Anterior Blepharitis Research Articles

Current state and future perspectives in the diagnosis of eyelid margin disease: clinical review.

The eyelid margin is vital to ocular surface integrity. Much peer-reviewed literature has been established in eyelid margin inflammation, better known as blepharitis. The purpose was to review and understand the impact of eyelid margin disease. Anterior blepharitis causes inflammation at the eyelash base, ciliary follicles, and the palpebral skin. Posterior blepharitis occurs when there is inflammation with the posterior eyelid margin disease. In common usage, the term "blepharitis" used alone almost always refers to anterior blepharitis. Classification of eyelid margin disease should be based on etiopathogenesis, location, primary vs secondary, and chronicity. Blepharitis has several etiopathologies (infectious, inflammatory, and squamous). Meibomian gland dysfunction (MGD) can refer to the functional and/or structural problems with the meibomian gland. Meibomitis (or meibomianitis) occurs when there is inflammation associated with the MGD. The presence of blepharitis and/or MGD (with or without inflammation) can affect the ocular surface and thereby affect anterior segment and cataract surgeries. This review article evaluates the differential diagnoses of eyelid margin disease, including various forms of blepharitis, MGD, and meibomitis.

Long-Term Prognosis of Anterior Blepharitis After Topical Antibiotics Treatment.

We conducted a retrospective evaluation of the long-term prognosis associated with anterior blepharitis subsequent to topical antibiotic intervention. Inclusion criteria encompassed 92 eyes of 92 patients who exhibited clinical manifestations of anterior blepharitis and undergone a regimen of topical azithromycin. The follow-up duration extended to a minimum of one year within our medical facility. The diagnostic framework for anterior blepharitis, along with the evaluation of both objective and subjective manifestations, adhered to the Blepharitis Preferred Practice Pattern as promulgated by the American Academy of Ophthalmology. Relapse denoted the resurgence of blepharitis symptoms subsequent to the primary treatment, necessitating the instigation of either topical or oral therapeutic measures. Of 92 cases of anterior blepharitis, 48 showed recurrence, with a recurrence rate of 52.2%. During the follow-up period, 2 patients experienced 5 relapses, 2 patients experienced 4 relapses, 5 patients experienced 3 relapses, 13 patients experienced 2 relapses, and 26 patients experienced 1 relapse. When the patients were divided into three groups: multiple recurrence group (22 patients), single recurrence group (26 patients), and no recurrence group (44 patients), there were no significant differences in the blepharitis finding score before and after the initial treatment among three groups. However, significantly fewer patients in the no recurrence group required further treatment after initial treatment, and the percentage of patients with residual blepharitis during follow-up was significantly lower in the no recurrence group. Our data suggest that patients with residual findings after blepharitis treatment are at a risk of recurrence.

Challenges in the Diagnosis and Management of Anterior Blepharitis

Challenges in the Diagnosis and Management of Anterior Blepharitis

Comprehensive Ophthalmological Evaluation in Atopic Dermatitis

Introduction: Atopic dermatitis (AD), a chronic type 2 inflammatory skin disease, is frequently associated with ocular surface diseases (OSD) which may appear or worsen under anti-type 2-targeted treatments. However, the exact prevalence of OSD and the ophthalmology referral criteria remain ill-defined in AD patients before initiating such biotherapies. We aimed to characterize the prevalence, the nature and the factors related to OSD development in AD that may justify an ophthalmological management. Methods: A total of 98 consecutive AD inpatients without biological treatment were retrospectively included. These were systematically evaluated by an ophthalmologist during their dermatological care. Clinical and laboratory data were analysed to characterize OSD and their risk factors. Results: OSD were found in 83/98 AD patients (85%); mainly dry eye syndrome (64%, 63/98), allergic conjunctivitis (42%, 41/98), posterior (33%, 32/98), and anterior blepharitis (27%, 26/98). In AD patients without ocular symptoms, OSDs were also frequently found (63%, 12/19) and were mostly mild. Risk factors for OSD were history of allergic rhinitis, allergic sensitization, head and neck AD, ocular symptoms (foreign body sensation in the eye, burning, itching, photophobia), and total IgE level >3,000 kU/L. Conclusion: The prevalence of OSD was high, even in asymptomatic patients. The risk factors identified may indicate the need for ophthalmological examination for therapeutic management, especially when biological agents targeting type 2 inflammation are considered.

