Chronic Blepharoconjunctivitis Research Articles

Ocular surface changes in allergic blepharoconjunctivitis and dry eye syndrome: diagnosis and therapy possibilities

Purpose: to evaluate the ocular surface changes (OSC) in seasonal and chronic allergic blepharoconjunctivitis (ABC) under dry eye (DE) conditions and to consider therapeutic possibilities.Materials and methods. 60 patients with seasonal ABC and mild DE syndrome (group 1) and 50 patients with chronic ABC and moderate DE syndrome (group 2) were tested for lipid deficiency (LD; negative lipid-interference test), aqua-deficiency (AD; inferior tear meniscus height < 250 fim), and mucose deficiency (Bijsterveld`s xerosis index > 3 scores; XI, scores), Ocular surface disease index (OSDI), tear film break-up time (TBUT, seconds), meibomian gland dysfunction (MGD) according to Korb, taking into account the proportion of MGD (%) and its severity (MGDS, scores), and the “lid-wiper” symptom (LWS, scores) Statistics: M ± s; Mann — Whitney U-test; differences were statistically significant at p < 0.05.Results. LD was diagnosed in 65% of the 1st group patients (OSDI 32.3 ± 4.2, TBUT 6.5 ± 0.6, TMH 363.4 ± 43.96, XI 2.1 ± 0.4, MGDproportion — 41.02 %, LWS 1.1 ± 0.2). LD and MD were detected in 35 % of 1st group patients (OSDI 41.3 ± 5.7, TBUT 5.7 ± 0.5, TMH 332.9 ± 29.9, XI 4.2 ± 0.7, MGD proportion — 61.9 %, LWS 1.24 ± 0.4). The differences in OSDI, TBUT and XI values between DE patients with LD and DE patients with LD and MD were statistically significant. LD and AD were diagnosed in 48 % of 2nd group (OSDI 48.5 ± 6.4, TBUT 5.5 ± 0.6, TMH 192.3 ± 20.8, XI 2.5 ± 0.5, MGDS 1.8 ± 0.4, LWS 1.9 ± 0.3). LD, AD and MD were detected in 52 % of the 2nd group patients (OSDI 57.5 ± 5.8, TBUT 4.6 ± 0.6, TMH 177.7 ± 16.9, XI 5.5 ± 0.6, MGD-S 2.2 ± 0.4, LWS 2.3 ± 0.4). The differences in OSDI, TBUT and XI values between DE patients with LD-AD combination and DE patients with LD-AD-MD were statistically significant.Conclusion. OSC included lipid deficiency (65 %) and lipid-mucose deficiency (35 %) in S-ABC patients; OSC were represented by lipid-aqua-deficiency (48 %) and lipid-aqua-mucose-deficiency (52 %) in C-ABC patients. In our opinion, the diagnostics of these clinical variants of OSP diagnosis, opens up opportunities for differentiated tear replacement therapy. MGD was diagnosed in one half of S-ABC patients and in all C-ABC patients, which we believe determines another possible therapy direction — eyelid therapeutic hygiene aimed at MGD relieving and lipid deficiency compensation.

Conjunctive cavity microflora features in children with inflammatory eye adnexa pathologies

Purpose. To evaluate microflora of the conjunctival cavity of children in different age periods without and with inflammatory diseases of the eye adnexa. Material and methods. 370 children (398 eyes) aged from 1 month to 17 years were examined. 204 clinically healthy patients (225 eyes) made up the control group. The remaining 166 children (173 eyes) were diagnosed with various inflammatory diseases: 81 children (85 eyes) had neonatal dacryocystitis; 28 (28 eyes) – acute barley and 57 (60 eyes) – chronic blepharoconjunctivitis. All children underwent conjunctival cavity smear which were cultured for flora growth and sensitivity to antibacterial drugs. Results. Most common results shows that coagulase-negative staphylococci (CNS) are detected from the conjunctival cavity, with different frequency in different age periods: infancy – 38.5%, early childhood – 70.0%, first childhood – 40.4%, second childhood – 54.3%, teenage – 53.8%, youth – 20.0%. Frequency of detection of Staphylococcus aureusincreases during inflammatory diseases, and the detection of CNS decreases. Microflora shows the greatest sensitivity tofluoroquinolones in healthy children as well as in children with inflammatory diseases. Conclusion. A diverse spectrum of microflora was revealed at the age of 4 to 15 years, as well as under 1 year old kids. There is a significant increase in the incidence of Staphylococcus aureusand a decrease in the incidence of CNS in the considered inflammatory diseases. Identified microorganisms shows the greatest sensitivity to fluoroquinolones both in healthy children and their peers with inflammatory diseases. Key words: microflora, children, inflammatory eye diseases, antibacterial drugs

