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



ABSTRACT 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.
Outline for Perspective on Deciencies in Systematic Literature
Goal: To identify problems in peer and editorial evaluation of systematic literature
reviews and to recommend solutions.
I. The Problem: perpetuation of misinformation and faulty science through
inadequate peer review and editorial oversight of systematic literature
a. Recognition of inadequacies of peer review in science and medical
i. Cochran review on peer review
ii. Cardiology editorials
iii. Science editorial
b. Reasons for impairment of peer review
i. Increasing number of submitted publications
ii. Increasing demand for qualied peer reviewers
iii. Increasing challenge for editors to select qualied peer
reviewers and vet them
II. Examples from recently published systematic reviews regarding
measurement of tear lm osmolarity demonstrating the problem
a. Baeninger article
i. Identify bad science
1. Verifying instrument selection and methodology (eg,
Garcia paper)
2. Selection bias (eg, Esperjesi paper, Szalai paper)
3. Spectrum bias (eg, Esperjesi paper, Szalai paper)
4. Flawed statistical analysis
5. Omission of relevant data
6. Regression to the mean
ii. Note the inclusion of Szalai manuscript without recognition of
prior critique of letter to editor.
b. Szalai article
i. Identify bad science
1. Selection bias
2. Spectrum bias
ii. Note prior critique and lack of reference
III. Other examples
a. Omega-3 EFA systematic review
b. Studies outside of dry eye (?)
i. Downie article in JAMA Ophthalmology
IV. Possible Solutions
a. Awareness of the problem
i. Authors
ii. Peer reviewers
iii. Editors
b. Citation index options
i. Including citation of critiques and comments in the listing of
primary publication
ii. Including citation of letters to the editor in the listing of the
primary publication
c. Vetting of evidence (?)
i. Develop a vetting system to assure that peer reviewers are
aware of published critiques via available citations
ii. Use of independent expert opinion
d. Withdrawal of publications
i. Specic recommendations for adjudication
V. Conclusion
Suggested format:
I. Title: Deciencies in Published Systematic Literature Reviews
II. Authors
III. Abstract
IV. Table of contents
V. Introduction and statement of goal
VI. Text
VII. References
VIII. Disclosures
... Confusion on the differential diagnosis of blepharitis and its frequent association with dry eye disease complicates to achieve clear information from prevalence studies. A survey of clinicians in the United States showed that 37-47% of adults patients had findings of blepharitis (2). Venturino et al. studied ocular discomfort in 1148 patients and found that 12% of the subjects had anterior blepharitis, 24% had posterior blepharitis, and 21% had dry eye (3). ...
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Objectives: The purpose of the study was to determine interobserver and intraobserver agreement, repeatability, and intrasubject variation of the detection of Demodex infestation in eyelids of blepharitis patients using in vivo confocal microscopy (IVCM). Methods: Eighty-three eyes of 42 blepharitis patients were included in the study. All eyelids were evaluated from temporal to nasal with IVCM using section mode and 10 lashes with their follicles were imagined, and every image with suspicion of Demodex infestation was recorded. Two experienced and two inexperienced ophthalmologists were masked for the diagnosis and interpreted the IVCM images regarding the presence of Demodex infestation with a 3-week interval. Interobserver and intraobserver agreements were calculated with Cohen's kappa and its variant statistics between and within experienced observers and between inexperienced observers. Results: While average sensitivity for the diagnosis of demodicosis in IVCM images was 83.35% for experienced and 51.35% for inexperienced observers, the average positive predictive value was 88.6% for experienced observers and 91.05% for inexperienced ones. Interobserver agreement between experienced observers was moderate (κ = 0.529) and intraobserver agreements within experienced observers were perfect (κ = 0.918 for observer-1; κ = 0.958 for observer-2). Interobserver agreement between inexperienced observers was poor (κ = 0.162) and intraobserver agreements within inexperienced observers were fair (κ = 0.427 for observer-3; κ = 0.475 for observer-4). Conclusion: The sensitivity, interobserver and intraobserver agreements in IVCM image analysis for the detection of Demodex infestation were highly associated with the clinical experience on IVCM imaging. In the hands of an experienced clinician, IVCM could be reliable for the diagnosis of ocular demodicosis.
