Posterior Blepharitis Research Articles

One man's poison is another man's meat: Using azithromycin-induced phospholipidosis to promote ocular surface health

Drug-induced phospholipidosis (PLD) is a common adverse effect which has led to the termination of clinical trials for many candidate pharmaceuticals. However, this lipid-inducing effect may be beneficial in the treatment of meibomian gland dysfunction (MGD). MGD is the major cause of dry eye disease (DED), which affects 40 million people in the USA and has no cure. Azithromycin (AZM) is a PLD-inducing antibiotic that is used off-label to treat MGD, and is presumably effective because it suppresses the MGD-associated conjunctival inflammation (i.e. posterior blepharitis) and growth of lid bacteria. We hypothesize that AZM can act directly to promote the function of human meibomian gland epithelial cells by inducing PLD in these cells, characterized by the accumulation of lipids and lysosomes. Immortalized human meibomian gland epithelial cells (HMGEC) were cultured with or without azithromycin for 5 days. Cells were evaluated for cholesterol (Filipin) and neutral lipid (LipidTox) staining, as well as the appearance of lysosomes (LysoTracker) and lamellar bodies (transmission electron microscopy, TEM). The lipid composition of cellular lysates was analyzed by high performance thin-layer chromatography. Our findings demonstrate that AZM stimulates the accumulation of free cholesterol, neutral lipids and lysosomes in HMGEC. This AZM-induced increase of neutral lipid content occurred predominantly within lysosomes. Many of these vesicles appeared to be lamellar bodies by TEM, which is the characteristic of PLD. Our findings also show that AZM promotes an accumulation of free and esterified cholesterol, as well as phospholipids in HMGECimmortalized. Our results support our hypothesis and confirm the beneficial effect of PLD induced by AZM on HMGEC. Our discovery reveals a new potential use of PLD-inducing drugs, and makes this adverse effect a beneficial effect.

Effect of Azithromycin on Lipid Accumulation in Immortalized Human Meibomian Gland Epithelial Cells

Meibomian gland dysfunction (MGD) is believed to be the leading cause of dry eye disease (DED), which afflicts tens of millions Americans (1). Of particular interest, the most common pharmaceutical treatment for the management of MGD in the United Statesis the off-label use of topical azithromycin (2). This macrolide antibiotic is presumed to be effective because of its anti-inflammatory and anti-bacterial actions, which may suppress the MGD-associated posterior blepharitis and growth of lid bacteria (3). However, there are no published, peer-reviewed data demonstrating that azithromycin has the ability to act directly on the human meibomian gland to enhance this tissue’s function, and to ameliorate the pathophysiology of MGD. We hypothesize that azithromycin can act directly on human meibomian gland epithelial cells to stimulate their differentiation, enhance the quality and quantity of their lipid production, and promote their holocrine secretion. Our purpose was to begin to test our hypothesis.

Posterior blefaritli hastalarda topikal siklosporin A tedavisinin gözyaşı film instabilitesine etkisi

Objective: The aim of this study is to evaluate the efficacy of topical cyclosporine A (CsA) 0.05% (Restasis, Allergan Pharmaceuticals) in patients with posterior blepharitis. Methods: The study included 15 patients with posterior blepharitis. Topical CsA 0.05% (Restasis, Allergan Pharmaceuticals) was applied twice a daily for 2 months. They were evaluated at baseline and after treatment for subjective symptoms and objective signs including tear breakup time (BUT), Schirmer scores, conjunctival hyperemia, tarsal telangiectasis and Meibomian gland inclusions. Results: Fifteen patients completed the study. At the 2-month visit, the patients showed improvement in ocular symptom including burning, itching, conjunctival hyperemia (p

Blepharitis — a review of diagnosis and management

Blepharitis is a common chronic inflammatory condition of the eyelid margin, but its true incidence and prevalence is unknown. It is classified anatomically into anterior blepharitis involving the anterior lid margin and posterior blepharitis involving meibomian gland dysfunction. Its presentation include: soreness, itchiness, burning sensation associated with scales and abnormal eye lash architecture. Diagnosis is made with a careful history and slit-lamp examination, with careful attention to the eyelid. Eye lashes can also be examined under high magnification for Demodex mite. Management includes conservative (eye-massaging with warm flannels and mild soap), and pharmacological interventions (topical and systemic antibiotics, with occasional use of topical steroids and cyclosporin A). This article will explore the epidemiology, clinical features, investigations and clinical management plans involved in blepharitis.

