Eyelid Diseases Research Articles

The role of Helicobacter pylori in the development of inflammatory eyelid diseases

Background. Blepharitis is one of the most common eye diseases: it accounts for 23.3 % of the total number of patients with inflammatory eye diseases worldwide. 40.2 % of these patients seek outpatient care. The incidence of blepharitis is 1.5–2 times higher in women than in men. The leading factors in the development of blepharitis are both general (gastrointestinal tract diseases, diabetes mellitus, hypertension, systemic use of corticosteroids, etc.) and local (atopic and seborrheic dermatitis or rosacea). The main causative agents of this disease are Staphylococcus spp. (S. aureus, S. epidermidis). As a rule, the disease manifests itself in patients aged 30–50 years, while in women aged 40 to 45 years, 80 % of blepharitis are of staphylococcal origin. Currently, there are reports in the literature about apotential link between Helicobacter pylori infection and the development of chronic blepharitis, but the data are very contradictory.The aim of the study. To analyze the features of the relationship between Helicobacter pylori and inflammatory eyelid diseases.Materials and methods. We conducted a search and analysis of literary sources in the Web of Science, PubMed and Google Scholar databases, as well as in the Russian Science Citation Index database for the period from 2000 to 2022.Conclusion. The review analyzes and summarizes the pathogenic mechanisms of the relationship between chronic blepharitis and Helicobacter pylori. We carried out an analysis of numerous studies, which give grounds to assume a possible role of Helicobacter pylori infection in the development and course of inflammatory eyelid diseases (blepharitis). The main pathogenic aspects in these studies are: chronic inflammation of the eyelids and gastrointestinal tract (antigenic mimicry); excretion of toxic substances from the oral cavity (ammonia, hydrogen nitrite, hydrogen cyanide and other substances causing indirect inflammation of the conjunctiva and eyelid cartilage); the presence of Helicobacter pylori in tears.

Global research of artificial intelligence in eyelid diseases: A bibliometric analysis

PurposeTo generate an overview of global research on artificial intelligence (AI) in eyelid diseases using a bibliometric approach. MethodsAll publications related to AI in eyelid diseases from 1900 to 2023 were retrieved from the Web of Science (WoS) Core Collection database. After manual screening, 98 publications published between 2000 and 2023 were finally included. We analyzed the annual trend of publication and citation count, productivity and co-authorship of countries/territories and institutions, research domain, source journal, co-occurrence and evolution of the keywords and co-citation and clustering of the references, using the analytic tool of the WoS, VOSviewer, Wordcloud Python package and CiteSpace. ResultsBy analyzing a total of 98 relevant publications, we detected that this field had continuously developed over the past two decades and had entered a phase of rapid development in the last three years. Among these countries/territories and institutions contributing to this field, China was the most productive country and had the most institutions with high productivity, while USA was the most active in collaborating with others. The most popular research domains was Ophthalmology and the most productive journals were Ocular Surface. The co-occurrence network of keywords could be classified into 3 clusters respectively concerned about blepharoptosis, meibomian gland dysfunction and blepharospasm. The evolution of research hotspots is from clinical features to clinical scenarios and from image processing to deep learning. In the clustering analysis of co-cited reference network, cluster “0# deep learning” was the largest and latest, and cluster “#5 meibomian glands visibility assessment” existed for the longest time. ConclusionsAlthough the research of AI in eyelid diseases has rapidly developed in the last three years, there are still gaps in this area. Our findings provide researchers with a better understanding of the development of the field and a reference for future research directions.

Application of artificial intelligence in oculoplastics

Oculoplastics is a subspecialty of ophthalmology/dermatology concerned with eyelid, orbital, and lacrimal diseases. Artificial intelligence (AI), with its powerful ability to analyze large data sets, has dramatically benefited oculoplastics. The cutting-edge AI technology is widely applied to extract ocular parameters and to use these results for further assessment, such as screening and diagnosis of blepharoptosis and predicting the progression of thyroid eye disease. AI also assists in treatment procedures, such as surgical strategy planning in blepharoptosis. High efficiency and high reliability are the most apparent advantages of AI, with promising prospects. The possibilities of AI in oculoplastics may lie in three-dimensional modeling technology and image generation. We retrospectively summarize AI applications involving eyelid, orbital, and lacrimal diseases in oculoplastics, and we also examine the strengths and weaknesses of AI technology in oculoplastics.

