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Cornea Aug 2022Demodex blepharitis is a common ophthalmologic disease that is often overlooked in the workup of blepharitis. Demodex infestation occurs in both symptomatic and... (Review)
Review
Demodex blepharitis is a common ophthalmologic disease that is often overlooked in the workup of blepharitis. Demodex infestation occurs in both symptomatic and asymptomatic individuals at similar rates; consequently, its role in the development of blepharitis has not been well elucidated. Two species have been confirmed to inhabit the human eyelid- Demodex folliculorum and Demodex brevis. These species differ in their preferred location of infestation, with D. folliculorum occupying the base of the eyelash and D. brevis inhabiting the meibomian glands, contributing to anterior and posterior Demodex blepharitis, respectively. A clinical index of suspicion must be developed from the history when blepharitis, conjunctivitis, or keratitis in adults and blepharoconjunctivitis or chalazia in children are resistant to treatment. The diagnosis can be strongly suspected by the presence of cylindrical dandruff at the base of the eyelash and confirmed by light microscopy of an epilated lash or by in vivo confocal microscopy. No cure is currently available. Management most frequently includes topical tea tree oil and its active ingredient terpinen-4-ol, both of which have produced good clinical outcomes. Topical tea tree oil is typically applied by a professional due to risk of toxicity. Several second-line treatment options have been studied, including ivermectin, metronidazole, selenium sulfide, microblepharoexfoliation, and lid hygiene. Novel, targeted therapies such as TP-03 (Tarsus Pharmaceuticals) are also currently being investigated in phase 2b/3 clinical trials. The purpose of this review purpose is to characterize Demodex blepharitis in detail, including its historical perspective and various classifications, and describe the latest diagnostic and management strategies.
Topics: Adult; Animals; Blepharitis; Child; Conjunctivitis; Eye Infections, Parasitic; Eyelashes; Humans; Meibomian Gland Dysfunction; Mite Infestations; Mites; Tea Tree Oil
PubMed: 34743107
DOI: 10.1097/ICO.0000000000002911 -
Ophthalmology Jan 2019
Review
Topics: Academies and Institutes; Anti-Bacterial Agents; Blepharitis; Diagnosis, Differential; Drug Therapy, Combination; Eyelid Diseases; Glucocorticoids; Humans; Meibomian Glands; Ophthalmology; Physical Examination; Practice Patterns, Physicians'; Quality of Health Care; United States
PubMed: 30366800
DOI: 10.1016/j.ophtha.2018.10.019 -
Seminars in Ophthalmology May 2010Blepharitis is a chronic inflammatory process of the eyelid margin. It is a common eye disorder throughout the world and can affect any age group. It may be associated... (Review)
Review
Blepharitis is a chronic inflammatory process of the eyelid margin. It is a common eye disorder throughout the world and can affect any age group. It may be associated with several systemic diseases, particularly rosacea and seborrheic dermatitis, and is related to other ocular conditions like dry eye, chalazion, conjunctivitis, and keratitis. Common symptoms associated with blepharitis are burning sensation, irritation, tearing, photophobia, blurred vision, and red eyes. Clinical examination reveals the presence of scurf, telangiectatic vascular changes of the eyelid margin, inspissated meibomian glands, conjuntival hyperemia, punctuate keratopathy, cornea vascularization, and ulceration. Patients with longstanding chronic blepharitis may present hypertrophy of the lid margin, scars, madarosis, trichiasis, and poliosis. Treatment of blepharitis is long and unsatisfactory. Long-term commitment to eyelid hygiene is essential. Other treatment options are discussed.
Topics: Blepharitis; Humans
PubMed: 20590417
DOI: 10.3109/08820538.2010.488562 -
Infectious Disease Clinics of North... Dec 1992Blepharitis is an acute or chronic inflammatory process involving the eyelids that is frequently associated with conjunctivitis. In its many clinical forms, blepharitis... (Review)
Review
Blepharitis is an acute or chronic inflammatory process involving the eyelids that is frequently associated with conjunctivitis. In its many clinical forms, blepharitis is one of the most common diseases seen by ophthalmologists; yet it remains a diagnostic and therapeutic challenge. This article reviews the clinical presentation, classification, diagnosis, etiology and pathogenesis, and treatment of blepharitis.
