Comparison of the effect of tea tree oil eye gel with standard treatment in patients with anterior blepharitis: An open-label clinical trial

Purpose: Daily cleansing of eyelids is very important to carry out a successful blepharitis treatment. However, there are no therapeutic guidelines for blepharitis. The aim was to compare the symptomatic relief of anterior blepharitis using Blephamed eye gel, a cosmetic product, versus standard treatment. Methods: The study was a prospective, interventional open label clinical trial at a university?based hospital. The test population was subjects aged 18–65 years who presented with mild to moderate anterior blepharitis. Eyelid hygiene was applied twice a day. At each visit, a detailed assessment of symptomatology was carried out. A two?way repeated measure mixed model ANOVA was used to compare two groups by time. Results: In total, 61 patients with mean age of 60.08 ± 16.69 years were enrolled in the study including 30 patients in standard group and 31 patients in Blephamed group. Two groups did not differ in terms of age (P = 0.31) and eye laterality (P = 0.50). The baseline scores of erythema, edema, debris, and symptoms as well as total score were similar between two groups (all P values >0.50). Two groups became different for all these parameters at day 45 (all P values <0.001). Significant interaction was detected between time and intervention groups for all severity parameters of blepharitis as well as total score (all P values <0.001). Conclusion: Eyelid hygiene with Blephamed more significantly decreased symptoms of anterior blepharitis compared to standard treatment.

Efficacy of optimal pulse technology in the treatment of demodex blepharitis and its effect on ocular surface function / 国际眼科杂志(Guoji Yanke Zazhi)

AIM: To investigate the efficacy of optimal pulse technology(OPT)in the treatment of demodex blepharitis and its influence on ocular surface function.METHODS: A retrospective study was conducted from February 2018 to October 2020. A total of 127 patients(254 eyes)with demodex blepharitis were assigned to the observation group and the control group according to the treatment method. The control group(63 patients, 126 eyes)were given conventional hot compress, eye cleansing and drug therapy. On this basis, the observation group(64 patients, 128 eyes)was treated with OPT. Both groups were given 6wk of continuous treatment. Demodex count, Marx's line scores, meibum character scores, ocular surface disease index(OSDI)scores, non-invasive tear break-up time(NIBUT), non-invasive tear meniscus height(NITMH)and lipid layer thickness(LLT)were compared between the two groups, and safety was evaluated.RESULTS: After 6wk of treatment, demodex count, Marx's line scores, meibum character scores and OSDI scores of the two groups decreased. NIBUT, NITMH and LLT increased. Meanwhile, demodex count, Marx's line scores, meibum character scores and OSDI scores of the observation group were significantly lower than those in the control group. NIBUT, NITMH and LLT were longer/larger than those in the control group(P<0.001). No obvious abnormality of intraocular pressure or conjunctival/corneal injury was observed in either group.CONCLUSION:OPT is effective and safe in the treatment of demodex blepharitis.

Advance in the risk factors and pathogenesis of Demodex blepharitis / 中华实验眼科杂志

Demodex is a common small parasite in the human body, with a body length of about 150-350 μm and mainly found in human sebaceous glands and skin hair follicles.In recent years, numerous studies in dermatology and ophthalmology have shown that Demodex is related to the occurrence and development of rosacea, blepharitis and other diseases. Demodex blepharitis has become one of the clinical concerns. Demodex blepharitis is an inflammation in the skin of the eyelid margin caused by Demodex infection.In severe cases, cornea and conjunctiva can be involved, and vision can be affected. Demodex blepharitis is a widespread and easily overlooked disease.Up to 90% of patients with blepharitis are infected with Demodex, and the main pathogenic diagnostic methods are light microscopy and in vivo confocal microscopy.At present, the treatment of Demodex blepharitis is mainly to remove mites by metronidazole and tea tree oil etc.Its risk factors and pathogenesis are not fully understood yet.This article mainly summarized and analyzed the research progress on the risk factors for Demodex blepharitis and its possible pathogenesis at home and abroad in order to provide references for further research and clinical treatment.