The effect of long‐term use of gadgets on the condition of the bulbar conjunctiva in young people

Aims/Purpose: To evaluate the condition of the bulbar conjunctiva in young people by the method of impression cytology in response to long‐term use of gadgets.Methods: The research design consisted of 40 students (80 eyes) aged 18–20 years (19 ± 1.2). All students underwent general ophthalmological examinations, including blink rate per minute and impression cytology of the bulbar conjunctiva from the temporal side. Changes in the bulbar conjunctiva were evaluated according to Nelson's classification. Criterion for inclusion in the study: time spent on gadgets at least 6 h per day. Exclusion criteria: contact lens users, chronic eyelid diseases, diabetes, systemic connective tissue diseases, Sjögren's disease...).Results: Morphological and morphometric studies of the bulbar conjunctiva showed that most of the subjects (35 students, which is 87.5%) had a normal epithelial state of the front surface of the eye, which corresponds to 0–1 degrees according to Nelson, while 5 students had changes in the form of partial squamous metaplasia, which corresponded to the II degree according to Nelson and amounted to 12.5%. Blink frequency was reduced in 27 subjects, which was 67.5%. In most cases (n = 34, 85%) had a reduced blink frequency while working with gadgets, and 27 students (67.5%) had it reduced even without using digital devices.Conclusions: The results of our research showed that 12.5% of students had changes in the epithelium of the bulbar conjunctiva, corresponding to the II degree according to Nelson, which can be considered as adaptively compensatory processes, in response to long‐term use of gadgets. Therefore, it is necessary to prescribe moisturizing drops to young people, which do not contain preservatives, phosphates and buffers (for example, Thealoz duo).

Characteristics of eye-related emergency visits and triage differences by nurses and ophthalmologists: Perspective from a single eye center in southern China.

To describe characteristics of eye-related emergency department (ED) visits and investigate differences in priorities assigned to patients by triage nurses and ophthalmologists. A prospective survey was conducted at the ED of Zhongshan Ophthalmic Center from January 1, 2021, to May 31, 2021. Clinical data from patients with acute ophthalmic conditions lasting less than 7 days were collected via a standard questionnaire and the urgency levels assigned by nurses and physicians were also recorded. Binary logistic regression was performed to identify characteristics associated with truly emergency conditions and up- or down-triage. A total of 1907 patients were enrolled, with 582 (30.5%) classified as "non-emergency." Red eye (69.7%), eye pain (53.0%), ocular trauma (44.1%), tearing (43.6%), and blurred vision (43.1%) were the most common complaints. Truly emergency tended to be male (OR 2.019, p < 0.001) and with unilateral eye involvement (OR 2.992, p < 0.001). Nurses prioritized conjunctival, scleral, closed ocular trauma and eyelid diseases over doctors while giving less priority to open ocular trauma, cornea, uveitis, and vitreoretinal diseases (p < 0.05). Overemphasis on mild blurred vision (OR 3.718, p = 0.001) and insufficient understanding of conjunctival diseases without red eye (OR 0.254, p = 0.001) were associated with conjunctival disease "up-triage." Insufficient awareness of moderate and severe blurred vision was associated with "down-triage" for ocular trauma (OR 3.475, p = 0.001 and OR 2.422, p = 0.020, respectively). Ophthalmic EDs are typically flooded with patients suffering from acute ocular problems, with a considerable portion for non-emergency conditions. The identification of characteristics associated with truly emergency cases and nurses' triage preferences is valuable in providing target guidance for future ED practice and facilitating the proper allocation of emergency resources.

Normal palpebral anthropometric measurements in Uygur population： A cross-sectional study.

