In Vitro Evaluation of a Hypochlorous Acid Hygiene Solution on Established Biofilms.

OBJECTIVES: The purpose of this study was to determine whether a commercial formulation of hypochlorous acid hygiene solution (0.01%), Avenova, can destroy existing biofilms formed by ocular clinical bacterial isolates, including blepharitis isolates of Staphylococcus aureus and coagulase-negative staphylococci, and a keratitis isolate of Pseudomonas aeruginosa. METHODS: Biofilms grown in bacterial growth media on disposable contact lens cases were challenged with hypochlorous acid hygiene solution. At various time points, surviving bacteria were quantified by serial dilution and colony counts. Staphylococcus aureus biofilms formed on glass were challenged using a hypochlorous acid hygiene solution and imaged using vital staining and confocal laser scanning microscopy. RESULTS: Bactericidal activity (≥3 Log10; 99.9%) was observed for all tested bacterial species after a 30-min exposure. Staphylococcus aureus biofilms had a bactericidal level of killing by 10 min (P<0.01), Staphylococcus capitis by 5 min (P<0.001), Staphylococcus epidermidis by 30 min (P<0.001), and P. aeruginosa by 10 min (P<0.01). Confocal microscopy and crystal violet staining analysis of bacterial biofilms treated with hypochlorous acid solution both demonstrated that biofilm bacteria were readily killed, but biofilm structure was largely maintained. CONCLUSIONS: Hypochlorous acid (0.01%) hygiene solution was able to achieve bactericidal levels of killing of bacteria in biofilms but did not disrupt biofilm structures. Susceptibility of tested staphylococcal blepharitis isolates varied by species, with S. capitis being the most susceptible and S. epidermidis being the least susceptible.

Ocular surface microbiome in meibomian gland dysfunction.

BACKGROUND: To investigate the ocular microbiome in meibomian gland dysfunction in Auckland, New Zealand. DESIGN: Prospective, cross-sectional, observational, university-based study. PARTICIPANTS: Participants resident in New Zealand for ≥2 years (n = 157) were classified as normal (n = 66), mild (n = 41) or moderate-to-severe meibomian gland dysfunction (n = 50). Contact lens wear and anterior blepharitis status were recorded, as well as symptoms and clinical features. METHODS: Bacteria collected from lid margin swabs, before and after gland expression, were isolated and identified by conventional microbiological culture techniques. Aerobic isolates were identified in all 157 participants, and both aerobic and anaerobic bacteria isolated in a subset of 87 subjects. MAIN OUTCOME MEASURES: Bacterial incidence according to meibomian gland dysfunction status RESULTS: Symptoms, bulbar hyperaemia, conjunctival staining, lipid layer grade and tear film stability, but not corneal staining, showed moderate association with meibomian gland dysfunction severity. Participants with and without meibomian gland dysfunction showed a similar microbiome, unaffected by gland expression. Anterior blepharitis, a common co-morbidity, was not an independent predictor of the microbiome. Sterile cultures were more common in contact lens wearers than non-wearers. The incidence of Staphylococcus aureus was higher than anticipated across all severity groups, and that of coagulase-negative Staphylococcus, Corynebacterium and streptococci was lower. CONCLUSIONS: Modest differences in relative proportions of bacteria compared with other studies support climatic variations in the ocular surface microbiome. Similarity in microbiome profile, irrespective of meibomian gland dysfunction severity, anterior blepharitis presence or contact lens wear, suggests potential for commonality in treatment.

Bacterial isolates and their antimicrobial susceptibility pattern among patients with external ocular infections at Borumeda hospital, Northeast Ethiopia.