Efficacy and safety evaluation of three medicated eye patches in Demodex blepharitis: a multicenter, double-blind, randomized controlled clinical trial / 中华实验眼科杂志

Objective:To evaluate and compare the clinical efficacy and safety of three different medicated eye patches in the treatment of Demodex blepharitis. Methods:A multicenter, randomized, double-blind, parallel-controlled clinical trial was conducted.A total of 140 patients (280 eyes) with Demodex blepharitis were recruited in Shanghai Jing'an District Shibei Hospital, Xi'an Fourth Hospital and Kunming First People's Hospital from July 2021 to December 2022.The affected eyes were randomly divided into tea tree oil group, okra oil group, basal fluid control group and metronidazole group by the random number table method.Eye patches containing 20% tea tree oil, 1% okra oil, prepared base solution and 2% metronidazole were applied to the eyes for 28 days by the double-blind method.The count of Demodex was evaluated before treatment and on days 14 and 28 of treatment.Ocular surface symptoms were scored according to Ocular Surface Disease Index (OSDI). The degree of congestion at the eyelid margin and cylindrical dandruff at the root of eyelashes were scored under a slit lamp microscope.The effective rate was calculated according to the comprehensive scores above, and the adverse reactions of the subjects were observed.This study adhered to the Declaration of Helsinki.The study protocol was approved by the Ethics Committee of Shanghai Jing'an District Shibei Hospital (No.YL-20200320-05). All the subjects were informed of the significance, purpose and method of the study.Written informed consent was obtained from each subject before any medical examination. Results:All subjects completed the treatment and follow-up, and the loss to follow-up rate was 0%.After 14 and 28 days of treatment, the Demodex count was significantly decreased in all groups compared with before treatment (all at P<0.05). After 28 days of treatment, the number of Demodex in tea tree oil group, okra oil group and metronidazole group were significantly lower than that in basal fluid control group, with statistically significant differences (all at P<0.05). The OSDI score, palpebral margin congestion score and cylindrical dandruff score on 14 and 28 days after treatment in tea tree oil group, okra oil group and metronidazole group were significantly lower than before treatment, showing statistically significant differences (all at P<0.05). After 28 days of treatment, the effective rates of tea tree oil group, okra oil group and metronidazole group were 71.4%, 71.4% and 62.9%, respectively, which were significantly higher than 25.7% in basal solution control group.No serious local or systemic adverse reactions were found during the treatment and follow-up. Conclusions:Eye patches containing tea tree oil, okra oil and metronidazole have significant effects on the treatment of Demodex blepharitis, which can improve the biological environment of the palpebral margin and eliminate the inflammation related to blepharitis.

Research progress on the diagnosis and treatment of demodex blepharitis / 国际眼科杂志(Guoji Yanke Zazhi)

Demodex is one of the most common parasites in the human body. It can be classified into demodex folliculorum and demodex brevis based on the parasitic sites. It is an opportunistic pathogenic microorganism, and clinical symptoms may not appear in part of infected people, but the parasite can cause multiple common ocular diseases represented by blepharitis. Its typical symptoms include dry eyes, foreign body sensation in eyes, secretion attached to eyelashes, and ocular surface irritation. The diagnosis of demodex blepharitis should be based on the clinical manifestations and the results of etiological tests. The treatment is related to many kinds of drugs including plant essential oil and physical therapy. At present, diagnosing and treating demodex blepharitis is increasingly sophisticated, but the relationship between demodex infection and its pathogenicity remains unclear. This paper summarizes the current characteristics of demodex and the clinical manifestation, diagnosis, treatment, and existing issues of demodex blepharitis, hoping to provide a reference for future studies in demodex.

Eye diseases associated with psoriatic arthritis in the Amazon / Achados oftalmológicos em pacientes com artrite psoriásica na região Amazônica

ABSTRACT Purpose: Ocular disorders are among the most frequent manifestations of psoriatic arthritis. The incidence, type, and severity of these disorders may be influenced by genetics, local environmental factors, and access to ophthalmic treatment. Here we describe the ocular manifestations of psoriatic arthritis among denizens of the Amazon region of Para, Brazil, treated by the rheumatology service of Universidade do Estado do Pará. Methods: This cross-sectional study examined 23 psoriatic arthritis patients (median age 47.78 years, no sex predominance) diagnosed according to Caspar's criteria. Disease activity was evaluated according to the Clinical Disease Activity Index for Psoriatic Arthritis. Ophthalmological examinations performed included visual acuity with distance correction, biomicroscopy, applanation tonometry, fundoscopy, Schirmer test I, tear breakup time, fluorescein staining, and lissamine green staining. Patients also completed The Ocular Surface Disease Index questionnaire. Results: The most common ophthalmic disorders were dry eye (60.9%), cataracts (56.5%), blepharitis (47.8%), keratitis (43.5%), meibomitis (30.4%), pterygium (26, 1%), and pinguecula (13%). More than half of all patients demonstrated recent onset (>5 years), the peripheral disease type, and severe symptoms according to Clinical Disease Activity Index for Psoriatic Arthritis. Conclusion: The ocular manifestations of psoriatic arthritis are varied and mainly affect the ocular surface. Regular ophthalmological follow-up is recommended for patients in the early stage with high disease activity.