To provide a normative palpebral database for the Uygur subjects to determine norms that may contribute to the diagnosis and prognosis of eyelid diseases. The cross-sectional study was conducted from March to May 2021 at the First People's Hospital of Kashi, China, and comprised Uygur subjects of either gender aged 18-70 years. The slant, height and width of the palpebral fissure, vertical brow-upper lid distance, intercanthal distance, pupillary distance, brow height, crease height and levator function were measured. Data was analysed using SPSS 22. Of the 335 subjects having mean age 41.41±14.53 years, 165(49.3%) were males with mean age 41.08±14.23 years and 170(50.7%) were females with mean age 41.74±14.85 years. There were 107(31.9%) subjects aged 18-30 years, 115(34.3%) aged 31-50 years and 113(33.7%) aged 51-70 years. Mean palpebral fissure width and margin reflex distance of the palpebrae were significantly different in terms of gender (p<0.05). Age was also a significant factor on several counts (p<0.05). Anthropometric measurements of eyelid in Uygur subjects indicated certain peculiarities.

Surgical Studies on Disorders of Eyes, Mouth and Nose in domestic dogs: A Retrospective Clinical Study

This study was aimed to describe the most frequently recorded disorders in dogs in Alexandria Government and provides a prevalence baseline against which to measure progress in canine health. The surgical conditions affecting the eyes, mouth and nose and its surrounding structures are numerous. These conditions affect adversely the general health condition of the animal as it is causing disruption of the important biological processes in the body. In the present study, a total number of 422 pet animals suffering from different surgical conditions were recorded. The surgical conditions of the eye and its surrounding structures represented about 25.11% of the encountered surgical conditions along this study with maximum incidence of diseases of nictating membrane. Meanwhile, the surgical conditions of the mouth and their surrounding structures were recorded in 14.21% of the encountered surgical conditions. The surgical conditions of the nose represent 0.47 %. The results of the present study revealed that the surgical conditions affecting the eyes and its related structures were recorded in 106 cases. These conditions include eyelid laceration and trauma (17 cases), eye lid abscess (1 case), eye lid neoplasia (2 cases), entropion (10 cases), neonatal defect in eyelid opening (5 cases), eye proptosis (2 cases), eye infection (1 case) and diseases of nictating membrane (68 cases). The mouth and nose disorders include dental tartar (13 cases), periodontal diseases (3 cases), persisting deciduous teeth and polydontium (3 cases), neoplastic lesion (3 cases), foreign body in mouth (22 cases), lip wound (16 cases), and epistaxis (2 cases). Most of the surgical disorders of the mouth and related structures affected the animal health and usually associated with difficult mastication. These disorders usually required immediate surgical interferences. German Shepherd, Rottweiler and Pit bull recorded highest incidence of disorders with maximum cases in young age group up to 2 years 104 cases (24.63%) of age. Sex wise incidence was higher in male 101 cases (23.91%) dogs.

Orbital and eyelid diseases: The next breakthrough in artificial intelligence?

Orbital and eyelid disorders affect normal visual functions and facial appearance, and precise oculoplastic and reconstructive surgeries are crucial. Artificial intelligence (AI) network models exhibit a remarkable ability to analyze large sets of medical images to locate lesions. Currently, AI-based technology can automatically diagnose and grade orbital and eyelid diseases, such as thyroid-associated ophthalmopathy (TAO), as well as measure eyelid morphological parameters based on external ocular photographs to assist surgical strategies. The various types of imaging data for orbital and eyelid diseases provide a large amount of training data for network models, which might be the next breakthrough in AI-related research. This paper retrospectively summarizes different imaging data aspects addressed in AI-related research on orbital and eyelid diseases, and discusses the advantages and limitations of this research field.

Oculoplastic publication trends in general ophthalmology journals.

