Challenges in the Diagnosis and Management of Anterior Blepharitis
DOI:
https://doi.org/10.58931/cect.2024.3245Abstract
Blepharitis is defined as inflammation of the eyelids, classified according to anatomical location: anterior (eyelid skin, base of the lashes including the eyelash follicle) or posterior (meibomian glands) blepharitis. Although blepharitis is one of the most common ocular disorders, epidemiological data on the condition is lacking, making prevalence difficult to assess. A 2009 survey of eyecare practitioners reported observing blepharitis in 37%–47% of patients in their clinical practice. This observation may vary depending on the age, sex, and types of patients (i.e., dry eye) in the practice. Younger females are found to have more acute short-term presentation of blepharitis, whereas older, more fair-skinned females present with chronic blepharitis often concurrent with rosacea. Large population‑based studies, using a standardized definition and diagnostic technique, are needed to properly assess the prevalence and incidence of blepharitis and to allow for study comparisons among various age groups.
The ocular surface, including the lid margin, has a natural flora or microbiome, which is imperative in maintaining the health and defence mechanism of the ocular surface. This can be affected by age, gender, inflammation, disease, medication, cosmetics, and treatment (systemic or topical). An overgrowth of microbes or an imbalance of the natural flora may result in an inflammatory response, leading to blepharitis, conjunctivitis, keratitis, or a combination of these.
References
Amescua G, Akpek EK, Farid M, et al. Blepharitis preferred practice pattern(p). Ophthalmology 2019;126(1):56-93. DOI: https://doi.org/10.1016/j.ophtha.2018.10.019
Lemp MA, Nichols KK. Blepharitis in the United States 2009: a survey-based perspective on prevalence and treatment. Ocul Surf 2009;7(2 Suppl):S1-S14. DOI: https://doi.org/10.1016/S1542-0124(12)70620-1
Putnam CM. Diagnosis and management of blepharitis: an optometrist’s perspective. Clin Optom (Auckl) 2016;8:71-78. DOI: https://doi.org/10.2147/OPTO.S84795
Fredricks DN. Microbial ecology of human skin in health and disease. J Investig Dermatol Symp Proc 2001;6(3):167-169. DOI: https://doi.org/10.1046/j.0022-202x.2001.00039.x
Aragona P, Baudouin C, Benitez Del Castillo JM, et al. The ocular microbiome and microbiota and their effects on ocular surface pathophysiology and disorders. Surv Ophthalmol 2021;66(6):907-925. DOI: https://doi.org/10.1016/j.survophthal.2021.03.010
Kemal M, Sumer Z, Toker MI, et al. The prevalence of Demodex folliculorum in blepharitis patients and the normal population. Ophthalmic Epidemiol 2005;12(4):287-290. DOI: https://doi.org/10.1080/092865805910057
Fromstein SR, Harthan JS, Patel J, et al. Demodex blepharitis: clinical perspectives. Clin Optom (Auckl) 2018;10:57-63. DOI: https://doi.org/10.2147/OPTO.S142708
Gao YY, Di Pascuale MA, Li W, et al. High prevalence of Demodex in eyelashes with cylindrical dandruff. Invest Ophthalmol Vis Sci 2005;46(9):3089-3094. DOI: https://doi.org/10.1167/iovs.05-0275
Sedzikowska A, Oseka M, Grytner-Ziecina B. Ocular symptoms reported by patients infested with Demodex mites. Acta Parasitol 2016;61(4):808-814. DOI: https://doi.org/10.1515/ap-2016-0112
Sedzikowska A, Oseka M, Skopinski P. The impact of age, sex, blepharitis, rosacea and rheumatoid arthritis on Demodex mite infection. Arch Med Sci 2018;14(2):353-56. DOI: https://doi.org/10.5114/aoms.2016.60663
Luo X, Li J, Chen C, et al. Ocular demodicosis as a Potential Cause of Ocular Surface Inflammation. Cornea 2017;36 Suppl 1(Suppl 1):S9-S14. DOI: https://doi.org/10.1097/ICO.0000000000001361
Ayyildiz T, Sezgin FM. The Effect of ocular Demodex colonization on Schirmer test and OSDI scores in newly diagnosed dry eye patients. Eye & contact lens 2020;46 Suppl 1:S39-S41. DOI: https://doi.org/10.1097/ICL.0000000000000640
Liang L, Ding X, Tseng SC. High prevalence of demodex brevis infestation in chalazia. Am J Ophthalmol 2014;157(2):342-348 e1. DOI: https://doi.org/10.1016/j.ajo.2013.09.031
Jalbert I, Rejab S. Increased numbers of Demodex in contact lens wearers. Optom Vis Sci 2015;92(6):671-678. DOI: https://doi.org/10.1097/OPX.0000000000000605