RESUMO Objetivo: Descrever as manifestações oftalmológicas observadas em pacientes com artrite psoriásica atendidos no Serviço de Reumatologia da Universidade do Estado do Pará. Métodos: Estudo transversal. A amostra foi composta por 23 pacientes com artrite psoriásica, segundo os critérios de Caspar, atendidos no ambulatório de reumatologia da Universidade do Estado do Pará. Para avaliação da atividade de doença foi aplicado o Clinical Disease Activity index for Psoriatic Arthritis e, posteriormente, foi realizado o exame oftalmológico (acuidade visual com correção para distância, biomicroscopia, tonometria de aplanação de Goldmann, fundoscopia, teste de Schirmer I, tempo de ruptura do filme lacrimal, lissamina verde e questionário The Ocular Surface Disease Index). Resultados: Nesta pesquisa não houve predomínio entre os sexos e a população tinha uma mediana de idade de 47,78 anos. As manifestações mais comuns foram olho seco (60,9%), catarata (56,5%), blefarite (47,8%), ceratite (43,5%), meibomite (30,4%) e pterígio (26,1%). Conclusão: As manifestações oculares encontradas em pacientes com artrite psoriásica são variadas e afetam sobretudo a superfície ocular; no entanto, são clinicamente subestimadas; por isso recomenda-se o acompanhamento oftalmológico regular e periódico para pacientes com artrite psoriásica.

Meibomian gland dysfunction and dry eye in keratoconus / Disfunção de glândulas de Meibomius e olho seco em ceratocone

ABSTRACT The objective of this report is to describe a case of meibomian gland dysfunction associated with keratoconus and to examine the importance of treatment for evaporative dry eye in cases of corneal ectasia. A 45-year-old man diagnosed as having keratoconus complained of burning, tearing, itching, and red eye. He had a history of penetrating corneal transplantation and wearing rigid contact lenses. The meibography revealed a severe meibomian gland dropout and normal tear meniscus height in both eyes. Objective propaedeutic tests are important tools for dry eye diagnosis and proper evaluation of ocular surface and tear film. In older patients, the classic signs of atopic conjunctivitis are not always present, and the causes of chronic rubbing must be further investigated. Treatment of underlying chronic inflammation such as dry eye, meibomian gland dysfunction, and blepharitis might be important to prevent keratoconus progression and guarantee symptom relief.

RESUMO O objetivo é relatar um caso de associação entre disfunção de glândulas de meibomius (DGM) e ceratocone, assim como ressaltar a importância do tratamento do olho seco evaporativo em casos de ectasia corneana. Paciente do sexo masculino de 45 anos com ceratocone e queixas de ardência, lacrimejamento, prurido e olho vermelho. O mesmo tem histórico de transplante de córnea penetrante e uso de lentes de contato rígidas. A meibografia revelou severa perda de glândulas de meibomius e menisco lacrimal normal em ambos os olhos. Testes propedêuticos objetivos são importantes ferramentas para diagnóstico de olho seco e apropriada avaliação da superfície ocular e filme lacrimal. Em pacientes mais velhos, os sinais clássicos de atopia não estão sempre presentes e investigações adicionais das causas de prurido crônico são necessárias. O tratamento da inflamação crônica subjacente como olho seco, disfunção de glândulas de meibomius e blefarite podem ser importantes para prevenir a progressão do ceratocone e garantir alívio dos sintomas.

