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At least 19 recordsLinked to original sources

PubMed1997

[Blepharitis. Demodex folliculorum, associated pathogen spectrum and specific therapy].

UNLABELLED: Demodex folliculorum has been demonstrated with an elevated frequency in patients with blepharitis, and is thought to cause therapy-resistant blepharitis. This paper presents the germ spectrum of patients with blepharitis and demodex and discusses the efficiency of a specific therapy. METHODS: In all, 3152 cilia from 139 patients with blepharitis (38% blepharitis, 44% blepharoconjunctivitis, others) and 108 persons with quiet eyes were examined for demodex. Smears n = 125, from the conjunctive of symptomatic patients were investigated for bacteria, 3 weeks of therapy with mercury ointment, 2%: Lindan, cortisone (prednisolone, dexamethasone, hydrocortisone, fluorometholone) or antibiotics after antibiogram (gentamicin, kanamicin, neomicin, erythromicin, ofloxacin, polymyxin-B, colistin) followed in all Demodex-positive blepharitis patients (n = 41). RESULTS: Demodex was found in 52% (62/139) of patients with chronic blepharitis, as against 20% (3/15) of those with acute blepharitis (statistically significant difference, chi 2-test, alpha = 2.5%) and in 29% of quiet eyes (statistically significantly less, alpha = 2.5%, chi 2-test). Gram-positive cocci were isolated from 79% of 57 Demodex-positive patients with blepharitis and 72% of 68 Demodex-negative patients anaerobes in 39% and 37%, gram-negative rods in 11% and 3% (statistically significant difference for gram-negative rods, alpha = 5%, chi 2-test). Of the patients with Demodex, 25% apparently had no more parasites after mercury ointment, 2% (n = 8) and lindan (n = 5) and 15% after cortisone and antibiotics (n = 13). (The best and statistically very significant results (alpha = 1%) were those obtained with mercury ointment, 2%, and lindan: t-test for connected spot checks). CONCLUSIONS: Gram-positive and gram-negative bacteria grew more often in patients with Demodex. Demodex seems to be a mediator of chronic blepharitis; we recommend that mites be sought in cilia of chronic blepharitis patients. Mercury ointment, 2% and lindan proved efficient for specific therapy, the main problem being the laborious application and toxicity.

Administration, Topical↗

PubMed1985

Tear lysozyme measurements in chronic blepharitis.

Tear lysozyme concentrations were measured on 47 patients with chronic blepharitis and 22 normal control patients. The patients consisted of 26 individuals with various types of chronic blepharitis alone and 21 individuals with chronic blepharitis and clinically-diagnosed keratoconjunctivitis sicca (KCS). The mean lysozyme concentration of blepharitis patients without KCS (4070 micrograms/ml) was not significantly different from normals (3760 micrograms/ml). However, mean lysozyme concentration of the blepharitis patients with KCS (2530 micrograms/ml) was significantly lower than normals or blepharitis patients without KCS (p less than 0.01). It was concluded that tear lysozyme deficiency does not play a significant role in the etiology of chronic blepharitis. However, a large percentage of patients with chronic blepharitis were found to have KCS.

Adolescent↗

PubMed1992

Ulcerative blepharitis in atopic patients--is Candida species the causative agent?

A total of 50 patients suffering both from atopic skin disease and different clinical forms of blepharitis have been included in this study. Microbiological investigations (for bacteria and fungi) of the lid margins were performed in all cases. In 21 (42%) of the patients an ulcerative blepharitis which heavily involved the follicles of the lashes was diagnosed. The remaining 29 cases presented with blepharitis of the squamous type. The cultures revealed that 19 of the 21 patients with ulcerative blepharitis were found to grow Candida species, whereas fungi could not be detected in any of the other cases of blepharitis. The frequencies of concomitant bacterial organisms found in the cultures were similar in both groups. As atopic patients are known to exhibit a defect in their cell-mediated immunity and possibly also a defective IgA antibody response it is a widely accepted assumption that these immunological changes are contributing factors to the development of a localised inflammation of the lids which is initiated by a variety of micro-organisms. We postulate that when Candida species happen to coincide with severe inflammation in atopic patients a blepharitis of the ulcerative type will develop or deteriorate thereby implying that these microorganisms may play an important role in the development or deterioration of this severe chronic inflammation. It is therefore advisable to perform repeated scrapings and cultures in every case of recalcitrant blepharitis.

Adult↗

PubMed1991

Meibomian gland dysfunction in chronic blepharitis.

