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High prevalence of blepharitis, multifactorial etiology and chronic course with the possibility of serious complications, including conjunctivitis, multiple chalazions, keratitis, dry eye syndrome — cause significant difficulties in the treatment of this disease. Prescribing treatment of the process only in case of exacerbation with the use of even modern antimicrobial and anti-inflammatory drugs gives only a short-term effect.The aim is to present the clinical features of the blepharitis of different localization and the choice of the optimal treatment algorithm on the example of specific clinical cases. The article presents current data on the classification, etiology and mechanism of blepharitis development. Based on a detailed description of two clinical cases of blepharitis, the features of the clinical course, the range of necessary examinations and consultations of specialists are presented. The first case describes blepharitis associated with the severe rosacea in a teenager with a typical complication in the form of rosacea — keratitis. The second case is devoted to the features of the posterior blepharitis clinical course with meibomian gland dysfunction, complicated by multiple chalazions. The article explains in detail the stages of prescribing various medications, including eyelid hygiene, antibacterial, anti-inflammatory therapy and artificial tears, discusses possible side effects of the therapy and ways to restore the eye surface.Conclusion. The basis of blepharitis treatment is regular three-component eyelid hygiene. In case of exacerbation it is advisable to prescribe antibacterial and anti-inflammatory drugs, taking into account the sensitivity and ability to destroy microbial biofilms. In order to increase patient adherence to treatment, the choice of hygiene products and moisturizing drops should take into account the tolerability of the drug and the convenience of its use.

The meibomian gland is a unique sebaceous gland located in the eyelid. Its main function is to secrete lipids and form the lipid layer of the tear film to delay the evaporation of waterborne tears, increase the surface tension of the tear film, and to lubricate the contact area of the eyelid and eyeball. Abnormal secretion of the meibomian gland is known as meibomian gland dysfunction (MGD), which has become the most important cause of evaporative dry eye disease (DED). The clinical pathophysio-logical process and underlying molecular mechanisms of MGD are not clear. As serious side effects may occur with the long-term use of hormonotherapy and non-steroidal anti-inflammatory drugs (NSAIDs) for the treatment of MGD, meibomian gland physiotherapy is considered the most effective and safest therapy for MGD. This review summarizes the physical therapy modalities of western medicine (WM) and traditiond Chinese medicine (TCM) for the treatment of MGD to provide optimal treatments for these patients and to further lay a foundation for mechanistic studies of MGD.

Nowadays, Meibomian gland dysfunction is considered as the leading cause of dry eye syndrome. Standard methods of the treatment rather often give us only shirt term remission, that’s why so actually to find new alternative treatment options with increasing of patients’ life quality and possibility for long-time remission. This study was directed to evaluate the effectiveness of complex dry eye treatment, included transdermal Intensive Pulse Light method, combined with preservative-free forms of eyelid hygiene and artificial tears eye drops. The study involved 30 patients (60 eyes) with dry eye syndrome and meibomian gland dysfunction. There were included patients with severe conjunctival hyperemia, follicular reaction, meibomeitis with changed, heavy Meibomian glands secret, rough eyelid margin, telangiectasias, tear break-up time (Norn test) not more than 5 seconds, necessity of very frequent instillations of artificial tear eye drops. All patients in anamnesis had already received courses of antiinflammation, artificial tears therapy and had courses of eyelid hygiene (eyelid margin massage with glass stick) with short-term positive dynamic and returning of symptoms during one month. As a result of studied algorithm, with a help of Intensive Pulse Light it was possible to decrease the period of positive dynamic receiving. From the other side, preservative-free forms of artificial tears eye drops (Hylaback) and eyelid hygiene (Blephaclean TheaGel Steri-Free) gave the prolongation of positive effect.