Efficacy and safety of tea tree essential oil with different concentrations in the treatment of Demodex blepharitis / 国际眼科杂志(Guoji Yanke Zazhi)

@#AIM: To analyze the effectiveness and safety of different concentrations of tea tree essential oil in the treatment of Demodex blepharitis. <p>METHODS: The clinical data of 120 patients(240 eyes)with blepharitis caused by Demodex infection in our hospital from June 2017 to June 2019 were retrospectively analyzed. According to the use of tea tree essential oil concentrations of 10%, 15%, 20% and 25%, patients were divided into 4 groups(group A, group B, group C, group D), each group with 30 people. All patients were given meibomian gland massage, eyelid margin cleaning, and then scrubbed with different concentrations of tea tree oil to clean the eyelid margin. The number of demodex mites, clinical symptom score, clinical sign score, tear film break-up time(BUT), corneal fluorescein staining(FL)and SchirmerⅠtest(SⅠt)were compared before and 2, 4wk after treatment.<p>RESULTS: The number of Demodex mites, clinical symptom score, clinical sign score, BUT, FL and SⅠt were not statistically significant in the four groups before treatment(<i>P</i>>0.05). After treatment, the number of Dmodex mites, clinical symptom score, and clinical sign score in each group were lower than those before treatment, and the number of Demodex mites, clinical symptom score, and clinical sign score after 4wk of treatment in each group were lower than those after 2wk of treatment(all <i>P</i><0.008). After 2 and 4wk of treatment, the number, clinical symptom score and clinical signs score of Demodex mites in group A were the highest, while those in group D were the lowest(all <i>P</i><0.008). After treatment, the BUT of each group was higher than before treatment, and reached the peak in the 4wk. After 2 and 4wk of treatment, BUT among groups was highest in group D and lowest in group A(all <i>P</i><0.008). After treatment, FL and S I t of each group were lower than before treatment, and reached the lowest value in the 4wk. After 2 and 4wk of treatment, FL among the groups was the lowest in group D and the highest in group A(all <i>P</i><0.008). <p>CONCLUSION: Compared with 10% tea tree essential oil, 15% tea tree essential oil can effectively repel mites, relieve clinical symptoms and eye signs in patients with Demodex blepharitis, and is safer than 20% and 25% tea tree essential oils. As the preferred concentration of tea tree essential oil against Demodex blepharitis.

Research progress of antibiotics in the treatment of meibomian gland dysfunction / 国际眼科杂志(Guoji Yanke Zazhi)

@#Meibomian gland dysfunction(MGD)is a chronic, diffuse blepharoplasty that is characterized by obstruction of the terminal ducts of the blepharoplasty gland and abnormal lid ester secretion, which is a common ocular surface disease as well as the major cause of hyper evaporation type dry eye. MGD can cause ocular surface lid ester abnormalities and bacterial proliferation, which in turn leads to associated ocular symptoms. Physical therapies and medicines are widely used to treat MGD in clinics. Through the topical or systemic use of antibiotics that are effective anti-bacteria medicine, ocular surface symptoms caused by MGD-induced bacterial proliferation and abnormal eyelid lipids can be alleviated. Currently, the effectiveness of various types of antibiotics in treating MGD has been demonstrated. In this review, the mechanism, modality, and efficacy of various antibiotics in the treatment of MGD were highlighted and summarized from the perspective of topical or systemic use of antibiotics, which can provide promising guidance for clinical treatments of MGD.

Dupilumab-associated ocular adverse event in patients with atopic dermatitis / 中华实验眼科杂志

Atopic dermatitis (AD) is a chronic, relapsing, pruritic inflammatory skin disease.Dupilumab is a monoclonal antibody that inhibits interleukin (IL)-4 and IL-13 signaling pathways through its binding to IL-4α receptor, which has been demonstrated effective in treatment of moderate-to-severe AD.There is an increased incidence of the associated ocular adverse event in the treatment of AD, the probable mechanisms of which are likely related to abnormal mucosal immune regulation, dysfunction of the ocular barrier, and Demodex colonization.In this article, the epidemiology, clinical features, and management of dupilumab for AD were reviewed, and the shortcomings of the current researches about dupilumab-associated adverse events were analyzed, as well as further study directions in exploring etiology, mechanism, and matters needing attention in diagnosis and treatment were discussed.

Optimal pulse technology combined with tea tree essential oil paste in the treatment of Demodex blepharitis / 国际眼科杂志(Guoji Yanke Zazhi)