Evaluation of clinical efficacy and safety of Bibrocathol 2% eye ointment in the treatment of Chronic Blepharoconjunctivitis

Purpose: To assess the efficacy and safety of bibrocathol 2% eye ointment in patients with chronic blepharoconjunctivitis. Materials and methods: This was a multi-center, randomized, double-masked, placebo-controlled, parallel-group, phase III study. Patients with chronic blepharoconjunctivitis were randomized to apply either bibrocathol 2% (n = 100) or placebo (n = 100) three times a day for 14 days. The primary efficacy endpoint was the change from baseline to Day 15(+1 day) in the total score of signs summarizing the investigators’ assessment of the severity of lid oedema, lid erythema, debris, hyperemia, and pouting of Meibomian glands based on slit-lamp examination (modified Intention-to-treat (mITT) set). Safety endpoints included visual acuity, intraocular pressure, and adverse events. Investigators and patients performed an overall assessment of treatment tolerability. Results: On Day 15(+1 day) the least square (LS) mean change from baseline in the total sum score of signs was -8.62 (95% CI: -9.16; -8.08) in the bibrocathol group and -6.00 (95%CI: -6.54; -5.45) in the placebo group. The LS means the difference between treatment groups was statistically significant in favor of bibrocathol (-2.63 [95% CI: -3.36, -1.89], p < 0.001). Bibrocathol was statistically significantly superior to placebo in reduction of the individual ocular signs scores and the patient’s-assessed ocular discomfort severity (p < 0.001). No safety issues were observed concerning visual acuity, intraocular pressure, and the occurrence of adverse events. Conclusions: The study showed superior efficacy of two weeks of treatment with bibrocathol versus placebo in reducing signs and symptoms of chronic blepharoconjunctivitis. Treatment with bibrocathol 2% eye ointment was safe and well-tolerated.

New Possibilities of Antibiotic Therapy for Blepharoconjunctivitis in Children

The problem of drug therapy for bacterial eye infections in children has remained relevant for many years. The greatest interest of ophthalmologists in recent years is associated with the use of fluoroquinolones in the treatment of inflammatory eye diseases of the bacterial etiology. At the same time, new ophthalmic dosage forms of fluoroquinolones that have appeared in recent years naturally require additional research on their effectiveness.Objective: to study the clinical efficacy of the antibacterial drug Oftocypro (0.3 % cyprofloxacin in ophthalmic ointment) in the treatment of chronic blepharoconjunctivitis in children.Materials. The study involved 38 children aged 3 to 18 years (mean age 10.3 ± 2.7 years) with clinical manifestations of blepharoconjunctivitis. All patients were divided into 2 groups of equal size: 18 children (36 eyes) — with bacterial blepharoconjunctivitis and 20 (40) — with chlamydial blepharoconjunctivitis. The diagnosis was verified based on the clinical picture of blepharoconjunctivitis and laboratory data: detection of pathogenic microflora in the conjunctival cavity of patients of the first group and chlamydia antigen — in epithelial cells in scraping material from the conjunctiva by immunohistochemical analysis.Results. The analysis of the data obtained during the examination and treatment of children with blepharoconjunctivitis of bacterial etiology (group I), a reliable dynamics of controlled clinical and laboratory parameters was established. There was a significant positive dynamics of all controlled parameters of the clinical course of chronic bacterial blepharoconjunctivitis against the background of the drug Oftocipro ophthalmic ointment 0.3 % use. All children with chronic chlamydial blepharoconjunctivitis with the background of treatment with Oftocypro, ophthalmic ointment 0.3 %, showed a steady tendency towards relief of the estimated clinical signs of the disease. According to the results of laboratory studies, it was found that on the 28th day of treatment with Oftocypro chlamydia in the cells of the epithelium of the conjunctiva was re-detected in 4 out of 20 patients (20 %).Conclusion. The high efficacy of the drug Oftocypro ophthalmic ointment 0.3 %, in combination with the absence of pronounced side effects, makes it possible to recommend this drug for wider practical use.