To examine the publication trend of oculoplastic articles throughout the last decade in general ophthalmology journals. A review of all abstracts published between January 2010 to December 2019 in general, clinical ophthalmic journals was conducted. Articles that were categorized as original articles in general and clinical journals were included in the study. Totally 10 281 abstracts were included. Of them 465 (4.5%) were oculoplastic publications. The mean number of annual-publications was 46.5 and the mean annual-rate of oculoplastic publications was 4.51%. A significant decreasing trend in the number of oculoplastic publication in the last decade was found (P<0.01, R 2=0.770). However, there was no significant change in the annual-rate of oculoplastic publications during the last decade (P=0.191, R 2=0.203). From the 465 oculoplastic articles: 179 (38.5%) were articles about eyelid diseases, 160 (34.40%) were about orbit diseases, 92 (19.80%) were about lacrimal diseases and 34 (7.30%) were about thyroid eye disease (TED). A significant decreasing trends in the number of orbital and eyelids publications were found (P<0.01, P<0.01). However, there were no significant changes in the annual-rate of orbital, eyelids, TED and lacrimal-diseases publications throughout the last decade. Oculoplastic subspecialty deals with a wide range of pathologies in different ages. However, less than 5% of the articles in general, clinical, high impact factor ophthalmology journals are about oculoplastic diseases. One of the best way for ophthalmologists from different subspecilties, nowadays, to be updated, is to read high-impact-factor, general ophthalmology journals. Therefore, it is important that those journals will include articles about breakthroughs in oculoplastic.

Clinical Results of Punch Biopsy for Various Eyelid Disorders in the Office Setting

Purpose: To introduce punch biopsy, which can be easily performed in an outpatient setting, and to evaluate its clinical usefulness.Methods: A retrospective study was performed in 33 patients with atypical eyelid disorders who underwent punch biopsy.Results: This study included 33 eyes (33 patients; male:female = 12:21) with a mean age of 57.27 ± 19.12 years. There were 19 (57.6%) right eye, 14 (42.4%) left eye, 15 (45.5%) upper eyelid, and 18 (54.5%) lower eyelid lesions. The biopsy approaches were percutaneous and transconjunctival in 24 (72.7%) and nine (27.3%) eyes, respectively. Benign and malignant lesions were found in 21 (63.6%) and 12 (36.4%) eyes, respectively. The benign lesions included chalazion (52.4%), acute and chronic inflammation (23.8%), acanthosis (4.8%), and ectopic cillia (4.8%), and were treated conservatively by intralesional steroid injections or incision and drainage. The malignant lesions included sebaceous carcinomas (33.3%), squamous cell carcinomas (25%), and basal cell carcinomas (16.7%), with various treatments, including surgical resections, chemotherapy, and radiation therapy.Conclusions: Punch biopsy is a safe and quick procedure that can easily be performed in the office setting for patients who require a pathologic diagnosis for eyelid diseases, including malignancies. It may be useful for diagnosis and treatment planning.

Descriptive study of a telemedicine program in palpebral pathology for primary care (tele-eyelid).

In 2013 we implemented an asynchronous telemedicine circuit for the diagnosis of eyelid diseases (tele-eyelid), connecting the outpatient primary healthcare with the hospital's specialists. The purpose of this study is to assess the use of telemedicine in the diagnosis of eyelid diseases by primary care teams, to evaluate its usefulness and to analyse the epidemiology of the pathological conditions referred to the tertiary level hospital, as well as the need for surgery. This study was carried out in the Spanish public health system, in a mainly rural area assisted by the Institut Català de la Salut (ICS) and Althaia Xarxa Assistencial Universitària de Manresa. This is a retrospective, descriptive analysis of the telematic consultations undertaken between 2013 and 2019. The consultations between 2018 and 2019 underwent a further descriptive retrospective-prospective analysis to assess the conditions referred to the hospital. Unnecessary referrals were avoided in 72% of telematic consultations. More than 50% of primary care practitioners used tele-eyelid. Up to 68% of the referrals were due to eyelid tumours, 50% needed surgery and 18%, a biopsy. Moreover, we found a high reliability between telematic and face-to-face diagnosis. Teleophthalmology applied to eyelid pathology is a useful tool to improve access to specialized care and helps solving pathological conditions. It avoids unnecessary consultations and increases efficiency, both in primary and hospital care.

