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Purpose: to evaluate the effectiveness and safety of complex therapy in patients with demodex blepharitis and dry eye. Methods. 25 patients with mixed demodex blepharitis and dry eye (50 eyes; 10 men, 15 women; 61.9 ± 5.6 years) were examined before and after treatment with 0.5 % levofloxacin instillation (5 times a day, 5 days); sulfur and metronidazole gel applications (Blefarogel-forte) as part of therapeutic eyelid hygiene (Blepharogel-cleansing, Blepharolotion; starting from day 6, 2 times a day, 45 days); 0.24 % sodium hyaluronate instillation (3 times a day). Therapy effectiveness criteria were as follows: D. folliculorum mite population reduction; positive dynamics of blepharitis objective signs and meibomian gland dysfunction severity (MGD-S, points). Therapy safety criteria included the absence of negative dynamics of OSDI, tear film breakup time (TBUT, s), inferior tear meniscus height (ITMH, µm) and xerosis index (XI, points). Results. As a result of the therapy, statistically significant changes were noted, including mite population reduction (from 9.23 ± 0.81 to 3.54 ± 0.80 imagos); eyelid margins edema intensity decrease (from 3.18 ± 0.39 to 1.30 ± 0.45 points) and hyperemia decrease (from 2.90 ± 0.29 to 0.9 ± 0.3 points); MGD-S decrease (from 2.1 ± 0.3 to 0.95 ± 0.21 points); OSDI decrease (from 43.23 ± 4.70 to 25.10 ± 2.65 points); TBUT increase (from 4.05 ± 0.50 to 5.55 ± 0.50 s); XI decrease (from 5.36 ± 0.49 to 4.04 ± 0.60 points). Conclusion. The treatment of demodex blepharitis and dry eye treatment, including sulfur and metronidazole gel applications, therapeutic eyelid hygiene and 0.5 % levofloxacin and 0.24 % sodium hyaluronate instillation demonstrated a high efficiency and a good safety profile.

Kento Yokobori,1,* Masahiko Ayaki,1,2,* Motoko Kawashima,1 Hidemasa Torii,1 Erisa Yotsukura,1 Sachiko Masui,1 Kazuno Negishi1 1Department of Ophthalmology, Keio University School of Medicine, Tokyo, Japan; 2Otake Eye Clinic, Yamato City, Kanagawa, Japan*These authors contributed equally to this workCorrespondence: Masahiko Ayaki, Email mayaki@olive.ocn.ne.jpPurpose: To evaluate the effect of eyelid hygiene after cataract surgery on eyelid and ocular surface findings, subjective symptoms and visual function, including functional visual acuity (FVA) and higher order aberration, in a randomized controlled study.Methods: Fifty patients who underwent cataract surgery at a single institution were involved. Twenty-five patients were instructed to wipe their eyelids twice a day from one to four weeks postoperatively, whereas the other 25 patients did not perform any eyelid hygiene. Optical measurement, FVA, meibomian glands, the grade of meibum, lid margin findings, fluorescein corneal staining findings, dry eye-related subjective symptoms and surgical satisfaction were assessed both preoperatively and one month postoperatively.Results: In the eyelid hygiene group, the visual maintenance ratio of FVA improved significantly (p = 0.048) and the higher order aberration of the 4th + 6th order deteriorated less (p = 0.027) compared with the control group. Multiple regression analyses showed that the change in visual maintenance ratio was associated with surgical satisfaction (p = 0.003), change in corneal staining score (p = 0.007), history of eye diseases (p = 0.029) and eyelid hygiene (p = 0.048).Conclusions: Eyelid hygiene after cataract surgery may be effective for visual function measured with an FVA test.Keywords: cataract surgery, dry eye, eyelid hygiene, functional visual acuity, higher order aberration, meibomian gland dysfunction, visual maintenance ratio