... 4 Pada sebuah survei, para dokter mata di Amerika Serikat melaporkan bahwa 37% hingga 47% pasien menderita blefaritis. 5 Pada studi kohort di Korea Selatan menggunakan data Korean National Health Insurance Service selama periode 2004-2013 ditemukan bahwa 1.116.363 individu terdiagnosis blefaritis dengan insiden keseluruhan adalah 1,1 per 100 orang per tahun dan perbandingan antara pria dan wanita adalah sekitar 1,3:0,9. ...
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p>Blefaritis merupakan kondisi oftalmologis yang ditandai dengan inflamasi pada margo kelopak mata. Secara anatomis, blefaritis dibagi menjadi blefaritis anterior dan posterior. Pilihan terapi blefaritis telah mengalami perkembangan dalam beberapa tahun terakhir. Kompres hangat dan membersihkan kelopak mata masih menjadi regimen pengobatan dasar; penggunaan antibiotik, steroid, dan inhibitor calcineurin menunjukkan efikasi yang baik. Suplementasi dan berbagai prosedur intervensi mungkin dapat dipertimbangkan di masa depan. Blepharitis is an ophthalmological condition characterized by inflammation of the eyelids. Anatomically, blepharitis is divided into anterior and posterior blepharitis. Therapeutic options for blepharitis have evolved in recent years. Warm compresses and eyelid hygiene are still the basic treatment regimen, but the use of antibiotics, steroids, and calcineurin inhibitors has shown good efficacy. Supplementations and various possible intervention procedures may be considered in the future.</p
Craig McArthur continues his series on developing a specialist care service for common ocular surface disorders with an in-depth look at an individual case of management of blepharitis and meibomian gland dysfunction
Craig McArthur continues his series on developing a specialist care service for common ocular surface disorders with an in-depth look at blepharitis and meibomian gland dysfunction.
Dr Marian Elder, Dr Sruthi Srinivasan, and Professor Lyndon Jones take a look at a new method of evaluating the tear film and anterior segment using the Easytear view+ dacrioscope.
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In the world, microorganisms are the main cause of eye illnesses. Common bacterial infections of the eye, if untreated, can damage the eye's structures and lead to blindness and other visual impairments. The eye may get infected from the outside or as a result of bloodstream-borne germs invading the eye. Infectious bacteria can cause eye infections. Blepharitis, conjunctivitis, Listeriosis, keratitis, dacryocystitis, etc. are some of the frequent eye illnesses brought on by bacterial and fungal pathogens. The information on the variety of ocular surface microorganisms has been significantly increased by the series of genome-based methods through 16S rRNA gene-based identification. According to this research, a sufficient number of bacteria have a substantial part in the pathophysiology of eye illnesses, even though certain bacteria contribute to normal ocular processes. As a result, those with good vision can shed light on the intricacy of the ocular microflora and learn more about some visual requirements in addition to their vital contribution to the regular operation of the eye. Under these conditions, it is crucial to establish a quick, dependable, and affordable procedure that will eventually become a standard diagnostic process. In this literature review, many databases have searched, and the review has been methodically conducted to produce specific results for the hard eye infection disorders.
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Introduction To investigate the association of blepharitis and ischemic stroke (IS). Methods This retrospective cohort study used population-based data in Taiwan. We identified 424,161 patients with blepharitis between 2008 and 2018. Results 424,161 pairs of blepharitis cohort and non-blepharitis cohort were 1:1 propensity score matched for statistical analysis. Patients with blepharitis had significantly increased risks of IS compared with the individuals without blepharitis (adjusted hazard ratio 1.32, 95% CI 1.29–1.34, P < 0.001). A significantly higher risk of IS was observed in blepharitis cohort with a previous diagnosis of cancer than in those without cancer (P for interaction < 0.0001). Kaplan–Meier survival analysis revealed the cumulative incidence of IS increased in the blepharitis cohort compared with that in the non-blepharitis cohort in 10 years (log-rank P < 0.001). The follow-up period analysis further indicated 1.41-fold adjusted hazard (95% CI 1.35 − 1.46, P < 0.001) of IS within a year after blepharitis diagnosis. Conclusions Patients with blepharitis had an elevated risk of developing IS. Further research is required to determine the causal relationship between blepharitis and IS, as well as the underlying mechanism.
