Cases Of Blepharitis Research Articles

Multidisciplinary perspectives in Demodex blepharitis: A new view of treatment from clinical, payer, and patient perspectives.

Demodex infestation is the cause of more than two-thirds of all cases of blepharitis in the United States. Although symptoms may include crustiness, redness, or itching of the eyelids, diagnosis can be accomplished through a simple examination of the eyelashes. The presence of a waste product of the Demodex mite, known as collarettes, on the base of the eyelashes is a pathognomonic sign of Demodex blepharitis. Demodex infestation that results in blepharitis may cause blockage and ultimately atrophy of the meibomian glands, worsening dry eye disease. Until recently, management of Demodex blepharitis has been limited by a lack of approved therapy options. Lotilaner ophthalmic solution 0.25%, the first approved therapy for treatment of Demodex blepharitis, has not only been shown to eradicate Demodex mites in one-half to two-thirds of patients following short-term treatment but also demonstrated continued benefits through 1 year of follow-up. In addition to managing Demodex blepharitis, treatment with lotilaner ophthalmic solution 0.25% may aid in the management of dry eye disease and other forms of ocular surface disease caused by complications of Demodex infestation. As a result, it is possible that successful management of Demodex blepharitis may reduce chronic use of health care resources dedicated to managing other chronic ocular conditions. As eye care professionals recognize Demodex infestation as a key mediator of ocular surface disease, increasing diagnostic awareness and addressing this underlying cause of Demodex blepharitis may reduce the need for specialist follow-up care, decrease the need for chronic therapy, and improve patient outcomes. Through routine screening for Demodex infestation and Demodex blepharitis, eye care professionals can now address an underlying factor in ocular surface disease to improve use of health care resources in the community.

Salt Water Induced Blepharitis: A Lifestyle-Related Case from a Coast of Java

Introduction: Blepharitis is a disease that is often countered. This condition could occur in all ages, sexes, and ethnic groups. Several factors can be the cause of blepharitis. However, blepharitis cases caused by saltwater have never been reported. Case Presentation: There was a case of a 62-year-old woman who came to the hospital complaining of a foreign body sensation in both eyes. Through examination, it was found that the eyelashes looked dirty with brownish-yellow deposits. Management by doing eyelid hygiene, giving ofloxacin eye drops, NaCl / KCl eye drops, and hygiene education had been done. Conclusions: Blepharitis is a frequently encountered case. However, blepharitis caused by salt water has not been reported. Through this case, it could be learned that the patient's lifestyle and geographical location of the patient's residence must be of particular concern to the clinician.

Uncommon Blepharitis

Blepharitis is a common chronic inflammatory condition affecting the eyelid margins; the pathophysiology of blepharitis is complex and not fully understood. The disease is anatomically divided into anterior (inflammation of eyelashes) and posterior (meibomian gland dysfunction) types. Diagnosis relies on clinical examination, revealing characteristic features like scurf, vascular changes, and meibomian gland dysfunction. The main goals of blepharitis treatment are symptom relief, recurrence prevention, and complication risk minimization. Treatment options include lid hygiene, topical and systemic antibiotics, topical corticosteroids, and omega-3 supplements. However, it is important to highlight reported cases of blepharitis as side effects of systemic therapies, particularly in the context of chemotherapy, bortezomib, cetuximab, TNFα inhibitors, and dupilumab. It is crucial to monitor patients undergoing such treatments regularly and attentively in order to promptly set up adequate supportive therapy. Of even more importance is future research on the pathophysiological mechanisms responsible for the occurrence of these ocular side effects in order to find a nosological cure for the issue.