To determine the efficacy duration of eyelid hygiene for meibomian gland dysfunction (MGD) treatment, a total of 1015 participants with primary MGD, followed for at least 6 months, were enrolled. The participants were classified into the eyelid hygiene group and the control group. The participants who had stopped eyelid hygiene at any point in the observation period after the initial 2 months were classified into the withdrawal group. Analysis was conducted with a generalized linear mixed model. Treatment group, age, sex, ocular surface inflammation, anti-inflammatory treatments, and baseline MGD subtype were considered as fixed effects, and the individual factor was considered as a random effect. The MGD stage decreased significantly for the observational period in the eyelid hygiene group (p < 0.001). Approximately 40.1% of the participants continuously maintained eyelid hygiene throughout the observational period. The MGD stage in the eyelid hygiene group continued to decrease for 6 months and was maintained thereafter. After 4 months of stopping eyelid hygiene, the MGD stage in the withdrawal group was worse than in the eyelid hygiene group (p < 0.001) and similar to that in the control group (p = 0.762). Maintaining eyelid hygiene was significantly effective in MGD treatment. Efficacy increased with treatment for 6 months, and the efficacy duration was maintained for 4 months even after stopping eyelid hygiene. Therefore, we recommend that patients with MGD maintain eyelid hygiene, and compliance should be checked continuously.

Riadh Messaoud,1 Lamia El Fekih,2,3 Anis Mahmoud,1 Hager Ben Amor,4 Radhouane Bannour,5 Serge Doan,6,7 Moncef Khairallah41Department of Ophthalmology, Tahar Sfar University Hospital, Mahdia, Tunisia; 2Department of Ophthalmology, Internal Security Forces Hospital, La Marsa, Tunisia; 3Faculty of Medicine, Tunis-El Manar University, Tunis, Tunisia; 4Fattouma Bourguiba University Hospital, Monastir, Tunisia; 5Ophthalmology Private Practice, Monastir, Tunisia; 6Department of Ophthalmology, Bichat Hospital, Paris, France; 7Fondation A de Rothschild, Paris, FrancePurpose: To evaluate the clinical improvement in ocular symptoms and signs in patients suffering from Demodex anterior blepharitis after using a novel cleansing wipe impregnated with 2.5% terpinen-4-ol and 0.2% hyaluronic acid.Study design: This was an exploratory, multicenter, open, randomized, two-parallel group comparative study.Methods: Forty-eight patients with Demodex anterior blepharitis were randomly assigned to apply the sterile wipe T1172 (Blephademodex®), either once daily (n=24, Group 1) or twice daily (n=24, Group 2) for 29 days. Overall ocular discomfort and other individual symptoms were measured using a 0–10 numeric rating scale at Day 8 and Day 29. Ocular signs, including eyelid margin hyperemia and number of cylindrical dandruff, were examined at slit lamp. Overall treatment performance by investigator, patient satisfaction and tolerance were evaluated with questionnaires.Results: Overall ocular discomfort was significantly reduced from baseline (p

Purpose. To evaluate the effectiveness of dry eye syndrome (DES) treatment in patients with meibomian gland dysfunction (MGD) before refractive surgery.Materials and methods. We examined 48 women (aged 29.6 ± 3.9 years) with myopia, DES, and MGD of noninfectious etiology before performing LASIK. Group 1 of these patients received presurgical correction of DES for 2 months, including instillation of 3 % trehalose as a bioprotector (Thealoz®; 3–4 times a day); application of 5 % dexpanthenol in the conjunctival cavity (before going to bed); eyelid hygiene (2 times per day), which included cleaning (Theagel®), warm compresses on eyelid area, massage of eyelid margin (Blephaclean wipes). Group 2 only received bioprotective and reparative therapy for 2 months. Testing included a standard ophthalmological examination; assessment of DES symptoms (OSDI scale, points); BUT test (sec) and Schirmer-1 test (Sh-1, mm); measuring the height of the lower tear meniscus (optical coherence tomography, μm); lissamine green staining with calculation of xerosis index by Bijsterveld (points); assessment of MGD severity (points). Processing of the results included calculation of M ± s; Wilcoxon t-test, Mann Whitney U-test.Results. A positive change of OSDI (decrease from 31.9 ± 2.9 to 8.71 ± 1.1 points), xerosis index (decrease from 4.71 ± 0.5 to 2.1 ± 0.3 points) and BUT test (increase from 4.14 ± 0.53 to 8.66 ± 0.93 sec) was significantly stronger in patients of group 1 (p < 0.05) in comparison with patients of group 2 (decrease in OSDI from 33.2 ± 3.1 to 15.6 ± 2.4 points; decrease of xerosis index from 4.75 ± 0.50 to 3.7 ± 0.5 points; BUT increase from 4.21 ± 0.47 to 6.05 ± 0.73 sec). Apparently, this was caused by a significant decrease in the severity of MGD (from 2.1 ± 0.3 to 0.9 ± 0.2 points) and a decrease in the severity of lipid deficiency due to eyelid hygiene in patients of group 1. In group 2, MGD severity change proved unreliable. Change of Sh-1 and the height of the lower tear meniscus was unreliable in all cases. Conclusion. The inclusion of eyelid hygiene (Theagel and Blephaclean) in the pre-surgery preparation of patients with DES and MGD leads to a more significant correction of eye surface condition compared to isolated bioprotective and reparative therapy, thus providing an opportunity of more favorable conditions for carrying out surgical correction of ametropia.