Eyelid margin disease (blepharitis and meibomian gland dysfunction): clinical review of evidence-based and emerging treatments.

Blepharitis is a common ophthalmic condition with multiple etiologies and no definitive, universal treatment. The treatment modalities for managing lid margin diseases vary depending on the disease's cause, location, and severity. For anterior blepharitis, management options include eyelid hygiene with warm compresses, eyelid scrubs, baby shampoo, and over-the-counter eyelid cleansers. Topical antibiotics and antibiotic-steroid combination drops/ointments for the eye and eyelid may accompany these. For posterior blepharitis/meibomian gland dysfunction (MGD), at-home warm compress or in-office administration of heat therapy/thermal pulsation treatment that aims to clear obstruction in the meibomian glands and restore meibum secretions to maintain a healthy tear film is recommended. In addition to the above treatment strategies, various other compounds to manage lid margin diseases are in the late stages of development. This review summarizes the available treatment modalities or those in the pipeline for treating blepharitis and MGD.

Diagnostic Challenges of Ocular Rosacea.

This study aims to address the issues surrounding the diagnosis of ocular rosacea and to evaluate the development of the patients’ condition after treatment, as well as to distinguish between healthy and diseased patients using a glycomic analysis of tears. A prospective study was conducted to assess a total of 68 eyes in 34 patients over a six-week period. These patients were diagnosed with ocular rosacea based on subjective symptoms and clinical examination. The study monitored the development of objective and subjective values. The difference between patients with the pathology and healthy controls was established by means of analysis of glycans in tears. Skin lesions were diagnosed in 94% of patients with ocular rosacea, with the most commonly observed phenotype being erythematotelangiectatic (68.8%). The mean duration of symptoms was 29.3 months (range 0.5–126 months) with a median of 12 months. Throughout the study, an improvement in all monitored parameters was observed, including Meibomian gland dysfunction, bulbar conjunctival hyperemia, telangiectasia of the eyelid margin, anterior blepharitis, uneven and reddened eyelid margins, and corneal neovascularization. The study also observed improvements in subjective manifestations of the disease, such as foreign body sensation, burning, dryness, lachrymation, itching eyes, photophobia, and morning discomfort. The analysis of glycans in tears partially separated tear samples based on their origin, which allowed for the differentiation of patients with rosacea from healthy controls. In the first sample, the pathology was determined in a total of 63 eyes (98.4%) of 32 patients, with further samples showing a change in the glycomic profile of patients’ tears during treatment. The study demonstrated objective and subjective improvements in all the patients. Tear sampling and analysis could provide a means of timely diagnosis of ocular rosacea.

Tear film proteome changes following Tobradex® therapy in anterior blepharitis.

The management of blepharitis continues to challenge clinicians due to the poorly understood aetiology of the condition. We recently identified the family of intracellular plakin proteins as essential driving forces underlying anterior blepharitis. A large-scale protein analysis was used to study if a topical dexamethasone/tobramycin solution could be used to reverse the expression of plakin proteins. Tear film samples from treatment naïve patients with anterior blepharitis (n = 15) were collected with Schirmer filtration paper. A subgroup of the patients (n = 10) received treatment with a dexamethasone/tobramycin 1 + 3 mg/mL ophthalmic suspension (Tobradex®) for 3 weeks and collection of tear film samples was repeated. The samples were analysed with label-free quantification nano liquid chromatography-tandem mass spectrometry requiring quantification in at least 70% of the samples in each group. Proteins were considered differentially expressed if p < 0.05. Following Tobradex® intervention, 27 proteins were upregulated while 61 proteins were downregulated. Regulated proteins after Tobradex® treatment were involved in intermediate filament cytoskeleton organization including downregulation of the plakin proteins envoplakin, epiplakin and periplakin. Plectin, a protein of the plakin family, remained unchanged after Tobradex® therapy. Tobradex® treatment resulted in the regulation of proteins involved in translation including a cluster of downregulated ribosomal proteins. Tobradex® intervention was associated with the regulation of proteins involved in fructose metabolism and glycolytic processes including fructose-1.6-bisphosphatase 1, fructose-bisphosphate aldolases A and B, pyruvate kinase PKM and transketolase. Ig lambda chain V-I region, prominin-1, and protein Niban were upregulated after Tobradex® treatment. Tobradex treatment reversed the expression of plakin proteins in anterior blepharitis. Topical solutions which inhibit the expression of plakin proteins may have the potential to restore the ocular surface integrity in anterior blepharitis and should be explored further.