Steroid induced glaucoma in the paediatric population

Aims/Purpose: Steroid induced glaucoma is an iatrogenic pathology secondary to the prolonged use of corticosteroids, it is a serious pathology with a high risk of blindness. The aim of this study is to evaluate the epidemiological, clinical, therapeutic and evolutionary profile of steroid induced glaucoma in children.Methods: It is a retrospective study of cases treated between November 2007 and February 2022, including patients followed in the paediatric ophthalmology department of Casablanca for steroid induced glaucoma.Results: Our study involved́ 35 children (60 eyes), including 20 boys and 15 girls, with an average age of 12 years. The involvement was bilateral in 25 eyes. All the patients had a history of discontinuous self‐medication with local corticosteroids for a mean period of 5 years. The initial condition that led to the use of steroids was in 19 cases allergic conjunctivitis, in 10 cases it was used for recurrent meibomian cysts, 3 cases of uveitis, 2 cases of blepharitis and one episcleritis. 60% eyes had visual acuity raging between 0.1 to 0.3. Mean Intraocular pressure was 36 ± 1 2 mmHg. Mean vertical cup disc ratio was 0.68 ± 0.25. all our patients had an open angle on gonioscopy and severe perimetric deficits were noted in all our patients. 19 eyes (32%) had an associated cataract. IOP was controlled after the withdrawal of steroids in 8 eyes, associated to antiglaucoma treatment in 22 eyes. The surgical management consisted of a Trabeculectomy + IP + 5 F.U in 30 eyes. Cyclophotocoagulation was not required in any of the patients. On a follow up of 24 months, the average final visual acuity was <2/10th and the tonometric results were globally good with a stabilization of the papillary excavation and visual field in 82% of the cases.Conclusions: Steroid induced glaucoma is a condition in which the functional prognosis is at risk, especially in young patients. It shows the importance of regular monitoring of the IOP in patients undergoing corticosteroid treatment. The first line of treatment consist of the prevention: awareness of the risks of self‐medication by steroids.

Frequency and Antibiotic Susceptibility of Bacteria Isolated in Patients with Blepharitis

Objective: To determine the frequency and antibiotic susceptibility of bacteria isolated in patients with blepharitis. StudyDesign: Cross-sectional study. Place and Duration of Study: Armed Forces Institute of Ophthalmology, Rawalpindi Pakistan, from Oct 2019 to Oct 2021. Methdology: 160 cases of blepharitis, during a period of 2 years, who were not using topical or systemic antibiotics were recruited in this cross-sectional study. After detailed history and slit-lamp examination of eyelids and tears film each patient underwent sample collection under aseptic conditions, from the eyelid margin. The samples were inoculated in a culture of blood agar and chocolate agar (Biomeriux) , Then the susceptibility of the identified bacteria to common systemic and topical antibiotics were tested using the disc diffusion method (Rosco Neo-Sensitab). Results: In 160 patients,118(73.7%) were males and 42(26.3%) were females. According to type of blepharitis, 98(61.3%) had posterior blepharitis and 62(38.7%) had anterior blepharitis.Culture of eyelid sample of 77(48.1%) patients showed growth of coagulase-negative staphylococcus Coagulase-negative staphylococcus (CoNS) show greater resistance towards Penicillin 77(100%), Ciprofloxacin 55(72.5%) and Erythromycin 33(42.8%) however more susceptibility was shown towards Linezolid (CoNS). 71(45%) had Staphylococcus aureus isolated from their culture. 77(100%),Vancomycin 77(100%), Gentamycin 66(85.8%), Chloramphenicol 56(74.5%) and Cotrimoxazole 55(72.5%).Staphylococcus aureus show greater resistance towards Penicillin 72(100%),Ciprofloxacin 41(56.9%) and Tetracyclins 30(41.6%) however more susceptibility was found towards Gentamycin 72(100%), Linezolid 72(100%),Vancomycin 72(100%) and Chloramphenicol 61(84.7%). Conclusion: Coagulase-negative staphylococcus (CoNS) and Staphylococcus aureus have been the main isolated organisms in blepharitis. These bacteria have been shown to be resistant to Penicillin,

