Comparison of the clinical effects of two different doses (0. 05% and 0. 1%) of topical cyclosporine A in dry eyes with meibomian gland dysfunction / Comparação de efeitos clínicos de duas doses diferentes (0, 05% e 0, 1%) de ciclosporina A tópica em olhos secos com disfunção da glândula tarsal

ABSTRACT Objective: To compare the clinical efficacy of two different doses of topical cyclosporine A used in addition to artificial tears in the treatment of patients with meibomian dysfunction and secondary dry eye. Methods: Fifty patients aged 18 to 40 years, who presented to our clinic between June 2020 and June 2021 were included in our study. Patients were divided into two groups as Group A (topical cyclosporine A 0.05%) and Group B (topical cyclosporine A 0.1%). All the patients underwent a detailed ophthalmological examination, basal Ocular Surface Disease Index measurement, and Schirmer 1 and tear break-up time tests at all visits. Results: The mean age was 32±7.1 years in Group A and 30.7±8.5 years in Group B. In Group A, there were 15 women and ten men, and Group B consisted of 14 women and 11 men. There was no difference between the groups in terms of age and gender distribution (p>0.05). Schirmer 1 and tear break-up time results and Ocular Surface Disease Index score also did not significantly differ between the groups (p>0.05). Conclusion: Cyclosporine A 0.05% and 0.1% eye drops were both seen to be effective in managing dry eye disease in patients with meibomian gland dysfunction.

RESUMO Objetivo: Comparar a eficácia clínica de duas doses diferentes de ciclosporina A tópica utilizada além da lágrima artificial no tratamento de pacientes com disfunção da glândula tarsal e olho seco secundário. Métodos: No estudo, foram incluídos 50 pacientes com idades entre 18 e 40 anos, que se apresentaram em nossa clínica entre junho de 2020 e junho de 2021. Os pacientes foram divididos em dois grupos: Grupo A (ciclosporina A 0,05% tópica) e Grupo B (ciclosporina A 0,1% tópica). Todos os pacientes foram submetidos a um exame oftalmológico detalhado, medição basal do Índice de Doença da Superfície Ocular, e testes de Schirmer 1 e de tempo de ruptura em todas as visitas. Resultados: A idade média foi de 32±7,1 anos no Grupo A e 30,7±8,5 anos no Grupo B. No Grupo A, havia 15 mulheres e dez homens, e o Grupo B consistia de 14 mulheres e 11 homens. Não havia diferença significativa entre os grupos em termos de distribuição por idade e gênero (p>0,05). Os resultados do Schirmer 1 e do tempo de ruptura e do Índice de Doenças da Superfície Ocular também não apresentaram diferença significativa entre os grupos (p>0,05). Conclusão: Observou-se que os colírios de ciclosporina A 0,05% e 0,1% são eficazes no tratamento da síndrome do olho seco em pacientes com disfunção da glândula tarsal.

Design and Implementation of User-oriented Auxiliary Treatment Instrument for Meibomian Gland Dysfunction / 中国医疗器械杂志

Dry eye is a common ophthalmic disease caused by eye maladjustment due to meibomian gland dysfunction (MGD), which is often accompanied by symptoms such as increased tear film osmotic pressure and ocular surface inflammation. In the treatment of dry eye patients, dredging gland obstruction caused by meibomian gland secretion is an effective treatment method. Based on electrothermal effect and hyperelasticity of the silicone, an auxiliary treatment instrument for MGD is designed, which can improve the blood circulation of the glands through heat compress and massage to achieve the purpose of dredging the meibomian glands. The therapy device can display the temperature and pressure during the treatment in real time, so that the surgeon can grasp the progress of the treatment in real time. The therapy device constructs a user-oriented interactive interface based on parametric modeling method, which can be customized by 3D printing according to the user's eyeball geometric parameters. The designed therapeutic device was finally tested on New Zealand white rabbits. The experimental results show that the therapeutic device has significant effectiveness and safety, as well as clinical application prospects.

