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PubMed2006

Efficacy of topical cyclosporin 0.05% in the treatment of posterior blepharitis.

We assessed the efficacy of topical cyclosporin 0.05% ophthalmic emulsion versus tobramycin 0.3%/dexamethasone 0.1% in patients with posterior blepharitis. Posterior blepharitis improved significantly from the initial study visit with both cyclosporin treatment and tobramycin/dexamethasone. Cyclosporin provided greater improvements in Schirmer's scores (P < 0.001) and tear break-up time (P = 0.018) than tobramycin/dexamethasone after 12 weeks of treatment. Eyelid health also improved in both groups, but the mean improvement in meibomian gland secretion quality was significantly greater with cyclosporin than with tobramycin/dexamethasone (P = 0.015). Moreover, a higher percentage of patients in the cyclosporin treatment group had improvements in symptoms of blurred vision, burning, and itching and more cyclosporin-treated patients experienced resolution of lid telangiectasia. The findings in this prospective study suggest that posterior blepharitis can be more effectively treated with cyclosporin than with tobramycin/dexamethasone. These findings should be further evaluated in large-scale, controlled, clinical trials.

Administration, Topical↗
PubMed1996

Meibomian gland triglyceride fatty acid differences in chronic blepharitis patients.

In this study, we analyzed the triglyceride fraction of human meibomian gland secretions to determine whether specific fatty acids were significantly associated with specific chronic blepharitis disease groups. Triglycerides, isolated from the lipid component of human meibomian secretions by thin-layer chromatography, were transmethylated with sodium methoxide/methanol. Samples from individuals were then analyzed by gas chromatography-mass spectroscopy (GC-MS). Significant fatty acid differences were determined by nonparametric analyses, utilizing Kruskal-Wallis analysis of between group differences and Student-Newman-Keuls multiple comparisons. The analyses showed that the triglyceride samples contained the expected normal, iso, and anteiso fatty acids; disease group differences (from normals) in some of these fatty acid types were significant only with a Bonferroni adjustment. The triglycerides also contained previously unreported polyunsaturated fatty acids as well as two four-member families of fatty acids that had mass spectra and retention times consistent with dimethylated carbon chains. Additionally, some members of the meibomian keratoconjunctivitis (MKC) group contained an unusual pattern of normal 20-carbon fatty acids, including a higher level of saturated and lower levels of unsaturated fatty acids. An important exception was the presence of a monosaturated fatty acid whose GC retention time and mass spectrum were consistent with the uncommon cis-10-20:1 isomer. This pattern was associated with the presence of patient posterior hordeola. Thus, the association of triglyceride fatty acid composition with chronic blepharitis disease signs could be much more important than previously thought. Furthermore, this is the first example of the association of specific fatty acids with a specific chronic blepharitis disease sign.

Blepharitis↗
PubMed2000

Changing concepts in the diagnosis and management of blepharitis.

PURPOSE: Chronic blepharitis is one of the most common conditions seen in the ophthalmologist's office; but, it is difficult to treat effectively. Nevertheless, much progress has been made over the last quarter century, not only in diagnosis but also in treatment of blepharitis. METHODS: Perhaps the most important progress has been made as the result of extensive and detailed clinical evaluations of patients, sometimes over extended periods of time with diverse patient populations. RESULTS: The availability of sophisticated instrumentation and laboratory techniques, as well as an array of antibiotics, has enhanced the whole picture for effective blepharitis treatment. CONCLUSION: Although much progress has been made, it is important to build on the present understanding. Most important is the continued development of targeted treatment protocols that address specific signs, as is now possible with microbial abnormalities. Progress in the understanding and treatment of relevant inflammatory processes will benefit from continuing biomedical discoveries.

Anti-Bacterial Agents↗
PubMed2002

N-acetylcysteine in chronic blepharitis.

PURPOSE: To investigate the effects of N-acetylcysteine (NAC) in chronic posterior blepharitis. METHODS: This was a prospective randomized, controlled study that included 79 eyes of 40 patients with chronic posterior blepharitis. Routine ophthalmologic examination, Schirmer-1 test, fluorescein break-up time (FBUT), and mucous fern tests were carried out during the first visit of all patients. A topical steroid, topical antibiotic, and artificial tears were started in 36 eyes of 18 patients. The therapy group (43 eyes of 22 patients) was administered three daily doses of 100 mg oral NAC. All patients were examined weekly for 1 to 4 months (average, 24 +/- 0.7). A Schirmer-1 test and FBUT were administered at every visit, but mucous fern tests were administered every two weeks. The results of the first and last Schirmer-1 tests, FBUT, and mucous fern test were compared between the therapy and control groups. Student's t and Mann-Whitney U tests were used for statistical analysis. RESULTS: FBUT was significantly increased (p < 0.0001), and the mucous fern pattern was also significantly improved (p = 0.0096) in the therapy group. CONCLUSION: NAC is thought to increase FBUT and improve mucous fern pattern by blocking lipid peroxidation in chronic blepharitis.