Evaluation of Aerobic Conjunctival Flora in Patients with Demodex Blepharitis

Demodex species are frequently found in blepharitis cases. This study aimed to compare the conjunctival flora of eyes with Demodex-positive blepharitis and Demodex-negative blepharitis with healthy individuals. Eyelash epilation was performed to detect Demodex from 44 eyes of 44 patients with chronic blepharitis and 44 eyes of 44 healthy controls and examined under a microscope. A conjunctival swab was taken from the same eye and inoculated on eosin methylene blue agar, Sabouraud dextrose agar, chocolate agar, and 5% sheep blood agar. Aerobic conjunctival flora was evaluated among Demodex-positive blepharitis, Demodex-negative blepharitis and healthy eyes. Demodex spp. was detected in 3 (6.8%) of 44 healthy controls and 24 (54.5%) of 44 patients with blepharitis. The most frequently isolated bacteria in healthy controls were coagulase-negative Staphylococci (CNS) spp. (n=32, 72.7%), Streptococcus spp. (n=16, 36.4%), Corynebacterium spp. (n=13, 29.5%). The most frequently isolated bacteria in Demodex-positive blepharitis were CNS spp. (n=14, 58.3%), Staphylococcus aureus (n=11, 45.8%), Corynebacterium spp. (n=7, 29.2%). In Demodex-negative blepharitis, CNS (n=10, 50.0%), S. aureus (n=10, 50.0%), Corynebacterium spp. (n=5, 25.0%) were most commonly isolated. S. aureus growth was significantly increased in the Demodex negative and positive blepharitis groups compared with the healthy group (p=0.001 and p=0.002, respectively). Although CNS spp. growth decreased in both groups with Demodex-negative and positive blepharitis compared with the healthy group; the decrease was significant only in those with Demodex-negative blepharitis (p=0.045). In terms of other bacterial growth, there was no significant difference between healthy eyes and Demodex positive and negative eyes with blepharitis. We found that Demodex blepharitis has no significant effect on conjunctival flora. Blepharitis itself may be the main factor in changes in the conjunctival flora.

Susceptibility of drug-resistant staphylococci isolated from different parts of the ocular anterior segment to common ophthalmic antibiotics

Objectie To investigate the susceptibility of drug-resistant staphylococci isolated from different parts of the anterior segment to levofloxacin, tobramycin, cefazolin sodium, fusidic acid and clindamycin. Methods: Experimental Study. A total of 67 patients with anterior segment infection (33 cases of conjunctivitis, 6 cases of bacterial keratitis, 7 cases of blepharitis, 9 cases of neonatal dacryocystitis, 9 cases of neonatal dacryocystitis, 1 case of adult dacryocystitis and 11 cases of other infectious eye diseases) were collected from the conjunctival sac, cornea, eyelid margin and lacrimal sac. Minimum inhibitory concentration (MIC) determination of methicillin-resistant Staphylococcus (MRS) strains and β-lactamase-producing (β-Lac) strains by a micro-liquid-based method, according to the M100 standard of the American Institute for Clinical and Laboratory Standardization Susceptibility and resistance determinations were made. Data were statistically analyzed using Chi-square or Fisher's exact test. Results: Thirty-five MRS, 30 β-Lac and 2 β-Lac MRS isolates were identified from 67 multidrug-resistant Staphylococcus . There were 3, 9, 4, and 19 MRS isolates isolated from the lacrimal sac, cornea, eyelid margin and conjunctival sac, accounting for 3/4, 9/12, 4/8, 19/43 (44.2%) of the isolated sites respectively. There were 1, 3, 3, and 23 β-Lac isolates, accounting for 1/4, 3/12, 3/8 and 23/43 (53.5%) of the isolated sites, respectively. The highest proportion of β-Lac isolates isolated from patients with a diagnosis of conjunctivitis was 17 (25.3%) from the conjunctival sac. Among the MRS strains isolated from the cornea and lacrimal sac, 5 (7.5%) and 3 (4.5%) were from patients diagnosed with bacterial keratitis and neonatal tear, respectively. The number of MRS strains and β-Lac isolates isolated from patients with a diagnosis of blepharitis were both 3 (4.5%) from the lid margin.Among the strains isolated from the eyelid margin and the conjunctival sac, drug-resistant Staphylococcus epidermidis was the main strain, the drug-resistant Staphylococcus aureus was the major isolates in lacrimal sac and cornea. Among the 35 MRS isoaltes, 25, 24, 12, 12, and 11 were sensitive to cefazolin sodium, fusidic acid, levofloxacin, clindamycin and tobramycin, and the sensitivity rates were 71.4%, 68.6%, 34.3%, 34.3% and 31.4%, the difference was statistically significant (χ2=22.756, P<0.001), The sensitivity rates of levofloxacin, tobramycin, cefazolin sodium, fusidic acid and clindamycin against MRS isolates from the anterior segment were both statistically significant differences (χ2=18.493, 11.594, 8.906, 9.841, 16.059; all P<0.05). The susceptibility rates of MRS isolates against five antibiotics was statistically significant differences (χ2=33.080, P<0.001). Among the 30 β-Lac isolates, 27, 22, 19, 16, and 8 were sensitive to cefazolin sodium, fusidic acid, levofloxacin, tobramycin and clindamycin, and the sensitivity rates were 90.0 % , 73.3%, 63.3%, 53.3% and 26.7%, the difference was statistically significant (χ2=28.280, P<0.001). The sensitivity rates of five antibiotics against β-Lac isolates from the anterior segment were both statistically significant differences (χ2=50.971, 24.543, 48.147, 44.899, 18.676; all P<0.001). The susceptibility rates of β-Lac isolates against five antibiotics was statistically significant differences (χ2=23.383, P<0.001). The sensitivity of cefazolin sodium and fusidic acid against β-Lac isolates were higher than MRS isolates. Conclusions: Cefazolin sodium and fusidic acid may be the best choice for the treatment of drug-resistant Staphylococcus isolated from anterior conjunctival sac, cornea, eyelid margin and lacrimal sac, especially for β-Lac-producing drug-resistant Staphylococcus infection.

