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Abstract
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.
... Blepharitis is defined as a chronic inflammatory condition of the eyelid margin associated with various discomforts including soreness, itching, tearing, irritation, and a burning sensation (1,2). Long-term serious blepharitis may cause other ocular surface complications, such as dry eye, chalazion, eyelid ulcer, and blepharokeratoconjunctivitis (BKC), leading to severe ocular surface infection and even blindness (2,3). ...
... The diagnosis of blepharitis was established according to the Blepharitis Preferred Practice Pattern of the American Academy of Ophthalmology (17). Blepharitis can be classified according to the anatomic location or underlying cause (1,2,(17)(18)(19). ...
Purpose: To investigate the composition and diversity of the microbiota on the ocular surface of patients with blepharitis in northwestern China via 16S rDNA amplicon sequencing.
Methods: Thirty-seven patients with blepharitis divided into groups of anterior, posterior and mixed blepharitis and twenty healthy controls from northwestern China were enrolled in the study. Samples were collected from the eyelid margin and conjunctival sac of each participant. The V3–V4 region of bacterial 16S rDNA in each sample was amplified and sequenced on the Illumina HiSeq 2500 sequencing platform, and the differences in taxonomy and diversity among different groups were compared.
Results: The composition of the ocular surface microbiota of patients with blepharitis was similar to that of healthy subjects, but there were differences in the relative abundance of each bacterium. At the phylum level, the abundances of Actinobacteria, Cyanobacteria, Verrucomicrobia, Acidobacteria, Chloroflexi , and Atribacteria were significantly higher in the blepharitis group than in the healthy control group, while the relative abundance of Firmicutes was significantly lower ( p < 0.05, Mann-Whitney U). At the genus level, the abundances of Lactobacillus, Ralstonia, Bacteroides, Akkermansia, Bifidobacterium, Escherichia-Shigella, Faecalibacterium , and Brevibacterium were significantly higher in the blepharitis group than in the healthy control group, while the relative abundances of Bacillus, Staphylococcus, Streptococcus , and Acinetobacter were significantly lower in the blepharitis group ( p < 0.05, Mann-Whitney U). The microbiota of anterior blepharitis was similar to that of mixed blepharitis but different from that of posterior blepharitis. Lactobacillus and Bifidobacterium are biomarkers of posterior blepharitis, and Ralstonia is a biomarker of mixed blepharitis. There was no significant difference in the ocular surface microbiota between the eyelid margin and conjunctival sac with or without blepharitis.
Conclusion: The ocular surface microbiota of patients with blepharitis varied among different study groups, according to 16S rDNA amplicon sequencing analysis. The reason might be due to the participants being from different environments and having different lifestyles. Lactobacillus, Bifidobacterium, Akkermansia, Ralstonia , and Bacteroides may play important roles in the pathogenesis of blepharitis.
... 3,9 BLEFARITIS ANTERIOR Gejala klinis blefaritis anterior berupa rasa tidak nyaman di mata, fotofobia ringan, collarette disertai debris pada bulu mata, hiperemia pada tepi kelopak mata, ulserasi kelopak, madarosis, dan trikiasis. 10 Kompres Hangat dan Pijat Kelopak Mata Dilakukan dengan aplikasi kompres hangat ke kelopak mata selama beberapa menit untuk melunakkan sisik atau discharge dan/ atau menghangatkan sekret meibom. Tingkat kehangatan kompres bisa terjaga tahan lama dengan menggunakan air kran panas pada kain bersih, atau menggunakan heat pack, atau menggunakan kantung nasi yang dipanaskan di microwave. ...
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.
... [15][16][17] Therefore, to achieve better clinical outcomes, it is highly recommended that optometrists must be aware of the role Demodex can play in causing blepharitis. 18 Recent studies in the US, UK and Turkey have provided an insight on the prevalence of blepharitis and/or its subtypes. 10,19,20 Such data in the south Asian region is, however, lacking. ...
Purpose:
To investigate the knowledge, attitudes, and practice towards Demodex blepharitis among optometrists in India.
Methods:
The study was conducted in the form of an online survey using Research Electronic Data Capture (REDCap). The survey link was distributed via direct e-mail and social media platforms, and it was comprised of 20 questions divided into two sections. The first section focused on the practitioners' demographics and their views on the general health of the eyelid. The second section of the survey was specific and aimed at obtaining information on identifying and treating Demodex blepharitis, and was only completed by those respondents who looked for Demodex mites.