Acetylcysteine↗
PubMed2003

Effects of minocycline on the ocular flora of patients with acne rosacea or seborrheic blepharitis.

PURPOSE: To assess the effect of minocycline on the ocular flora in patients with acne rosacea or blepharitis. METHODS: A total of ten patients were enrolled in this prospective study, with six patients diagnosed with acne rosacea with concomitant meibomianitis, two patients with acne rosacea without concomitant ocular involvement, and two patients with seborrheic blepharitis. The eyelids and conjunctiva of both eyes were cultured before the initiation of systemic minocycline therapy, after 3 months of active therapy, and 3 months after the discontinuation of therapy. Isolated bacteria were identified and quantified, and antibiotic susceptibility was determined. RESULTS: The colony-forming units (CFU) isolated from the eyelids significantly decreased after a 3-month treatment with minocycline (P = 0.0013). The CFU significantly increased to approach that of the baseline with the discontinuation of minocycline (P = 0.0275). The most common isolated bacteria, including coagulase-negative Staphylococcus (CNS), Staphylococcus aureus (S. aureus), and Propionibacterium acne (P. acne), except for corynebacterium, had a significant decrease in bacterial count with minocycline therapy compared with baseline (P < 0.05). There was a trend in the decrease of bacterial CFU isolated from the conjunctiva with minocycline therapy, although this was not statistically significant (P = 0.1955). Four of the ten patients carried tetracycline-resistant CNS strains, but none of the S. aureus or P. acne isolated at baseline was resistant to tetracycline. All six patients with acne rosacea and concomitant meibomianitis had marked clinical improvement. CONCLUSION: Minocycline effectively decreased eyelid bacterial flora in patients with acne rosacea or blepharitis. One of the mechanisms of newer generation tetracycline analogues may be a decrease or elimination of bacterial flora from the eyelids.

Anti-Bacterial Agents↗
PubMed2004

Kaposi varicelliform eruption associated with 0.1% tacrolimus ointment treatment in atopic blepharitis.

OBJECTIVE: To report the association of Kaposi varicelliform eruption (KVE) with 0.1% tacrolimus ointment treatment of atopic blepharitis in a patient with atopic dermatitis (AD). METHOD: We encountered KVE in a 20-year-old male patient with atopic blepharitis and AD who developed generalized herpetic lesions on his face 28 days after commencement of treatment. RESULT: The lesions resolved quickly with intravenous acyclovir treatment. CONCLUSION: Ophthalmologists should be well aware of KVE as a complication of immunosuppressive treatment in patients with atopic blepharitis.

Acyclovir↗
PubMed2003

Eyelid disorders: the meibomian gland, blepharitis, and contact lenses.

PURPOSE: To present our results to date on the evaluation of the pathophysiology of chronic blepharitis and its relationship to the tear lipid layer, and to propose a structure to that layer. METHODS: Compilation of work to date. RESULTS: A classification system of chronic blepharitis has been developed that has use in diagnosis, planning therapy, and assessment of mechanisms. Abnormalities in meibum have been identified that provide insight into disease mechanisms and have led to the development of a proposed structure to the tear lipid layer. A defect in polar lipids explaining the frequently associated evaporative dry eye has been identified. Mechanisms accounting for the therapeutic benefit of minocycline have been elucidated. CONCLUSION: Chronic blepharitis has associated meibum abnormalities that explain defects in the tear lipid layer that may result in a frankly unstable tear film and that explain the frequently associated evaporative dry eye.

Blepharitis↗
PubMedDate not supplied

Discoid lupus erythematosus presenting as unilateral blepharitis.

A 39-year-old man presented with a 4-month history of unilateral blepharitis that did not respond to conventional treatment. Punch biopsy confirmed the diagnosis of discoid lupus erythematosus. Unilateral blepharitis as the only presenting sign of discoid lupus erythematosus is uncommon but should be considered in the differential diagnosis in patients with asymmetric blepharitis.

Adult↗
PubMed2006

Discoid lupus erythematosus of the eyelids associated with staphylococcal blepharitis and Meibomian gland dysfunction.