Estudio descriptivo de un programa de telemedicina en patología palpebral para atención primaria (telepárpados)

Background and objectiveIn 2013 we implemented an asynchronous telemedicine circuit for the diagnosis of eyelid diseases (tele-eyelid), connecting the outpatient primary healthcare with the hospital's specialists. The purpose of this study is to assess the use of telemedicine in the diagnosis of eyelid diseases by primary care teams, to evaluate its usefulness and to analyse the epidemiology of the pathological conditions referred to the tertiary level hospital, as well as the need for surgery. Materials and methodsThis study was carried out in the Spanish public health system, in a mainly rural area assisted by the Institut Català de la Salut (ICS) and Althaia Xarxa Assistencial Universitària de Manresa. This is a retrospective, descriptive analysis of the telematic consultations undertaken between 2013 and 2019. The consultations between 2018 and 2019 underwent a further descriptive retrospective-prospective analysis to assess the conditions referred to the hospital. ResultsUnnecessary referrals were avoided in 72% of telematic consultations. More than 50% of primary care practitioners used tele-eyelid. Up to 68% of the referrals were due to eyelid tumours, 50% needed surgery and 18%, a biopsy. Moreover, we found a high reliability between telematic and face-to-face diagnosis. ConclusionsTeleophthalmology applied to eyelid pathology is a useful tool to improve access to specialized care and helps solving pathological conditions. It avoids unnecessary consultations and increases efficiency, both in primary and hospital care.

Rare presentations of primary amyloidosis as ptosis: a case report

BackgroundAmyloidosis is a rare, progressive and variable group of diseases characterized by extracellular deposits of amyloid protein in different tissues and organs. It is a protein-misfolding disease in which small proteins of about 10 to 15 kDa acquire an alternative and relatively misfolded state at minimum energy and subsequently aggregate into oligomers and polymers. It mimics other eyelid diseases, such as involutional ptosis, eyelid granulomatous or cancerous lesions. Misdiagnosis of eyelid amyloidosis is usual when the lesion grows slowly and insidiously. Definite diagnosis depends on clinical suspicion and tissue-proven biopsy.Case presentationA 50-year-old female had painless progressive ptosis in both eyes for 6 months. She presented with limited upward gaze due to swelling of the upper eyelids OU. She complained of mild foreign body sensation. Upon examination, we observed an infiltrated irregular yellowish mass on the surface of her upper palpebral conjunctiva in both eyes. The mass was non-movable without tenderness. We performed excisional biopsy for the masses and subsequent histopathology of the biopsy specimens revealed amyloidosis. Systemic workup showed no other lesions. Unfortunately, her ptosis and upward gaze restriction was not improved after the operation. However, the masses did not enlarge in the following 3 months.ConclusionsThe varied presentations of ocular adnexal and orbital amyloidosis often lead to a significant delay between first symptoms and diagnosis. Immediate confirmatory biopsy and subsequent systemic workup should be performed whenever amyloidosis is highly suspected.KeywordsAmyloidosisConjunctival massPtosis

The Efficacy of Kohl (Surma) and Erythromycin in Treatment of Blepharitis: An Open-Label Clinical Trial.

Introduction Blepharitis is a common and chronic form of eyelid inflammation. Blepharitis treatment aims to decrease symptoms through antibacterial effects. One of the most common treatments of eyelid diseases in traditional medicine is using kohl. This clinical trial aimed to investigate its efficacy as a complementary treatment in staphylococcal blepharitis through an open-label clinical trial. Materials and Methods Thirty patients were randomized to receive kohl in one eye contralateral and erythromycin ointment in another eye for 90 days. At baseline and after 90 days of treatment, symptoms, clinical signs, and side effects of treatments were recorded. Statistical analysis was carried out using SPSS software, version 19. Results Despite randomization, there was a significant difference between the intervention and control eyes in the baseline mean clinical score (intervention eye: 9.86 (2.95) and control eye: 4.30 (2.81), P < 0.001). The degree of reduction of related signs and symptoms in the eyes treated with kohl was significantly higher than that in the control group: (5.2 vs. 2.20, P < 0.001) for symptoms and (7.40 vs. 2.46, P < 0.001) for clinical signs. Cohen's d statistic for mean difference of sign and symptom was 2.4 and 1.75, respectively, indicating a very strong effect. Conclusion The present study results demonstrated a significant improvement in blepharitis-related signs and symptoms. The degree of improvement in the eyes treated with kohl was much higher than that in the control eyes.