Antibiotic Delivery System for Treating Bacteria-Induced Anterior Blepharitis.

The eyelid-related disease of blepharitis remains a tricky ocular disorder and affects patient compliance. However, there is no available and effective treatment, making it extremely challenging. Herein, an antibacterial system based on antibiotic delivery was developed and applied in a blepharitis model induced by bacteria. The antibacterial tests against Staphylococcus aureus both in vitro and in vivo demonstrated that the system shows a favorable bactericidal effect. Then, histological evaluation indicated that the system shows both antibacterial and anti-inflammatory effects. This facile design provided an effective ocular infection management, which displays a promising prospect while addressing other complex ocular disorders.

Evaluation of possible relief of OSD-specific symptoms by PURALID® Lipogel combined with eyelid hygiene in patients suffering from anterior blepharitis and consecutive meibomian gland dysfunction

Zusammenfassung Hintergrund PURALID® Lipogel (Santen Pharmaceutical Co., Ltd., Osaka, Japan) ist ein neues Produkt zur Behandlung akuter Augenliderkrankungen wie Blepharitis. Trotz seiner mittlerweile häufigen Verwendung in der klinischen Praxis wurde nach Wissen des Autors bisher keine kontrollierte klinische Studie über die Wirksamkeit der oben genannten Therapie publiziert. Das Ziel dieser Studie war es darzustellen, ob es eine bessere symptomlindernde Wirkung mit PURALID® Lipogel bei der Augenlidhygiene im Vergleich zur alleinigen Augenlidhygiene gibt. Methoden Es liegt eine nicht verblindete, Single-center-Interventionsstudie vor, die die Augenlidhygiene mit und ohne PURALID® Lipogel zur Behandlung einer Blepharitis von MDD vergleicht. Es wurden 30 Patienten im Zuge der täglichen Sprechstunde rekrutiert. Primäre Endpunkte waren die NIK-BUT („non-invasive break-up-time“) und der OSD(„ocular surface disease“)-Index, sekundäre waren die Meibom-Drüsen-Dysfunktion und die LIPKO(„Lid-Parallel Conjunctival Folds“)-Falten. Es unterzogen sich 15 Patienten (12 Frauen) der Augenlidhygiene in Kombination mit PURALID® Lipogel, während 15 Patienten (13 Frauen) die Augenlidhygiene allein durchführten. Alle Patienten wendeten zusätzlich 3‑mal täglich die Applikation von Cationorm® Augentropfen (Santen Pharmaceutical Co., Ltd.) an. Die Behandlungsdauer erstreckte sich über 2 Monate, die Patienten wurden vor Beginn der Therapie und 2 Monate danach untersucht. Ergebnisse Vor den beiden Behandlungsmethoden bestanden keine Unterschiede in oben genannten Parametern, ebenfalls waren Geschlecht und Alter normverteilt. Nach der Behandlung verbesserten sich in beiden Gruppen die subjektiven als auch die objektiven Kriterien, die zusätzliche Anwendung von PURALID® Lipogel erbrachte allerdings keinen Vorteil. Sicherheitsparameter wie Visus und IOD blieben bei allen Patienten unauffällig. Schlussfolgerungen Die neben der Anwendung von Tränenersatzmittel und Durchführung einer Lidrandhygiene zusätzliche Verwendung von PURALID® Lipogel erbringt keine Verbesserung der symptomatischen Blepharitis.