A case of blepharitis caused by Trichophyton rubrum

A case of blepharitis caused by Trichophyton rubrum

A deviant behaviour of squamous cell carcinoma of eyelid: Rare case report

Squamous cell carcinoma (SCC) is a malignant tumour of the squamous cell layer of the epidermis accounting for about 9.2% of all eyelid malignancies. We report a case of a 45 year old female patient presented with itching, sticky discharge and swelling over the right upper eyelid (RUL) for 20 days. Initially, it was diagnosed as a case of blepharitis of Right Eye and antibiotic eye ointment and lubricants were prescribed. And 2 months later she presented with a mass over the same site. Past history of trauma, burn and chronic exposure to sunlight was absent. Examination revealed a mass of 1.25cm -1.50cm width &amp; 1cm - 1.25cm in height approximately, shape was irregular &amp; firm in consistency. Eyelid margin contour was lost with loss of eyelashes. Other ocular structures were within normal limits. No associated lymphadenopathy was noted. Incisional biopsy of the mass was suggestive of moderately differentiated SCC. Wide excision of the mass was done. Full thickness defect of the upper eyelid was reconstructed with Cutler - Beard technique. : Wide variation at presentation, delay in diagnosis and high propensity to recur with risk of perineural spread leads to difficulty in management. Therefore, any suspicious lesion eyelid lesion should be excised and biopsied.

Individual Approach to the Treatment of Complicated Forms of Blepharitis: from Theory to Practice

High prevalence of blepharitis, multifactorial etiology and chronic course with the possibility of serious complications, including conjunctivitis, multiple chalazions, keratitis, dry eye syndrome — cause significant difficulties in the treatment of this disease. Prescribing treatment of the process only in case of exacerbation with the use of even modern antimicrobial and anti-inflammatory drugs gives only a short-term effect.The aim is to present the clinical features of the blepharitis of different localization and the choice of the optimal treatment algorithm on the example of specific clinical cases. The article presents current data on the classification, etiology and mechanism of blepharitis development. Based on a detailed description of two clinical cases of blepharitis, the features of the clinical course, the range of necessary examinations and consultations of specialists are presented. The first case describes blepharitis associated with the severe rosacea in a teenager with a typical complication in the form of rosacea — keratitis. The second case is devoted to the features of the posterior blepharitis clinical course with meibomian gland dysfunction, complicated by multiple chalazions. The article explains in detail the stages of prescribing various medications, including eyelid hygiene, antibacterial, anti-inflammatory therapy and artificial tears, discusses possible side effects of the therapy and ways to restore the eye surface.Conclusion. The basis of blepharitis treatment is regular three-component eyelid hygiene. In case of exacerbation it is advisable to prescribe antibacterial and anti-inflammatory drugs, taking into account the sensitivity and ability to destroy microbial biofilms. In order to increase patient adherence to treatment, the choice of hygiene products and moisturizing drops should take into account the tolerability of the drug and the convenience of its use.

Comparison of Biomicroscopy and Light Microscopy Findings in Demodex Diagnosis in Patients With Chronic Blepharitis.