Azithromycin 1.5% ophthalmic solution: efficacy and treatment modalities in chronic blepharitis.

To assess the efficacy of topical 1.5% azithromycin in the treatment of moderate to severe chronic blepharitis and to compare the efficacy of two different treatment modalities. A randomized clinical trial included 67 patients with chronic anterior and/or posterior blepharitis, followed-up for 3 months. Signs and symptoms were graded according to severity. Patients were randomized into two groups: 33 patients in group I and 34 patients in group II. Group I patients were treated with topical 1.5% azithromycin twice a day for three days, and Group II patients were treated with topical 1.5% azithromycin twice a day for three days then at bedtime for the rest of the month. All patients were instructed to apply warm compresses and an eye-friendly soap twice daily. Patients in both groups tolerated the treatment with minimal irritation. A significant improvement in signs and symptoms was noted at the one week follow-up visit. Group II showed a more pronounced and longer-lasting improvement that persisted after three months of follow-up. Topical 1.5% azithromycin ophthalmic solution is an effective treatment option for chronic blepharitis. In moderate to severe blepharitis, a one month treatment is safe and shows better improvement than the three-day protocol with no significant relapse until three months of follow-up.

Interventions for chronic blepharitis.

Blepharitis, an inflammatory condition associated with itchiness, redness, flaking, and crusting of the eyelids, is a common eye condition that affects both children and adults. It is common in all ethnic groups and across all ages. Although infrequent, blepharitis can lead to permanent alterations to the eyelid margin or vision loss from superficial keratopathy (abnormality of the cornea), corneal neovascularization, and ulceration. Most importantly, blepharitis frequently causes significant ocular symptoms such as burning sensation, irritation, tearing, and red eyes as well as visual problems such as photophobia and blurred vision. The exact etiopathogenesis is unknown, but suspected to be multifactorial, including chronic low-grade infections of the ocular surface with bacteria, infestations with certain parasites such as demodex, and inflammatory skin conditions such as atopy and seborrhea. Blepharitis can be categorized in several different ways. First, categorization is based on the length of disease process: acute or chronic blepharitis. Second, categorization is based on the anatomical location of disease: anterior, or front of the eye (e.g. staphylococcal and seborrheic blepharitis), and posterior, or back of the eye (e.g. meibomian gland dysfunction (MGD)). This review focuses on chronic blepharitis and stratifies anterior and posterior blepharitis. To examine the effectiveness of interventions in the treatment of chronic blepharitis. We searched CENTRAL (which contains the Cochrane Eyes and Vision Group Trials Register) (The Cochrane Library 2012, Issue 1), MEDLINE (January 1950 to February 2012), EMBASE (January 1980 to February 2012), the metaRegister of Controlled Trials (mRCT) (www.controlled-trials.com), ClinicalTrials.gov (www.clinicaltrials.gov) and the WHO International Clinical Trials Registry Platform (ICTRP) (www.who.int/ictrp/search/en). We searched the reference lists of included studies for any additional studies not identified by the electronic searches. There were no date or language restrictions in the electronic searches for trials. The electronic databases were last searched on 9 February 2012. We included randomized controlled trials (RCTs) and quasi-randomized controlled trials (CCTs) in which participants were adults aged 16 years or older and clinically diagnosed with chronic blepharitis. We also included trials where participants with chronic blepharitis were a subset of the participants included in the study and data were reported separately for these participants. Interventions within the scope of this review included medical treatment and lid hygiene measures. Two authors independently assessed search results, reviewed full-text copies for eligibility, examined risk of bias, and extracted data. Data were meta-analyzed for studies comparing similar interventions and reporting comparable outcomes with the same timing. Otherwise, results for included studies were summarized in the text. There were 34 studies (2169 participants with blepharitis) included in this review: 20 studies (14 RCTs and 6 CCTs) included 1661 participants with anterior or mixed blepharitis and 14 studies (12 RCTs and 2 CCTs) included 508 participants with posterior blepharitis (MGD). Due to the heterogeneity of study characteristics among the included studies, with respect to follow-up periods and types of interventions, comparisons, and condition of participants, our ability to perform meta-analyses was limited. Topical antibiotics were shown to provide some symptomatic relief and were effective in eradicating bacteria from the eyelid margin for anterior blepharitis. Lid hygiene may provide symptomatic relief for anterior and posterior blepharitis. The effectiveness of other treatments for blepharitis, such as topical steroids and oral antibiotics, were inconclusive. Despite identifying 34 trials related to treatments for blepharitis, there is no strong evidence for any of the treatments in terms of curing chronic blepharitis. Commercial products are marketed to consumers and prescribed to patients without substantial evidence of effectiveness. Further research is needed to evaluate the effectiveness of such treatments. Any RCT designed for this purpose should separate participants by type of condition (e.g. staphylococcal blepharitis or MGD) in order to minimize imbalances between groups (type I errors) and to achieve statistical power for analyses (prevent type II errors). Medical interventions and commercial products should be compared with conventional lid hygiene measures, such as warm compresses and eyelid margin washing, to determine effectiveness, as well as head-to-head to show comparative effectiveness between treatments. Outcomes of interest should be patient-centered and measured using validated questionnaires or scales. It is important that participants be followed long-term, at least one year, to assess chronic outcomes properly.