Evaluación funcional de los parámetros del Oculus KERATOGRAPH 5M posterior a la realización de luz pulsada intensa (IPL). Pacientes con disfunción de la glándula de Meibomio (período de enero a diciembre del 2018). En el Instituto Scorsetti / FUNCTIONAL EVALUATION OF THE PARAMETERS OF OCULUS KERATOGRAPH 5M AFTER THE REALIZATION OF INTENSE PULSED LIGHT in patients with gland dysfunction Mebomio during the period January-December 2018 in the Institute Scorsetti

Objetivo: Evaluar los cambios funcionales obtenidos en el KERATOGRAPH 5M posterior a la terapia de luz pulsada intensa (IPL), durante el periodo de enero a diciembre del 2018 en el Instituto Scorsetti de la Ciudad de Buenos Aires ­ Argentina Introduccion: El ojo seco es una patología crónica muy frecuente en la edad adulta que puede ocasionar disminución en la productividad y es de muy alto costo en nuestro medio, existen diferentes terapias para el manejo del ojo seco (1); Este trabajo está enfocado al ojo seco de tipo evaporativo con disfunción de la glándulas de Meibomio y su manejo con la terapia de luz pulsada intensa con el equipo Thermaeyes que ha mostrado muy buenos resultados en algunos artículos científicos (Toyos R,Mcgill W, Briscoe D. . Tratamiento con luz pulsada intensa para la enfermedad de ojo seco debido a disfunción de la glándula de Meibomio)(2) Diseño: Estudio retrospectivo de cohorte trasversal de fuentes secundarias. Materiales y métodos: Este estudio fue realizado en el Instituto Scorsetti de la Ciudad de Buenos Aires ­ Argentina de la base de dato del OCULUS KERATOGRAPH 5M durante el año 2018, que incluyo 50 ojos de 25 paciente con antecedentes de ojo seco evaporativo y disfunción de la glándulas de Meibomio con un rango de edad de 50-80 años, de diferentes sexos, que realizaron terapia completa de IPL durante el periodo del 2018. Resultados: En la medición de la altura del menisco lagrimal: El 64% presentaron mejoría posterior a la terapia con luz pulsada, 24% no mostraron cambios significativos y 12% empeoraron. En el tiempo de ruptura de la lagrimal: 52% mostraron una mejoría posterior a la terapia con luz pulsada, 40% no obtuvo cambio y 8% empeoraron. En el enrojecimiento conjuntival: el 48% mostraron una mejoría posterior a la terapia con luz pulsada, 48% no obtuvo cambio y 4% empeoró. Y en la encuesta sintomática (DEQ ): el 48% mostraron una mejoría posterior a la terapia con luz pulsada, 32% no obtuvo cambio y 20% empeoraron. Conclusiones: La terapia de IPL es una excelente opción de tratamiento del el ojo seco evaporativo con disfunción de la glándula de meibonio mostrando mejoría objetiva con estabilización de la película lagrimal, en la altura del menisco lagrimal, enrojecimiento conjuntival, tinción de superficie, así como también mejoría subjetiva en los síntomas.

Objective: To evaluate the functional changes obtained in the KERATOGRAPH 5M after intense pulsed light therapy (IPL), during the period from January to December 2018 in the Ophthalmological Institute Prof. Dr. Daniel Scorsetti of the City of Buenos Aires ­ Argentina Introduction: The dry eye is a chronic pathology very frequent in adulthood that can cause decrease in productivity and is very high cost in our environment, there are different therapies for the management of dry eyes; This work is focused on evaporative dry eye with dysfunction of the meibomian glands and its management with intense pulsed light therapy with Thermaeyes equipment that has shown very good results in some scientific articles. Design: Retrospective study of cross-sectional cohort of secondary sources. Materials and methods: This study was conducted in the Ophthalmological Institute Prof. Dr. Daniel Scorsetti of the City of Buenos Aires - Argentina of the data base of OCULUS KERATOGRAPH 5M during the year 2018, which included 50 eyes of 25 patients with a history of evaporative dry eye and dysfunction of the meibomian glands with an age range of 50-80 years, of different sexes, who performed complete IPL therapy during the period of 2018. Results: In the measurement of tear meniscus height: 64% showed improvement after pulsed light therapy, 24% did not show significant changes and 12% worsened. At the time of rupture of the lacrimal: 52% showed a subsequent improvement to the therapy with pulsed light, 40% did not obtain change and 8% worsened. In the conjunctival redness: 48% showed an improvement after the pulsed light therapy, 48% did not change and 4% got worse. And in the symptomatic survey (DEQ ): 48% showed an improvement after pulsed light therapy, 32% did not change and 20% worsened. Conclusions: IPL therapy is an excellent treatment option for evaporative dry eye with dysfunction of the meibonio gland, showing objective improvement with stabilization of the lacrimal film, in the height of the lacrimal meniscus, conjunctival reddening, surface staining, as well as also subjective improvement in symptoms.