We examined 57 patients with symptoms of chronic blepharitis using meibomian gland expression, meibography, tear osmolarity, and the Schirmer's test. We also performed meibography on 20 normal patients free of chronic blepharitis. We found that 42 blepharitis patients (74%) had evidence of meibomian gland loss, whereas only four of 20 normal patients (20%) had any gland dropout. We performed cluster analysis on the data from the patients with blepharitis and found that these patients tended to fall into distinct groups with clinically relevant characteristics. We also found that tear osmolarity correlated positively with gland dropout (+0.413) and negatively with excreta volume (-0.499). This study demonstrates that an objective analysis of meibomian gland function may be used to assess chronic blepharitis and define subsets of blepharitis with measurable differences. It also supports the significance of meibomian gland dysfunction on tear osmolarity and the evaporative state of the eye.

Adult↗

PubMed2001

Quantitative evaluation of atopic blepharitis by scoring of eyelid conditions and measuring the water content of the skin and evaporation from the eyelid surface.

PURPOSE: To quantitatively evaluate the condition of the eyelid skin of patients with atopic blepharitis, their symptoms were scored and the water content of the skin and evaporation from the skin were measured. METHODS: Forty patients with atopic blepharitis were examined. The condition of eyelid skin (erythema, edema/papulation/oozing/crust, excoriation/lichenification) was scored from 0 to 3 points. Water content and water evaporation were measured with a Moisture Checker and an evaporimeter, respectively. Eleven age-matched volunteers without atopic disorders were recruited as normal controls. RESULTS: The Moisture Checker values and water evaporation from lid skin were significantly correlated (r = -0.44, p = 0.006). The Moisture Checker values of the patients with atopic blepharitis was 35.5+/-8.2% (44.7 +/-10.6% in the normal controls, p = 0.009), and water evaporation from their lid skin was 3.6+/-0.9 g/cm2 per second (2.0+/-0.3 g/cm2 per second, p < 0.001); then, the patients were divided into four groups, from "asymptomatic" to "severe," according to the sum of their blepharitis scores. Patients with lower blepharitis scores tended to have higher Moisture Checker values and lower water evaporation values. CONCLUSION: Scoring of eyelid condition enabled us to objectively estimate the severity of atopic blepharitis. Measurements of the water content of lid skin and water evaporation from lid skin are useful in evaluation of the severity of this disease.

Adolescent↗

PubMed1996

The effect of Staphylococcus aureus phage lysate vaccine on a rabbit model of staphylococcal blepharitis, phlyctenulosis, and catarrhal infiltrates.

PURPOSE: To evaluate the effect of Staphylococcus aureus phage lysate (SPL) vaccination on the development of blepharitis, corneal phlyctenules, and catarrhal infiltrates and on the development of antibodies and the delayed-type hypersensitivity response to S. aureus. METHODS: Eighty rabbits received an intradermal immunization of cell wall-complete Freund's adjuvant followed by a booster immunization. Rabbits were given topical applications of viable S. aureus in both eyes and 40 rabbits received subcutaneous SPL vaccinations. Clinical observations were made weekly. An enzyme-linked immunosorbent assay was used to measure IgG, IgA, and IgM antibody levels to ribitol teichoic acid in sera, corneas, and tears. The delayed-type hypersensitivity response was evaluated by skin testing after subcutaneous injection of staphylococcal antigens. RESULTS: In the SPL-vaccinated group, phlyctenules developed in eight of 40 rabbits while blepharitis developed in 13 of 40. In the nonvaccinated group, phlyctenules developed in three of 40 rabbits and blepharitis developed in five of 40. The number of rabbits with blepharitis was significantly higher in the SPL-vaccinated group than in the nonvaccinated group. In general, the antibody response to ribitol teichoic acid was enhanced, while the delayed-type hypersensitivity response to S. aureus was depressed. CONCLUSIONS: Vaccination with SPL was not found to have a beneficial effect on the development of blepharitis, phlyctenules, and catarrhal infiltrates in our rabbit model.

Animals↗

PubMedDate not supplied

Slime production by coagulase-negative staphylococci isolated in chronic blepharitis.