Oral Azithromycin for Treatment of Posterior Blepharitis

To evaluate the effects of oral azithromycin in patients with posterior blepharitis. Twenty-six eyes of 13 patients with posterior blepharitis diagnosed by a qualified ophthalmologist were enrolled in this study. Patients were instructed to use oral azithromycin 500 mg per day for 3 days in 3 cycles with 7-day intervals. Subjective clinical outcomes were graded and scored 1 day before and 30 days after the end of the treatment (53 days after initiating the treatment) based on severity scores of: (1) eyelid debris; (2) eyelid telangiectasia; (3) swelling of the eyelid margin; (4) redness of the eyelid margin; and (5) ocular mucus secretion. For the assessment of global efficacy, patients were asked by the investigator to rate the subjective symptoms (eyelid itching, ocular itching, eyelid hyperemia, ocular hyperemia, ocular mucus secretion, photophobia, foreign body sensation, and dry eye sensation) on a scale of 0 (no symptoms) to 5 (severe symptoms). Break-up time, Schirmer I test, corneal fluorescein staining score, and rose bengal staining score were also performed in all patients. All clinical outcomes scoring showed statistically significant improvement after oral azithromycin, except for eyelid swelling. Average subjective symptom grading improved statistically after treatment with oral azithromycin, except for eyelid hyperemia, photophobia, and foreign body sensation. Average tear film break-up time values showed statistically significant improvement after the treatment with oral azithromycin. No statistically significant improvement was observed on average values of Schirmer I test, corneal fluorescein staining score, and rose bengal staining score. The combination of multiple clinical parameters shown in this study supports the clinical efficacy of pulsed oral azithromycin therapy for the management of posterior blepharitis.

Efficacy of wet chamber warming goggles (Blephasteam®) in patients with posterior blepharitis

AbstractPurpose Posterior blepharitis is a main cause of dry eye. Lid hygiene is an important treatment, but compliance is often poor because of its complexity and lack of specific devices. The aim of this study is to assess the efficacy of wet chamber warming goggles (Blephasteam®) in patients with posterior blepharitis.Methods In this interventional multicenter prospective uncontrolled study, patients with meibomian gland dysfunction were enrolled. Blephasteam® (Laboratoires Thea, Clermont‐Ferrand, France) was used once or twice a day during 10 minutes, with a following lid massage. Main outcome measures were assessed at baseline and after 3 weeks, including symptoms (ocular discomfort on a visual analogic scale‐primary endpoint, and separate symptoms), signs of blepharitis, Schirmer test, Break up time, corneal fluorescein vital staining, and tear osmolarity (measured with the Tearlab® system).Results Thirty patients (16 women, 14 men), mean age 48 ± 22 years (4 to 82 years) were included. After 3 weeks of treatment, mean global visual analogic scale symptom score decreased by 15.2 ± 22 mm (range, +32 to ‐57 mm on a 100 mm scale)(p=0.004). Mean composite blepharitis score decreased by ‐3.5 points on the worst eye (range, +1 to ‐10 on a 20 points scale)(p<0,001). No change was observed for the other parameters among which BUT, IOP and tear osmolarity. Improvement rated by the patient was important in 48 % of cases, moderate in 36% and fair in 16%.Conclusion Blephasteam® wet chamber warming goggles are a promising alternative to classical lid hygiene techniques. A multicenter extended study is ongoing. Commercial interest