Decreased vision in the aged population poses significant morbidity and decreases quality of life. At least one third of the American population over age 65 has significant vision compromise due to ophthalmic disease. Decreased vision limits independence and poses significant economic and societal burdens. Ophthalmic disease in the elderly poses significant challenges to patients and providers due to the vast and diverse spectrum of ophthalmic conditions, and therefore requires specialized care by optometrists and ophthalmologists. Ophthalmic diseases are seen at a higher frequency in aged patients and include structural changes, malignancies, and infections of the eyelids and orbit. In addition, diseases such as cataracts, age-related macular degeneration (ARMD), glaucoma, and ischemic optic neuropathy are seen at a significantly higher incidence in elderly patients and can result in severe vision loss. Routine ophthalmic care is required to identify, manage, and treat such diseases in order to prevent sequelae, optimize independence, and preserve vision. Medical therapies, surgical intervention, low-vision aids, and social support systems can be utilized to aid in treatment.
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Honey has been widely purported as a natural remedy due to its antimicrobial and anti-inflammatory effects. In recent years, several studies have suggested that the considerably high methylglyoxal (MGO) concentration in Mānuka honey (MH) makes it particularly effective to manage bacterial overload, such as that observed in blepharitis. However, the poor solubility, high viscosity, and osmolarity of aqueous honey solutions, especially at the high MGO concentrations studied in the literature, render the formulation of an acceptable dosage form for topical application to the eyelids challenging. Here, the antibacterial properties of raw MH and alpha-cyclodextrin (α-CD)-complexed MH were evaluated at relatively low MGO concentrations, and a liquid crystalline-forming microemulsion containing α-CD-complexed MH was formulated. After determining pH and osmolarity, ocular tolerability was assessed using human primary corneal epithelial cells and chorioallantoic membranes, while the antibacterial efficacy was further evaluated in vitro. The α-CD–MH complex had significantly greater antibacterial activity against Staphylococcus aureus than either constituent alone, which was evident even when formulated as a microemulsion. Moreover, the final formulation had a physiologically acceptable pH and osmolarity for eyelid application and was well-tolerated when diluted 1:10 with artificial tear fluid, as expected to be the case after accidental exposure to the ocular surface in the clinical setting. Thus, a safe and efficient MH dosage form was developed for topical application to the eyelids, which can potentially be used to support optimal eyelid health in the management of blepharitis.
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This study was performed to determine the prevalence of Meibomian gland dysfunction (MGD) and to determine which patient profile factors might be associated with the syndrome. Patients were randomly selected, apparently normal patients presenting for routine vision examinations. Of the 398 patients for whom Meibomian gland expression was performed and a detailed history obtained, 155 patients or 38.9% exhibited MGD based on the principal clinical criterion of an absent or cloudy Meibomian gland secretion upon expression. Patient profile factors of gender, age, allergy occurrence, and contact lens wear were analyzed for correlation with MGD. Age was found to be the only significant correlating factor (positive correlation, p less than 0.0001).
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Although blepharitis is one of the most common ocular disorders encountered in clinical practice, it may constitute a diagnostic and therapeutic enigma. Attempts to classify this disorder are difficult because of the complex mechanisms underlying its pathogenesis. Clinical and laboratory investigations have clearly established bacteria and meibomian gland abnormalities as major etiologic determinants. In addition, changes in tear film dynamics and underlying dermatologic abnormalities appear to contribute to pathogenesis. The clinical manifestations primarily occur along the lid margin, and the predominant symptoms are itching and burning. Currently there is no cure for this condition. In the case of staphylococcal blepharitis, for example, there is no long-term cure because patients are likely susceptible to the causative organism(s), and thus become reinfected. Therapy is aimed then at bringing the disease process under control. A therapeutic regimen consisting of lid hygiene, topical or systemic antibiotics, and tear replacement seems to be most effective in alleviating symptoms and maintaining disease control but requires prolonged treatment.
The aim of the DEWs Definition and Classification Subcommittee was to provide a contemporary definition of dry eye disease, supported within a comprehensive classification framework. A new definition of dry eye was developed to reflect current understanding of the disease, and the committee recommended a three-part classification system. The first part is etiopathogenic and illustrates the multiple causes of dry eye. The second is mechanistic and shows how each cause of dry eye may act through a common pathway. It is stressed that any form of dry eye can interact with and exacerbate other forms of dry eye, as part of a vicious circle. Finally, a scheme is presented, based on the severity of the dry eye disease, which is expected to provide a rational basis for therapy. these guidelines are not intended to override the clinical assessment and judgment of an expert clinician in individual cases, but they should prove helpful in the conduct of clinical practice and research.