BACKGROUND: Bacteria are major cause of ocular infections and possible loss of vision. The emergence of antimicrobial resistant bacteria increases the risk of treatment failure with potentially serious consequences. The aim of this study was to determine the prevalence of bacterial isolates and their antimicrobial susceptibility pattern among patients with external ocular infections. METHODS: A cross sectional study was conducted among 160 patients with external ocular infections at Borumeda hospital, Northeast Ethiopia. Socio-demographic and clinical data were collected using structured questionnaire. External ocular specimens were collected using sterile swabs and inoculated on MacConkey agar, Chocolate agar and Blood agar culture Medias. Presumptive isolates were further identified by a series of biochemical tests. The antimicrobial susceptibility patterns of the isolates were determined by disk diffusion method. RESULT: The overall prevalence of bacterial pathogens among external ocular samples was 59.4 %. The majority of the isolates (93.7 %; 89/95) were Gram positive and the other 6.3 % (6/95) Gram negative bacteria. The proportion of coagulase negative Staphylococci among the Gram positive bacterial isolates was 53.7 % (n = 51/95). All Gram positive isolates were susceptible for vancomycin but 67.4 % (n = 60/95) of them were resistant against amoxicillin. Moreover, drug resistance to tetracycline, norfloxacylin, ceftriaxone and ciprofloxacin were observed among Gram negative bacteria isolates. CONCLUSION: The prevalence of bacterial pathogens among external ocular samples was high and the predominant isolate was coagulase negative Staphylococci. Exceptionally high amoxicillin resistance was observed among Gram positive bacterial isolates that may dictate to conduct drug susceptibility test routinely.

Clinical spectrum in microbiologically proven Demodex blepharokeratoconjunctivitis: An observational study.

PURPOSE: To study the demographic, clinical, and microbiological profile of Demodex-related blepharokeratoconjunctivitis (BKC) at a tertiary eye care hospital. METHODS: This retrospective observational study was conducted from January 2016 to September 2022. It included 83 patients with microbiologically proven Demodex BKC who presented to the cornea department of our tertiary care eye center. The clinical, microbiological, and demographic data of the 83 cases were analyzed. RESULTS: Of the 83 cases, 57 (68.67%) were younger than 40 years, and 25 (30.12%) were below 20. Most patients presented with a good visual acuity of 20/40 or better (93 eyes; 84.55%). The disease was unilateral in 55 patients and bilateral in 28. Cylindrical dandruff was the predominant presentation noted in 61 eyes (54.95%), followed by corneal scarring in 47 eyes (42.34%) and corneal vascularization in 40 eyes (36.04%). On light microscopy, 87.95% of the positive samples were identified as Demodex folliculorum , 7.23% as Demodex brevis , and 6.02% remained unidentified. Tea tree oil and lid scrubs eradicated the disease in most patients clinically (75/83, 90.36%). CONCLUSION: The spectrum of BKC includes both lid signs and corneal involvement. It can be a cause of recurrent BKC and detection of the mite by microscopic evaluation of the lashes can confirm the diagnosis. In most cases, the tea tree oil can effectively manage this condition. However, low doses of topical steroids are needed to control the inflammation in patients with corneal involvement.

Antibiotic Delivery System for Treating Bacteria-Induced Anterior Blepharitis.

The eyelid-related disease of blepharitis remains a tricky ocular disorder and affects patient compliance. However, there is no available and effective treatment, making it extremely challenging. Herein, an antibacterial system based on antibiotic delivery was developed and applied in a blepharitis model induced by bacteria. The antibacterial tests against Staphylococcus aureus both in vitro and in vivo demonstrated that the system shows a favorable bactericidal effect. Then, histological evaluation indicated that the system shows both antibacterial and anti-inflammatory effects. This facile design provided an effective ocular infection management, which displays a promising prospect while addressing other complex ocular disorders.

In vitro evaluation of multiple antibacterial agents for the treatment of chronic staphylococcal anterior blepharitis.