Tarkowski W, Moneta-Wielgos J, Mlocicki D. Demodex sp. as a potential cause of the abandonment of soft contact lenses by their existing users. Biomed Res Int 2015;2015:259109. doi: 10.1155/2015/259109 [published Online First: 20150721] DOI: https://doi.org/10.1155/2015/259109
Mastrota KM. Method to identify Demodex in the eyelash follicle without epilation. Optom Vis Sci 2013;90(6):e172-174. DOI: https://doi.org/10.1097/OPX.0b013e318294c2c0
Muntz A, Purslow C, Wolffsohn JS, et al. Improved Demodex diagnosis in the clinical setting using a novel in situ technique. Contact Lens & Anterior Eye: The Journal of the British Contact Lens Association 2020;43(4):345-349. DOI: https://doi.org/10.1016/j.clae.2019.11.009
Lindsley K, Matsumura S, Hatef E, et al. Interventions for chronic blepharitis. Cochrane Database Syst Rev 2012(5):CD005556. doi: 10.1002/14651858.CD005556.pub2 [published Online First: 20120516] DOI: https://doi.org/10.1002/14651858.CD005556.pub2
Carson CF, Hammer KA, Riley TV. Melaleuca alternifolia (tea tree) oil: a review of antimicrobial and other medicinal properties. Clin Microbiol Rev 2006;19(1):50-62. DOI: https://doi.org/10.1128/CMR.19.1.50-62.2006
Cheung IMY, Xue AL, Kim A, et al. In vitro anti-demodectic effects and terpinen-4-ol content of commercial eyelid cleansers. Contact Lens & Anterior Eye: The Journal of the British Contact Lens Association 2018;41(6):513-517. DOI: https://doi.org/10.1016/j.clae.2018.08.003
Ngo W, Jones L, Bitton E. Short-term comfort responses associated with the use of eyelid cleansing products to manage Demodex folliculorum. Eye & Contact Lens 2018;44 Suppl 2:S87-S92. DOI: https://doi.org/10.1097/ICL.0000000000000415
Craig JP, Bitton E, Dantam J, et al. Short-term tolerability of commercial eyelid cleansers: a randomised crossover study. Contact lens & anterior eye: The Journal of the British Contact Lens Association 2022;45(6):101733. doi: 10.1016/j.clae.2022.101733 [published Online First: 20220713] DOI: https://doi.org/10.1016/j.clae.2022.101733
Chen D, Wang J, Sullivan DA, et al. Effects of terpinen-4-ol on meibomian gland epithelial cells in vitro. Cornea 2020;39(12):1541-1546. DOI: https://doi.org/10.1097/ICO.0000000000002506
Guillon M, Maissa C, Wong S. Symptomatic relief associated with eyelid hygiene in anterior blepharitis and MGD. Eye & Contact Lens 2012;38(5):306-312. DOI: https://doi.org/10.1097/ICL.0b013e3182658699
Petropoulos S, Fernandes A, Barros L, et al. The chemical composition, nutritional value and antimicrobial properties of Abelmoschus esculentus seeds. Food Funct 2017;8(12):4733-4743. DOI: https://doi.org/10.1039/C7FO01446E
Romanowski EG, Stella NA, Yates KA, et al. In vitro evaluation of a hypochlorous acid hygiene solution on established biofilms. Eye & Contact Lens 2018;44 Suppl 2(Suppl 2):S187-S191. DOI: https://doi.org/10.1097/ICL.0000000000000456
Kabat AG. In vitro demodicidal activity of commercial lid hygiene products. Clin Ophthalmol 2019;13:1493-1497. DOI: https://doi.org/10.2147/OPTH.S209067
Shah PP, Stein RL, Perry HD. Update on the management of Demodex blepharitis. Cornea 2022;41(8):934-939. DOI: https://doi.org/10.1097/ICO.0000000000002911
Gonzalez-Salinas R, Karpecki P, Yeu E, et al. Safety and efficacy of lotilaner ophthalmic solution, 0.25% for the treatment of blepharitis due to demodex infestation: A randomized, controlled, double-masked clinical trial. Contact lens & Anterior Eye: The Journal of the British Contact Lens Association 2022;45(4):101492. doi: 10.1016/j.clae.2021.101492 [published Online First: 20210728] DOI: https://doi.org/10.1016/j.clae.2021.101492
Cai Y, Zhu Y, Wang Y, et al. Intense pulsed light treatment for inflammatory skin diseases: a review. Lasers Med Sci 2022;37(8):3085-105. DOI: https://doi.org/10.1007/s10103-022-03620-1
Tashbayev B, Yazdani M, Arita R, et al. Intense pulsed light treatment in meibomian gland dysfunction: A concise review. Ocul Surf 2020;18(4):583-594. DOI: https://doi.org/10.1016/j.jtos.2020.06.002
Zhang X, Song N, Gong L. Therapeutic effect of intense pulsed light on ocular demodicosis. Curr Eye Res 2019;44(3):250-256. DOI: https://doi.org/10.1080/02713683.2018.1536217
Zhai Z, Jiang H, Wu Y, et al. Safety and Feasibility of Low Fluence Intense Pulsed Light for Treating Pediatric Patients with Moderate-to-Severe Blepharitis. J Clin Med 2022;11(11) doi: 10.3390/jcm11113080 [published Online First: 20220530 DOI: https://doi.org/10.3390/jcm11113080
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