Lower eyelid involvement occurs in 6% of patients with discoid lupus erythematosus (DLE). Eyelid lesions are rarely the initial manifestation of DLE. We describe a 25-year-old woman presenting with discoid lesions of the lower eyelids, staphylococcal blepharitis and Meibomian gland dysfunction, who later developed a discoid lesion on the chin. Histopathological and immunofluorescence studies of a biopsy specimen from this lesion established the diagnosis of DLE. We are unaware of any previously reported cases of DLE presenting with discoid eyelid lesions associated with staphylococcal blepharitis and Meibomian gland dysfunction. DLE should be considered as a differential diagnosis in chronic blepharitis that persists despite usual medical management and eyelid hygiene. Misdiagnosis may lead to eyelid margin deformities, necessitate a complicated full-thickness biopsy, and delay diagnosis of systemic lupus.

Adult↗
PubMed1985

Microbial and immunological investigations of chronic non-ulcerative blepharitis and meibomianitis.

Concentrations of tear lysozyme, lactoferrin, ceruloplasmin, IgG, and IgA have been measured by enzyme linked immunosorbent assay (ELISA) in patients with chronic non-ulcerative blepharitis and meibomianitis at the same time as the lid and conjunctivae were cultured for bacteria and fungi by a semiquantitative method. A group of normal controls aged 20 to 80 were similarly sampled, when strains of Staphylococcus epidermidis from their eyes and the patients' eyes were biotyped according to Baird-Parker's scheme. 5% of blepharitis cases had increased numbers of Staph. aureus present on the lids, compared with only a scanty growth obtained from 5% of normals. 7% of blepharitis cases had increased numbers of Staph. epidermidis type VI (coagulase-negative, mannitol-fermenting) present compared with a scanty growth obtained from 6% of normals. Isolation rates of other types of Staph. epidermidis did not differ from those in normals; no types were associated with meibomianitis. Tear protein profiles were normal in most patients, and there was no increase in tear IgA or IgG, which is expected with chronic infection. Overall our evidence suggests that in 88% of cases these lid conditions have an inflammatory aetiology not associated with infection. Staphylococcal isolates often found in the eye usually represent a normal commensal rather than pathogenic flora.

Adult↗
PubMed1992

Blepharitis.

Blepharitis is an acute or chronic inflammatory process involving the eyelids that is frequently associated with conjunctivitis. In its many clinical forms, blepharitis is one of the most common diseases seen by ophthalmologists; yet it remains a diagnostic and therapeutic challenge. This article reviews the clinical presentation, classification, diagnosis, etiology and pathogenesis, and treatment of blepharitis.

Blepharitis↗
PubMed2004

[Observation on therapeutic effect of squamous blepharitis treated with liquefacient nitrogen cryotherapy].

PURPOSE: To observe the therapeutic effect of squamous blepharitis treated with liquefacient nitrogen cryotherapy. METHODS: 126 patients (234 eyes) with squamous blepharitis were randomly divided into two groups. Observation group 65 patients (120 eyes) were treated with liquefacient nitrogen cryotherapy adding antibiotic eye drops and ointments. Control group 61 patients (114 eyes) were treated with antibiotic eye drops and 2% yellow mercury oxide ointments. Both groups were treated for two courses, 20-25 days per course. RESULTS: Sixty-four eyes of observation group were cured, 30 eyes were improved and 26 eyes were ineffective. Thirty-two eyes of improved and ineffective patients were cured after an additional course. Total cured rate was 80%. Fourty-eight eyes of control group were cured, 30 eyes were improved and 36 eyes were ineffective. Total cured rate was 42.11%. The difference of two groups were significant (chi2=35.47, P < 0.01). CONCLUSIONS: Liquefacient nitrogen cryotherapy was an effective method for squamous blepharitis.

Adolescent↗
PubMed2005

[Investigations on the occurrence as well as the role of Demodex follicuforum and Demodex brevis in the pathogensis of blepharitis].

PURPOSE: The aim of the paper was to describe the prevalence and the role of Demodex folliculorum and Demodex brevis in the pathogenesis of chronic blepharitis. MATERIAL AND METHODS: Examinations were carried out on a group of 435 people aged from 3 to 96 years. A sample of four eyelashes were taken aseptically from each individual and later studied under a light microscope. Infection of Demodex was classified on the basis of presence of mature and larval forms or after observing chitinous exuviae affixed to the studied eyelashes. RESULTS: It has been concluded that Demodex occurs among: 13% of the people aged from 3 to 15 years; 34% of the people aged from 19 to 25 years; 69% of the people aged from 31 to 50 years; 87% of the people aged from 51 to 70 years and 95% of the people aged from 71 to 96 years. It has been observed that 58% of the people infected with Demodex suffer from chronic blepharitis. It was also found that Demodex frequently occurs among people taking care of the elderly and among students of the Medical School. CONCLUSIONS: (1) Demodex folliculorum and Demodex brevis are an etiological factor in chronic blepharitis. (2) With age the prevalence of infection of Demodex rises. (3) People taking care of the elderly and students of Medical Schools are at higher risk of being infected with Demodex.

