secretions may contribute to the proliferation of Staphylococcus spp, especially Staphylococcus aureus, observed in some chronic blepharitis disease groups.

Blepharitis↗
PubMed1987

A rabbit model of staphylococcal blepharitis.

Rabbits immunized with cell wall antigens of Staphylococcus aureus developed blepharitis after topical challenge with viable S aureus. The lids of these rabbits were thickened and erythematous. Crusting was found around the lashes, and the lids developed loss of lashes and hair. Histopathologic examination of lids from rabbits with blepharitis showed a dense leukocytic infiltrate and dilated blood vessels beneath an intact epidermis and palpebral conjunctival epithelium. The infiltrate contained neutrophils as well as mononuclear cells, including macrophages, plasma cells, and lymphocytes. The meibomian glands appeared normal. Gram's staining of lid sections did not show gram-positive cocci. The results of this study suggest that hypersensitivity to the S aureus cell wall, and particularly the ribitol teichoic acid that it contains, plays a role in the pathogenesis of staphylococcal blepharitis.

Animals↗
PubMed2004

[Blepharitis].

Blepharitis is characterized by a great variety of clinical manifestations, which often include alterations of the ocular surface. This as well as its tendency to be therapy-resistant and recurrent explains why blepharitis marks a challenge for all ophthalmologists. Occasionally dermatologic diseases represent one of the causes of the disease, thus calling for an interdisciplinary approach. The present article describes the state of the art with regard to pathogenesis and therapy of blepharitis.

Anti-Bacterial Agents↗
PubMed1982

Classification of chronic blepharitis.

Since last thoroughly evaluated over three decades ago, the clinical spectrum of chronic blepharitis has changed. The relative prevalence of Staphylococcus aureus alone or in combination with seborrheic blepharitis has decreased. The relative prevalence has increased of seborrheic blepharitis with or without associated excess meibomian secretions (meibomian seborrhea) or inflammation (meibomitis). Primary meibomitis appears not to be a primarily infectious entity but to represent a facet of generalized sebaceous gland dysfunction and to be found in association with seborrheic dermatitis or acne rosacea. The keratoconjunctivitis found in association with primary meibomitis may be contributed to by the production of bacterial lypolytic exoenzymes that split neutral lipids, resulting in an increased level of free fatty acids in the tears. A frequent finding of keratoconjunctivitis sicca in this patient population, especially the S. aureus group (50%), is of note. Of particular importance is that these entities be recognized as chronic diseases requiring control and ones for which there is no "cure."

Adolescent↗
PubMed1990

Role of staphylococcal toxin production in blepharitis.

Lid isolates of Staphylococcus aureus and coagulase-negative staphylococci (CNS) from controls (12 S. aureus and 110 CNS) and from patients with blepharitis (17 S. aureus and 171 CNS) were tested for production of alpha, beta, delta, epsilon, and previously undescribed hemolytic toxins, because toxin production has been implicated as a cause of blepharoconjunctivitis. The electrolyte content of agar media required for toxin production was first investigated. Alpha-lysin was found to be produced by all isolates of S. aureus colonizing lids of normal controls and patients with blepharitis, but by none of 281 CNS isolates. A new toxin was identified, having low molecular weight (5 kd), produced by one CNS strain isolated from a blepharitic lid. It was produced on basic nutrient agar that lacked sodium but contained glucose, which inhibited production of alpha-lysin. It hemolyzed rabbit and sheep erythrocytes and, surprisingly, was neutralized by polyclonal antiserum to alpha-lysin. This may explain occasional reports of alpha-lysin production by CNS. The overall results do not support a hypothesis of hemolytic toxin production by staphylococci as a general cause of blepharitis.

Bacterial Toxins↗
PubMed1983

[Necrotizing blepharitis following captopril-induced agranulocytosis].

A case of necrotizing blepharitis due to a side-effect of captopril medication is described. Blepharitis was the first clinical sign of drug-induced agranulocytosis. The history of drug intake as part of the anamnesis was the most important diagnostic tool for the ophthalmologist since the course of agranulocytotic blepharitis depends on the elimination of the drug.

Agranulocytosis↗