@#AIM: To investigate the therapeutic effect of optimal pulse technology combined with tea tree essential oil paste in the treatment of Demodex blepharitis.<p>METHODS: Prospective clinical study. Totally 283 patients(566 eyes)with Demodex blepharitis were selected and randomly divided into three groups. Group A(94 cases, 188 eyes)was treated with optimal pulse technology, group B(96 cases, 192 eyes)was treated with tea tree essential oil paste, and group C(93 cases, 186 eyes)was treated with optimal pulse technology combined with tea tree essential oil paste. After 6wk of treatment, the number of Demodex, subjective symptom score, clinical sign score, tear film rupture time and corneal fluorescein staining were analyzed.<p>RESULTS: There was no significant difference in Demodex count, symptom score, sign score, tear film rupture time and corneal fluorescein staining among the three groups before treatment(<i>P</i>>0.05). After treatment, the number of Demodex among the three groups were significantly reduced(<i>P</i><0.05), and there were significant differences among group C, group A and group B(<i>P</i><0.05). The scores of subjective symptoms and signs of the three groups were significantly improved after treatment(<i>P</i><0.05), and the improvement of group C was more significant than that of group A and group B(<i>P</i><0.05). After treatment, tear break-up time of the group B not significantly improved, tear break-up time that of group C was significantly longer than that of groups A and B(<i>P</i><0.05); Fluorescent staining scores of three groups before and after treatment were significantly improved(<i>P</i><0.05). The statistical results of group C were better than those of groups A and B, but there was no difference among the three groups. No obvious complications occurred in all patients.<p>CONCLUSION: The effect of optimal pulse technology combined with tea tree essential oil in the treatment of acariasis blepharitis is significant, which is significantly better than that of single optimal pulse technology therapy and single use of tea tree essential oil.

Short-term clinical effect of hypochlorous acid eye cleansing wipes on blepharitis / 国际眼科杂志(Guoji Yanke Zazhi)

@#AIM: To evaluate the therapeutic effect on blepharitis by using hypochlorous acid eye cleansing wipes for 1wk. <p>METHODS: Prospective case-control study. Unlateral eyes of 48 patients with blepharitis who attended the ophthalmology clinic of our hospital on March 08, 2020 were selected and grouped according to the clinical diagnosis, including 16 patients in the staphylococcal blepharitis group and 22 patients in the seborrheic blepharitis group, 10 patients in the meibomian gland dysfunction blepharitis group. Hypochlorous acid eye cleansing wipes were given to clean the eyelid margin for 1wk, and related parameters of the eye surface and meibomian glands were collected before and after treatment.<p>RESULTS: Compared with pre-treatment, after 1wk of treatment, the overall ocular surface disease index(OSDI), conjunctival hyperemia, and eyelid margin hyperemia scores of the patients included in this study were significantly reduced(<i>P</i><0.001), and the OSDI scores of the three groups of patients were all significantly decreased, the tear film rupture time(TBUT)of patients in the seborrheic blepharitis group was significantly increased, and the degree of conjunctival congestion was significantly alleviated, and the scores of blepharocongestion in the staphylococcal blepharitis group and the seborrheic blepharitis group were both significantly decreased(<i>P</i><0.05).<p>CONCLUSION: The use of hypochlorous acid eye cleansing wipes to clean the eyelid margins for 1wk has a positive effect on different types of blepharitis. It could relieve the ocular symptoms of blepharitis and reduce the incidence of staphylococcal blepharitis and seborrheic blepharitis. Eyelid congestion, improve conjunctival hyperemia of seborrheic blepharitis, and improve tear film stability.

Caracterización clínica de pacientes con blefaritis y demodecosis / Clinical characterization of patient with blefaritis and demodecosis

RESUMEN Fundamento: la blefaritis es una enfermedad común en la práctica oftalmológica, de curso crónico con crisis de exacerbación y causa multifactorial, a menudo se le asocia a Demodex spp., ácaro del folículo piloso, parásito extendido y frecuente; su infestación en humano se conoce como demodecosis. Objetivo: caracterizar desde el punto de vista clínico a pacientes con blefaritis y demodecosis. Métodos: se realizó un estudio descriptivo, transversal, en el Hospital Militar Clínico Quirúrgico Docente Dr. Octavio de la Concepción y de la Pedraja de la provincia Camagüey desde septiembre de 2017 a noviembre de 2018. La población objeto de estudio quedó conformada por 84 pacientes con diagnóstico de blefaritis en quienes se confirmó presencia de Demodex spp. que cumplieron criterios definidos por el autor. Se estudiaron variables biológicas (edad y sexo), clínica (síntomas y signos). Los resultados se expusieron en tablas, se utilizó estadística descriptiva para distribuciones de frecuencias. Se respetaron aspectos éticos para investigación en humanos. Resultados: en más de la mitad de los pacientes con diagnóstico de blefaritis se confirmó la presencia de Demodex spp., predominó los enfermos mayores de 61 años, así como del sexo femenino, las manifestaciones clínicas con mayor incidencia fueron: presencia de caspa cilíndrica, alteraciones de las pestaña, escozor y prurito, seguidos por inestabilidad de la película lagrimal, alteraciones de bordes palpebrales, queratitis superficial y sensación de cuerpo extraño. Conclusiones: el estudio demostró la presencia del Demodex spp. en un importante número pacientes con blefaritis lo que contrasta que, en Cuba no existe suficiente literatura documentada que muestre su prevalencia, comportamiento o técnicas diagnósticas, así como variantes terapéuticas eficientes en esta enfermedad.