The International Workshop on Meibomian Gland Dysfunction: Report of the Subcommittee on the Epidemiology of, and Associated Risk Factors for, MGD

Scientists have been interested in studying the secretions of the meibomian glands for many years, 1– 8 and diseases associated with the meibomian glands (e.g., cancers, posterior blepharitis) have been noted in the medical literature since at least the early part of the 20th Century. 9 –13 However, the term “meibomian gland dysfunction” (MGD) was only introduced by Korb and Henriquez in 1980. 14 The terminology “meibomian gland disease” was later introduced by Bron et al. 15 as an umbrella term to indicate any disease affecting the meibomian glands (see Definition and Classification). Although the etiology of MGD may differ from that of aqueous-deficient dry eye disease (which is due to insufficient lacrimal gland production), the two conditions share many clinical features, including symptoms of ocular surface irritation and visual fluctuation, altered tear film stability, and potential ocular surface compromise. When MGD is of sufficient degree, it may give rise to the second major subtype of dry eye disease, evaporative dry eye. 16 These subtypes are not mutually exclusive, as has been acknowledged. 16

The International Workshop on Meibomian Gland Dysfunction: Report of the Subcommittee on Management and Treatment of Meibomian Gland Dysfunction

The goals of the subcommittee were to review the current practice and published evidence of medical and surgical treatment options for meibomian gland dysfunction (MGD) and to identify areas with conflicting, or lack of, evidence, observations, concepts, or even mechanisms where further research is required. To achieve these goals, a comprehensive review of clinical textbooks and the scientific literature was performed and the quality of published evidence graded according to an agreed on standard, using objective criteria for clinical and basic research studies adapted from the American Academy of Ophthalmology Practice Guidelines1 (Table 1). It should be noted that, in many of the clinical textbooks and previous reports, terminology is often interchanged and the management of anterior and posterior blepharitis and/or meibomitis is often considered concurrently. Thus, a broad scope of documents was reviewed in this process. Consistency in terminology and global adoption of the term “meibomian gland dysfunction” would significantly aid clinical research and clinical care in MGD going forward. Table 1. Grading Level of Evidence of Clinical and Basic Research Studies1

Efficacy of azithromycin 1% ophthalmic solution for treatment of ocular surface disease from posterior blepharitis

Background: Posterior blepharitis is an eyelid disease primarily of the meibomian glands. Bacteria and chronic inflammation are contributing factors for meibomian gland disease, which leads to ocular surface and tear film alterations and chronic patient symptoms. Azithromycin 1.0% ophthalmic solution is a broad spectrum topical antibiotic with anti‐inflammatory properties. The present study evaluates the efficacy of azithromycin 1.0% ophthalmic solution in the treatment of the clinical signs and symptoms, including vision‐related function, associated with meibomian gland dysfunction.Methods: In an open label study, 33 patients with meibomian gland dysfunction were treated with azithromycin 1.0% ophthalmic solution twice a day for two days, then every evening for a total of 30-days. Tear break‐up time, corneal staining, conjunctival staining, Schirmer scores with anaesthetic, meibomian gland score and patient's symptom scores were evaluated at baseline and after 30-days of treatment. The Ocular Surface Disease Index (OSDI) was administered at baseline, after two weeks of treatment and after 30-days of treatment.Results: Twenty‐six of 33 patients completed the study. Tear break‐up time and Schirmer score increased by 52.7 per cent (p < 0.0001) and 24 per cent (p < 0.05), respectively. There was a reduction in corneal and conjunctival staining by 83.2 and 67.9 per cent, respectively (p < 0.0001). Lid margin scores were reduced by 33.9 per cent (p < 0.0001). The patient's symptom score improved from 2.73 at baseline to 2.21 after 30-days of treatment (p < 0.01). The mean OSDI at baseline was 34.44. After two weeks and 30-days of treatment, the ODSI was 14.51 and 13.15 respectively (p < 0.0001).Conclusion: These results demonstrate clinically and statistically significant improvement in the signs and symptoms associated with posterior blepharitis. Based on these results, azithromycin 1% ophthalmic solution offers a viable option for the treatment of posterior blepharitis.