OBJECTIVE: To evaluate the bactericidal efficacy of several compounds used in the treatment of chronic staphylococcal anterior blepharitis through an in vitro study. MATERIALS AND METHODS: Standard commercial strains of Staphylococcus aureus (SAu) (ATCC 25923 Culti-Loops) and coagulase-negative Staphylococcus (CoNS) (ATCC 12228 Culti-Loops) were cultured. Susceptibility tests were performed to vancomycin 30 µg, netilmicin 30 µg, hypochlorous acid (HOCl) 0.01% (Ocudox™, Brill®), Melaleuca alternifolia leaf oil (MeAl) (Navyblef® Daily Care, NOVAX®) and 1% chlorhexidine digluconate (DGCH) (Cristalmina™, Salvat®) using the agar disk diffusion method (Rosco Neo-Sensitabs®). After 24 h, the induced halos were measured with automatic calipers. The results were analyzed using the EUCAST- and CLSI potency Neo-Sensitabs® guidelines. RESULTS: Vancomycin induced a halo of 22.37 mm and 21.81 mm in SAu and CoNS, respectively. Netilmicin produced halos of 24.45 mm in SAu and 32.49 mm in CoNS. MeAl induced halos of 12.65 mm in SAu and 15.83 mm in CoNS. A 12.11 mm halo was found in SAu and an 18.38 mm halo in CoNS using HOCl. DGCH produced halos of 26.55 mm and 23.12 mm in SAu and CoNS, respectively. CONCLUSION: Netilmicin and vancomycin demonstrated antibiotic activity against both pathogens, so they can be alternative rescue therapies to treat chronic staphylococcal blepharitis. DGCH has efficacy against both comparable to antibiotics, while HOCl and MeAl show less efficacy.

Disseminated histoplasmosis with concurrent oral candidiasis in an Eclectus parrot (Eclectus roratus).

Disseminated histoplasmosis caused by Histoplasma capsulatum, a zoonotic fungal organism, is an important disease in animals and humans, particularly those with compromised immune systems. Reports of disseminated histoplasmosis in an avian species are not available within the current literature. Candida albicans, another fungal agent with zoonotic importance, is a commensal of the avian digestive tract that is often associated with opportunistic infections particularly in young or immunocompromised birds. This report describes a case of concomitant histoplasmosis and candidiasis in an Eclectus parrot (Eclectus roratus) characterized by severe granulomatous glossitis, blepharitis and osteomyelitis with numerous intrahistiocytic and extracellular yeasts (H. capsulatum) as well as intralesional hyphae, pseudohyphae and conidia (C. albicans). To our knowledge, co-infection with H. capsulatum and C. albicans has not been reported in an avian species.

Evaluation of the bacterial microflora of the conjunctival sac of healthy dogs and dogs with atopic dermatitis.

The aim of this case-control study was to evaluate and compare the bacterial microflora from the conjunctival sac of dogs with atopic dermatitis and healthy dogs. Twenty-one atopic dogs without clinical and/or cytopathological signs of bacterial blepharoconjunctivitis and 21 breed-matched healthy dogs were enrolled. Under topical anaesthesia, the inferior conjunctival sac of one eye was scraped twice. Material was collected with a Kimura spatula, spread over a slide and stained with a Diff Quick(®) -type stain (Medion Diagnostics GmbH, Düdingen, Switzerland) for cytological examination. An area of 0.5 cm(2) was examined at ×1000 magnification, and the types and numbers of cells and bacteria were recorded. A bacterial swab was collected and inoculated into culture media for the growth of aerobic bacteria. Before sampling, each atopic dog was evaluated for severity of cutaneous lesions, pruritus and conjunctival inflammation. Significant differences were observed between atopic and healthy dogs for the presence of bacteria on cytology (P = 0.015), keratinized (P = 0.001) and nonkeratinized epithelial cells (P = 0.013), eosinophils (P = 0.019) and lymphocytes (P = 0.008). Bacteria were recovered from 12 atopic dogs and three healthy dogs (P = 0.004). Staphylococcus pseudintermedius was the most commonly isolated species in atopic dogs (seven of 12). In atopic dogs, no significant relation was found between conjunctival bacterial colonization (on cytology and culture) and the severity of any of the clinical parameters. This study suggests differences in conjunctival bacterial colonization and cytological features between atopic and healthy dogs.

Mycoplasma infection and ocular surface diseases: a nationwide cohort study.