Topics: Blepharitis; Chalazion; Diagnosis, Differential; Dry Eye Syndromes; Eye Infections, Bacterial; Eye Infections, Parasitic; Hordeolum; Humans; Staphylococcal Infections
PubMed: 1460262
DOI: No ID Found -
The Veterinary Clinics of North... Mar 2023Canine eyelid masses (tumors) should include the differential clinical diagnoses of neoplasia and blepharitis. They have many common clinical signs including tumor,... (Review)
Review
Canine eyelid masses (tumors) should include the differential clinical diagnoses of neoplasia and blepharitis. They have many common clinical signs including tumor, alopecia, and hyperemia. Biopsy and histologic examination remains the most effective diagnostic test to establish a confirmed diagnosis and appropriate treatment. Neoplasms are typically benign (tarsal gland adenomas, melanocytomas, and so forth) with the exception of lymphosarcoma. Blepharitis is noted in 2 age groups including dogs aged less than 1.5 years and middle aged to older dogs. Most blepharitis cases will respond to specific therapy once an accurate diagnosis is established.
Topics: Dogs; Animals; Blepharitis; Skin; Meibomian Glands; Neoplasms; Diagnosis, Differential; Dog Diseases
PubMed: 36813395
DOI: 10.1016/j.cvsm.2022.11.002 -
Der Ophthalmologe : Zeitschrift Der... Nov 2004Blepharitis is characterized by a great variety of clinical manifestations, which often include alterations of the ocular surface. This as well as its tendency to be... (Review)
Review
Blepharitis is characterized by a great variety of clinical manifestations, which often include alterations of the ocular surface. This as well as its tendency to be therapy-resistant and recurrent explains why blepharitis marks a challenge for all ophthalmologists. Occasionally dermatologic diseases represent one of the causes of the disease, thus calling for an interdisciplinary approach. The present article describes the state of the art with regard to pathogenesis and therapy of blepharitis.
Topics: Anti-Bacterial Agents; Blepharitis; Dermatitis; Humans; Practice Patterns, Physicians'; Tetracycline
PubMed: 15480700
DOI: 10.1007/s00347-004-1115-0 -
Klinische Monatsblatter Fur... Nov 2022Blepharitis represents a frequent inflammatory condition of the lids including the lid margin, which can be apparent in adults and children. Chronic blepharitis is...
Blepharitis represents a frequent inflammatory condition of the lids including the lid margin, which can be apparent in adults and children. Chronic blepharitis is therapeutically challenging. According to the anatomic localization, blepharitis can be graded in anterior and posterior forms. Blepharitis can lead to severe symptoms and complications, mainly dry eye disease, corneal complications and defective lid position. The pathogenesis of chronic blepharitis is not fully understood so far, however, multifactorial disease proceedings are supposed, which include systemic diseases (mainly dermatological disorders), habitual bacteria and infections. In all these processes inflammatory changes are the common final path.Therapeutic strategies include topical and systemic therapies, however evidence levels are generally low and patients are often resistant to therapy. Basic therapeutic measures are warm compresses, lid hygiene and lubricants. Topical anti-inflammatory drugs comprise corticosteroids and ciclosporin A. Topical and systemic antibiotics are commonly used. Systemic intake of omega-3 fatty acids is often recommended due to its anti-inflammatory potential.
Topics: Child; Adult; Humans; Blepharitis; Eyelids; Dry Eye Syndromes; Anti-Bacterial Agents; Chronic Disease
PubMed: 35970192
DOI: 10.1055/a-1896-3441 -
Ophthalmology Oct 2023To evaluate the safety and efficacy of lotilaner ophthalmic solution 0.25% compared with vehicle for the treatment of Demodex blepharitis. (Randomized Controlled Trial)
Randomized Controlled Trial
PURPOSE
To evaluate the safety and efficacy of lotilaner ophthalmic solution 0.25% compared with vehicle for the treatment of Demodex blepharitis.
