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The purpose of this randomized clinical trial is to evaluate the effect of eyelid hygiene on subjective symptoms, anterior blepharitis, and meibomian gland dysfunction (MGD) after cataract surgery. Subjects with obstructive MGD who underwent cataract surgery were randomly divided into two groups. In the eyelid hygiene group, eyelid hygiene was performed twice a day for 10 days from 3 days before to 1 week after cataract surgery. The control group did not perform eyelid hygiene. A subjective symptom questionnaire of SPEED, anterior blepharitis grade, and meibum quality and quantity was evaluated at baseline and at postoperative 1 and 4 weeks. The eyelid hygiene group (n = 36) showed decreased SPEED score after cataract surgery and the control group (n = 33) did not. Anterior blepharitis grade was worse 1 week after surgery in the control group but not in the eyelid hygiene group. The control group had significantly decreased meibum quality and quantity in both the upper and lower eyelids after cataract surgery, but the eyelid hygiene group did not. Eyelid hygiene before/after cataract surgery improved postoperative subjective symptoms and prevented postoperative exacerbation of anterior blepharitis and MGD. Thus, perioperative eyelid hygiene is recommended for patients with obstructive MGD who undergo cataract surgery.

Background Twelve ocular surface disease experts convened to achieve consensus about Demodex blepharitis (DB) using a modified Delphi panel process. Methods Online surveys were administered using scaled, open-ended, true/false, and multiple-choice questions. Consensus for questions using a 1 to 9 Likert scale was predefined as median scores of 7–9 and 1–3. For other question types, consensus was achieved when 8 of 12 panellists agreed. Questions were randomized, and results of each survey informed the following survey. Results Twelve practitioners comprised the D emodex E xpert P anel on T reatment and Eyelid H ealth (DEPTH). Following 3 surveys, experts agreed that DB is chronic ( n  = 11) and recurrent ( n  = 12) and is often misdiagnosed. Consensus was achieved regarding inflammation driving symptoms (median = 7; range 7–9), collarettes as the most common sign ( n  = 10) and pathognomonic for DB (median = 9; range 8–9), and itching as the most common symptom ( n  = 12). Panellists agreed that DB may be diagnosed based on collarettes, mites, and/or patient symptoms ( n  = 10) and felt that patients unresponsive to typical therapies should be evaluated for DB ( n  = 12). Consensus about the most effective currently available OTC treatment was not reached. Conclusions The Delphi methodology proved effective in establishing consensus about DB, including signs, symptoms, and diagnosis. Consensus was not reached about the best treatment or how to grade severity. With increased awareness, eyecare practitioners can offer DB patients better clinical outcomes. A follow-up Delphi panel is planned to obtain further consensus surrounding DB treatment.

Purpose. To investigate the effect of preoperative treatment and postoperative enhanced anti-inflammatory treatment on alleviating meibomian gland dysfunction (MGD) and dry eye induced by cataract surgery. Design. Prospective, randomized clinical trial. Methods. A total of 120 cataract patients with moderate obstructive-MGD were enrolled and randomized with 60:30:30 number of patients in cohorts I, II, and III, respectively: Cohort I: routine postoperative anti-inflammatory treatment; Cohort II: preoperative treatment (warming compress, lid hygiene, and anti-inflammatory treatment) and routine postoperative anti-inflammatory treatment; Cohort III: enhanced postoperative anti-inflammatory treatment. Main Outcomes Measures. All participants were examined preoperatively and postoperatively for ocular symptom score (OSS), noninvasive keratographic tear break-up time (NIKBUT), corneal fluorescein staining, Schirmer I test, lid margin, meibum quality and expressibility, and meibomian gland dropout. Results. Ocular surface disorders and MGD showed aggravated status at 1 month postoperatively in Cohort I and Cohort III, and the aggravated MGD resolved by 3 months postoperatively. At 1 month postoperatively, Cohort II and Cohort III presented high NIKBUT and low OSS, lid margin, and meibum quality and expressibility (Cohort II vs Cohort I: all P<0.001, respectively; Cohort III vs Cohort I: P=0.011, P=0.024, P=0.046, P=0.045, and P=0.012, respectively). Additionally, Cohort II had better outcomes of lid margin and meibum quality and expressibility than Cohort III at 1 month postoperatively (P=0.031, P=0.026, and P<0.001, respectively). At 3 months postoperatively, Cohort II presented a significantly higher NIKBUT than Cohort I and Cohort III (P<0.001 and P=0.001, respectively). Conclusion. Preoperative management of MGD is effective and optimal in alleviating obstructive-MGD and dry eye induced by cataract surgery.