Whether patients with Mycoplasma infection have an increased risk of ocular surface ulcers. Using a nation-wide database, we identified patients with a new diagnosis of Mycoplasma infection between 1997 and 2013, and compared them with age-, sex-, and index year-matched subjects without the infection. Cox proportional regression was performed to compare the risk of corneal diseases between the two cohorts. The incidence of corneal diseases was significantly higher in the 4223 patients with Mycoplasma infection than in the 16,892 patients without (7.28 vs. 5.94 per 1000 person-years, P < 0.01). The adjusted hazard ratio for the risk of corneal diseases in the study cohort was 1.21 times higher (95% CI 1.02-1.44) than that in the comparison cohort. Mycoplasma infection might be a predisposing factor for patients with keratitis.

Correlation between ocular Demodex infestation and serum immunoreactivity to Bacillus proteins in patients with Facial rosacea.

PURPOSE: To investigate correlation between ocular Demodex infestation and serum. DESIGN: A prospective study to correlate clinical findings with laboratory data. PARTICIPANTS: We consecutively enrolled 59 patients: 34 men and 25 women with a mean age of 60.4+/-17.6 years (range, 17-93). METHODS: Demodex counting was performed based on lash sampling. Serum immunoreactivity to two 62-kDa and 83-kDa proteins derived from B oleronius was determined by Western blot analysis. Facial rosacea, lid margin, and ocular surface inflammation were documented by photography and graded in a masked fashion. MAIN OUTCOME MEASURES: Statistical significance based on correlative analyses of clinical and laboratory data. RESULTS: These 59 patients were age matched, but not gender matched, regarding serum immunoreactivity, ocular Demodex infestation, or facial rosacea. There was a significant correlation between serum immunoreactivity and facial rosacea (P = 0.009), lid margin inflammation (P = 0.040), and ocular Demodex infestation (P = 0.048), but not inferior bulbar conjunctival inflammation (P = 0.573). The Demodex count was significantly higher in patients with positive facial rosacea (6.6+/-9.0 vs. 1.9+/-2.2; P = 0.014). There was a significant correlation of facial rosacea with lid margin inflammation (P = 0.016), but not with inferior bulbar conjunctival inflammation (P = 0.728). Ocular Demodex infestation was less prevalent in patients with aqueous tear-deficiency dry eye than those without (7/38 vs. 12/21; P = 0.002). CONCLUSIONS: The strong correlation provides a better understanding of comorbidity between Demodex mites and their symbiotic B oleronius in facial rosacea and blepharitis. Treatments directed to both warrant future investigation.

Clavispora lusitaniae and Chaetomium atrobrunneum as rare agents of cutaneous infection.

We describe the first case of cutaneous infection caused by Chaetomium atrobrunneum and Clavispora lusitaniae in a one-and-a-half-year-old boy with acute and severe inflammation around his left eyelid. He presented to our outpatient center with a 6-day history and previously ineffective antibacterial therapy. Scanning electron microscopy (SEM) revealed hyphae and spores were on the surface of the crusty exudates and also penetrated into it, and the microbiology study further showed their characteristic cultural features. Fungal isolates were identified by the amplification and sequencing of the 26S RNA gene and of the ITS region, as C. lusitaniae and C. atrobrunneum. Up until now, most known clinical records of these rare species have shown them as agents of deep mycosis. Due to the emergency situation, medications were administered promptly and confirmed by subsequent fungal identification and successful therapeutic outcome. This article illustrates the importance of recognizing fungal infections, especially those caused by uncommon pathogens. Limitations in the routine identification procedures and therapeutic options of this emerging opportunistic agent are also discussed in this report.

Prevalence and antibiotic susceptibility of bacteria isolated in patients affected with blepharitis in a tertiary eye centre in Spain.

