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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

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.

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.

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.

Abstract The most prevalent type of meibomian gland dysfunction (MGD), which is obstructive, is the main cause of evaporative dry eye and is characterized by changes in the meibum composition and duct obstruction. Eyelid hygiene has usually been the most common clinical approach. However, alternative therapies for MGD are emerging on the market. Some warming and humidity devices have led to an improvement in the signs and symptoms in MGD patients. Likewise, eyelid massaging and cleaning devices are also beneficial for ocular signs and symptoms; however, patients usually need more than one session to maintain the therapeutic effect. Thermal pulsation has been reported to be more efficient than other strategies, and the effects can last up to 12 months. Moreover, intense pulsed light therapy has been demonstrated to improve ocular signs and symptoms alone and in combination with other therapies. Proper counseling of clinicians considering MGD status and patient compliance will help patients to undergo the adequate technique that best suits their condition.

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.

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.

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. [ABSTRACT FROM AUTHOR]