Purpose: to evaluate the ocular surface changes (OSC) in seasonal and chronic allergic blepharoconjunctivitis (ABC) under dry eye (DE) conditions and to consider therapeutic possibilities.Materials and methods. 60 patients with seasonal ABC and mild DE syndrome (group 1) and 50 patients with chronic ABC and moderate DE syndrome (group 2) were tested for lipid deficiency (LD; negative lipid-interference test), aqua-deficiency (AD; inferior tear meniscus height < 250 fim), and mucose deficiency (Bijsterveld`s xerosis index > 3 scores; XI, scores), Ocular surface disease index (OSDI), tear film break-up time (TBUT, seconds), meibomian gland dysfunction (MGD) according to Korb, taking into account the proportion of MGD (%) and its severity (MGDS, scores), and the “lid-wiper” symptom (LWS, scores) Statistics: M ± s; Mann — Whitney U-test; differences were statistically significant at p < 0.05.Results. LD was diagnosed in 65% of the 1st group patients (OSDI 32.3 ± 4.2, TBUT 6.5 ± 0.6, TMH 363.4 ± 43.96, XI 2.1 ± 0.4, MGDproportion — 41.02 %, LWS 1.1 ± 0.2). LD and MD were detected in 35 % of 1st group patients (OSDI 41.3 ± 5.7, TBUT 5.7 ± 0.5, TMH 332.9 ± 29.9, XI 4.2 ± 0.7, MGD proportion — 61.9 %, LWS 1.24 ± 0.4). The differences in OSDI, TBUT and XI values between DE patients with LD and DE patients with LD and MD were statistically significant. LD and AD were diagnosed in 48 % of 2nd group (OSDI 48.5 ± 6.4, TBUT 5.5 ± 0.6, TMH 192.3 ± 20.8, XI 2.5 ± 0.5, MGDS 1.8 ± 0.4, LWS 1.9 ± 0.3). LD, AD and MD were detected in 52 % of the 2nd group patients (OSDI 57.5 ± 5.8, TBUT 4.6 ± 0.6, TMH 177.7 ± 16.9, XI 5.5 ± 0.6, MGD-S 2.2 ± 0.4, LWS 2.3 ± 0.4). The differences in OSDI, TBUT and XI values between DE patients with LD-AD combination and DE patients with LD-AD-MD were statistically significant.Conclusion. OSC included lipid deficiency (65 %) and lipid-mucose deficiency (35 %) in S-ABC patients; OSC were represented by lipid-aqua-deficiency (48 %) and lipid-aqua-mucose-deficiency (52 %) in C-ABC patients. In our opinion, the diagnostics of these clinical variants of OSP diagnosis, opens up opportunities for differentiated tear replacement therapy. MGD was diagnosed in one half of S-ABC patients and in all C-ABC patients, which we believe determines another possible therapy direction — eyelid therapeutic hygiene aimed at MGD relieving and lipid deficiency compensation.

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

Purpose. Comparative analysis of the efficacy and safety of Blefarovit product in the complex therapy of chronical blepharoconjunctivitis and «dry eye» syndrome with a pronounced demodicosis component in patients, previously received standard treatment with or without short-term positive effect. Material and methods. The present study included 60 patients (120 eyes) with chronical blepharoconjunctivitis, «dry eye» syndrome and demodicosis component. The patients, involved in the study had pronounced thickening of the eyelid margin, scabs and «clutches» in the eyelashes, meibomeitis, hyperemia, follicular reaction of the tarsal and bulbar conjunctiva. This study was devoted to finding a new approach for the demodecosis component therapy, using staged eyelid hygiene technology with the multicomponent product Blefarovit. The purpose of this study was to estimate efficacy and safety in isolated Blefarovit usage (1st stage of therapy) and Blefarovit in the combination with anti-inflammatory and artificial tears therapy (2nd stage of therapy). Results. The results of the study were increasing of the TBUT test and decreasing the of Demodex Folliculorum number. Conclusion. The usage of Blefarovit product made possible to show significant decreasing in the severity of the demodectic component without increasing the toxico-allergic background.

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. [ABSTRACT FROM AUTHOR]

To make appropriate therapeutic decisions of intense pulsed light (IPL) for meibomian gland dysfunction (MGD) patients. Sixty patients with MGD stage 2–3 were enrolled in IPL Group1 and Self-hygiene Group; 110 patients with MGD stage 3–4 were included in IPL + MGX Group and IPL Group2. Patients in IPL groups received IPL treatment once a month for three times. Meibomian gland expression (MGX) was combined with IPL treatment in IPL + MGX Group. Meibomian gland (MG) functions, MGD stage, associated ocular-surface indexes, and response rate were evaluated. Population characteristics and clinical conditions were comparable between groups. In patients with MGD stage 2–3, both IPL Group1 and Self-hygiene Group improved in MG functions, ocular surface disease index (OSDI) and tear break-up time (TBUT). No statistical difference was found in improvements. Posttreatment response rate was 64.3–66.7% in two groups. In patients with MGD stage 3–4, IPL + MGX Group achieved better improvements in MG expressibility and higher response rate (75.5%) than IPL Group2 (63.3%). Referring to IPL treatment, no statistical difference in MG functions and OSDI improvements was found among MGD patients with different ages, genders, and IPL energy exposure. Patients with higher Fitzpatrick scale improved more in MG expressibility. Self-eyelid hygiene is cost-effective for milder MGD stages. Combining MGX with IPL is necessary in more severe stages. Adult patients with all age and different genders can benefit from IPL treatment. Patients with darker skin can benefit more in expressiblity. [ABSTRACT FROM AUTHOR]