ABSTRACT Background: the blepharitis is a common illness in the ophthalmological practice, of chronic course with exacerbation crisis and multifactorial etiology, often associated with Demodex spp., mite of the hair follicle, extended and frequent parasite; its infestation in human is known as demodecosis. Objective: to characterize from the clinical point of view patients with blepharitis and demodecosis. Methods: a descriptive, traverse study was carried out in the Educational Surgical Clinical Military Hospital Dr. Octavio of the Concepción and of the Pedraja of Camagüey in the period of September, 2017 to November, 2018. The population study object was conformed by 84 patients with diagnostic of blepharitis who were confirmed with the presence of Demodex spp. and they completed criteria defined by the author. Biological variables were studied (age and sex) and clinic (symptoms and signs). The results were exposed in charts using descriptive statistic for distributions of frequencies. Ethical aspects for investigation in human were respected. Results: in more than half of the patients with diagnostic of blepharitis was confirmed the presence of Demodex spp., the sick persons older than 61 years prevailed, as well as of the feminine sex, the clinical manifestations with more incidence were: presence of cylindrical dandruff, alterations of the lash, smarting and pruritus, continued by uncertainty of the lachrymal movie, alterations palpebral embroider, superficial keratitis and sensation of strange corpse in the eye. Conclusions: the study demonstrates the presence of the Demodex spp. in an important number patient with blepharitis which contrasts with, in Cuba there isn´t enough documented literature that shows their prevalence, behavior or diagnostic techniques, as well as efficient therapeutic variants in this illness.

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.

Effect of tea tree oil eye patch combined with eyelid margin deep cleaning device in treating demodex blepharitis / 国际眼科杂志(Guoji Yanke Zazhi)

@#AIM: To investigate the clinical effect of tea tree oil eye patch combined with eyelid margin deep cleaning device in treating demodex blepharitis.<p>METHODS: This was a prospective, randomized and self-controlled study. Thirty-two patients(sixty-four eyes)diagnosed in demodex blepharitis were enrolled in the study. We randomly assigned one eye of the participants to the study group, which received tea tree oil eye patch once a day combined with monthly eyelid margin deep cleaning, and the other eye to the control group, which received tea tree oil eye patch therapy only. OSDI score of each subject, demodex mite counts, eyelid margin cleanness degree, eyelid margin abnormal score, non-invasive tear break-up time-first, tear meniscus height, redness, meibography score and Schirmer I test of each eye were evaluated before, and three months after the treatment. <p>RESULTS: Three months after treatment, demodex mite counts in both groups were significantly decreased(<i>P</i><0.05), the counts were lower in the study group(<i>P</i><0.05). Significant improvements were observed in the eyelid margin cleanness degree of the two groups(<i>P</i><0.05), and the degree was lower in the study group(<i>P</i><0.05). The OSDI score decreased significantly after treatment(<i>P</i><0.05). The NITBUT-first, redness and FL of the study group were significantly improved after treatment(<i>P</i><0.05), and the redness and FL of the control group were significantly improved after treatment(<i>P</i><0.05), NITBUT-first was longer after treatment but there was no statistical difference. The tear film parameters were no significant differences between the two groups. No significant changes were found in tear meniscus height, Schirmer I test and meibomian gland loss score after treatment. No obvious complications were observed in the study.<p>CONCLUSION: Tea tree oil eye patch therapy is effective in treating demodex blepharitis. With eyelid margin deep cleaning device combining, can further strengthen the efficacy of tea tree oil in eliminating mites and cylindrical cuffs, maintain the eyelid margin cleanness, and improve the abnormality of eyelid margin, which is a convenient,effective and safe treatment for demodex blepharitis.