We aimed to compare the results of biomicroscopic examination and light microscopy in the diagnosis of Demodex infestation in chronic blepharitis cases. The study was performed with retrospective data and included patients with chronic blepharitis and who were admitted to the Medipol University Ophthalmology Outpatient Clinic. Biomicroscopic evaluation was performed intentionally under 40x magnification to investigate the presence of Demodex ectoparasites. Three or four pieces of eyelashes were obtained from all cases with epilation technique, and Demodex parasites were examined under ×100 and ×400 magnifications with light microscopy. The presence of one or more Demodex parasites in the examined area under light microscopy was considered to be positive for infestation. We calculated sensitivity, specificity, false-positive rate, false-negative rate, and positive and negative predictive values of biomicroscopic examination compared with those of positive light microscopy. Of the 255 subjects included in the study, 134 (52.5%) were men and 121 (47.5%) were women. The mean age was 43.9±11.9 years. Of the 255 chronic blepharitis cases, 130 (51%) presented Demodex infestation on light microscopy. We calculated the sensitivity, specificity, false-positive rate, false-negative rate, positive predictive value, and negative predictive value and were found to be 83.07%, 90.4%, 9.6%, 16.9%, 90%, and 83.7%, respectively, for the biomicroscopic examination. Careful biomicroscopic examination can be time-efficient and cost-effective, and the need for more advanced and invasive procedures for the identification of Demodex in patients with chronic blepharitis can be reduced.

Role of demodex infestation in blepharitis and coconut oil as a treatment option

To assess incidence of demodex species, correlate ocular symptomatology, evaluate efficacy of coconut oil as treatment method in all types of blepharitis. 30 patients with anterior &amp; mixed blepharitis, meibomian gland dysfunction &amp; non-specific irritation were enrolled for study. History taken &amp; examined clinically. 2 lashes/lid were sampled &amp; mounted on slides with normal saline &amp; observed under light microscope. Number of mites counted. Patients positive for demodex were treated with coconut oil application over lid margins &amp; reviewed after 3 weeks. Incidence of demodex was 40% &amp; it increased with age. Demodex was commonly associated with meibomian gland dysfunction, non-specific irritation, madarosis, cloudy &amp; toothpaste like meibum quality. Burning sensation and itching were common complaints. At 3rd week, all patients were symptom-free. Mite count dropped by 52.8% but were not eliminated. Demodex infestation is often overlooked but it is associated with about half of blepharitis cases. Hence further evaluation should be considered. Coconut oil is an easily available mode of treatment &amp; helps reduce symptoms and mite counts.

Investigation of Demodex Parasite Existence in Treatment-Resistant Chronic Blepharitis Cases.

Demodex acari is an obligate ectoparasite, and it is usually located in the human hair follicles, eyelash roots, and sebaceous glands. The aim of this study was to investigate the presence of Demodex infestation in chronic blepharitis cases that are resistant to therapy. Patients who were admitted at the Istanbul Medipol University School of Medicine Hospital with a diagnosis of chronic blepharitis were included. All cases received conventional therapy at least three times. Three or four eyelash samples from patients with blepharitis were collected and examined under light microscopy. For the diagnosis, the presence of one or more Demodex parasites at 10× and 40× magnification by a light microscope was considered as positive for infestation. Overall, 153 cases were included in the study. Of the cases, 79 (51.6%) were males and 74 (48.4%) were females. The mean age was 43.1±9.7 years. The presence of D. acari in the follicles of the eyelashes in patients with chronic blepharitis was found in 69 (45.1%) cases. D. acari should be considered in patients with chronic blepharitis, especially in treatment-resistant cases. We believe that it would be useful to search for the parasite in patients with blepharitis prior to treatment on a routine basis.

Blefarites refratárias ao tratamento convencional - papel do Demodex

Blepharitis is one of the most common conditions seen in ophthalmological practice. The term represents a spectrum of diseases characterized by varying degrees of eyelid inflammation, and the predominant symptoms include itching, a burning sensation, and ocular discomfort. Though very common, blepharitis is not completely defined, and its exact physiopathological mechanisms are not yet established. Blepharitis offers a diagnostic and therapeutic challenge. Distinctions between different clinical manifestations may be subtle or may overlap and may have a relevant impact on treatment. Moreover, a universal classification system for blepharitis remains unavailable. Although the condition does not typically create risks for patients’ vision, complaints of occular irritation and discomfort may be so persistent that they may have a relevant impact on quality of life. Mites from the genus Demodex are thought to be involved in some blepharitis cases resistant to conventional treatment. The objective of this review is to discuss the role of Demodex mites as agents associated with chronic blepharitis, as well as the physiopathological mechanisms underlying the condition, its diagnosis, and its treatment.