Clinical Treatment of Ocular Demodex folliculorum by Systemic Ivermectin

To report clinical outcomes of the treatment of ocular Demodex folliculorum with oral ivermectin. Noncomparative, interventional case series. Setting. Institutional. Study Population. Twenty-four eyes of 12 patients (3 male and 9 female; mean age ± standard deviation, 50.4 ± 21.0 years) with refractory posterior blepharitis with the presence of D. folliculorum in lash samples were enrolled in this study. Intervention. Patients were instructed to take 1 dose of oral ivermectin (200 μg/kg). All patients were instructed to repeat the treatment after 7 days. Main outcome measures. Tear meniscus height, Schirmer I test results, noninvasive tear film break-up time (BUT), quantification of the absolute number of D. folliculorum found in the lashes, and corneal fluorescein and rose bengal staining scores were obtained from all patients 1 day before and 28 days after treatment. Statistical improvement was observed in the absolute number of D. folliculorum found in the lashes after the treatment with oral ivermectin. Average values of Schirmer I test results and tear film break-up time improved statistically after the treatment of oral ivermectin. No statistical improvement was observed in average lacrimal meniscus height or value of corneal fluorescein and rose bengal staining after treatment with oral ivermectin. Ivermectin successfully reduced the number of D. folliculorum found in the lashes of patients with refractory blepharitis. Oral ivermectin may be very useful as a complement in the treatment of D. folliculorum infestation with ocular manifestation, especially in cases of unsuccessful treatment related to patient compliance.

Clinical spectrum of pediatric blepharokeratoconjunctivitis

To evaluate the incidence, symptoms, clinical signs, and therapy instituted in children with blepharokeratoconjunctivitis (BKC). In this observational, retrospective case series, we reviewed all medical records of pediatric patients presenting to the ophthalmology clinic at the Kalawati Saran Children's Hospital, New Delhi, India from 2003 to 2006. History, clinical characteristics, and treatment protocol were noted, as well as reason for presentation/referral and subsequent diagnosis. Of 5,012 pediatric patients, 615 (12%) demonstrated features of BKC. Boys were more commonly affected (62%) than girls. The mean age at presentation was 6.7 years (range, 7 months to 16 years). Lid involvement and conjunctival congestion were consistent features. Anterior (seborrheic variety) blepharitis was seen in nearly half the children (302), followed by chalazion (18%), external hordeolum (17%), ulcerative anterior blepharitis (6%), phlyctenular keratoconjunctivitis (6%), and marginal ulcerative keratitis (2%). Refractive error was evident in 521 of 615 children (85%) with BKC. All patients were treated with daily eyelid hygiene, warm compresses, and topical antibiotics. Corticosteroid drops were prescribed in 14% and oral erythromycin in 23%. BKC was the commonest diagnosis at consultation among all pediatric referrals. Anterior blepharitis was more common than posterior blepharitis. Severe cases with corneal involvement accounted for only 5% of the disease spectrum.

Pathogenic role of Demodex mites in blepharitis

To summarize the key literature and our research experience regarding Demodex infestation as a potential cause of ocular inflammatory diseases with a special emphasis on Demodex blepharitis. Two distinct Demodex species have been confirmed as a cause of blepharitis: Demodex folliculorum can cause anterior blepharitis associated with disorders of eyelashes, and D. brevis can cause posterior blepharitis with meibomian gland dysfunction and keratoconjunctivitis. Tea tree oil treatments with either 50% lid scrubs or 5% lid massages are effective in eradicating mites and reducing ocular surface inflammation. Demodex blepharitis is a common but overlooked external eye disease. The pathogenesis of Demodex blepharitis in eliciting ocular surface inflammation has been further clarified. The modified eyelash sampling and counting method makes it easier and more accurate to diagnose Demodex infestation. Tea tree oil shows promising potential to treat Demodex blepharitis by reducing Demodex counts with additional antibacterial, antifungal, and anti-inflammatory actions.