PurposeTo investigate the efficacy of lid wipes (LWs) containing terpinen-4-ol and sodium hyaluronate (Hy-ter®) for the treatment of seborrheic blepharitis compared to baby shampoo (BS).MethodsThis randomized, double-blind, active control, parallel group, multicentre clinical trial included 48 eyes of 48 patients with seborrheic blepharitis who were randomly divided into two treatment arms (1:1, n = 24) using block randomization. LWs or BS were prescribed twice a day for 8 weeks followed by a discontinuation period of 4 weeks. Change in Blepharitis Symptom measure (BLISS), Schirmer’s test, tear breakup time (TBUT), noninvasive TBUT (NI-TBUT), ocular surface disease index (OSDI) score, corneal and conjunctival staining, meibography, and Demodex count at different visits (Baseline, 4th, 8th, and 12th week) were the main outcome measures.ResultsThe baseline values of both groups were similar (p > 0.05). Despite high clinical efficacy in both treatment arms, patients using LWs showed a lower BLISS score at the 8th and 12th-week visit (1.9 ± 2.2 versus 7.2 ± 6.6, p = 0.003; 4.0 ± 1.3 versus 5.8 ± 6.3, p = 0.026). NI-TBUT showed a significant increase starting from the 4th week for patients using LWs and 8th week for patients using BS. Both treatment modalities caused a reduction in the Demodex count after 4 weeks of treatment (p < 0.001). The treatment withdrawal did not cause any recurrence in both treatment arms.ConclusionBS or LWs containing Hy-ter® can be used with good efficacy for the treatment of seborrheic blepharitis. However, LWs may provide a better symptomatic relief compared to BS after 8 weeks of treatment.

Background Blepharitis is a chronic inflammatory condition of the eyelids that affects a large proportion of patients in eye care settings. First-line treatments provide only partial relief for many patients. The BlephEx™ device provides automated eyelid debridement and aims to remove pathogenic biofilms from the eyelid margin to treat blepharitis long-term. However, evidence supporting the efficacy of BlephEx™ is limited. Methods In this double-masked randomized controlled trial, 42 patients with symptomatic blepharitis refractory to treatment were assigned to the BlephEx™ treatment or sham treatment group. Outcome measures including Ocular surface disease index (OSDI), tear break-up time (TBUT), Schirmer test, and Efron grading scale scores were assessed at baseline and after 4 weeks. A crossover design in which the treatment groups were swapped after 4 weeks was used as a recruitment tool. After receiving treatment, two patients (one per group) were lost to follow-up. Results The sham group exhibited a significant decrease in the Efron Grading Scale score. No significant differences were observed in the other outcomes between the two groups. The BlephEx™ group showed slightly greater decreases in the OSDI and Efron grading scale scores and an increase in the TBUT than did the sham group, but these differences were not statistically significant. Mild discomfort was the most common side effect and occurred equally in both groups. Conclusions No significant difference in outcomes was observed between patients who underwent BlephEx™ therapy and those who received sham treatment. BlephEx™ treatment cannot be recommended for treating blepharitis. Trial registration Retrospectively registered on February 16, 2024 in the DRKS (German Clinical Trials Register under https://drks.de/search/de/trial/DRKS00033492 ) under the trial registration number DRKS00033492.