Eyelid discoid lupus erythematosus

Discoid lupus erythematosus (DLE) most commonly affects the face and scalp. Palpebral involvement is rare and not evocative when presenting as the prime manifestation of the disease. We report hereby the case of a young male patient with isolated palpebral and labial DLE. A 34-year-old patient with no medical history was referred from ophthalmology for an erythematous plaque of the eyelid resisting usual treatment of blepharitis. Skin examination revealed a congestive erythema on the right lower eyelid with eyelash fall (Fig. 1). There was also an atrophic cheilitis of the lower lip with slight erosions (Fig. 2). Scalp, oral mucosa and the rest of the integument were not affected. Skin biopsy of the eyelid revealed marked orthokeratosis with slight basal vacuolization and perivascular lymphoplasma cells infiltrate. Direct immunofluorescence displayed a positive lupus band (Fig. 3). Work-up for systemic involvement was negative. Ophthalmologic assessment found no intraocular involvement. Hydroxychloroquine 200mg twice a day with clothing and chemical photoprotection were implemented allowing significant improvement after 3 months (Fig. 4). Palpebral involvement of DLE is uncommon compared to the other suggestive locations including scalp, nose, cheekbones, ears, neckline and hands. An isolated involvement does not suggest DLE at first sight and often leads to delayed diagnosis while scarring and lid deformities might be expected if left untreated [1]. Most commonly it presents as erythematous telangiectasic scaly plaques on the external third of lower eyelid. Blepharitis-like, madarosis, periorbital edema or cellulitis presentations have also been reported [2]. Differential diagnosis may arise with several chronic palpebral dermatoses, as carcinomas, eczema, blepharoconjunctivitis, or seborheic dermatosis. Assessment for intraocular involvement such as keratitis should always be performed [3]. Early recognition and treatment are essential to avoid eyelid complications as ectropion, entropion, and trichiasis. Photoprotection and antimalarials are the mainstay treatment showing remarkable efficacy.

Staphylococcus-associated marginal keratitis secondary to pterygium surgery: a case report

BackgroundStaphylococcus-associated marginal keratitis is an immune-mediated corneal disorder mainly secondary to chronic blepharoconjunctivitis. We report a rare case of Staphylococcus-associated marginal keratitis following pterygium excision. To the best of our knowledge, none of the previous literature has described such an acute complication after pterygium surgery.Case presentationWe report a case of a 50-year-old woman who suffered from pterygium in the left eye and underwent pterygium surgery. After surgery, slit-lamp examination showed an incomplete ring-shaped creamy white infiltrate. Corneal pathogenic microbial detection was negative. Staphylococcus aureus was found on the upper eyelid margin of the affected eye. Therefore, she was clinically diagnosed with Staphylococcus-associated marginal keratitis. The infiltrate was gradually absorbed after steroids, topical antibiotics, and lubricant eye drops were administered. After 2 years of follow-up, neither corneal infiltrate nor pterygium recurrence was observed.ConclusionStaphylococcus-associated marginal keratitis is an immune reaction mainly secondary to chronic blepharoconjunctivitis, which usually activates an antigen-antibody reaction with complementary activation and neutrophil infiltration in patients sensitized to staphylococcal antigens. Early detection and treatment is of great importance. Topical steroids are effective and should be initiated early once pathogenic microbial infections are excluded. Although chronic staphylococcal blepharoconjunctivitis is a common disease, ophthalmologists should pay more attention to it to avoid potential complications.

Ocular manifestations of rosacea: A clinical review.

Ocular rosacea is a chronic inflammatory condition that can occur in the absence of cutaneous features. The most common ocular features are chronic blepharoconjunctivitis with eyelid margin inflammation and meibomian gland dysfunction. Corneal complications include corneal vascularization, ulceration, scarring and, rarely, perforation. Diagnosis is largely based on clinical signs, although it is often delayed in the absence of cutaneous changes, particularly in children. It can also be associated with systemic disorders such as cardiovascular disease. Management ranges from local therapy to systemic treatment, depending on the severity of the disease. In this review, we describe the epidemiology, pathophysiology, clinical features and treatment of rosacea and ocular rosacea.