Features of Damage to the Organ of Vision in Coronavirus Infection

Introduction. Recently, there have been a number of reports of damage to the posterior segment of the eyeball (retina and vascular tract) as a complication of coronavirus infection. Moreover, such lesions occur in the long term (after a few weeks or more). We also observed similar changes, sometimes with the development of a second wave of the disease. At the same time, early diagnosis of damage to the microcirculatory bed and phenomena — precursors of thrombosis (blood clotting disorders) is very important.The aim of the study was to determine the types of complications of coronovirus infection on the part of the organ of vision and their clinical form. Creation of methods for early diagnosis of the progression of possible thrombogenic processes in the anterior and posterior segments of the eyeball.Methods. The object of the study were patients with various types of complications due to coronavirus infection. The state of the bulbar microcirculation and the diagnosis of thrombotic symptoms caused by complications of coronavirus infection (COVID-19) were studied.Results. The types of complications of coronovirus infection on the part of the organ of vision and their clinical forms were determined. Methods for early diagnosis of the progression of possible thrombogenic processes in the anterior and posterior segments of the eyeball have been developed.Conclusion. As a result of a survey of 75 patients who had a coronavirus infection, it was revealed that the most common eye complications are anterior and posterior blepharitis, in addition, in some cases, damage to the microcirculatory bed of the bulbar conjunctiva was found in the form of arteriolar and venular angiitis and damage to the vessels of the posterior segment of the eyeball.

Anterior blepharitis is associated with elevated plectin levels consistent with a pronounced intracellular response

PurposeAnterior blepharitis is a frequent ocular condition which may result in severe ocular surface disease. In this study, advanced proteome analysis was performed to elucidate biological mechanisms underlying anterior blepharitis. MethodsAll patients underwent full ophthalmological examination including Ocular Surface Disease Index score (OSDI). Measurement of non-invasive break-up time (NBUT), Oxford score, and meibography were performed. Tear film samples from treatment naïve patients with anterior blepharitis (n = 15) and age-matched controls (n = 11) were collected with Schirmer filtration paper. The samples were analyzed with label-free quantification nano liquid chromatography - tandem mass spectrometry (LFQ nLC-MS/MS). Significantly regulated proteins were identified with a permutation-based calculation with a false discovery rate at 0.05. ResultsAmong the 927 proteins detected, a total of 162 proteins were significantly changed. Regulated proteins were involved in cytoplasmic translation, positive regulation of B cell activation, complement activation and phagocytosis. High levels of plakin proteins, a group of proteins involved in cytoskeleton organization, were observed in anterior blepharitis, including plectin, desmoplakin, envoplakin, epiplakin, periplakin, and vimentin. The upregulation of plectin was confirmed with single reaction monitoring. Patients with anterior blepharitis had lower levels of immunoglobulin chains, VEGF coregulated chemokine 1 (CXCL17), and platelet-derived growth factor C. ConclusionsAnterior blepharitis was associated with a high level of plectin indicating a pronounced intracellular response with cytoskeletal reorganization. Our data suggest a lack of immunoglobulin chains and CXCL17 in anterior blepharitis with potential alterations in the ocular surface immune response.