Background To date, there have been few detailed reports of the clinical findings in cases of fungal blepharitis. In this report, we present a rare case of anterior blepharitis in a Japanese child in whom Candida albicans was identified from secretions on the eyelash roots and present the clinical findings of the patient’s eyelid margin via photograph documentation. Case presentation This study involved a 6-year-old Japanese boy with Treacher–Collins syndrome and severe ulcerative colitis who, during a follow-up visit at the Department of Pediatrics at Osaka Medical and Pharmaceutical University Hospital, Takatsuki City, Osaka, Japan, suffered a cardiac arrest due to massive gastrointestinal hemorrhage, which led to persistent altered consciousness following resuscitation. Subsequently, the patient developed lagophthalmos, resulting in corneal ulcers caused by methicillin-resistant Staphylococcus aureus , which were successfully treated with a six-times-daily administration of 1% vancomycin ophthalmic ointment. Thereafter, the patient underwent a six-times-daily administration of ofloxacin ophthalmic ointment for the treatment of lagophthalmos keratitis. However, increased ocular discharge, upper eyelid edema, redness of the eyelash roots, and eyelash loss (madarosis) developed in his left eye, leading to a diagnosis of anterior blepharitis. Smear and culture tests of the eyelash root secretions revealed the presence of Candida albicans . The patient was then treated with a six-times-daily administered 1% pimaricin ophthalmic ointment, resulting in rapid resolution of the blepharitis and subsequent regrowth of the eyelashes. Conclusion In this study, we report the clinical findings of a rare case of fungal anterior blepharitis in a Japanese child in which Candida albicans was identified. A noticeable white discharge at the base of the eyelashes and somewhat rapid eyelash loss were characteristic symptoms.

Background To evaluate the efficacy of topical ivermectin 1% ointment, for the treatment of Demodex blepharitis. Methods A retrospective study was designed to review electronic medical records of patients seen between January 2017 and December 2022, who had a diagnosis of Demodex blepharitis, treated with topical ivermectin 1% with at least 6 months of follow-up (Centro de Ojos Quilmes, Buenos Aires, Argentina). The presence of collarettes was graded from 0 to 4. An imaging system (Keratograph) was used, to evaluate tear meniscus height (TMH), non-invasive tear break-up time (NIKBUT), and degree of conjunctival redness. In addition, the ocular surface disease index (OSDI) test was performed. Results were compared before and after ivermectin treatment, which was performed once a day for 2 months. Results A total of 2157 patients (4314 eyes) were included. The mean age was 50.43 ± 15.3 years, and the follow-up time was 26.1 ± 8.5 months. No one discontinued treatment due to intolerance, although 14 cases (0.6 %) reported occasional discomfort. The grade of collarettes decreased with statistical significance, from 3.37 ± 0.7 to 0.1 ± 0.3 ( p < 0.01), as well as conjunctival redness from 1.32 ± 0.3 to 0.94 ± 0.4 ( p < 0.01) and OSDI score from 58.74 ± 17.9 to 17.1 ± 10.5 ( p = 0.02). TMH and NIKBUT improved without statistical difference. Conclusion Treatment with ivermectin 1% topical ointment, once daily for 2 months, was effective in reducing the presence of collarettes and in improving symptoms in patients with Demodex blepharitis.

Purpose To examine the prevalence of corneal changes and refractive amblyopia risk factors (ARFs) associated with blepharokeratoconjunctivitis (BKC) to evaluate the safety of remote pediatric chalazion management. Methods The authors retrospectively reviewed 381 in-person patients with chalazia 0 to younger than 18 years. The prevalence of corneal changes associated with BKC in all patients with chalazion 0 to younger than 18 years was compared with the population prevalence. Patient-reported symptoms were compared in patients with chalazion with and without corneal findings associated with BKC. The 2021 American Association for Pediatric Ophthalmology and Strabismus (AAPOS) ARF and visually significant refractive error failure level definitions were used to compare population prevalence of refractive ARFs to prevalence in patients with chalazia younger than 9 years. Results Ten of 381 patients with a chalazion (2.62%) had simultaneous active corneal changes associated with BKC, with a relative risk compared to the population of 444.9739 (P < .0001); 90% reported eye pain, eye redness, photophobia, or blurred vision. The prevalence of patients with a chalazion who concurrently met the 2021 AAPOS ARF and visually significant refractive error failure level definitions was 9.89% in 71 patients younger than 48 months and 21.79% in 78 patients 48 months to younger than 9 years. The relative risk of refractive ARFs was 1.7871 (P = .1397) in patients with chalazion younger than 48 months and 1.8014 (P = .0261) in those 48 months to younger than 9 years compared to the general population. Conclusions The elevated risk of corneal changes associated with BKC in patients with chalazia 0 to younger than 18 years and refractive ARFs in patients with chalazia 48 months to younger than 9 years should prompt screening for these conditions in association with teleophthalmology encounters. [J Pediatr Ophthalmol Strabismus. 20XX;XX(X):XXX–XXX.]