The aim of this study was to evaluate the antimicrobial activity of a novel preservative-free lid wipe formulation containing Aloe vera gel and hyaluronic acid that is commercialized for the hygiene of the periocular area.In vitro susceptibility testing of the solution contained in wipes against bacteria and fungi commonly colonizing the periocular area, both reference strains and multidrug-resistant (MDR) clinical isolates, was assessed following the CLSI M07-A9 and M27-A3 broth methods, respectively. The solution was 2-fold serially diluted in broth from 25 μL (25% v/v) to 0.012 μL (0.012% v/v) in microtiter plates. Plates were incubated and minimal inhibitory concentrations (MICs) were read visually. The antimicrobial effectiveness test was performed by inoculating the wipe solution with microbial suspensions at the initial concentration of 10The MIC value of the solution ranged from 25% to 12.5% for bacteria and was 6.25% for Candida albicans. The MIC for MDR isolates was 12.5%. By assessing antimicrobial effectiveness, we found that the solution meets the criteria reported by the European Pharmacopoeia and United States Pharmacopeia for its preservative effect.This study demonstrates that the novel wipes herein tested possess antimicrobial activity against bacteria and yeast commonly found in the periocular area, and against MDR clinical isolates. The microbial death curves obtained following deliberate contamination of the wipe solution revealed potent bactericidal and fungicidal activity of the formulation.

Purpose: To evaluate the clinical improvement in ocular symptoms and signs in patients suffering from Demodex anterior blepharitis after using a novel cleansing wipe impregnated with 2.5% terpinen-4-ol and 0.2% hyaluronic acid. Study design: This was an exploratory, multicenter, open, randomized, two-parallel group comparative study. Methods: Forty-eight patients with Demodex anterior blepharitis were randomly assigned to apply the sterile wipe T1172 (Blephademodex®), either once daily (n=24, Group 1) or twice daily (n=24, Group 2) for 29 days. Overall ocular discomfort and other individual symptoms were measured using a 0–10 numeric rating scale at Day 8 and Day 29. Ocular signs, including eyelid margin hyperemia and number of cylindrical dandruff, were examined at slit lamp. Overall treatment performance by investigator, patient satisfaction and tolerance were evaluated with questionnaires. Results: Overall ocular discomfort was significantly reduced from baseline (p