Working conditions and occupational risks of anterior eye pathology in metalworking machine operators

Introduction. The profession of “machine operator in metalworking”, one of the most common professions in various industries, characterized by a large volume of abrasive operations, accompanied by dust formation, which creates a potential for the occurrence of diseases of the visual organ.The aim of the study is to provide a hygienic assessment of working conditions and occupational risk of visual organ pathology in metalworking machine operators.Materials and methods. Observation groups — machine operators for metalworking of two training groups (experience up to 5 years, experience of 6–20 years). Two comparison groups (administrative and technical personnel of the enterprise) are formed according to the same age-experience principle.Results. The working conditions of machine operators were classified as class 3.2. taking into account the severity and intensity of the work process and the noise level (80 dBA) in the workplace. Nitrogen oxide, carbon monoxide, and manganese were registered in the air of the working area in concentrations below the permissible concentration (PC), and the aerosol dihydroxide was registered above the PC in 25.8% of cases. In the main working groups, diseases of the anterior segment of the eye were more often registered, among which dry eye syndrome (DYS) prevailed (94.1%), chronic blepharoconjunctivitis (79.9%), persistent corneal opacification (21.7%). There was an increase in the prevalence of detected diseases with an increase in work experience (p≤0.05). In machine operators, the frequency of inhibition of lacrimal formation and decreased stability of the tear film was recorded significantly more often, with increasing work experience, the degree of violation of lacrimal formation and stability of the tear film increased. The chances of detecting pathology of the anterior segment of the eye in machine operators are 5.9 and 3.5 times higher than in the comparison group. There are different forces of connection, increasing with the increase of work experience in the profession, between the working conditions of machine operators and the occurrence of SHG (relatively strong), with chronic blepharoconjunctivitis and persistent corneal opacity (medium strength), which suggests the professional conditionality of this pathology.Conclusions. The results obtained suggest that the pathology of the anterior segment of the eye is professionally conditioned in metalworking machine operators and necessitate the introduction of preventive measures aimed at protecting the visual organ.

Клинико-эпидемиологические особенности поражения органа зрения при системных заболеваниях соединительной ткани

To this date, uveitis associated with connective tissue diseases remain relevant due to serious complications that significantly reduce vision and thus worsen the quality of life of patients. Aim. To study the frequency and prevalence, as well as clinical manifestations of ophthalmopathology in connective tissue diseases. Material and methods. A retrospective and prospective study of 534 patients (144 men and 390 women) with connective tissue diseases was conducted, in which ophthalmological disorders were detected. The patients underwent standard rheumatological examination in the department. And also, ophthalmological examination with the determination of visual acuity, intraocular pressure and the use of biomicroscopy, ophthalmoscopy (or cycloscopy). If necessary and possible, additional studies were performed such as: ultrasound B-scan, optical coherence tomography, perimetry. The study examined the type of common disease, age of onset and gender of the patient. Of particular interest were patients with uveal inflammation, in which the localization and nature of the course of inflammation were evaluated. Results and discussion. The most common diseases with eye damage were rheumatoid arthritis (RA) – 129 (24.1%), systemic lupus erythematosus (SLE) – 92 (17.2%), inflammatory bowel disease (IBD) – 95 (17.8%), systemic scleroderma (SDS) – 54 (10.1%) and spondylarthritis (Spa) – 41 (7.8%). In a small percentage of cases, other connective tissue diseases were diagnosed, such as: mixed connective tissue diseases (MCTS) – 24 (4.5%), Overlap syndrome – 21 (3.9%), systemic vasculitis – 23 (4.3%), Behcet's syndrome -18 (3.4%), Sjogren disease – 14 (2.6%) and juvenile idiopathic arthritis - 7 (1.3%). All ophthalmic disorders were divided into four general groups and distributed as follows: inflammatory 27.7%, degenerative 4.9%, vascular 48.7%, side effects of glucocorticoids 18.7%. Uveitis accounted for 52 (9.7%) of all ophthalmopathology, occurring in connective tissue diseases. Unilateral acute anterior uveitis (AAU) was diagnosed in 13 (25%) patients with ankylosing spondylitis, of which 4 (7.8%) had a relapse in the paired eye. Simultaneously, bilateral AAU was detected in 3 (5.7%) patients with Behcet's syndrome. Chronic, recurrent posterior uveitis was diagnosed in 13 (25%) patients with Behcet's systemic vasculitis. All patients with Behcet's syndrome were male at the age of 31±3.1 years. The uveal process approximately started 3.2±1.16 years after the onset of systemic disease. Generalization of inflammation in all departments of uvea was detected in patients with PSA-5 (9.6%), AC – 3 (5.7%), DS – 2 (3.8%) and SLE – 2 (3.8%). In 5 (9.6%) patients, the process was bilateral. Inflammation of the paired eye by the type of AAU was observed in 1 patient and posterior uveitis - in 2 patients. Conclusions. Ophthalmic disorders in the structure of systemic diseases make up 20.2% and vary widely in their clinical manifestations. Chronic blepharoconjunctivitis, combined with rheumatoid arthritis (46%) is a common inflammation of the accessory structures of the eye. About 20% of patients have complications from general immunosuppressive therapy, leading to impaired visual function. The frequency of uveitis in the structure of ophthalmopathology associated with connective tissue disease is 9.7%. Uveitis associated with ankylosing spondylitis and systemic vasculitis of Behcet occurs in men at a younger age and is 31%. More than half (63%) of patients with uveitis have a severe course with the development of panuveitis and neuropathy. An increase in the thickness of the choroid (up to 2 mm) according to two-dimensional ultrasound is an early diagnostic criterion for the development of uveitis and the underlying disease of connective tissue. Keywords: inflammatory eye diseases, uveitis, connective tissue diseases, spondyloarthritis, Behcet's syndrome, complications.