In vitro evaluation of multiple antibacterial agents for the treatment of chronic staphylococcal anterior blepharitis

ObjectiveTo evaluate the bactericidal efficacy of several compounds used in the treatment of chronic staphylococcal anterior blepharitis through an in vitro study. Materials and methodsStandard commercial strains of Staphylococcus aureus (SAu) (ATCC 25923 Culti-Loops) and coagulase-negative Staphylococcus (CoNS) (ATCC 12228 Culti-Loops) were cultured. Susceptibility tests were performed to vancomycin 30 μg, netilmicin 30 μg, hypochlorous acid (HOCl) 0.01% (Ocudox™, Brill®), Melaleuca alternifolia leaf oil (MeAl) (Navyblef® Daily Care, NOVAX®) and 1% chlorhexidine digluconate (DGCH) (Cristalmina™, Salvat®) using the agar disk diffusion method (Rosco Neo-Sensitabs®). After 24 h, the induced halos were measured with automatic calipers. The results were analyzed using the EUCAST- and CLSI potency Neo-Sensitabs® guidelines. ResultsVancomycin induced a halo of 22.37 mm and 21.81 mm in SAu and CoNS, respectively. Netilmicin produced halos of 24.45 mm in SAu and 32.49 mm in CoNS. MeAl induced halos of 12.65 mm in SAu and 15.83 mm in CoNS. A 12.11 mm halo was found in SAu and an 18.38 mm halo in CoNS using HOCl. DGCH produced halos of 26.55 mm and 23.12 mm in SAu and CoNS, respectively. ConclusionNetilmicin and vancomycin demonstrated antibiotic activity against both pathogens, so they can be alternative rescue therapies to treat chronic staphylococcal blepharitis. DGCH has efficacy against both comparable to antibiotics, while HOCl and MeAl show less efficacy.

Evaluación in vitro de múltiples agentes antibacterianos para el tratamiento de la blefaritis anterior crónica estafilocócica

ObjectiveTo evaluate the bactericidal efficacy of several compounds used in the treatment of chronic staphylococcal anterior blepharitis through an in vitro study. Materials and methodsStandard commercial strains of Staphylococcus aureus (SAu) (ATCC 25923 Culti-Loops) and coagulase-negative Staphylococcus (CoNS) (ATCC 12228 Culti-Loops) were cultured. Susceptibility tests were performed to vancomycin 30μg, netilmicin 30μg, hypochlorous acid (HOCl) 0.01% (Ocudox™, Brill®), Melaleuca alternifolia leaf oil (MeAl) (Navyblef® Daily Care, NOVAX®) and 1% chlorhexidine digluconate (DGCH) (Cristalmina™, Salvat®) using the agar disk diffusion method (Rosco Neo-Sensitabs®). After 24hours, the induced halos were measured with automatic calipers. The results were analyzed using the EUCAST- and CLSI potency Neo-Sensitabs® guidelines. ResultsVancomycin induced a halo of 22.37mm and 21.81mm in SAu and CoNS, respectively. Netilmicin produced halos of 24.45mm in SAu and 32.49mm in CoNS. MeAl induced halos of 12.65mm in SAu and 15.83mm in CoNS. A 12.11mm halo was found in SAu and an 18.38mm halo in CoNS using HOCl. DGCH produced halos of 26.55mm and 23.12mm in SAu and CoNS, respectively. ConclusionNetilmicin and vancomycin demonstrated antibiotic activity against both pathogens, so they can be alternative rescue therapies to treat chronic staphylococcal blepharitis. DGCH has efficacy against both comparable to antibiotics, while HOCl and MeAl show less efficacy.

Clinical features of anterior blepharitis after cataract surgery

We evaluated the clinical features of postoperative anterior blepharitis following cataract surgery and the efficacy of topical azithromycin retrospectively. Thirty eyes of 30 patients with a clinical diagnosis of anterior blepharitis by 6 months postoperatively among those who underwent cataract surgery at our institution between November 2020 and June 2022 were included. The diagnosis of anterior blepharitis and the assessment of objective and subjective findings were based on the American Academy of Ophthalmology Blepharitis Preferred Practice Pattern®. Azithromycin eye drops were prescribed for all patients, and findings and symptoms before and after the drops were reviewed. The time of onset ranged from 2 weeks to 6 months after cataract surgery, with the most common onset at 2 to 3 months postoperatively (mean time of onset 79.4 ± 39.6 days). The type of anterior blepharitis was staphylococcal blepharitis in 26 eyes and seborrheic blepharitis in 4 eyes, while mixed type with posterior blepharitis was noted in 6 eyes. Symptoms at the time of examination included irritation (including foreign body sensation) in 24 eyes, tearing in 4 eyes, and redness in 3 eyes. The findings and symptoms of anterior blepharitis were alleviated or resolved with azithromycin eye drops in 26 of the 30 eyes, but the blepharitis recurred in 6 of these eyes, requiring azithromycin eye drops to be re-prescribed. The onset of anterior blepharitis after cataract surgery may be related to a gradual decrease in postoperative eye drops. Patients tended to complain of irritation and foreign body sensation, and azithromycin eye drops were effective in such cases.

