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Purpose: Blepharitis, simply defined as eyelid inflammation, is one of the common ocular conditions associated with discomfort and irritation. Because blepharitis causes meibomian gland dysfunction and dry eye, this study aimed to confirm the effect of photobiomodulation (PBM) on blepharitis., Methods: A total of 20 rats were randomly assigned to 4 equal groups, including control, blepharitis, PBM, and eye drop. Blepharitis was induced in rats by injecting complete Freund's adjuvant in the eyelid margins. PBM intervention was given every 3 days after blepharitis induction. Clinical signs including tear volume, tear breakup time (TBUT), meibomian gland swelling, fluorescein, telangiectasia, and meibomian gland secretion scores were measured every week, and the rats were killed for histological analysis after 4 weeks. Immunohistochemistry was performed to compare the level of inflammatory cytokines, interleukin-1β and tumor necrosis factor-α, and terminal deoxynucleotidyl transferase dUTP nick end labeling staining on retina was performed to observe any retinal damage., Results: Tear volume and TBUT increased with PBM intervention, and with improved eyelid swelling, corneal staining, telangiectasia, and meibomian gland secretion scores increased. Hematoxylin and eosin staining showed no structural abnormalities of meibomian gland caused by blepharitis induction. Immunohistochemistry revealed that the levels of inflammatory cytokines interleukin-1β and tumor necrosis factor-α were lowered with PBM treatment in both eyelid and conjunctiva. Terminal deoxynucleotidyl transferase dUTP nick end labeling staining showed no retinal damage., Conclusions: Laser PBM at 808 nm was effective in alleviating ocular signs and controlling inflammation in blepharitis rat model. The in vivo results suggest that PBM has the potential to be used in treating blepharitis patients., Competing Interests: The authors have no conflict of interest to disclose., (Copyright © 2020 Wolters Kluwer Health, Inc. All rights reserved.)

Dysfunctional tear syndrome (DTS) is a common and complex condition affecting the ocular surface. The health and normal functioning of the ocular surface is dependent on a stable and sufficient tear film. Clinician awareness of conditions affecting the ocular surface has increased in recent years because of expanded research and the publication of diagnosis and treatment guidelines pertaining to disorders resulting in DTS, including the Delphi panel treatment recommendations for DTS (2006), the International Dry Eye Workshop (DEWS) (2007), the Meibomian Gland Dysfunction (MGD) Workshop (2011), and the updated Preferred Practice Pattern guidelines from the American Academy of Ophthalmology pertaining to dry eye and blepharitis (2013). Since the publication of the existing guidelines, new diagnostic techniques and treatment options that provide an opportunity for better management of patients have become available. Clinicians are now able to access a wealth of information that can help them obtain a differential diagnosis and treatment approach for patients presenting with DTS. This review provides a practical and directed approach to the diagnosis and treatment of patients with DTS, emphasizing treatment that is tailored to the specific disease subtype as well as the severity of the condition.

Despite the fact that cosmetic products undergo rigorous testing to ensure they are safe for human use, some users report mild discomfort following their application. The cutaneous changes, such as allergic dermatitis, are well reported, but the ocular changes associated with eye cosmetic use are less so. Some pigmented cosmetic products may accumulate within the lacrimal system and conjunctivae over many years of use, but immediate reports of eye discomfort after application are most common. Changes to the tear film and its stability may occur shortly after application, and contact lens wearers can also be affected by lens spoliation from cosmetic products. Additionally, creams used in the prevention of skin aging are often applied around the eyes, and retinoids present in these formulations can have negative effects on meibomian gland function and may be a contributing factor to dry eye disease. The aim of this review is to summarize current knowledge regarding the impact of cosmetic products on the eye, ocular surface, and tear film.

Purpose: To report the efficacy of sub-Tenon triamcinolone acetonide (TA) injections for chronic blepharokeratoconjunctivitis (BKC) in 2 patients who were intolerant to topical therapies., Methods: In this retrospective observational case series, the records of 2 patients with chronic BKC who received sub-Tenon TA injections were reviewed., Results: Both patients, a 4-year-old girl and a 21-year-old developmentally delayed man, were managed successfully with sub-Tenon TA injections. The treatment resulted in resolution of symptoms, diminished corneal haze, reduced conjunctival injection, and improved visual acuity without complications., Conclusions: This case series illustrates the potential benefit of using sub-Tenon TA injections for chronic BKC in patients who are intolerant to topical corticosteroid therapy. Therefore, sub-Tenon TA injections may be considered for patients with vision-threatening BKC and nonadherence to topical therapies.