English

Bacterial external ocular infection is a common health problem along with increase and spread of drug resistance in Ethiopia. The objective of this study was to identify potential bacterial isolate of external ocular infections and their antimicrobial susceptibility patterns in patients attending eye clinic of the Hawassa University Teaching and Referral Hospital, from December 2012 to April 2013. A total of 281 consecutive, non-repetitive ocular specimens were collected among conjunctivitis cases (n=140), blepharitis cases (n=55), keratitis cases (n=31), dacryocystitis cases (n=19), and other cases (n=36). All samples were processed for culture and identification by standard methods. Susceptibility testing was done by Kirby-Bauer method as per Clinical and Laboratory Standards Institute (CLSI) guideline. Out of 281 ocular specimens submitted to culture, 137 (48.8%) specimen were positive. The most common bacterial isolates were Gram positive cocci (n=88; 61.5%). The predominant bacterial species isolated was Staphylococcus aureus (n=30; 21.0%) followed by coagulase negative Staphylococci (CoNS) (n=26; 18.2%) and Streptococcus pneumoniae (n=20; 14.0%). In vitro ciprofloxacin was effective against 86% of isolated pathogen. Multi-drug resistance was observed in 69.9% of the bacterial isolates. Our study confirmed that S. aureus was the overall predominant isolated pathogen followed by CoNS, S. pneumoniae and Klebsiella spp. Gram positive isolates were more susceptible to amoxicillin-clavulanic acid and vancomycin, whereas Gram negative isolates were more susceptible to ciprofloxacin and gentamicin. Relatively, ciprofloxacin is effective against most isolated pathogen. Key words: External ocular infections, conjunctivitis, blepharitis, keratitis, dacryocystitis, susceptibility.

Análise da produção de lágrima em pacientes com alopecia periocular: estudo retrospectivo entre os anos 2008 e 2012 no Hospital Veterinário da Universidade Estadual de Londrina

The Keratoconjunctivitis Sicca is a common ophthalmopathy among dogs and can be accompanied by periocular alopecia resulting from the extension of inflammation and concomitant eyelid. In the study, medical records of dogs with keratoconjunctivitis sicca and blepharitis treated at the Veterinary Teaching Hospital of the Londrina State University between the years 2008 and 2012 were analyzed, seeking patients with periocular alopecia and checking the frequency of these diseases in the population in relation to gender, age, breed, affected eye, other concomitant ophthalmic disorders, possible etiologies and the presence of systemic diseases. From the analysis of data it was intended to discuss the relationship between the occurrence of periocular alopecia and decreased tear production and possible causes, ocular present, systemic illnesses, affected breeds, gender and age. The Schirmer Tear Test was the method used to measure the tear production. 187 dogs were studied, 147 of which had keratoconjunctivitis sicca and 71 had blepharitis. 31 dogs showed associated diseases. There were 41 cases of alopecia periocular with no difference in the frequency of involvement in relation to gender. In regard to the affected eye, 95% of cases were bilateral. The breeds with higher prevalence were Poodle, Lhasa Apso, English Cocker Spaniel and mixed breed dogs. The ages with higher occurrence were two years, with 19% of the animals, four and twelve years with 12%. Among the 32 animals with periocular alopecia who had systemic diseases, 22 had dermatopathies. It was concluded that keratoconjunctivitis sicca and blepharitis are not frequently associated and the occurrence of periocular alopecia occurs in most cases of blepharitis, although it may less frequently present itself in the CCS. Despite the decreased tear production displayed in some patients with periocular alopecia, one cannot say that it is always present in these cases.