PUNARNAVA BIDALAKA IN MANAGEMENT OF BLEPHARITIS: A CASE STUDY

Acharya Sushruta has explained 21 vartmaroga (eyelid disorders) in Sushruta Samhita. Blepharitis is an eyelid disorder defined as inflammation of lid margins and is common worldwide. It accounts for 45% of all ophthalmic diseases. Blepharitis has two major types anterior and posterior Blepharitis. Seborrheic Blepharitis is a subtype of anterior Blepharitis. In modern sciences, various antibiotic and steroidal ointments are provided as treatment for Blepharitis, which has its limitations and side effects. Bidalaka is a kriyakalpa (Ayurvedic therapy) advised for treating eyelid disorders due to its direct action and longer contact time with targeted tissues. Punarnava is preferred as a drug of choice for bidalaka in treating inflammation, itching, scaling and redness in Blepharitis with its anti-inflammatory, anti-edematic, anti-tumour, anti-allergic, and anti-bacterial properties. A 27-year-old female patient was diagnosed with Seborrheic blepharitis and is treated with Punarnava bidalaka, where the results prove to be significantly influential based on its clinical assessment.

Microbiota in MGD

AbstractMGD is characterized by significant changes in meibum quality that may lead to the changes in the existing ocular surface flora that can contribute to the inflammatory state typical of the condition. Several papers have addressed this aspect. Li and coworkers, dividing the DE group into MGD and non‐MGD patients, found that no statistically significant differences between the two groups. 67 Pseudomonas, Bacillus, Acinetobacter and Corynebacterium were the most represented, although Bacilli showed a higher relative abundance in the MGD group and could be considered typical pathogens of MGD. Watters and colleagues studied patients with several degrees of MGD, among which CL wearers were included. Meibum expression did not modify the bacterial profile. CoNS were the most prevalent organisms isolated, present in two thirds of the population studied, although their presence was not correlated to the severity of MGD. CL wearers showed an increased presence of P. acnes that was correlated to MGD severity. No differences in microbiota were observed related to the severity of anterior blepharitis or CL wear. Dong and coworkers, using 16 S rDNA sequencing, investigated the microbiome of 47 Chinese MGD patients compared with a control group of 42 sex‐ and age‐matched subjects without MGD. They found significant differences at the phyla level, with a significantly higher abundance of Firmicutes (31.7% vs. 19.7%) and Proteobacteria (27.5% vs. 14.7%), and a lower abundance of Actinobacteria (34.2% vs. 57%) in MGD vs control patients. At the genus level, the numbers of Staphylococcus (20.7% vs. 7.9%) and Sphingomonas (5.7% vs. 0.8%) were significantly higher in patients with MGD vs controls, while the numbers of Corynebacterium (20.2% vs. 46.4%) were significantly lower. The meiboscores showed a significant direct correlation with the abundance of Staphylococcus in MGD patients. They concluded that patients with MGD can have bacterial microbiota alterations in the conjunctival sac, with a potential role of Staphylococcus, Corynebacterium and Sphingomonas sp. in MGD pathophysiology. In a previous study carried out on a small group of patients with blepharitis, Lee and coworkers demonstrated that blepharitis might be associated with a change in microbial composition, namely, greater quantities of Streptophyta, Corynebacterium and Enhydrobacter species. It was suggested that cytotoxicity and inflammatory components, triggered by bacterial growth, may contribute to the pathological process of MGD. Zheng et al confirmed the changes of ocular surface flora in MGD patients showing a wide bacterial profile and positive aerobic and anaerobic culture, significantly higher in both meibomian secretion and conjunctiva of MGD patients than in controls. The ocular surface inflammatory condition occurring in MGD and blepharitis could be mediated by the induced expression of acidic mammalian chitinase (AMCase) that is considered an immune response activator and is over expressed in MGD. It can be hypothesized that changes in ocular surface microbial flora can mediate AMCase upregulation.