OCULAR SURFACE SQUAMOUS CELL NEOPLASIA IN A 25 YEARS MAN FROM D.I.KHAN, PAKISTAN

Ocular surface squamous neoplasia (OSSN) is a term that describes the spectrum of abnormal growth of atypical squamous epithelial cells of the conjunctiva, cornea, and sclera. It is more common in people working for long in sun-exposed areas. It resembles other common ocular surface conditions such as pterygium, pinguecula, atopic conjunctivitis, diffuse episcleritis, chronic blepharoconjunctivitis which may result in the wrong diagnosis of the entity. Here we report a case of OSSN in a 25 years old man which was referred to us as a case of pterygium. An excisional biopsy revealed clusters of dysplastic squamous epithelial cells.

Diagnosing and managing allergic conjunctivitis in childhood: The allergist's perspective.

Allergic conjunctivitis in childhood often poses problems of diagnosis and management for the allergist. We present the salient points concerning the diagnosis and treatment of ocular allergy emerging from a large cohort survey conducted jointly in the departments of ophthalmology and paediatric allergy in a French teaching hospital. Seasonal acute conjunctivitis is a common disorder and not overly difficult to diagnose and treat when associated with rhinitis leading to allergic rhinoconjunctivitis. An ophthalmologist should be consulted when conjunctivitis occurs alone and if another form of conjunctivitis is suspected, such as perennial allergic conjunctivitis, vernal keratoconjunctivitis or atopic keratoconjunctivitis. When IgE-mediated hypersensitivity assessment does not establish aetiological diagnosis, a conjunctival allergen provocation test can be performed. The principal non-IgE-mediated allergy is chronic blepharoconjunctivitis. The main problem for differential diagnosis is the presence of signs suggestive of dry eye. Management includes non-pharmacological treatments, such as lacrimal substitutes, avoidance measures and protection of the ocular surface. Second-line treatment consists of eye drops, preferably single dose or without additives and with dual local action, mast cell stabilizer action and antihistaminic action. Third-line treatment is reserved for severe forms. Short-lasting local steroid therapy can control flare-ups of allergic keratoconjunctivitis, which should have specialized follow-up. Cyclosporine is a disease-modifying treatment, which is both effective and well tolerated.