Ocular surface changes in the treatment of rosacea: comparison between low-dose oral isotretinoin and doxycycline / Alterações da superfície ocular no tratamento da Rosácea: comparação entre isotretinoína oral em baixa dosagem e doxiciclina

ABSTRACT Purpose: To compare the impact of ocular changes between systemic treatment with doxycycline and low-dose oral isotretinoin in patients with moderate-to-severe papulopustular rosacea. Methods: Patients were randomized to receive either isotretinoin 0.3-0.4 mg/kg (group A) or doxycycline 100 mg/day (group B) for 16 weeks. Ocular symptoms were searched and evaluated, including best-corrected visual acuity (BCVA), Schirmer test, breakup time, rose bengal staining score, and meibomian gland dysfunction grading. The patients were retested at the end of treatment. Results: The present study included 39 patients (30 females and 9 males). Best-corrected visual acuity was > 20/30 in >90% of patients in both groups and did not change after treatment. After treatment, improvement in ocular symptoms and meibomian gland dysfunction was more pronounced in group B (p<0.05); the other parameters did not reach statistical significance. Conclusion: Doxycycline improved meibomian gland dysfunction, ocular symptoms, and ocular surface in patients with rosacea. Even though some patients experienced worsening meibomian gland dysfunction and symptoms, no subject experienced any serious complications after administration of low-dose isotretinoin.

RESUMO Objetivos: Comparar o impacto das alterações oculares entre o tratamento sistêmico de doxiciclina e isotretinoína em baixa dosagem em pacientes com rosácea papulopustulosa moderada a grave. Métodos: Os pacientes form randomizados para receber isotretinoína 0,3 a 0,4 mg/kg (grupo A) ou doxiciclina 100mg/dia (grupo B) por 16 semanas. Os sintomas oculares foram pesquisados e avaliados, incluindo melhor acuidade visual corrigida, teste de Schirmer, tempo de ruptura do filme lacrimal, coloração de rosa bengala e graduação da disfunção de glândula de Meibomius. Os pacientes foram novamente testados no final do tratamento. Resultados: O presente estudo incluiu 39 pacientes (30 mulheres e 9 homens). A melhor acuidade visual corrigida foi >20/30 em >90% dos pacientes em ambos os grupos e não se alterou após o tratamento. A melhora dos sintomas oculares e da disfunção de glândula de Meibomius foi mais pronunciada no grupo B (p<0,05) após o tratamento; as demais variáveis não atingiram significância estatística. Conclusão: A doxiciclina melhorou a disfunção de glândula de Meibomius, os sintomas oculares e a superfície ocular de pa cientes com rosácea. Mesmo que alguns pacientes tenham piorado a disfunção e os sintomas da glândula de Meibomius, nenhum indivíduo apresentou complicações graves após a admi nistração de baixas doses de isotretinoína.

Comparative analysis of meibomian gland dysfunction in eyes with and without eyelid margin tattoos

@#OBJECTIVE: To compare the presence and severity of meibomian gland (MG) dysfunction among eyes of female subjects with and without eyelid margin tattoos using infrared meibography and colored photographs. METHODS: This is a cross-sectional, descriptive study that involved 38 Filipino females with and without eyelid margin tattoos. Infrared meibography was performed on the upper and lower eyelids of each eye to assess total or partial MG dropout. Colored photographs were taken to evaluate vascularity, irregularity, thickening of the lid margins, and plugging of MG orifices. Severity of MG dysfunction (MGD) was assessed using Arita’s MGD proposed grading scale. Independent t-test was used to compare MG dropout and other lid margin parameters between the two groups. Prevalence ratio and prevalence odds ratio were calculated to measure the likelihood of MGD among eyes with eyelid tattoos. RESULTS: Seventy-four (74) eyes were included in the study (36 in the tattoo group and 38 in the control group). Scores for abnormal vascularity, irregularity, and thickening of the lid margins were significantly higher in the tattoo group compared to the control group (p<0.0000001). However, plugging of gland orifices scores between the two groups were found to be similar (upper eyelid: p=0.65; lower eyelid: p=0.91). Total MG dropout was significantly greater in the tattoo group (upper eyelid: -1.11 ± 0.82; lower eyelid: 1.37 ± 0.75) compared to the control group (upper eyelid: 0.53 ± 0.83; lower eyelid: 0.45 ± 0.76) (upper eyelid: p=0.003; lower eyelid: p=0.000001) for the upper and lower eyelid, respectively). Analysis of total MG dropout between the two groups showed a prevalence ratio of 2.13. CONCLUSION: Eyelid margin tattoos are associated with several eyelid margin abnormalities and increase the risk of meibomian gland droupout.