Device‐assisted therapies in MGD

AbstractMeibomian gland dysfunction (MGD) is the most frequent cause of evaporative dry eye disease (DED). Until now, the only available treatments were as follows: warm compresses, massage, omega 3, and antibiotics. As a result, multiple devices have appeared in the marketplace designed to use heat and pressure to alleviate MG blockages, as well as to remove residue along the lid margins. The mechanism of action of Lipiflow®, Miboflo®, iLux® and Jett Plasma Lift® is thermal expression. The Lipiflow® consists of a console and a single‐use sterile device that uses sensor‐regulated heat and peristaltic motion to evacuate obstructed meibum. One section of the device goes behind the eyelids, providing the warmth; an outer section gently massages the lids against the inner section. Its effects last usually 12 months. Jett Plasma Lift also remove keratinized material from de lid margin. ILux® system is not available in Europe.​Intense pulsed light (IPL) was originally developed for use in dermatology. Brief, powerful bursts of light at specific wavelengths (in this case, between 500 and 800 nm) cause changes in blood vessels near the surface of the skin, raise skin temperature and eliminate problematic flora on the skin and eyes, all of which may have a beneficial effect on meibomian gland dysfunction. Closing the abnormal vessels decrease inflammation and oxygen supply to meibocytes (they work in anaerobic conditions). Usually four sessions are needed. Expression with forceps and the treatment directly of the lids improve results. There are multiple platforms and not all are the same. BlephEx® produces microblepharoexfoliation. It's typically repeated at four to six‐month intervals. It is useful for anterior blepharitis. Rexon‐Eye® is an electro‐medical device for the treatment of DED. The applied electrical stimulation is based on the principle of quantum molecular resonance. Transferring energy to biological tissues in the form of high frequency oscillating electrical fields biostimulate the lachrymal and the MG. Thus, it is helpful for evaporative and aqueous‐deficient DED.​The use of these devices reset the MG. They should be used on the glands before they atrophy. A combination of these treatments will probably work best for difficult patients. Independent clinical trials and studies comparing these devices and the new coming instruments are needed.

Ocular manifestations in moderate-to-severe psoriasis in India: A prospective observational study.

Ocular manifestations in psoriasis are due to direct eye involvement with psoriatic plaques or psoriasis-related, immune-mediated inflammatory processes. The commonly reported pathologies are blepharitis, conjunctivitis, keratitis, dry eyes, and uveitis. Limited data is available on the ocular findings in psoriasis patients in India. In this study, we evaluated various ocular changes associated with moderate-to-severe psoriasis. In this prospective cohort study, treatment-naive psoriasis patients with Psoriasis Area Severity Index (PASI) score of more than 10 were included. The Ocular Surface Disease Index (OSDI) score, Schirmer's score, tear film breakup time (TBUT), corneal and conjunctival staining score, and meibomian gland dysfunction score were noted. All these parameters were re-evaluated at 8 weeks of follow-up after systemic treatment. Sixty-eight patients were enrolled in the study. The most common ocular pathologies observed in this study were tarsal hyperemia and anterior blepharitis in 128 (94.1%) and 64 (47%) eyes, respectively. Mild, moderate, and severe dry eyes were seen in 26 (19.1%), 14 (10.2%), and 34 (25%) eyes, respectively. Thirty-nine (57.3%) patients complained of significant difficulty watching television or digital screen. In 21 patients evaluated on follow-up at 8 weeks, cornea and conjunctiva's ocular surface staining score increased and TBUT decreased significantly. The most common ocular pathologies observed in this study were anterior blepharitis and moderate dry eye, which significantly affected most patients' daily routines. Screening patients with greater severity of psoriasis would help in early management of such problems.