Ocular surface diseases related to Demodex and their diagnosis and treatment / 国际眼科杂志(Guoji Yanke Zazhi)

@#Ocular Demodex infection is mainly manifested as ocular surface diseases, including meibomian gland dysfunction, dry eye disease, Demodex blepharitis, chalazion, keratoconjunctivitis,<i> etc</i>. The diagnosis is relatively simple and can be realized under the microscope, but it is easy to be misdiagnosed due to the subjective and objective factors such as similar symptoms, missing examination, experience diagnosis and treatment. There are many treatment methods for ocular Demodex infection, including external tea tree oil and other plant extracts, oral or external drugs, physical therapy(represented by strong pulse light therapy, moxibustion therapy), combined therapy,<i> etc</i>. In this paper, we reviewed the diagnosis and treatment of Demodex related ocular surface diseases, and discussed the latest research trends of this disease.

Comparative study on composition regularities of traditional Chinese medicine formulas for five kinds of ophthalmic diseases using association rules / 中草药

Objective: To analyze the composition regularities of the traditional Chinese medicine formulas (TCMFs) for treating five kinds of ophthalmic diseases, including swelling and pain of eyes, night blindness, pterygium, blepharitis marginalis and nebula based on the data mining methodology. Methods: A total of 1999 TCMFs for ophthalmic diseases were collected from the Dictionary of Chinese Medicine Prescriptions. Then frequency analyses and association rules analyses were conducted with the three indicators of support, confidence and lift based on the Apriori algorithm. Results: The diaphoretic drugs and heat-clearing drugs were the commonly used types of the traditional Chinese medicines (TCMs) for swelling and pain of eyes, pterygium and blepharitis marginalis. The heat-clearing drugs and tonifying drugs were the commonly used types of TCMs for night blindness and nebula. Coptidis Rhizoma was frequently used for swelling and pain of eyes, Schizonepetae Herba was for blepharitis marginalis, and Chuanxiong Rhizoma was for nebula. The latent association rules with significant lift included Margarita→Calamina for swelling and pain of eyes, Myrrha→Olibanum for pterygium, Notopterygii Rhizoma et Radix→Saposhnikoviae Radix for blepharitis marginalis, and Lithargite→Sal Ammoniac for nebula. Conclusion: Using association rules, the comparative study on the five kinds of ophthalmic diseases can reveal the similarities and differences of treatments for these ophthalmic diseases and explore the composition regularities of TCMs, which helps to explore the hidden value of TCMFs.

A prototype of a low-cost eyelid cleaning foaming solution for symptom management in patients with chronic blepharitis: An I-optimal mixture experimental design / Un prototipo de solución espumante de bajo costo para la limpieza de párpados y el manejo de síntomas en pacientes con blefaritis crónica: un diseño de mezcla I-óptimo

SUMMARY Blepharitis is a common chronic eye condition that causes eyelid inflammation, leading to inflamed, irritated, sticky and itchy eyelids and flaking of the skin. For its treatment, patients often need indefinite use of an eyelid cleaning solution which usually cost more than 20 USD per 80 ml bottle and lasts, on average, one month. For those patients unable to afford the treatment, physicians recommend the use of a do it yourself (DIY) solution. However, the efficacy of DIY eyelid solutions might fluctuate according to the type of blepharitis present in the patient and inadequate pH stabilization of the solution might promote additional itchiness, irritation, and dryness of the skin and eyes. Thus, we propose an optimized DIY solution prototype for symptom management in patients with chronic blepharitis. The formulation contains a significant ratio of tea tree oil and resulted in suitable pH and foam expansion values. The low cost and ease of preparation of the designed formulation make it an affordable, effective alternative in the treatment of chronic blepharitis.

RESUMEN La blefaritis crónica es una condición ocular que causa inflamación en los párpados, dando como resultado párpados irritados, pegadizos y descamación de la piel. Pacientes con esta condición necesitan usualmente de la aplicación de una solución de limpieza de párpados que cuesta en promedio 20 USD por cada 80 ml de solución y tiene un rendimiento de un mes. Para aquellos pacientes incapaces de costear el tratamiento, los médicos recomiendan el uso de soluciones hazlo tú mismo (DIY en inglés). Sin embargo, la eficacia de estas en el tratamiento de la condición puede fluctuar de acuerdo con el tipo de blefaritis presente. Adicionalmente, una inadecuada estabilización del pH de la solución puede promover una mayor irritación, resequedad y picazón en la piel y en los ojos. Por lo tanto, en este trabajo proponemos un prototipo experimental de solución DIY para el manejo sintomático de pacientes con blefaritis crónica. La formulación contiene una proporción significativa de aceite de árbol de té y posee un pH adecuado y alta producción de espuma para su correcta aplicación en la piel. El bajo costo y facilidad de preparación hacen de ella una alternativa efectiva y asequible en el tratamiento de la blefaritis crónica.