BACKGROUND: The purpose of the study was to determine the impact of slime-producing strains of coagulase-negative staphylococci (CNS) on non-ulcerative blepharitis. Formerly considered harmless organisms, CNS are now recognised as opportunistic pathogens. Although these microorganisms are a component of normal conjunctival flora, they often produce the typical signs and symptoms of chronic staphylococcal blepharoconjunctivitis. Certain strains produce a polysaccharide extracellular material called "slime". Slime production is considered to be associated with the virulence of the organism. METHODS: Swabs were taken from the lids of 38 eyes of 19 patients with chronic non-ulcerative blepharitis and cultured for CNS. A group of 42 normal control eyes were similarly sampled. The strains of CNS isolated from 26 eyes (68.4%) of the patients with blepharitis and 25 eyes (59.5%) of the normal subjects were studied for slime layer production. RESULTS: No significant difference was found between normal subjects and patients in the incidence of slime producing CNS strains from the conjunctiva. The antibiotic sensitivity profiles of the slime-producing strains were no different from the slime-negative isolates in the blepharitis (p=0.85) and normal group (p=0.25). CONCLUSIONS: Our data suggest that slime production by CNS does not play a significant role in the pathogenesis of staphylococcal blepharitis.

Adolescent↗

PubMed1997

Influence of topical anesthesia on tests diagnostic of blepharitis-associated dry eye syndrome.

PURPOSE: Despite the high frequency and clinical relevance of blepharitis-associated dry-eye syndrome, no agreement exists about whether diagnostic tests should be performed with or without topical anesthesia. The aim of this study was to compare the influence of topical anesthesia on the mean values of Schirmer's test, tear lysozyme, tear lactoferrin, and tear osmolarity in patients suffering from blepharitis-associated dry eye syndrome. METHODS: The authors compared the mean values of Schirmer's test, tear osmolarity, tear lysozyme (turbidimetric assay), and tear lactoferrin (radial immunodiffusion) before and after topical anesthesia in the following groups: 56 normal subjects (group 1), 62 blepharitis patients (group 2), and 15 patients with blepharitis-associated dry eye syndrome (group 3). All clinical and laboratory tests were performed by masked observers. RESULTS: In group I, mean values of Schirmer's test decreased 24.8% (p < 0.01) when performed after application of topical anesthesia. The other tests were not significantly modified. In groups 2 and 3, significant differences were seen in Schirmer's test (25.33% and 24.19% respectively, p < 0.001) and the lysozyme determination (14.00% and 13.22% respectively, p < 0.01). Differences between the normal subjects (group I) and the patient groups increased when the tests were performed after application of topical anesthesia reaching statistical significance in group 3 for all the tests. CONCLUSIONS: Performing diagnostic tests after topical anesthesia instillation could be useful in detecting dry eye associated with blepharitis.

Adrenergic alpha-Agonists↗

PubMed1999

Enhanced secretory group II PLA2 activity in the tears of chronic blepharitis patients.

PURPOSE: Phospholipase A2 (PLA2) hydrolyzes phospholipids, one of the important constituents of human meibomian gland secretions. This study was performed to investigate PLA2 type and activity in the tears of chronic blepharitis patients compared to those of normal persons. METHODS: Tear samples of 36 patients and 10 normal persons were collected in non-heparinized microcapillary tubes. PLA2 activity in the tears was measured by Dole's method, and the results of the blepharitis patients were compared to those of the normal persons. The characterization of PLA2 was performed by the head group preference test and the dithiothreitol (DTT) sensitivity test. The classification of PLA2 type was done using Western blot analysis with anti-human secretory PLA2 antibody. RESULTS: No statistically significant differences were found among the six categories of chronic blepharitis. However, the mean PLA2 activity in the tears of the chronic blepharitis patients was about two times higher than that of the normal controls with statistical significance (P < 0.05). The PLA2 substrate specificity test revealed group II PLA2 activity. Furthermore, the group II PLA2 was identified as a 14 kDa band in Western blot analysis using an antibody raised against human secretory group II PLA2. CONCLUSIONS: Secretory group II PLA2 activity was significantly enhanced in the tears of the chronic blepharitis patients compared with that of the normal controls. It is suggested that this increased enzymatic activity may decrease the tear film stability through increased hydrolysis of phospholipids.

Adult↗

PubMed1991

Lid flora in 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.

Bacteria↗

PubMed1986

Bacterial aspects of chronic blepharitis.