The Antibacterial Eye Ointments in the Treatment of Eyelids and Conjunctiva Acute and Chronic Diseases

Currently, there are many studies on the effectiveness of ointment ophthalmological medicines. Ophthalmic ointments are unique because they have a multi-component action mechanism. On the one hand, the action of the medicinal substance itself is prolonged due to the ointment base, and on the other hand, due to the structural features of the conjunctival cavity mucosa, these medicinal substances are very rapidly absorbed. In the treatment of ocular surface pathology, including as meibomiitis, barley and chalazions, local therapy and ointment forms are preferred. The purpose of the study was the investigation the antibacterial eye ointment effectiveness of domestic production Oftocipro — a fluoroquinolone derivative for the treatment of acute and chronic eyelid and conjunctiva diseases. During the study patients were divided into 2 groups with acute and chronic inflammatory diseases of the eyelids and conjunctiva in the acute stage. It is known that chronic pathological processes are often stopped in longer periods. This fact was a prerequisite for assessing the effectiveness of Ontocipro with a comparative analysis of the dynamics of subjective (patient complaints) and objective (biomicroscopy, tear production tests) indicators characterizing the severity of the inflammatory process. The study has showed a high drug efficacy, when it is applied topically 3–4 times a day. The average time to relieve the inflammatory process was 3–7 days. The possibility of using the drug Oftocipro locally, when it is applied to the eyelid area, without affecting the conjunctival cavity, allows to minimize the impact area due to the ointment base and limit the risk of side effects in the form of a violation of the natural conjunctival microflora. Considering high level of tolerance and low allergenicity of the drug Oftotsipro, it can be recommended for widespread use for the treatment of acute and chronic blepharoconjunctivitis, barley and chalazion in the acute stage, as well as meibomiitis.

Pathology of the Organs of Vision in Metallurgists

The frequency and structure of ophthalmopathology in workers of the Novokuznetsk Metallurgical Combine (NMC) have been studied. In total 1911 workers of NMC have been examined. The control group comprised 1801 people working in hazardous industrial conditions. The experimental group consisted of employees dealing with management, engineering center, accounting (110 people). Their work was not connected with the impact of unfavorable factors of metallurgical production. In the control group, the hazard classes ranged from 3.2 to 3.4. The difference between the classes of hazard impact consisted in an increase of the intensity of the hazardous factors exposure. In the structure of conjunctival diseases we have diagnosed chronic conjunctivitis (198.3 ‰), chronic blepharoconjunctivitis (109.4 ‰), pinguecula (266.7 ‰) and pterygium (7.2 ‰) in metallurgical workers. Pengucules in the control group of workers was not only more often than in engineers, but also larger, often located in the inner and outer corner of the eye, and was detected in workers under 30–35 years. The workers of the main shops suffered more severely from the function of tear production and the stability of the pre-corneal tear film. The miners suffered from the highest frequency of cataract development — 301 ‰. Thus, a high incidence of inflammatory and dystrophic diseases of the eyelids and conjunctiva, cataracts in metallurgy has been established. An increase in the frequency of ophthalmopathology was noted with an increase in the length of service under harmful conditions of metallurgical production. The authors suggest the term “metallurgy ophthalmopathy”, which includes manifestations of chronic conjunctivitis and / or blepharoconjunctivitis against the background of unstable precorneal film and frequent formation of posterior-subcapsular opacities of the lens.

Effectiveness of 0.1% topical salicylic acid on blepharoconjunctivitis affecting glaucoma patients treated with topical prostaglandin analogues: a prospective randomized trial.

To evaluate the efficacy of 0.1% topical salicylic acid (TSA) to treat iatrogenic chronic blepharoconjunctivitis in patients with primary open angle glaucoma (POAG), treated with topical prostaglandin analogues (TPAs). Totally 60 patients were randomly distributed into 3 equal size groups, two of which treated with 0.1% TSA (OMKASA®) and 0.1% topical clobetasone butyrate (TCB; VISUCLOBEN®) respectively, and one consisting of untreated controls. The parameters taken into account at baseline (T0) and after 30d (T1) of therapy were: conjunctival hyperemia, lacrimal function tests [Schirmer I test and break up time (BUT)] and intraocular pressure (IOP). Conjunctival hyperemia showed a substantial improvement in both treated groups (P<0.001) but not among controls. Similarly, lacrimal function tests displayed an improvement of Schirmer I test in both treated groups (P<0.05) and an extension of BUT only in the group treated with 0.1% TSA (P<0.05). The IOP increase was statistically significant only in those patients treated with 0.1% TCB (P<0.001). The 0.1% TSA has proved to be an effective anti-inflammatory treatment of blepharoconjunctivitis affecting glaucoma patients on therapy with TPAs, leading to a sizeable decrease of inflammation as well as both quantitative and qualitative improvement of tear film. Furthermore, differently from 0.1% TCB, it does not induce any significant IOP increase.