Petroleum jelly versus tea tree oil and tea tree facial wash lid scrub in patients with Blepharitis associated with above-normal Demodex count

Purpose@#To determine the effectiveness of lid scrub with petroleum jelly versus lid scrub with tea tree oil and tea tree facial wash in patients with symptomatic blepharitis associated with above-normal Demodex counts@*Methods@#Patients with symptomatic anterior blepharitis (AB), meibomian gland dysfunction (MGD), or mixed blepharitis (MB) were recruited into the study. Pertinent data, including ocular symptoms and findings, were recorded. Digital photographs of the lid margins were taken. Lash sampling was done using the modified Coston method for lash epilation. Patients with below-normal Demodex counts (DC <5) were excluded while those with DC ≥5 were randomly assigned to one of either treatment regimen: (1) lid scrub with tea tree oil and tea tree facial wash (The Body Wash®, control group), or (2) lid scrub with petroleum jelly (Apollo Pure Petroleum Jelly®, study drug). Lid scrub with the tea tree oil (TTO) or petroleum jelly was administered at the clinic during the initial visit and at 2-week intervals thereafter for 6 weeks. Patients were instructed to apply tea tree (TT) facial wash or petroleum jelly at home on specified intervals daily. DC posttreatment was recorded, and digital photographs of the eyelids were taken at the end of treatment.@*Results@#Thirteen patients were included in the study; 5 in the TTO and 8 petroleum jelly. In the TTO group, 3 patients had decrease in DC and 2 an increase, but all patients reported decrease in the severity and frequency of ocular symptoms. In the petroleum jelly group, 5 patients had decrease in DC after 6 weeks, while the remaining 3 had opposite results. All reported a general improvement in their symptoms. No adverse reactions were observed in either treatment groups.@*Conclusion@#Lid scrub with petroleum jelly caused a significant reduction (p<0.05) in Demodex counts compared to lid scrub with tea tree oil and tea tree facial wash. Petroleum jelly may have some effect in the eradication of Demodex mites in cases of Demodex-induced blepharitis. Although lid scrub with petroleum jelly and tea tree oil and tea tree facial wash both produced a decrease in Demodex counts and a decrease in the frequency and severity of ocular symptoms after 6 weeks of treatment, the presence of some conflicting results suggests that further studies with more patients should be initiated.

Demodex sp. infestation in anterior blepharitis, meibomian-gland dysfunction, and mixed blepharitis

Objective@#This study determined the incidence and density of Demodex species on the eyelashes of subjects with normal eyelids, anterior blepharitis (AB), meibomian-gland dysfunction (MGD), and mixed blepharitis (MB).@*Methods@#Consecutive patients diagnosed with AB, MGD, and MB were recruited, along with 50 normal individuals who served as controls. All underwent a standard eye exam. Data on demographics and ocular symptomatology were gathered. Digital photographs of the lid margins were taken. Lash sampling was done using the modified Coston procedure for epilating lashes. The collected lashes were checked for Demodex based on morphology and motility, and the total number of Demodex identified were tabulated for each eye. Patients with AB and MB had eyelid bacterial culture. Data were subjected to statistical analyses. @*Results@#A total of 167 patients with mean age of 53.7 years were included: 40% with MGD, 12% with AB, 19% with MB, and 30% normal. The overall incidence of Demodex infestation was 73%; 85% for MGD, 95% for AB, 97% for MB, and 34% for control group. The mean density count (MDC) was 13.63 for MB, 8.95 for AB, 4.08 for MGD, and 0.98 for the normal group. The incidence and density of Demodex infestation increased with age. Symptoms of irritation correlated with high MDC (>9 mites) (p <0.04). Asymptomatic patients had low MDC (0 to 2 mites) (p < 0.01). Sixty-eight percent of patients with cylindrical dandruff (p <0.001) and 36.1% with plugged meibomian glands (p < 0.001) had high MDC, while 82.7% with no eyelash findings had low MDC (p < 0.001). @*Conclusion@#The incidence and density of Demodex infestation was highest among patients with AB and MGD. Lid irritation and presence of cylindrical dandruff were indicative of high density count. These should alert the clinician to treat concomitant Demodex infestation of the eyelashes.