Purpose To assess the effects of 1% azithromycin ophthalmic solution (AZM) in patients with bacterial blepharitis accompanied by meibomian gland dysfunction (MGD). Study design A multicenter, single arm, prospective interventional study. Methods AZM was administered to the affected eyes twice daily for the first 2 days and once daily for the subsequent 12 days. Lid margin hyperaemia/redness, collarette at the root of the eyelashes, conjunctival hyperaemia, foreign body sensation, and epiphora were assessed on Days 1, 14, and 28. The Dry Eye-related Quality of Life Score (DEQS) and objectives related to MGD, including lid vascularity, lid margin irregularity, foaming, lid plugging, keratoconjunctival disorders, Marx line, meibum grade, and tear breakup time, were also assessed. Bacterial culture of the conjunctival sac and meibum was performed on Days 1 and 14. Results Twenty-four eyes of 24 patients (10 men/14 women, mean age 72.3 ± 13.2) were included. On Days 14 and 28, the total score, lid vascularity, lid plugging, and meibum grade showed significant improvement ( p  < 0.05). On Day 1, 71 strains were isolated from 22 of the 24 eyes (91.7%). Cutibacterium acnes , Corynebacterium spp., and Staphylococci were detected at high frequencies. The overall disappearance rates of the bacteria in the conjunctival sac and meibum at the end of treatment were 65.7% and 58.3%, respectively. No serious ocular or systemic adverse events were observed. Conclusion Fourteen-day treatment with AZM was effective in patients with blepharitis accompanied by MGD, and the efficacy of AZM persisted for a period after the treatment.

Background Demodex blepharitis (DB) is a common disease of the ocular surface. The characteristics of the bacterial community in eyelash roots after Demodex infestation are still unknown. Knowledge of the characteristics of the bacterial community of eyelash follicles in patients with DB can provide valuable insights for guiding the diagnosis and treatment of DB. Methods Twenty-five patients with DB (DB group) and 21 non-DB volunteers (control group) were enrolled in the study. Eyelashes from the upper eyelid of the right eye were sampled, and 16S ribosomal DNA (rDNA) sequencing was performed to determine the V3-V4 regions of the microbial 16S rDNA gene within 1 month of infestation. The sequencing data of the two groups were analyzed and compared. The effect of the bacterium Burkholderia on the survival of Demodex mites was evaluated using Demodex obtained from 12 patients with DB other that the patients in the DB group. Results A total of 31 phyla and 862 genera were identified in the DB and control groups. The five most abundant phyla in the two groups were Proteobacteria, Firmicutes, Actinobacteria, Bacteroidetes and Cyanobacteria. The abundance of Actinomycetes was significantly higher in the DB group than in the control group. At the genus level, the five most abundant genera in the two groups were Pseudomonas , Burkholderia-Caballeronia-Paraburkholderia , Rolstonia and Acinetobacter ; Clostridium sensu stricto 1 was abundant in the control group and Corynebacterium_1 was abundant in the DB group. Compared with the control group, the abundance of Burkholderia-Caballeronia-Paraburkholderia was 2.36-fold lower in the DB group. Linear discriminant analysis Effect Size (LEfSe) analysis revealed Burkholderia-Caballeronia-Paraburkholderia , SC_I_84_unclassified , Nonmyxobacteria and Succinvibrio to be the major biomarkers in the control group and Catenibacterium and Lachnospiraceae NK4A136 group to be the major biomarkers in the DB group. To explore the performance of these optimal marker models, receiver operational characteristic curve analysis was performed, and the average area under the curve value of Burkholderia-Caballeronia-Paraburkholderia was 0.7448. Burkholderia cepacia isolated from normal human eyelashes was fermented, and the Demodex mites isolated from patient eyelashes were cultured together with its fermented supernatant. The results showed that the fermentation supernatant could significantly reduce the survival time of the Demodex mites, suggesting the potential therapeutic value of this bacterium against Demodex . Conclusions The composition of the bacterial community in the eyelashes of DB patients differed from that in eyelashes of healthy volunteers, revealing a decrease in bacterial diversity in infested eyelashes. This decrease may be related to the occurrence and development of DB. The supernatant of Burkholderia cepacia culture medium was found to inhibit the growth of Demodex in eyelash hair follicles, providing a new insight with potential applications for the clinical treatment of Demodex infestation. Graphical Abstract