Роль хронических блефаритов и блефароконъюнктивитов в развитии ССГ и изменении глазной поверхности, основные принципы лечения (обзор литературы)

Роль хронических блефаритов и блефароконъюнктивитов в развитии ССГ и изменении глазной поверхности, основные принципы лечения (обзор литературы)

Para-phenylenediamine and its multiple co-sensitisations – two case reports

Introduction. In contact allergology, the situations with simultaneous positive tests to multiple molecules are not rare; sometimes, in these cases, interpretation and clinical relevance of the tests are difficult. Case report I. A 73-year-old woman, with chronic blepharoconjunctivitis and chronic rhinitis (under observation), not responding to the treatment with tobramycin ophthalmic drops, olopatadine ophthalmic drops, dexamethasone phosphate injectable solution, mometazone furoate nasal spray and fluorometholone ophthalmic drops. Personal history: ten years ago - dermatitis on the face and scalp after using black dye hair. Epicutaneous tests: European Baseline Series + additional series, three components of cortico­steroid series. Results: +++ to para-phenylenediamine (PFD), ++ to neomycin, Peru balsam, budesonide, tixocortol-21-pivalate, benzalkonium chloride, textile dye mix, disperse orange. Case report II. A 50-year-old woman, without personal history of atopy, presented three months ago an acute eczema on the scalp and neck after using black dye hair. Under treatment with strong corticosteroids, the evolution was favorable, the eczema being at the time of testing in the chronic stage (lichenification). Epicutaneous tests: European Baseline Series + additional series. Results: ++ to PFD and nickel, + to colophane, Peru Balsam, Paladium, Orange Disperse 1, textile dye mix. Clinical relevance of the tests. In both cases primary sensitization was caused by hair dye, the responsible hapten being para-phenylenediamine; the positive results to textile dye mix and disperse orange 3 in the first case, respectively, to textile dye mix and disperse orange 1, in the second case, are justified by the cross-reactions they may have with PFD. The positivity of the tests to budesonide and tixocortol pivalate but also to benzalkonium chloride, in the first case, can be explained by sensitization via fluorometolone, respectively, by the presence of benzalkonium chloride as an excipient in dexamethasone phosphate injectable solution,tobramycin ophthalmic drops, olopatadine ophthalmic drops and fluorometholone ophthalmic drops. Conclusion. Our results are concordant with those recently published, which showed that PFD is one of the top-ranking allergens regarding the absolute number of significant associations with concomitantly patch tested allergens, suggesting the possibility to identify a subset of patients who are genetically prone to multiple sensitizations.

Ophthalmoferon efficacy in the treatment of children with chronic blepharoconjunctivitis

To study possibilities of using the medication Ophthalmoferon in the treatment of children with chronic allergic and Demodex blepharoconjunctivitis. We examined 40 children (80 eyes) aged 3 to 17 years with chronic allergic (group I) and Demodex (group II) blepharoconjunctivitis. Each group was divided into two subgroups ('A' and 'B') respectively based on the treatment regimen used. Subgroup 'A' patients received Ophtalmoferon instillations (four times per day for four weeks) in addition to the standard therapy, whereas subgroup 'B' patients got only basic treatment of blepharoconjunctivitis. The latter included eyelids' ciliary edge massage, eyelids' free edge hygienic treatment, artificial tears instillations and oral intake of the medications, like enterosorbents, probiotics, enzymes and anti-allergic remedies. We evaluated the dynamics of subjective and objective blepharoconjunctivitis signs at 1,2,4 and 6 follow-up weeks. The dynamics of eosinophils content in cytograms as well as the dynamics of acarograms were also assessed. From the first treatment week in all patients, regardless of the treatment regimen used, we noted a statistically significant positive change in all subjective and the majority of objective blepharoconjunctivitis clinical manifestations, such as eyelids' edge and conjunctiva hyperemia and eyelid swelling. In patients with allergic and Demodex blepharoconjunctivitis, who received the medication Ophtalmoferon, a significantly more positive result was observed after the first treatment week, by comparing with the control group (p<0,01). The significant difference in the parameters of both comparison subgroups persisted for two weeks. There was a significant difference in the acarogram values, when Ophtalmoferon was used. A further decrease in the cellular infiltration of the conjunctiva by eosinophils was revealed in patients, who additionally used Ophthalmoferon, but without significant differences in parameters. There were no adverse effects in all cases, when the given medication was used. Our study results allow us to recommend the medication Ophtalmoferon for a wide clinical use in children with chronic allergic and Demodex blepharoconjunctivitis.