Composition and Diversity of the Ocular Surface Microbiota in Patients With Blepharitis in Northwestern China.

Purpose: To investigate the composition and diversity of the microbiota on the ocular surface of patients with blepharitis in northwestern China via 16S rDNA amplicon sequencing.Methods: Thirty-seven patients with blepharitis divided into groups of anterior, posterior and mixed blepharitis and twenty healthy controls from northwestern China were enrolled in the study. Samples were collected from the eyelid margin and conjunctival sac of each participant. The V3–V4 region of bacterial 16S rDNA in each sample was amplified and sequenced on the Illumina HiSeq 2500 sequencing platform, and the differences in taxonomy and diversity among different groups were compared.Results: The composition of the ocular surface microbiota of patients with blepharitis was similar to that of healthy subjects, but there were differences in the relative abundance of each bacterium. At the phylum level, the abundances of Actinobacteria, Cyanobacteria, Verrucomicrobia, Acidobacteria, Chloroflexi, and Atribacteria were significantly higher in the blepharitis group than in the healthy control group, while the relative abundance of Firmicutes was significantly lower (p < 0.05, Mann-Whitney U). At the genus level, the abundances of Lactobacillus, Ralstonia, Bacteroides, Akkermansia, Bifidobacterium, Escherichia-Shigella, Faecalibacterium, and Brevibacterium were significantly higher in the blepharitis group than in the healthy control group, while the relative abundances of Bacillus, Staphylococcus, Streptococcus, and Acinetobacter were significantly lower in the blepharitis group (p < 0.05, Mann-Whitney U). The microbiota of anterior blepharitis was similar to that of mixed blepharitis but different from that of posterior blepharitis. Lactobacillus and Bifidobacterium are biomarkers of posterior blepharitis, and Ralstonia is a biomarker of mixed blepharitis. There was no significant difference in the ocular surface microbiota between the eyelid margin and conjunctival sac with or without blepharitis.Conclusion: The ocular surface microbiota of patients with blepharitis varied among different study groups, according to 16S rDNA amplicon sequencing analysis. The reason might be due to the participants being from different environments and having different lifestyles. Lactobacillus, Bifidobacterium, Akkermansia, Ralstonia, and Bacteroides may play important roles in the pathogenesis of blepharitis.

Update on the Management of Demodex Blepharitis

Demodex blepharitis is a common ophthalmologic disease that is often overlooked in the workup of blepharitis. Demodex infestation occurs in both symptomatic and asymptomatic individuals at similar rates; consequently, its role in the development of blepharitis has not been well elucidated. Two species have been confirmed to inhabit the human eyelid- Demodex folliculorum and Demodex brevis. These species differ in their preferred location of infestation, with D. folliculorum occupying the base of the eyelash and D. brevis inhabiting the meibomian glands, contributing to anterior and posterior Demodex blepharitis, respectively. A clinical index of suspicion must be developed from the history when blepharitis, conjunctivitis, or keratitis in adults and blepharoconjunctivitis or chalazia in children are resistant to treatment. The diagnosis can be strongly suspected by the presence of cylindrical dandruff at the base of the eyelash and confirmed by light microscopy of an epilated lash or by in vivo confocal microscopy. No cure is currently available. Management most frequently includes topical tea tree oil and its active ingredient terpinen-4-ol, both of which have produced good clinical outcomes. Topical tea tree oil is typically applied by a professional due to risk of toxicity. Several second-line treatment options have been studied, including ivermectin, metronidazole, selenium sulfide, microblepharoexfoliation, and lid hygiene. Novel, targeted therapies such as TP-03 (Tarsus Pharmaceuticals) are also currently being investigated in phase 2b/3 clinical trials. The purpose of this review purpose is to characterize Demodex blepharitis in detail, including its historical perspective and various classifications, and describe the latest diagnostic and management strategies.