Currently, the main applied physiotherapeutic methods of treatment, whale, as well as the features of their application are considered. The basis of the meibomian glands dysfunction treatment is the hygiene of the eyelids. There are many modifications to the application of eyelid hygiene, but its basic principle is the use of warm compresses and eyelid massage. There are many modifications of warm compresses. Using them, it is necessary to remember about the possibility of the appearance of the cornea with various types of thermal effects on the eyelids when dysfunction of the meibomian glands is detected, therefore it is important to carefully dose the time of thermal exposure and temperature regime, which allows you to avoid side effects. The classic tool that a doctor uses to treat MGD — eyelid massage on a glass rod, has now been replaced by many high-tech devices for heating, moisturizing and massage of the eyelid. All commercial devices for the treatment of MGD on the world market can be divided into several groups, according to their effect: device for light therapy. The most high-tech devices include the LipiFlow® device (combined heat and eyelid massage) and the device for IPL therapy with intense pulsed light. many studies aimed at studying the effectiveness of various research methods. It should be noted that it is not by chance that in modern ophthalmological practice the range of new methods for studying MGD has expanded so much. This is due to the annual number of patients suffering from this pathology. Therefore, the urgent task is to search for new methods of treatment aimed at restoring the functional activity of the meibomian glands.

Purpose: to develop a comprehensive method of meibomian gland dysfunction (MGD) treatment, including the periorbital zone massage, aimed to improving the microcirculation of the eyelids and the functional activity of the meibomian glands, evaluating its effectiveness and safety.Patients and methods. The study included 92 patients (184 eyes) with all forms of permanent residence in accordance with the international classification of the DEWS working group, 32 of them were men and 60 women. All patients included in the study at the first stage of work were randomly divided into 3 groups, depending on the type of therapy. The first group included 34 patients (68 eye), in which complex therapy was carried out in the form of eyelid hygiene + massage in the periorbital zone according to the methodology developed during the study, the second group included 30 patients (60 eyes) who underwent IPL therapy (the use of intense pulsed light in the periorbital zone), the third group included 28 patients (56 eyes) who were treated in the form of eyelid hygiene (warm compresses + eyelid self-massage).Results and discussion. A technique of massage in the periorbital zone was developed, its effect on hemodynamic parameters of the eyelids was studied, and to assess its effectiveness, a comparison of hemodynamic parameters of the eyelids was carried out with two other methods of thermal exposure — eyelid hygiene (warm compresses + eyelid self-massage) and IPL therapy. It was found that all three types of exposure — IPL therapy, eyelid hygiene and eyelid hygiene + massage in the periorbital zone, carried out according to the original technique, lead to an increase in hemodynamic parameters of the eyelids and in the lacrimal artery (according to laser Doppler flowmetry and color Doppler mapping) to varying degrees of severity, which should contribute to an increase in the metabolism of Meibomian glands, therefore, and the improvement of their functional activity. At the same time, 3 months after the treatment starting, the improvement of the the meibomian glands’ functional activity of was higher in the group of patients in which IPL therapy and complex effects — eyelid hygiene + massage in the periorbital zone were performed, compared with the group with only eyelid hygiene. However, after 6 months, high indicators of the functional activity of the meibomian glands remained only in the group with complex effects — eyelid hygiene + massage in the periorbital zone. Such a therapeutic effect, according to the results of the study, improves the patients’ quality of life according to data of the SPEED questionnaire and directly depends on adherence to treatment on the Morisky scale (MMAS).Conclusions. The presented complex of therapy can be recommended for wide application in ophthalmological practice for the treatment of dysfunction of the meibomian glands.

Background: Progressively increasing number of eye surgeries forces the development of simple-to-use, effective methods to reduce the risk of postoperative endophthalmitis. We wondered whether the eyelid margin wipes containing 0,1% polyhexamethylene biguanide (PHMB) (HexaClean, VERCO, Poland) influence the reduction of bacterial flora localized in the conjunctival sac and whether it can be used for prophylaxis before the cataract surgery. MATERIAL AND METHODS: 95 patients before the cataract surgery were included in the study. The conjunctival swab was collected from patients twice -- before using eye wipes and after 5 days of eye wipes usage. The swabs were plated on microbiological enriched media and incubated under aerobic and microaerophilic conditions for 24-48 hours at 35°C ± 2°C. Then the identification of microorganisms was carried out using classic microbiological methods and tests. RESULTS: Bacterial strains were isolated from the conjunctival sac in 84% of patients before using the eye wipes. The largest group of isolated pathogens was Gram-positive cocci, and these were mainly methicillin-sensitive and methicillin-resistant coagulase-negative staphylococci, which accounted for 72% of isolated strains. When the eye wipes were used, the bacterial flora was eliminated from the conjunctival sac in 54% of patients. A reduction in isolated strains and decreased variety of bacteria was observed in another 22% of patients. CONCLUSION: These results indicate that the application of eyelid wipes with polyhexanide reduces a significant amount of the conjunctival sac microbiota, which may prevent inflammation after cataract surgery. [ABSTRACT FROM AUTHOR]