Purpose of Review: To summarize the key literature and our research experience regarding Demodex infestation as a potential cause of ocular inflammatory diseases with a special emphasis on Demodex blepharitis., Recent Findings: Two distinct Demodex species have been confirmed as a cause of blepharitis: Demodex folliculorum can cause anterior blepharitis associated with disorders of eyelashes, and D. brevis can cause posterior blepharitis with meibomian gland dysfunction and keratoconjunctivitis. Tea tree oil treatments with either 50% lid scrubs or 5% lid massages are effective in eradicating mites and reducing ocular surface inflammation., Summary: Demodex blepharitis is a common but overlooked external eye disease. The pathogenesis of Demodex blepharitis in eliciting ocular surface inflammation has been further clarified. The modified eyelash sampling and counting method makes it easier and more accurate to diagnose Demodex infestation. Tea tree oil shows promising potential to treat Demodex blepharitis by reducing Demodex counts with additional antibacterial, antifungal, and anti-inflammatory actions.

Purpose: To determine the differential features of tear physiology and meibomian gland function in blepharitics for ascertaining the diagnostic potential of a number of clinical tests., Methods: Two groups of subjects, 15 with clinically diagnosed blepharitis (11 women and 5 men mol/L; age 60.9 +/- 12.5; range 41-79) and 15 age- and sex-matched controls (11 women and 5 men mol/L; age 60.7 +/- 12.6; range 40-78), were included in the study. Tear physiology was assessed by evaporimetry and interferometry and the meibomian glands by expression and meibography., Results: Tear evaporation rate was significantly higher (P<0.001) in blepharitics (46.3 +/- 22.9 g/m/hr) than that in normals (18.0 +/- 10.7 g/m/hr). The lipid pattern was found to be significantly less stable (P=0.001) in the blepharitic group compared with that in the normal group. By meibography, meibomian gland dropout was scored and found to be significantly greater (P=0.001) in blepharitics in both the upper eyelids (blepharitis 1.0 +/- 0.8; normal 0.1 +/- 0.3) and lower eyelids (blepharitis 2.1 +/- 8.3; normal 1.0 +/- 0.8). The dropout score was the same or greater for the lower lids than for the upper lids, in all cases. A significant difference (P=0.000) in meibomian gland expression was found between blepharitics and normals; meibum was significantly thicker and more opaque in blepharitics in both the upper (blepharitis 2.2 +/- 0.7; normal 1.0 +/- 0.2) and lower (blepharitis 2.6 +/- 0.7; normal 1.3 +/- 0.4) eyelids., Conclusions: There are significant differences in tear physiology and meibomian gland function in patients with blepharitis when compared with those without. All the tests employed would be useful as single tests in the diagnosis of blepharitis, with meibomian gland dropout of the lower eyelid offering the greatest effectiveness as a single measure.

Purpose: To present our results to date on the evaluation of the pathophysiology of chronic blepharitis and its relationship to the tear lipid layer, and to propose a structure to that layer., Methods: Compilation of work to date., Results: A classification system of chronic blepharitis has been developed that has use in diagnosis, planning therapy, and assessment of mechanisms. Abnormalities in meibum have been identified that provide insight into disease mechanisms and have led to the development of a proposed structure to the tear lipid layer. A defect in polar lipids explaining the frequently associated evaporative dry eye has been identified. Mechanisms accounting for the therapeutic benefit of minocycline have been elucidated., Conclusion: Chronic blepharitis has associated meibum abnormalities that explain defects in the tear lipid layer that may result in a frankly unstable tear film and that explain the frequently associated evaporative dry eye.

Blepharitis patients have a number of disturbances in their tear film associated with meibomian gland dysfunction that affect evaporation and tear osmolarity. We tested a series of 156 consecutive patients, with a presumed diagnosis of blepharitis, dry eye, or allergic disease, and a series of 72 normals. We compared their tear film characteristics using tear osmolarity, tear volume, tear production (fluorophotometric and Schirmer test), tear turnover (decay constant), tear evaporation, and meibomian gland function evaluated by gland drop-out, expressed lipid viscosity, and volume. Of the 156 patients tested, we found 37 had dry eye, 10 had only allergic disease, 73 had meibomian gland dysfunction and dry eye, and 36 had only meibomian gland dysfunction. We created a model of the relative influence some of these factors had on each other using their correlation coefficients. The highest correlations for osmolarity were Schirmer test (-0.44), lipid volume low (-0.44), lipid viscosity high (0.39), gland drop-out (0.39), and tear evaporation (0.36). With regression analysis we accounted for 47% of the total variation in osmolarity, but only 17% of the variation in tear evaporation. We also present our classification system for blepharitis and dry eye patients based on our measurable physiologic parameters.

We examined 57 patients with symptoms of chronic blepharitis using meibomian gland expression, meibography, tear osmolarity, and the Schirmer's test. We also performed meibography on 20 normal patients free of chronic blepharitis. We found that 42 blepharitis patients (74%) had evidence of meibomian gland loss, whereas only four of 20 normal patients (20%) had any gland dropout. We performed cluster analysis on the data from the patients with blepharitis and found that these patients tended to fall into distinct groups with clinically relevant characteristics. We also found that tear osmolarity correlated positively with gland dropout (+0.413) and negatively with excreta volume (-0.499). This study demonstrates that an objective analysis of meibomian gland function may be used to assess chronic blepharitis and define subsets of blepharitis with measurable differences. It also supports the significance of meibomian gland dysfunction on tear osmolarity and the evaporative state of the eye.