Blepharitis is an acute or chronic inflammatory process involving the eyelids that is frequently associated with conjunctivitis. In its many clinical forms, blepharitis is one of the most common diseases seen by ophthalmologists; yet it remains a diagnostic and therapeutic challenge. This article reviews the clinical presentation, classification, diagnosis, etiology and pathogenesis, and treatment of blepharitis.
The microbiologic evaluations of 332 consecutive patients with the primary diagnosis of chronic blepharitis were reviewed and compared to those of 160 control patients. The most commonly isolated organisms from lids with blepharitis were Staphylococcus epidermidis (95.8%), Propronibacterium acnes (92.8%), Corynebacterium sp. (76.8%), Acinetobacter sp. (11.4%), and Staphylococcus aureus (10.5%). Compared to controls, S. epidermidis (p less than 0.01), P. acnes (p less than 0.02), and Corynebacterium sp. (p less than 0.001) were present significantly more often. S. aureus and the isolation of more than one microbial species were not more common in blepharitis patients. Quantitatively, heavy growth, by total and individual species, was significantly more common in blepharitis patients (total, p less than 0.001; S. epidermidis, p less than 0.001, P. acnes, p less than 0.001). These data demonstrate that patients with blepharitis are more likely to have normal skin bacteria on their lids and in greater quantities than nonblepharitis patients.
Since last thoroughly evaluated over three decades ago, the clinical spectrum of chronic blepharitis has changed. The relative prevalence of Staphylococcus aureus alone or in combination with seborrheic blepharitis has decreased. The relative prevalence has increased of seborrheic blepharitis with or without associated excess meibomian secretions (meibomian seborrhea) or inflammation (meibomitis). Primary meibomitis appears not to be a primarily infectious entity but to represent a facet of generalized sebaceous gland dysfunction and to be found in association with seborrheic dermatitis or acne rosacea. The keratoconjunctivitis found in association with primary meibomitis may be contributed to by the production of bacterial lypolytic exoenzymes that split neutral lipids, resulting in an increased level of free fatty acids in the tears. A frequent finding of keratoconjunctivitis sicca in this patient population, especially the S. aureus group (50%), is of note. Of particular importance is that these entities be recognized as chronic diseases requiring control and ones for which there is no "cure."
Most patients with chronic blepharoconjunctivitis will fall into one of the four seborrheic groups or the primary meibomianitis group. With all of these, there appears to be a predisposition to develop an abnormality in sebaceous glands, as manifested by the fact that such patients have clinically diagnosable seborrheic dermatitis or acne rosacea. These patients tend to develop an abnormality of either the anterior portion of the eyelid with involvement of the gland of Zeis or the posterior portion of the eyelid with involvement of the meibomian glands. Patients in the staphylococcal group are typically younger, a higher percentage are female, and they have a history of symptoms for a relatively shorter period of time. It is only in this latter group that one can hope for a cure with therapy, whereas in the other groups one must aim for control of the disease process. The diagnosis of the various types of blepharoconjunctivitis is important not only because it directs therapy, but also because it gives both the physician and patient an idea about the prognosis. Laboratory evaluation in these patients appears to be of limited value; only in the staphylococcal and mixed seborrheic-staphylococcal group is a pathogen found in the form of S. aureus. The other organism that may contribute directly to disease is S. epidermidis. The antibiotic susceptibility patterns of these two organisms are fairly consistent, and so it is not necessary to culture them to determine antibiotic sensitivities: The majority are sensitive to both bacitracin and erythromycin ointments, as well as the aminoglycosides. Attempts to identify Demodex or to obtain conjunctival scrapings for cytology have not proved helpful. Therefore, the diagnosis is a clinical one and, from a practical standpoint, laboratory evaluation is not required for either diagnosis or management. Therapy for each case of chronic blepharoconjunctivitis must be tailored to the individual and based on the type and severity of blepharoconjunctivitis present. The mainstays in therapy are mechanical and hygienic (i.e., warm compresses and eyelid scrubs ). The use of topical antibiotics must be based on the sensitivities of the likely pathogens (i.e., S. aureus and S. epidermidis). Therefore, while sulfonamides would not appear to be appropriate therapy, bacitracin, erythromycin, or the aminoglycosides are effective antibiotics. The therapy is topical, with the exception of the rare and more severe case of seborrheic blepharoconjunctivitis with secondary meibomianitis and all cases of primary meibomianitis (meibomian keratoconjunctivitis).(ABSTRACT TRUNCATED AT 400 WORDS)