Preseptal cellulitis is a commonly observed inflammation of the eyelid and the surrounding skin in pediatric patients, especially after a minor trauma. Although preseptal cellulitis is generally associated with a more favorable prognosis, it is vital to remember that all orbital infections require prompt diagnosis and treatment because of the risk of severe complications. Inadequate or failure to adhere to the treatment plan and unmet hygiene standards can lead to severe complications; therefore, diligent follow-up care should be undertaken by both the physician and the patient., Competing Interests: Human subjects: Consent for treatment and open access publication was obtained or waived by all participants in this study. Acibadem University Clinical Research Ethics Committee issued approval 75088915. All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards. Conflicts of interest: In compliance with the ICMJE uniform disclosure form, all authors declare the following: Payment/services info: All authors have declared that no financial support was received from any organization for the submitted work. Financial relationships: All authors have declared that they have no financial relationships at present or within the previous three years with any organizations that might have an interest in the submitted work. Other relationships: All authors have declared that there are no other relationships or activities that could appear to have influenced the submitted work., (Copyright © 2024, Kiliccioglu et al.)

Purpose: This study compares the effectiveness of various approaches to improvement of ocular surface condition in primary open-angle glaucoma (POAG) patients with dry eye syndrome (DES) and meibomian gland dysfunction (MGD)., Material and Methods: The study included 48 patients with stage II POAG, compensated with a fixed-combinations of dorzolamide and timolol (FC-DT) containing benzalkonium chloride (BAC), in the presence of DES and MGD. After randomization, patients in group 1 ( n =24) received FC-DT without BAC along with eyelid hygiene ("Blepharogel cleansing", "Blepharolotion", "Blepharogel-1"), while patients in group 2 received only FC-DT without BAC. The control points (CP) were: 1 - at baseline, 2 - after 4 weeks of therapy. Changes in OSDI score, tear break-up time (TBUT), Bijsterveld's xerosis index (XI), MGD severity, and intraocular pressure (IOP) were assessed at each CP., Results: By the second CP, in group 1 significant improvements were observed in OSDI, TBUT, XI, and MGD severity by the 2nd CP, while in group 2 - in OSDI and TBUT. The improvements in OSDI and TBUT were significantly more pronounced in group 1, likely due to the reduction in MGD severity. The changes in IOP in both groups were insignificant., Conclusion: In patients with POAG, DES, and MGD who are undergoing therapy with BAC-containing medications, an approach involving switching to BAC-free eye drops combined with eyelid hygiene (using "Blepharogel cleansing", "Blepharolotion", and "Blepharogel-1") proved to be more effective than the approach of switching to BAC-free medications without additional eyelid hygiene.

Purpose: The study comparatively evaluates the effectiveness of various approaches to acaricidal treatment in patients with chronic demodex blepharitis and meibomian gland dysfunctions., Material and Methods: The study included 40 patients with chronic blepharitis (CB) of demodicosis etiology in conditions of meibomian gland dysfunction (MGD) and dry eye (DE). The 1 st group of patients (20 people) received acaricidal treatment as part of therapeutic eyelid hygiene (TEH; 2 times a day) involving the use of «Blefarogel ochishchenie», «Blefarolosion», «Blefarogel forte» (contains sulfur and metronidazole). Acaricidal treatment in the patients of the 2 nd group involved applications of a product containing metronidazole (2 times a day) without TEH. Control points: 1) at inclusion in the study; 2) after a course of therapy (45 days). Evaluation included: patient acarograms, symptoms and signs of CB (points); OSDI; tear film break-up time (TBUT, sec), severity of meibomian gland dysfunction (S-MGD, points). Statistical analysis: calculation of M ± SD , Mann-Whitney, and Wilcoxon tests., Results: Acaricidal treatment was effective in both groups (reduction in demodex population, which was more pronounced in the 1 st group). Symptoms and signs of CB were significantly less pronounced in the patients of the 1 st group after therapy. The patients of the 1 st group showed a significant decrease in S-MGD, OSDI and an increase in TBUT, the 2 nd group - a significant decrease in OSDI and an increase in TBUT at the second control point. The positive OSDI and TBUT trends were significantly more pronounced in the 1 st group., Conclusion: Acaricidal treatment as part of TEH showed a significantly more pronounced reduction in demodex population, relief of CB symptoms and sign, OSDI decrease and TBUT increase, compared to the 2 nd group. Apparently, this was associated with combined acaricidal effect and significant S-MGD decrease in the patients of the 1 st group.

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. [ABSTRACT FROM AUTHOR]