Ocular morbidity among school children of Pokhara valley

Background: Ocular morbidity is common among school going children. The uncorrected refractive error is an important cause of childhood blindness and visual impairment. School based eye screening programs help to identify the ocular abnormalities so that early intervention can be done and prevent children from permanent visual disability. Objectives: This research was done to find the prevalence of ocular morbidity and their pattern among primary school children of Pokhara Valley, Nepal. Methods: A descriptive cross-sectional study was conducted among children of three primary schools of Pokhara Valley from January to March 2021. Children who needed further evaluation were referred to ophthalmology department, Gandaki Medical College. After the ethical clearance from the institutional review committee, 1034 children were taken by convenient sampling method. Visual acuity, objective and subjective refraction, extraocular motility, cover test, anterior and posterior segment findings were documented in predesigned proforma. Point estimate at 95% confidence interval along with frequency and proportion were calculated. SPSS 20.0 was used for data analysis. Results: A total 1034 children between 5-16 years were examined. Ocular morbidity was observed in 181 (17.5%) at 95% confidence interval (15.4-18.6). The mean age of children with ocular morbidity was 12.33 ± 2.39 years with male to female ratio of 1.18:1. The common type of ocular morbidity was refractive error 107 (10.35%), conjunctivital diseases 35 (3.38%) and eyelid diseases 26 (2.5%). Myopia 83 (8.02%) was the most common type of refractive error. Conclusion: Refractive error was the commonest form of ocular morbidity among school children.

The Etiology of Dry Eye Syndrome in a Group of Patients visited Ophthalmic Department of Azady Teaching Hospital in Kirkuk

Purpose: To clarify the etiology of dry eye syndrome, distribution of age and gender among study group and to identify risk factors for dry eye. Method: A descriptive study done in Azady Teaching Hospital from 1 of July 2020 to 1 September 2021. The research included 946 patients above 40 years of mixed population. Result: the mean age of study group was 55,5 years, mean age of dry eye group was 57,2 years, The prevalence of dry eye in was 17.8 % and founded to be maximum in the elderly as majority of diagnosed dry eye patients were in their sixties 42%. Dry eye syndrome funded to be more common in female (19.4%) than in male (15.8%). The main etiological factors in our study were either:1-Ocular causes: eye lid diseases (blepharitis and MGD) 20%, abnormal ocular surface 12%, old trachoma 4.8%, ocular surgery (3.6%). 2-systemic disease: were founded to be rheumatoid arthritis (12%), diabetes (10.8%), thyroid disease (4.8%) Sjogren disease (2.4%) and pemphigus (1.2%). 3-Drug induced dry eye: Drugs that contribute to dry eye syndrome discovered to be mainly antihypertensive (15.4%), antiglaucoma (8.4%), antihistamine (2.4%) and anticholinergic (1.2%). Conclusions: Dry eye disease is more common in people over 40,and this should be taken into account when examining patients in ophthalmology clinics, Dry is more common in women, especially postmenopausal Dry eye is a frequent disease and correct diagnosis is the main line in treatment and, so we need to keep in mind those at higher risk.