Bacterial profile and antimicrobial susceptibility pattern of anterior blepharitis in Misurata region, Libya

A total of 56 anterior blepharitis cases including 22 cases of ulcerative blepharitis and 34 cases of seborrheic blepharitis were studied. The predominant age group of anterior blepharitis cases was above 40 years. With males affected more than females. In the order of decreasing frequency, the isolated bacteria from anterior blepharitis in order of decreasing frequency were Staphylococcus aureus 14 (25%), Staphylococcus epidermidis 14 (25%), similar Klebsiella species 10 (18%), viridans Streptococci five (9%), Pseudomonas aeruginosa five (9%), Proteus species four (7%), Enterobacter aerugenes three (5%), and Escherichia coli one (2%). The common isolates observed in both samples were S. aureus, S. epidermidis, and Proteus species. The Gram-positive cocci S. aureus were resistant to four antibiotics and viridans Streptococci were resistant to three antibiotics, whereas the Gram-negative bacteria were resistant to two antibiotics. Improper selection of antibiotics, inadequate dosing, and poor compliance to therapy may play an important role in increasing resistance. Identification of anterior blepharitis pathogens and performing antibiotic susceptibility test are important factors in reducing the resistance to therapy.

Incidence and clinical characteristics of ocular infections after heart transplantation: a retrospective cohort study

Ocular infections associated with organ transplantation are well documented following renal and liver transplantation; however, few studies have reported ocular infections following heart transplant. We retrospectively studied patients who underwent heart transplantation in the Mayo Clinic Cardiac Transplant Program from January 1st 1988 through June 30th 2006. We report the frequency and type of ocular infections among 313 heart transplant recipients. There were eight patients (2.5%) diagnosed with ocular infections including three cases of ophthalmic zoster, one case of cytomegalovirus retinitis, one case of Aspergillus fumigatus endophthalmitis, one case of Haemophilus influenzae conjunctivitis, one case of blepharitis, and one case of preseptal orbital cellulitis. Ocular infections are rare after heart transplantation and usually present within the first year post-transplantation. The majority can be regarded as opportunistic infections which may be indicative of infections at other body sites. Ocular infections after heart transplantation may be associated with significant morbidity and visual loss if not promptly diagnosed.

Demodex y blefaritis crónica

Demodex is a mite commonly found in eyelash hair follicles and sebaceous glands of healthy people. Due to the fact this mite has also been reported in many chronic cases of blepharitis, we aimed to investigate the incidence of infestation with this mite in healthy people and in patients with chronic blepharitis, in addition to evaluating the response to the different treatments used for blepharitis. 105 subjects without blepharitis were selected as a control group and 20 subjects diagnosed as having chronic blepharitis were selected as patients. Epilated eyelashes were observed under microscope in both groups of patients. Those with overpopulation of mites were treated with ether lid and eyelash scrubs and 2% mercury oxide ointment. The incidence of Demodex infestation in the control group was 0.08 mites per eyelash, whereas in the patients with chronic blepharitis the incidence was 0.69 mites per eyelash; this difference was statistically significant (p=0.006). All the mites found were Demodex folliculorum except in one patient where the mite was identified as Demodex brevis. After 3-8 weeks of specific treatment the number of mites per eyelash decreased dramatically (0.03, with p=0.001). Two patients were intolerant of the therapy. In this study the incidence of Demodex in patients with blepharitis was very high, when compared with normal subjects, showing a clear association between blepharitis and Demodex infestation. Treatment with mercury oxide ointment was satisfactory in controlling the infection, despite difficulty in its application and occasional toxicity.

Ulcerative blepharitis in atopic patients--is Candida species the causative agent?

A total of 50 patients suffering both from atopic skin disease and different clinical forms of blepharitis have been included in this study. Microbiological investigations (for bacteria and fungi) of the lid margins were performed in all cases. In 21 (42%) of the patients an ulcerative blepharitis which heavily involved the follicles of the lashes was diagnosed. The remaining 29 cases presented with blepharitis of the squamous type. The cultures revealed that 19 of the 21 patients with ulcerative blepharitis were found to grow Candida species, whereas fungi could not be detected in any of the other cases of blepharitis. The frequencies of concomitant bacterial organisms found in the cultures were similar in both groups. As atopic patients are known to exhibit a defect in their cell-mediated immunity and possibly also a defective IgA antibody response it is a widely accepted assumption that these immunological changes are contributing factors to the development of a localised inflammation of the lids which is initiated by a variety of micro-organisms. We postulate that when Candida species happen to coincide with severe inflammation in atopic patients a blepharitis of the ulcerative type will develop or deteriorate thereby implying that these microorganisms may play an important role in the development or deterioration of this severe chronic inflammation. It is therefore advisable to perform repeated scrapings and cultures in every case of recalcitrant blepharitis.