Azithromycin in DuraSite&amp;reg; for the treatment of blepharitis

Blepharitis is a common inflammatory disease of the eyelid. Posterior blepharitis affects the posterior lamella of the eyelid and involves inflammation of the meibomian glands, whereas anterior blepharitis affects the anterior lamella of the eyelid and the eyelashes; either version can be inflammatory or infectious in nature. Each of these conditions can incite or propagate the other; anterior blepharitis, if not treated, can lead to meibomian gland disease, and vice versa. Blepharitis is typically chronic, and can be associated with a variety of systemic diseases such as dermatitis, as well as ocular diseases such as dry eye, conjunctivitis, or keratitis. The standard treatment regimen historically consists of lid hygiene with warm compresses and eyelid scrubs, although these treatment modalities may have limited efficacy for many patients, especially those with more severe disease. Adjunctive treatment includes systemic and topical antibiotics, topical corticosteroids, and tear replacement therapy. Topical antibiotics are recommended to decrease the bacterial load, and topical corticosteroids may help in cases of severe inflammation. Azithromycin ophthalmic solution 1% in DuraSite((R)) (AzaSite((R)); Inspire Pharmaceuticals, Durham, North Carolina, USA) has been proposed as a novel treatment for posterior blepharitis, based on its well-known anti-infective profile, its anti-inflammatory properties, its excellent tissue penetration, and its regulatory approval for the treatment of bacterial conjunctivitis. This review focuses on an off-label indication for topical azithromycin 1% in DuraSite for the treatment of blepharitis.

Successful treatment of staphylococcus-associated marginal keratitis with topical cyclosporine

Dear Editor, Staphylococcus-associated marginal keratitis is an immunemediated corneal disorder secondary to blepharoconjunctivitis. Marginal infiltrates (also referred to as catarrhal infiltrates) usually occur where the eyelid margins intersect with the corneal surface. Marginal infiltrates in staphylococcal blepharitis are typically gray–white, wellcircumscribed, and located approximately 1 mm inside the limbus, with a characteristic clear zone of cornea between the infiltrate and the limbus. Superficial blood vessels cross the clear interval into the area of infiltration, and pannus may develop in chronic disease. Therapy includes reduction of toxin-producing microorganisms by eyelid hygiene, application of topical antibiotics and corticosteroids [1]. We are unaware of previous reports about the treatment of staphylococcus-associated marginal keratitis with topical cyclosporine. A 19-year-old boy presented with redness, discomfort, photophobia, and decreased vision in his left eye. He previously had blepharitis history for 3 years and keratitis history for 8 months. He was prescribed various topical antibiotics, nonsteroids, and corticosteroids, including fluoromethalone, dexamethasone by other clinics, but his complaints have not recovered. His best-corrected visual acuity was 20/200, and intraocular pressure was 15 mmHg with air-puff tonometry in the left eye. Slit-lamp biomicroscopic examination revealed matted anterior eyelid crusting, papillary reaction of the tarsal conjunctiva, severe conjunctival hyperemia, and especially inferior corneal neovascularization involved the pupillary axis (Fig. 1a). Fundoscopic examination was normal. We diagnosed marginal keratitis associated with staphylococcal blepharoconjunctivitis. The diagnosis of staphylococcal blepharoconjunctivitis was confirmed by growth of staphylococcus aureus in eyelid and conjunctival cultures. Daily eyelid hygiene was advised and topical cyclosporine 0.05% ophthalmic suspension was started 2 times daily because of unresponsiveness to corticosteroid treatment. His complaints began to decrease after 2 weeks, and completely improved after 6 weeks of treatment. Conjunctival hyperemia, and corneal neovascularization completely regressed (Fig. 1b), and his best-corrected visual acuity increased to 20/40 after 6 weeks of treatment. After 6 months of cyclosporine treatment, neither recurrence of neovascularization nor complaints of the patient were observed. Cyclosporine has been used successfully as a systemic immunomodulator for more than 2 decades, but an ophthalmic formulation, topical cyclosporine 0.05% ophthalmic emulsion, was approved by the US Food and Drug Administration to treat dry eye disease in 2003. Treatment with topical cyclosporine has been shown to reduce cell surface markers of activated T lymphocytes, expression of a proinflammatory cytokine, and apoptotic cells, and to increase goblet cell densities in conjunctival epithelium. Many chronic ocular surface disorders share features with dry eye disease, and their responses to immunomodulation therapy with cyclosporine have been evaluated. Because of this, in a number of previous studies, cyclosporine 0.05% ophthalmic emulsion has shown efficacy for management of vernal and atopic keratoconjunctivitis, ocular rosacea, posterior blepharitis, contact lens intolerance, greft-versusElectronic supplementary material The online version of this article (doi:10.1007/s00417-009-1290-4) contains supplementary material, which is available to authorized users.