Adolescent↗
PubMedDate not supplied

EyeScrub: simplifying the management of blepharitis.

1. The cause of blepharitis is still a mystery, and, consequently, a cure for this condition does not exist. Patients suffering from blepharitis must be made to understand this and that it is a manageable condition. 2. EyeScrub provides cleansing of the eyelashes and lid margins. Good lid hygiene is crucial to controlling blepharitis. Performed daily in tandem with other simple procedures, EyeScrub removes the oily buildup under the lashes and in the lid margins which causes the eyes to become irritated and encrusted. 3. The application of EyeScrub is simple and does not damage the ocular surface. Lint-free pads allow the patient to feel exactly where the pad is contacting the eye area so that the solution can be applied effectively and harmlessly.

Blepharitis↗
PubMed1993

Chronic blepharitis, meibomitis and corneal lesions.

We have observed seven patients with longstanding complaints of ocular irritation who had blepharitis and/or meibomitis associated with corneal involvement. Corneal lesions varied from severe pannus formation, destruction of the limbal structure to marginal infiltrates and peripheral corneal melting. The corneal lesions did not regress until blepharitis was treated. The pathogenesis of chronic blepharitis with corneal involvement is discussed.

Adult↗
PubMed1993

Coagulase-negative staphylococci in conjunctivitis and blepharitis.

Coagulase-negative staphylococcus (C-NS) are regarded as normal flora of the lids and conjunctiva. The ability of these organisms to cause conjunctivitis and blepharitis can be overlooked or disregarded. To elucidate the role of individual C-NS species in these eye diseases we compared Staphylococcus sp. isolated from the conjunctiva and lids of 50 healthy volunteers with 248 strains of Staphylococcus isolated from patients with staphylococcal conjunctivitis or blepharitis. S. epidermidis was the most frequent species isolated from the conjunctiva and lids of both groups. S. aureus was isolated only from infected patients. No individual C-NS species was found to be significantly associated with eye disease, but the colony count of C-NS after isolation was a useful indicator of conjunctivitis and blepharitis. The ability of Staphylococcus to ferment mannitol or mannose was associated with isolates only from infected patients.

Blepharitis↗
PubMed1993

Role of wax ester fatty alcohols in chronic blepharitis.

PURPOSE: This study was performed to determine the difference in the composition of wax ester fatty alcohols from meibomian gland secretions from normal people and those with blepharitis, and to determine which lipids are associated significantly with specific chronic blepharitis disease groups. METHODS: Fatty alcohols, isolated by thin-layer chromatography from the wax and sterol ester fraction of human meibum, were analyzed by gas chromatography-mass spectroscopy after oxidative ozonolysis and silylation of the alcohol groups. Relative amounts of individual lipids or lipid groupings in each patient group were analyzed statistically by Dunnett's comparison, with the overall significance level adjusted for multiple testing (Bonferroni adjustment). RESULTS: Significant differences (P < 0.05) between the normal group and five disease groups were found in certain alcohol groups. These alcohols included certain normal (straight chain-methyl group on chain end) and anteiso (methyl group on second carbon from chain end) alcohols, as well as the ratio of iso (methyl group on first carbon from chain end) to anteiso alcohols. The results also suggested that alpha-oxidation activity was significantly different for certain groups. The unsaturated alcohols were primarily normal alcohols. Epoxy-fatty acids also were present in the alcohol fraction. CONCLUSIONS: These data suggest that meibomian gland lipid differences may contribute significantly to some chronic blepharitis disease signs and also suggest that peroxisomal or endoplasmic reticulum abnormalities may contribute in part to some of these lipid differences.

Blepharitis↗
PubMed2006

[Bibrocathol eye ointment is efficacious in blepharitis. Results from a randomized, double-blind, controlled clinical trial].

Bibrocathol (Noviform) 5% ointment is a frequently used therapy for blepharitis. The study included 197 patients who were randomized to be treated over 2 weeks with bibrocathol or an ointment vehicle, respectively. Slit lamp examinations were performed on day 1 (baseline) and day 14 (end of study) to assess lid edema, lid erythema, debris, and pouting of Meibomian glands; patients rated their subjective complaints. Bibrocathol was superior to the control treatment in improving the sum score of the 5 scales (by 7.0 vs 4.7 points, p<0.001), especially in patients with primarily severe symptoms (by 8.3 vs 4.8, p<0.0001). Antiseptic therapy with bibrocathol eye ointment 3 times daily over 2 weeks was found to be efficacious in the treatment of acute forms of blepharitis which do not require antibiotic therapy. Bibrocathol treatment is well tolerated and safe.

Adolescent↗