Patients with all forms of chronic blepharitis were thoroughly evaluated. These patients were found to have evidence for a primary bacterial component in the disease process only in the clinical staphylococcal and mixed seborrheic/staphylococcal forms of chronic blepharitis. Evidence was found for a shared common pathway for Staphylococcus aureus, coagulase negative staphylococci, and Propionibacterium acnes to contribute to the disease process. These organisms were found to produce lypolytic exoenzymes including fatty wax esterase, cholesteryl esterase, and triglyceride lipase. Statistically significantly larger numbers of coagulase negative staphylococci were found to produce these enzymes in patients with the various forms of seborrheic blepharitis and meibomian keratoconjunctivitis. Additionally, abnormalities in the free fatty acid component of the meibomian secretions were found in these patients supporting the hypothesis that lypolytic exoenzymes produced by bacteria might alter the meibomian secretion. Even though a primary pathogen is identifiable only in staphylococcal and mixed seborrheic/staphylococcal blepharitis, several different bacteria may contribute to the expression of disease in all other forms of chronic blepharitis.

Blepharitis↗

PubMed1991

Blepharitis--a diagnostic and therapeutic challenge. A report on 407 consecutive cases.

Over the last few years the number of patients with chronic bilateral blepharitis has increased dramatically. From January 1985 until the end of 1989, a total of 407 patients with this diagnosis underwent ophthalmological and dermatological investigations at our out-patient clinic. Keratoconjunctivitis sicca (KCS) in conjunction with blepharitis occurred in 14.5% of the patient population who also suffered from acne rosacea. A comparison of the spectrum of microorganisms that have previously been isolated from affected sites with data obtained in the present study revealed that the range of microorganisms associated with this chronic localized inflammation has apparently shifted in recent years. The prevalence of Staphylococcus aureus, which was considerable in the pre-antibiotic era, has markedly decreased, although a distinct entity of staphylococcal blepharitis seems to remain, either alone or in combination with seborrheic blepharitis (62.8% of our patients). The clinical picture, microbiological findings and therapy for this condition are presented.

Adolescent↗

PubMed1990

Ketoconazole in the treatment of blepharitis.

A double masked, placebo controlled clinical trial, of topical 2% ketoconazole cream with lid hygiene, for the treatment of seborrhoeic and mixed seborrhoeic/staphylococcal blepharitis was conducted. Forty patients with symptomatic blepharitis, 20 randomly allocated to ketoconazole, 20 to placebo were entered. Treatment efficacy was assessed by improvement of symptoms using visual analogue scales, appearance of the eyelids and reduction in numbers of pityrosporum yeasts on the eyelids. Both groups showed a similar reduction in symptoms, and signs of inflammation. The overall clinical impression in the ketoconazole group was better at week five than in the placebo group. Sixty nine per cent were either normal or markedly improved, as compared to 42% in the placebo group, although this was not statistically significant (p less than 0.1, one-sided Mann-Whitney). Pityrosporum numbers were reduced significantly in both groups during the treatment period. Ketoconazole was no better than placebo at improving the symptoms of blepharitis. More ketoconazole treated patients had normal or markedly improved lids after treatment than the placebo group. Pityrosporum yeasts may play a role in blepharitis, and treatment with an antifungal has some advantages over conventional therapy.

Adult↗

PubMed2001

[FK 506 ointment 0.1 % - A new therapeutic option for atopic blepharitis. Clinical trial with 14 patients].

BACKGROUND: Severe atopic blepharitis is difficult to treat, as topical steroids offer only a limited therapeutic benefit with increasing side effects by time. Topical FK 506 was found to be efficient and safe for treatment of atopic dermatitis in dermatologic studies. The use of topical FK 506 in atopic blepharitis has not been reported so far. PATIENTS AND METHODS: Fourteen patients with severe atopic blepharitis were treated with topical FK 506 0.1 %. The ointment was applied twice daily on the eye lids. Ophthalmologic examinations were scheduled at two weeks, two months and five months after onset of treatment. A score was defined for the skin of the lid (edema, erythema, lichenification, oozing, excoriation and crusting) and for the eye lid margin (erythema, thickening, crusting) respectively. Every patient graded pruritus on a visual analogue scale. RESULTS: The mean skin score prior to treatment was 25.6 +/- 5.8, after two weeks 7.9 +/- 4.8 (p < 0.001), after two months 5.8 +/- 5.0 (p < 0.001) and after five months 5.3 +/- 5.3 (p < 0.001). The mean score for the eye lid margin prior to treatment was 12.3 +/- 4.0, after two weeks 4.6 +/- 2.7 (p < 0.001), after two months 3.8 +/- 2.4 (p < 0.001) and after five months 4.3 +/- 2.6 (p < 0.001). The mean score for pruritus prior to treatment was 8.1 +/- 1.3, after two weeks 2.0 +/- 1.4 (p < 0.001), after two months 1.3 +/- 0.8 (p < 0.001) and after five months 0.8 +/- 0.7 (p < 0.001). All patients assessed the overall situation under therapy as markedly improved. CONCLUSIONS: Topical FK 506 0.1 % ointment turns out to be an excellent therapeutic option for treatment of severe atopic blepharitis. Long-term efficacy and safety have to be evaluated in long-term follow-up studies.