Meibom-Drüsen

Meibomian gland dysfunction (MGD), mainly synonymous with posterior blepharitis but typically without prominent inflammatory alterations of the lid margin, is a discrete disease entity and a frequent cause of wetting deficiencies of the ocular surface leading to dry eye disease that deserves increased recognition by clinicians. The history, classification, pathology, influencing factors, diagnostics and therapy are explained and discussed. MGD is mainly based on an obstructive mechanism caused by hyperkeratinization of the excretory duct and/or increased viscosity of the secretion (meibum) with subsequent deficiency of the tear film lipid layer. MGD is influenced by the hormonal status and by chemical and mechanical noxes as well as genetic defects and it occurs more frequently in women and generally increases with age. It results in stasis of meibum inside the glands, dilatation of the ductal system and eventually in atrophy and loss of glandular tissue (gland dropout). Careful investigation of the eyelids and lid margins with eversion, if necessary, should therefore be performed in every case of a wetting defect, notably before fitting contact lenses. Particularly important is the inspection of the meibomian orifices and diagnostic expression by mild mechanical compression of the lid.

Blepharitis in the United States 2009: A Survey-based Perspective on Prevalence and Treatment

Like dry eye disease 15 years ago, blepharitis today is a poorly defined condition about which there is considerable misunderstanding. For a variety of reasons, there is little good data on either the prevalence of blepharitis or how eyecare practitioners currently treat it. The work reported herein consists of two recent studies: a telephone survey of a representative sample of the adult US population (n = 5,000) whose purpose was to discover the frequency of common ocular surface symptoms associated with blepharitis; and a study that queried a selected group of ophthalmologists (n = 120) and a similarly selected group of optometrists (n = 84) about the frequency of blepharitis in their practices, the existence comorbid conditions, and their management strategies. This data suggests that blepharitis symptoms are very common in the US population, with younger individuals reporting more, and more frequent, symptoms than older people, contrary to clinical dogma. Ophthalmologists and optometrists report that blepharitis is commonly seen in clinical practice in 37% and 47% of their patients, respectively, and it is widely agreed that meibomian gland dysfunction (MGD) is the most common cause of evaporative dry eye disease In addition, management paradigms are shifting away from more traditional management with antibiotic ointment and warm compress therapy to prescription therapy for anterior and posterior blepharitis.

Efficacy of topical azithromycin ophthalmic solution 1% in the treatment of posterior blepharitis

Azithromycin, a broad-spectrum antibiotic with potent anti-inflammatory activities, has the potential to effectively treat blepharitis, an inflammatory disease of the eyelid with abnormal eyelid flora as an etiologic determinant. The present study compared the efficacy of topical azithromycin ophthalmic solution 1% (AzaSite; Inspire Pharmaceuticals, Inc, NC, USA) combined with warm compresses (azithromycin group) to warm compresses alone (compress group) in patients with posterior blepharitis. Twenty-one patients diagnosed with posterior blepharitis were randomized in an open-label study to receive either azithromycin plus warm compresses (10 patients), or compresses alone (11 patients). All patients were instructed to apply compresses to each eye for 5-10 minutes twice daily for 14 days. Each eye in the azithromycin group also received azithromycin solution (1 drop) twice daily for the first 2 days followed by once daily for the next 12 days. Patients were evaluated at study initiation (visit 1) and at end of treatment (visit 2) for the severity of five clinical signs: eyelid debris, eyelid redness, eyelid swelling, meibomian gland (MG) plugging, and the quality of MG secretion. At visit 2, patients also rated their degree of overall symptomatic relief. Twenty patients completed the study. At visit 2, patients in the azithromycin group demonstrated significant improvements in MG plugging, MG secretions, and eyelid redness as compared with the compress group. In the azithromycin group, MG plugging resolved completely in three patients and MG secretion returned to normal in two patients; no such results were seen in the compress group. Furthermore, a higher percentage of patients in the azithromycin group rated overall symptomatic relief as excellent or good. Visual acuity measurements and biomicroscopic evaluation revealed no ocular safety issues. Azithromycin ophthalmic solution in combination with warm compresses provided a significantly greater clinical benefit than warm compresses alone in treating the signs and symptoms of posterior blepharitis.

The Changing Times in Dry Eye Research

The Changing Times in Dry Eye Research