Aim. To assess the correlation between eyelid and facial demodicosis and to develop an optimal anti-parasitic treatment schedule for posterior blepharitis associated with eyelid demodicosis. Materials and methods. 100 patients with posterior blepharitis associated with eyelid demodicosis were enrolled in the study. The patients were divided into 2 groups depending on Demodex count. Demodex count less than 4 mites was considered normal while Demodex count more than 4 mites was considered pathological. 60 patients with Demodex count more than 4 mites were subdivided into 2 groups. Study group patients (n = 30) received anti-parasitic therapy with preceding anti-inflammatory treatment, eyelid hygiene and massage. Control group patients (n = 30) received antiparasitic therapy only. Patients with verified facial demodicosis received dermatological treatment as well. In all patients, integral indices of subjective discomfort and objective signs of posterior blepharitis were measured, Schirmer’s and Norn’s tests were performed, functional state of meibomian glands was evaluated (compressive test). Results. Eyelid demodicosis was associated with facial demodicosis in 48% of patients. In 10%, Demodex count was less than 4 mites. In 38%, Demodex count was more than 4 mites. Skin lesions were revealed in 1% of patients with Demodex count less than 4 mites and in 20% of patients with Demodex count more than 4 mites. Anti-parasitic therapy with preceding anti-inflammatory treatment, eyelid hygiene and massage improved functional state of meibomian glands and objective signs of posterior meibomian blepharitis. In 1.5 months after the treatment, Demodex was absent in 80% of study group patients and 56.6% of controls. Conclusion. Stepwise treatment of posterior blepharitis associated with eyelid demodicosis (anti-inflammatory and anti-parasitic therapy, eyelid hygiene) is effective and provides prolonged remission.

Purpose: to analyze the effect of eyelid hygiene and therapy on early post-op period following excimer laser refractive surgery.Methods: 144 patients (288 eyes) aged 18-57 yrs who underwent excimer laser vision correction (LASIK) were followed. All patients were divided into two groups depending on therapy. In treatment group (70 patients/140 eyes), eyelid hygiene was prescribed 7 days before and 7 days again following refractive surgery for 1 or 2 months. In control group (74 patients/148 eyes), no eyelid hygiene was prescribed.Results: Complex method of eyelid hygiene and therapy was developed that consisted in eyelid margins self-massage using Blepharogel 1 or Blepharogel 2 and warm compresses using Blepharopads impregnated with Blepharolotion. When using in combina- tion with antibacterial and tear replacement therapy, this method provides significant decrease in infectious complications rate and effective recovery of tear production in early post-op period following excimer laser surgery. these observations are confirmed by the dynamics of clinical, functional and subjective parameters.Conclusion: 7-days eyelid hygiene and therapy course that is prescribed immediately before and following laser vision correctionprovides multi-factorial effect, i.e., reduces post-op inflammatory complications rate and increases tear film stability.

Serge DoanDepartment of Ophthalmology, Bichat Hospital and Foundation, Paris, FranceAbstract: Commonly associated with dry eye, blepharitis is the most commonly encountered disorder in general ophthalmologic practice. Although anti-infective and anti-inflammatory therapies are available, eyelid hygiene is the cornerstone of effective management. A variety of products have been used to assist and encourage eyelid cleansing and massage. The present study examines the ocular and periocular tolerability and acceptability of Blephagel, a cosmetic, poloxamer-containing gel designed specifically for cleansing the eyelid in subjects with sensitive skin or eyes or contact lens users. Subjects with blepharitis and sensitive skin or eyes, a history of atopy, or who use contact lenses applied Blephagel twice daily at home. Clinical ophthalmologic examinations were conducted before and 21 days after aqueous gel application, and subjects completed a questionnaire on the acceptability of the preparation. Thirty-three predominantly female subjects entered and completed the study. A total of 36% of the subjects had used similar products in the past, 21% regularly. Upon questioning by the ophthalmologist, 85% of the subjects reported acceptability of the preparation as good to very good, and 73% rated the efficacy as good to very good. There were minor but statistically nonsignificant changes in fluorescein tear breakup time and visual acuity before and after 21 days of aqueous gel application. The questionnaire results indicated that the subjects found the product to be effective for cleansing the eyelids of mucus and squama around eyelash roots. Moreover, cosmetic qualities, sensation in use, and acceptability were also appreciated. No subject reported any adverse event considered to be related to the aqueous gel. Although the safety of Blephagel has already been established in standard tests, the current results suggest that it is also pleasant to use and acceptable to blepharitis patients with sensitive skin as an aid to an eyelid hygiene regime.Keywords: blepharitis, tolerability, eyelid hygiene