Results:
The survey was completed by 174 optometrists. The prevalence of blepharitis in the general population was judged by the respondents to be 40%, whereas the prevalence of Demodex mites was estimated to be 29%. Interestingly, the prevalence of Demodex mites in people with blepharitis was estimated to be 30%. This estimated prevalence was substantially lower than that reported in the literature on the subject. 66% of participants believed Demodex mites to be a significant cause of ocular discomfort, whereas only 30% of participants would intervene to diagnose and manage Demodex blepharitis in their patients. Optometrists differed in their preferred method of diagnosis and management of Demodex infestation in eyelids.
Conclusion:
The result of this survey suggests that Demodex blepharitis is a highly under-diagnosed condition in India, with nearly 30% of surveyed optometrists managing this condition. The study also observed a lack of awareness and consensus among surveyed optometrists with regards to diagnosis and appropriate treatment methods to control Demodex infestation in eyelids.
... 3,9 BLEFARITIS ANTERIOR Gejala klinis blefaritis anterior berupa rasa tidak nyaman di mata, fotofobia ringan, collarette disertai debris pada bulu mata, hiperemia pada tepi kelopak mata, ulserasi kelopak, madarosis, dan trikiasis. 10 Kompres Hangat dan Pijat Kelopak Mata Dilakukan dengan aplikasi kompres hangat ke kelopak mata selama beberapa menit untuk melunakkan sisik atau discharge dan/ atau menghangatkan sekret meibom. Tingkat kehangatan kompres bisa terjaga tahan lama dengan menggunakan air kran panas pada kain bersih, atau menggunakan heat pack, atau menggunakan kantung nasi yang dipanaskan di microwave. ...
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
... These symptoms can affect both eyes and become worse day by day. In anterior Blepharitis, erythema and oedema is the most common symptom which can be tested by slit lamp 5 exam. Clinical symptoms of the disease include pain in the eyelids, itchy eyes, you may feel the dust in your eyes, oily crusts or flakes accumulated in the roots of eyelashes, redness of eyelids or eyes and many more. ...
Objective: To identify symptoms, risk factors and outcomes of demographic analysis in adult patients withblepharitis.Study Design: Cross-sectional study.Place and Duration: The study was conducted in the Department of Ophthalmology at THQ Hospital, Kabirwala from 8 January 2020 to 8 June 2020.Materials and Methods: 100 patients were included in the study. Aged above 21 with symptoms of Blepharitis.Fluorescein strips and Slit lamp 90 D techniques were used to evaluate the patients for the presence of visualindications of blepharitis.Results: Sixty-five females and thirty-five males were included in the study. The age group of 21-30 years hadthe highest number of patients. Dry eyes, poor hygiene, low-socioeconomic factor and seborrhoea dermatitiswere significant risk factors. Most common symptoms included irritation, foreign body sensation, swelling overeyelids, hyperaemia, Epiphora and photosensitivity.Conclusion: Proper guidelines for protection and good hygiene should be provided to people. Dry eyes, poorhygiene, low-socioeconomic factor, seborrhoea dermatitis, irritation, foreign body sensation, swelling overeyelids, hyperaemia, Epiphora and photosensitivity are the most common symptoms and risk factors to find thereason behind Blepharitis, in this study. Females, due to their hormonal changes, are more prone to having thisdisease.
... Clinical symptoms of anterior blepharitis may include superficial discomfort, mild photophobia, collarettes with lash debris, lid margin hyperemia, lid ulceration, madarosis, and trichiasis. 11 Typically, symptoms are worse in the morning and are described as a series of remissions and exacerbations. In many cases, a low correlation between symptoms and extent of clinical involvement can exist. ...
Christopher M Putnam College of Optometry, Adjunct Faculty, University of Missouri-St Louis, St Louis, MO, USA Abstract: Blepharitis is a condition characterized by inflammation of the eyelid margin and is a common cause of discomfort and irritation among people of all ages, ethnicity, and sex. In general, blepharitis is not a sight-threatening condition, but if left untreated has the potential to cause keratopathy, corneal neovascularization and ulceration, and permanent alterations in eyelid morphology. Historically, blepharitis has been categorized according to multiple structural classifications, including anatomic location, duration, and etiology. The substantial overlap of symptoms and signs from the differing structural classifications has led to initial misdiagnoses, clinical underreporting, and variability in treatment of blepharitis. The multifactorial nature is still not fully appreciated but infection and inflammation have been identified as the primary contributors. Ongoing clinical research continues the pursuit for a treatment panacea; however, long-term management of the underlying causes of blepharitis remains the best clinical approach. Here, we will attempt to review the existing literature as it pertains to clinical management of blepharitis and address a stepwise approach to diagnosis, treatment, and management. Keywords: blepharitis, categorization, seborrhea, meibomian gland dysfunction, dry eye syndrome
Background
Demodex blepharitis is a common chronic disease. The number of mites is associated with ocular discomfort. The accurate number derived from well-stained specimens is, hence, in favor of diagnosing, monitoring, and determining treatment responses.