Effect of ocular demodicosis on the stability of the tear film and the tear break up time

The aim of the study was to analyze the correlation between the presence of Demodex mites in the hair follicles of patients' eyelashes and the stability and break up time of the tear film assessed with the Non-Invasive Tear Break Up Times (NIBUT) method. 319 patients were included in the study (195 women, 124 men). The patients were divided into two groups: those with Demodex infestation and without visible symptoms of eyelid or eye surface diseases, and asymptomatic non-infested patients. The NIBUT analysis was performed with a 5 M keratograph (oculus). Non-invasive tests were performed to identify the first and mean values of the tear break up time. The first and mean tear break up time in the Demodex-infested group was lower than in the non-infested subjects. The difference was a highly statistically significant. There was a significant correlation with the age of the patients for the first break up time. The first break up time in both eyes decreased with the age of the Demodex-infested and non-infested patients. The NIBUT analyses indicate the impact of Demodex mites on the tear film stability. This may suggest possible association of demodicosis with dry eye syndrome.

Eight years experience with botulinum toxin A and eyelid surgery in the treatment of hemifacial spasm

AIM: To report the therapeutic outcomes of botulinum toxin A (Botox) and eyelid surgery in patients with hemifacial spasm (HFS). METHODS: Patients’ images and medical notes were retrospectively reviewed with subsequent analysis of both the therapeutic outcomes and complications of Botox injections. RESULTS: The information of 76 patients (female=58) with HFS who received a minimum of 4 Botox injections were included. The mean follow-up interval was 83±50 (20-112)mo with an average of 16±10 (4-34) injections. The peak incidence was between 55 and 64 years and the average age of onset was 66±11 (32-85)y. Up to 23% of patients with HFS had aberrant vascular structures (right=8, left=7) in close relationship to the facial nerve (MRI=14, CT=1), where the vertebral artery (n=6) was the most involved vessel followed by the anterior inferior cerebellum artery (n=5). Patients with primary HFS had a shorter effective duration (2.5 vs 3.1mo, P&lt;0.05), a longer onset time (4.1 vs 3.8d, P=0.739) and a lower Subjective Spasm Alleviation score (SSAs; 1.7 vs 1.9, P=0.179) than those with secondary HFS. Twelve of the 19 patients with preexisting eyelid diseases underwent surgical correction including upper blepharoplasty (n=12), limited myectomy (n=7), browplasty (n=7) and advancement of levator aponeurosis (n=5). Five (41.7%) of those with surgical correction and suboptimal response to Botox showed improvement 6mo after surgery [onset time (P=0.0256), effective duration (P=0.374) and SSAs (P=0.0161)]. Those 12 patients with eyelid surgery had a lower complication rate than those without eyelid surgery (23% vs 42%, P≤0.05). CONCLUSION: Botox is an effective and safe treatment for HFS. Patients with primary HFS had a less favorable therapeutic outcome with Botox than those with secondary HFS. Eyelid surgery for patients with concurrent eyelid diseases can augment the effect of subsequent Botox injections by improving patient satisfaction and reducing complication rate.

Progress in eyelid diseases and surgery

Progress in eyelid diseases and surgery

Injectable bio-responsive hydrogel for therapy of inflammation related eyelid diseases

Eyelid plays a vital role in protecting the eye from injury or infection. Inflammation related eyelid diseases, such as blepharitis, are the most common ocular disorders that affect human's vision and quality of life. Due to the physiological barriers and anatomical structures of the eye, the bioavailability of topical administrated therapeutics is typically less than 5%. Herein, we developed a bio-responsive hydrogel drug delivery system using a generally recognized as safe compound, triglycerol monostearate (TG-18), for in-situ eyelid injection with sustained therapeutics release. In vitro, drug release and disassembly time of Rosiglitazone loaded hydrogel (Rosi-hydrogel) were estimated in the presence or absence of MMP-9, respectively. Moreover, the disassembly of TG-18 hydrogel was evaluated with 9-month-old and 12-month-old mice in vivo. Owing to the bio-responsive nature of Rosi-hydrogel, the on-demand Rosiglitazone release is achieved in response to local enzymes. These findings are proved by further evaluation in the age-related meibomian gland dysfunction mice model, and the bio-responsive hydrogel is used as an in-situ injection to treat eyelid diseases. Taken together, the in-situ eyelid injection with sustained drug release opens a window for the therapy of inflammation related eyelid diseases.