DESIGN
Prospective, randomized, double-masked, vehicle-controlled, multicenter, phase 3 clinical trial.
PARTICIPANTS
Four hundred twelve patients with Demodex blepharitis were assigned randomly in a 1:1 ratio to receive either lotilaner ophthalmic solution 0.25% (study group) or vehicle without lotilaner (control group).
METHODS
Patients with Demodex blepharitis treated at 21 United States clinical sites were assigned either to the study group (n = 203) to receive lotilaner ophthalmic solution 0.25% or to the control group (n = 209) to receive vehicle without lotilaner bilaterally twice daily for 6 weeks. Collarettes and erythema were graded for each eyelid at screening and at all visits after baseline. At screening and on days 15, 22, and 43, 4 or more eyelashes were epilated from each eye, and the number of Demodex mites present on the lashes was counted with a microscope. Mite density was calculated as the number of mites per lash.
MAIN OUTCOME MEASURES
Outcome measures included collarette cure (collarette grade 0), clinically meaningful collarette reduction to 10 collarettes or fewer (grade 0 or 1), mite eradication (0 mites/lash), erythema cure (grade 0), composite cure (grade 0 for collarettes as well as erythema), compliance with the drop regimen, drop comfort, and adverse events.
RESULTS
At day 43, the study group achieved a statistically significant (P < 0.0001) higher proportion of patients with collarette cure (56.0% vs. 12.5%), clinically meaningful collarette reduction to 10 collarettes or fewer (89.1% vs. 33.0%), mite eradication (51.8% vs. 14.6%), erythema cure (31.1% vs. 9.0%), and composite cure (19.2% vs. 4.0%) than the control group. High compliance with the drop regimen (mean ± standard deviation, 98.7 ± 5.3%) in the study group was observed, and 90.7% of patients found the drops to be neutral to very comfortable.
CONCLUSIONS
Twice-daily treatment with lotilaner ophthalmic solution 0.25% for 6 weeks generally was safe and well tolerated and met the primary end point and all secondary end points for the treatment of Demodex blepharitis compared with vehicle control.
FINANCIAL DISCLOSURE(S)
Proprietary or commercial disclosure may be found in the Footnotes and Disclosures at the end of this article.
Topics: Animals; Humans; Mite Infestations; Prospective Studies; Ophthalmic Solutions; Blepharitis; Mites; Eyelashes; Erythema; Eye Infections, Parasitic
PubMed: 37285925
DOI: 10.1016/j.ophtha.2023.05.030 -
Klinische Monatsblatter Fur... Oct 2005
Review
Topics: Blepharitis; Humans; Practice Guidelines as Topic; Practice Patterns, Physicians'
PubMed: 16240266
DOI: 10.1055/s-2005-865974 -
Current Opinion in Ophthalmology Jul 2015Blepharitis is one of the most common ocular pathologies encountered in the clinical setting. Despite its prevalence, successful treatment is often difficult. The... (Review)
Review
PURPOSE OF REVIEW
Blepharitis is one of the most common ocular pathologies encountered in the clinical setting. Despite its prevalence, successful treatment is often difficult. The purpose of this review is to provide an update on the medical management of blepharitis.
RECENT FINDINGS
The available treatment options for blepharitis have expanded rapidly in recent years. Eyelid hygiene remains the foundation of most treatment regimens, but the addition of topical and oral antibiotics, steroids, and calcineurin inhibitors is showing promising results. Dietary considerations and interventional procedures may also play a role in the future of blepharitis management.
SUMMARY
Although a curative therapy for blepharitis is unlikely in the near future, several novel treatment options may result in better control of this chronic condition.
Topics: Anti-Bacterial Agents; Blepharitis; Calcineurin Inhibitors; Dietary Supplements; Eyelids; Glucocorticoids; Humans; Hygiene
PubMed: 26058027
DOI: 10.1097/ICU.0000000000000164