Methods
A cross-sectional study was conducted between April and July 2022 at the dermatology and ophthalmology clinic, Walailak University, Thailand. Adult participants with clinical suspicion of Demodex blepharitis were recruited. We examined eyelashes under light microscopy to quantify the number of Demodex mites before and after adding CSB gel. The mite counts, evaluated by an untrained investigator and an experienced investigator, were recorded and compared.
Results
A total of 30 participants were included for final analysis, among which 25 (83.3%) were female. The median age was 64.0 years (IQR, 61.0–68.0). The median Demodex counts evaluated by the experienced investigator before and after adding CSB gel were 1.0 (IQR, 0.0–1.0) and 2.5 (IQR, 2.0–3.0), respectively ( p < 0.001). Moreover, the median Demodex counts evaluated by the untrained investigator before and after adding CSB gel were 1.0 (IQR, 0.0–1.0) and 2.0 (IQR, 1.0–3.0), respectively ( p < 0.001). The correlation coefficient between Demodex counts after the addition of CSB counted by the experienced investigator and those counted by the untrained investigator was 0.92 ( p < 0.001). CSB gel is a promising product to identify and quantify the number of Demodex mites. The findings supported the consideration of CSB gel as one of the diagnostic stains.
Red eye is a common ocular presentation in primary care, and there are several challenges that healthcare practitioners may encounter when caring for such patients. The main ocular conditions that can give rise to red eye are: primary acute angle closure glaucoma, acute iritis, dry eye, blepharitis and conjunctivitis. Red eye can be classified as sight-threatening or non-sight-threatening. Many patients presenting with painless red eye and normal vision usually recover well. However, when red eye is associated with pain, photophobia, watering and blurred vision, it is potentially sight-threatening and must be addressed urgently. Therefore, it is vital for healthcare practitioners to be able to undertake a careful assessment of the patient and make an accurate diagnosis early. This article provides an overview of the common causes of red eye encountered in general practice or an eye clinic. It discusses the nurse's role in the care and management of patients with red eye, with reference to patient assessment, the skills required to make an accurate diagnosis, treatment and health promotion.
Objective:
Mascara is a mild irritant that causes a range of medical problems. Animal models to predict ocular irritation have, however, been questioned at a number of levels, and there is a continued need to develop in vitro testing methods.
Methods:
We assess changes in an easily quantifiable attribute, ciliated protozoan growth rate, as a sensitive, sublethal measure. Specifically, we test six, randomly chosen, commercial mascara products against a control (as treatments) and reveal through ANOVA (n = 6, α = 0.05) significant differences in the specific growth rate to treatments (for both protozoa).
Results:
We provide evidence that two easily cultured protozoa (Paramecium caudatum, Blepharisma japonicum) should be considered as models to assess ocular irritancy (and possibly cosmetics in general) and establish the groundwork for such studies to be applied at a more commercial level. We do this by developing a bioassay for mascara toxicity and indicate the low cost (after equipment is purchased, on the order of $100s) and the ease of performing such tests (able to be conducted by undergraduate students), as a consideration for their future commercial application. We first examined dose dependence of responses, revealing that there was a need to conduct preliminary work to determine appropriate levels for sublethal responses. We then show that some products resulted in mortality at high concentrations, others decreased growth rate by >50% (compared with the control), whereas others had no significant effect, compared with the control.
Conclusion:
We have provided a novel, quick and inexpensive means to assess mascara; the next step is to validate these ciliate bioassays by comparison with animal testing and epidemiological studies, which is beyond the scope of this fundamental 'proof-of-concept' study.
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).
Chronic blepharitis is one of the most common diseases of the eyelids, but surprisingly, it is not often recognized. Frequently, a skin disease such as seborrheic dermatitis, atopic dermatitis, or acne rosacea is the underlying cause of chronic blepharitis. Bacterial pathological lipase, cholesterylesterase production, and bacterial lipopolysaccharides are pathogenetically relevant. Only rarely do genuine bacterial infections play a role. Collarettes occur at the base of the eye lashes, and the Meibomian glands show either abundant fluid secretion or inspissated secretion with obstruction of the orifices. Chronic blepharitis can include sequelae including dry eye and corneal and lid contour changes. The basic treatment comprises attendance of the underlying dermatological disease and lid hygiene. In addition, preservative-free tear film substitutes, antibiotics, immunomodulatory agents, or even surgical intervention may become necessary.
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."
Blepharitis update on research and management 2010.The New York Eye and Ear infirmary, MedEcus, Ophthalmolology Timesa Continuing Medical Education monograph
- R Lindstrom
- E D Donnenfeld
- G N Foulks