Blefarite: epidemiologia, etiologia, apresentações clínicas, tratamento e evolução de nossos pacientes / Blepharitis: epidemiology, etiology, clinical presentations, treatment and evolution of our patients

Resumo Objetivo: A blefarite é uma das condições mais comumente encontradas na prática oftalmológica e se constitui em uma causa frequente de irritação e desconforto ocular. Por ser uma doença de difícil tratamento, os autores buscaram compreender melhor a epidemiologia, etiologia, apresentações clínicas, tratamento e evolução de seus pacientes, visando maior sucesso terapêutico. Métodos: Foram avaliados retrospectivamente e transversalmente o prontuário de 124 pacientes do Centro de Oftalmologia Tadeu Cvintal, os quais apresentavam blefarite e foram submetidos à classificação de gravidade e coleta de secreções palpebrais para cultura bacteriana e antibiograma. Resultados: A media da idade dos pacientes foi de 67,4 anos, o sexo feminino foi responsável por 70 (56,4%) casos e o masculino por 54 (43,5%). Quanto à gravidade da doença, constatou-se 71 casos de blefarite leve (56,8%), 52 (41,6%) com intensidade moderada e 2 (1,6%) casos graves. Avaliando o seguimento do tratamento da doença, foi observado que 103 (82,4%) pacientes não retornaram para avaliar o resultado do tratamento e apenas 22 (17,6%) retornaram. Em relação às culturas realizadas, 82 (66,1%) não apresentaram crescimento microbiano. Dentre as 42 (33,8%) amostras positivas, os Staphylococcus coagulase negativo foram os mais prevalentes, sobretudo os Staphylococcus epidermidis, responsável por 35 (83,3%) delas. Quanto à sensibilidade aos antibióticos, os agentes de nossa amostra demonstraram maior resistência à Penicilina, Eritromicina e Ciprofloxacino e 100% de sensibilidade à Linezolida, Vancomicina e Daptomicina. Conclusão: Conhecendo melhor as características epidemiológicas da blefarite e a sensibilidade antimicrobiana das bactérias envolvidas, é possível oferecer tratamentos mais eficazes.

Abstract Objective: Blepharitis is one of the most commonly encountered conditions in ophthalmic practice and is a frequent cause of eye irritation and discomfort. Being a difficult to treat disease, the authors sought to better understand the epidemiology, etiology, clinical presentations, treatment and evolution of their patients, aiming at greater therapeutic success. Methods: The medical records of 124 patients of Centro de Oftalmologia Tadeu Cvintal who had blepharitis were retrospectively and cross-sectionally evaluated and underwent severity classification and collection of eyelid secretions for bacterial culture and antibiogram. Results: The mean age of the patients was 67.4 years, females accounted for 70 (56.4%) cases and males for 54 (43.5%). Regarding the severity of the disease, there were 71 cases of mild blepharitis (56.8%), 52 (41.6%) with moderate intensity and 2 (1.6%) severe cases. Evaluating the follow-up of treatment of the disease, it was observed that 103 (82.4%) patients did not return to evaluate the treatment outcome and only 22 (17.6%) returned. In respect of the cultures performed, 82 (66.1%) did not show microbial growth. Among the 42 (33.8%) positive samples, coagulase-negative staphylococci were the most prevalent, especially Staphylococcus epidermidis, responsible for 35 (83.3%) of them. As for antibiotic sensitivity, the agents in our sample showed greater resistance to Penicillin, Erythromycin and Ciprofloxacin and 100% sensitivity to Linezolid, Vancomycin and Daptomycin. Conclusion: By better understanding the epidemiological characteristics of blepharitis and the antimicrobial sensitivity of the bacteria involved, it is possible to offer more effective treatments.

Combined treatment modality for phthiriasis palpebrarum

Phthiriasis palpebrarum (PP) is the infestation of eyelids caused by the ectoparasite Phthirus pubis, frequently misdiagnosed as allergic conjunctivitis, blepharitis or dermatitis. There is no standard treatment of choice although various treatment modalities have been described. A 6-year-old male child with PP was successfully treated with local application of 20% fluorescein solution over the eyelashes and eyebrows of both the eyes, followed by the mechanical removal of all parasites and trimming of the eyelashes from the base and application of ophthalmic ointment.