Administration, Topical↗

PubMed1995

Placebo controlled trial of fusidic acid gel and oxytetracycline for recurrent blepharitis and rosacea.

A prospective, randomised, double blind, partial crossover, placebo controlled trial has been conducted to compare the performance of topical fusidic acid gel (Fucithalmic) and oral oxytetracycline as treatment for symptomatic chronic blepharitis. Treatment success was judged both by a reduction in symptoms and clinical examination before and after therapy. Seventy five per cent of patients with blepharitis and associated rosacea were symptomatically improved by fusidic acid gel and 50% by oxytetracycline, but fewer (35%) appeared to benefit from the combination. Patients with chronic blepharitis of other aetiologies did not respond to fusidic acid gel but 25% did benefit from oxytetracycline and 30% from the combination. Our results demonstrate the need to investigate patients with blepharitis for concomitant rosacea as they respond well to targeted therapy.

Blepharitis↗

PubMedDate not supplied

Comparative evaluation of the short-term bactericidal potential of a steroid-antibiotic combination versus steroid in the treatment of chronic bacterial blepharitis and conjunctivitis.

The effects of four days' treatment with topical Maxitrol (neomycin sulphate 3500 IU/mL, polymyxin-B sulphate 6000 IU/mL with dexamethasone 0.1%) were compared with those of Maxidex (dexamethasone 0.1% alone) in a double-masked study in 111 patients with bacterial blepharitis or conjunctivitis, 95 of whom were evaluable for efficacy. The majority of patients (N = 80) had chronic blepharitis. Maxitrol treatment resulted in a significantly greater reduction (90%) in bacterial counts and bacterial eradication (50%) compared with Maxidex (34% and 17% respectively). Maxitrol treatment also produced a significantly greater reduction in conjunctival discharge than did Maxidex, while the treatments were equally effective in alleviating other ocular signs and symptoms. It was concluded that use of a fixed dose combination steroid-antibiotic product was more effective for bacterial control and therapeutic efficacy in the treatment of chronic blepharitis and conjunctivitis patients than treatment with steroid alone. However, in the long-term treatment of chronic blepharitis the well-known toxic problems of neomycin sulphate have to be taken into account.

Administration, Topical↗

PubMed1999

[Blepharitis due to Demodex: myth or reality?].

PURPOSE: Demodex folliculorum has been incriminated in the development of blepharitis although much controversy persists. Certain authors suggest that Demodex is a direct pathogen in chronic palpebral conditions while others consider the saprophyte to be innocuous to skin. METHODS: We conducted a prospective study of eyelashes in 100 persons, searching for Demodex folliculorum and chronic blepharitis. Microscopy in immersion oil after storage in a moist chamber was performed. RESULTS: The incidence of Demodex folliculorum was very high in patients with blepharitis compared with normal controls. Incidence increased with age. Harmless cuffs around the base of the eyelashes was found in 4% with Demodex irradior. CONCLUSION: Demodex should be considered as the cause of chronic blepharitis. Anti-Demodex treatment is indicated when the parasite is found.

Adult↗

PubMed1992

Giant papillary conjunctivitis and meibomian gland dysfunction blepharitis.

In this prospective pilot study we saw 42 consecutive giant papillary conjunctivitis (GPC) patients (80 eyes), all of whom were found to have some meibomian gland dysfunction blepharitis. Severity of GPC at presentation correlated with severity of meibomian gland dysfunction blepharitis (Kendall's tau b averaged 0.246 across the adjusted statistical analyses). Thirty-two patients (63 eyes) were refit after treating meibomian gland dysfunction blepharitis. Twenty-eight of these patients (55 eyes; 87%) continue to wear contact lenses, maintaining an improvement in GPC (mean follow-up 21 months; range 11-36 months). We hypothesize that meibomian gland dysfunction blepharitis may play a role in the pathogenesis of GPC and suggest that a large, controlled, multi-observer study be performed to further investigate this possible association.

Adolescent↗