Ocular Rosacea—a Review

Ocular rosacea, a disease often associated with acne rosacea, can present with a variety of clinical features, which are often nonspecific. However, in about one-third of cases, it may occur as an isolated entity without skin involvement. Appropriate diagnosis and management is essential as potentially sight-threatening corneal involvement can occur in a significant number of patients if the condition remains unrecognized and untreated. Diagnosis remains mainly clinical and includes recognition of the commonly occurring signs of chronic blepharoconjunctivitis, lid margin telangiectasis,meibomian gland dysfunction, dry eyes, and corneal involvement in the form of vascularization, infiltration, and even perforation. Management depends on the severity of the disease, with milder forms being amenable to treatment with local measures like lid hygiene and topical lubricants, while more severe forms require treatment with systemic drugs including tetracyclines, azithromycin, erythromycin, or metronidazole and more aggressive local therapy with topical steroids and/or topical cyclosporine. Surgical treatment may be required to manage the sequelae of chronic ocular surface inflammation.

Inveterate squamous cell carcinoma of the upper eyelid: a case report

Squamous cell carcinoma (SCC) is a malignant tumor of epithelium that shows squamous cell differentiation. It is the second most common cancer of the skin and usually occurs in areas exposed to the sun but it can rarely arise within the conjunctival epithelium with a deep component. We describe a woman with a history of chronic blepharoconjunctivitis unresponsive to topical medications. Examination disclosed a hyperaemic translucent patch with blurred margins of the upper palpebral conjunctiva. Tarsoconjunctival biopsy revealed intraepithelial squamous cell carcinoma. Management consisted of complete tumor excision with removal of the entire posterior lamella of the left upper eyelid and reconstruction. Histopathologic analysis confirmed primary squamous cell carcinoma arising from conjunctival epithelium, involving the underlying tarsus. Patients with unexplained chronic unilateral blepharoconjunctivitis or papillary hypertrophy of the palpebral conjunctiva should be considered for biopsy to rule out neoplasia, even when there is no sign of an evident mass.

Eye lid hygiene in chronic allergic blepharoconjunctivitis patients before laser refractive surgery

To evaluate the effectiveness of eyelid hygiene in patients with chronic allergic blepharoconjunctivitis (ABC) as a part of their preparation for laser refractive surgery. The study involved 32 patients (12 males and 20 females aged 25-42 years) with refractive errors, namely, compound myopic astigmatism (23 patients) and hyperopic astigmatism (9 patients) suffering from chronic ABC and secondary dry eye syndrome (DES). All the patients initially received a standard treatment for ABC and DES, that is olopatodin hydrochloride instillations - 1 mg/ml 2 times daily, preservative-free hyaluronic acid preparation - 1 mg/ml 3 times daily, and polyacrylic acid and dexpanthenol gel at night for one month. The scheme, however, appeared not effective enough. Hence, the patients were prescribed eyelid hygiene (Blepharolotion or Blepharosalfetka plus Blepharogel-1 2 times daily) to relive meibomian gland dysfunction (MGD). They also underwent a conventional ophthalmic examination, allergy tests, evaluation of ABC and DES signs and symptoms, tear film break-up time test, Schirmer's test, meibomian glands evaluation, optical coherence tomography with meniscometry, xerosis index evaluation, and lissamine green staining for lid wiper epitheliopathy. At the beginning of the study signs and symptoms of MGD-associated DES were predominant in all patients. Chronic ABC signs were mild. In 2-3 months, meibomian gland function and tear film break-up time improved significantly in most patients, while xerosis index decreased and lid wiper epitheliopathy resolved. Laser refractive surgery (LASIK) was performed in 81.25% of patients, all of whom were satisfied with the results. Inclusion of eyelid hygiene into preoperative management of patients with chronic ABC and DES allows to achieve optimum conditions for laser refractive surgery in most cases.