PURPOSE: To describe which bacteria can be found on lid margins in patients affected with blepharitis, to show their antibiotic susceptibility pattern, and to evaluate the antibiotic resistance trend of coagulase-negative Staphylococcus through time. MATERIALS AND METHODS: Consecutive cases of 198 eyes affected with blepharitis between 2012 and 2018 were reviewed. A sample was collected by rubbing a swab against the base of the eyelashes of both the eyes of all patients. The samples were inoculated in blood agar and chocolate agar. The susceptibility of the identified bacteria to common antibiotics was tested. In addition, the antibiotic susceptibility pattern of coagulase-negative Staphylococcus detected from year 2016 to 2018 was compared with that of 4 years before. RESULTS: The most common isolated bacterium was coagulase-negative Staphylococcus (89%) and Staphylococcus aureus (28%). Coagulase-negative Staphylococcus showed highest susceptibility to vancomycin (100%), neomycin (94%) and chloramphenicol (91%). Coagulase-negative Staphylococcus and Staphylococcus aureus were the most resistant to penicillin and erythromycin (resistance in 92%, 91% for coagulase-negative Staphylococcus, 86% and 43% of eyes for Staphylococcus aureus). Corynebacterium was resistant to oxacillin and erythromycin. Streptococcus viridans showed resistance to gentamycin and tobramycin. Moraxella was susceptible to most antibiotics. Bacillus was resistant to oxacillin. The antibiotic resistance trend of coagulase-negative Staphylococcus showed that the resistance to rifampicin increased through the years 2012-2018. CONCLUSION: Coagulase-negative Staphylococcus and Staphylococcus aureus were the most isolated bacteria in patients affected by blepharitis in our tertiary eye centre. Both bacteria were resistant to erythromycin. Through the years, it seems that coagulase-negative Staphylococcus gained resistance to penicillin, erythromycin, ciprofloxacin and rifampicin.

Treatment of Malassezia species associated seborrheic blepharitis with fluconazole.

UNLABELLED: The AIM of the present study was to evaluate the therapeutic effect of fluconazole (FungoIon) in patients with seborrheic blepharitis. PATIENTS AND METHODS: Four seborrheic blepharitis patients with Malassezia spp. positive cultures on Dixon's agar were treated with fluconazole (Fungolon) (0.200) weekly for 4 weeks. RESULTS: The therapeutic effect of the treatment was positive in all patients--the clinical symptoms withdrew and cultures became mycologically negative. CONCLUSION: The results indicate that antifungal agents are efficient in the treatment of seborrheic dermatitis.

Use of azithromycin ophthalmic solution in the treatment of chronic mixed anterior blepharitis.

We tested the efficacy of azithromycin ophthalmic solution for the treatment of chronic mixed anterior blepharitis. The findings suggest that patients with chronic mixed anterior blepharitis can be more effectively treated with azithromycin ophthalmic solution than erythromycin ophthalmic ointment. Patients treated with azithromycin ophthalmic solution show an extraordinary clinical response with shorter treatment duration.

Comparison of the Clinical Efficacy of Topical and Systemic Azithromycin Treatment for Posterior Blepharitis.

PURPOSE: To compare the clinical efficacy of topical and oral azithromycin treatments for posterior blepharitis. METHODS: Both topical and oral treatment groups comprised 15 patients. In the topical group, azithromycin 15 mg/g ophthalmic solution (Azyter; Thea Pharmaceuticals, Clermont-Ferrand, France) was used twice a day for 3 days and then once a day until the treatment completes a month. In the systemic treatment group, azithromycin 250 mg tablets (Azitro; Deva Pharmaceuticals, Istanbul, Turkey) were used, 1 × 2 tablets (500 mg) at the first day of treatment and then 1 × 1 tablet (250 mg) for 4 days. Three cycles of treatment with 5-day intervals were completed. The ocular symptoms, eyelid margin sings, Ocular Surface Disease Index (OSDI), tear film break-up time, corneal/conjunctival staining score, Schirmer test, and conjunctival brush cytology were evaluated at baseline, 1, and 5 weeks after the end of treatment. RESULTS: Both topical azithromycin and oral azithromycin were found to be effective in improving the clinical signs and symptoms of posterior blepharitis. The mean OSDI scores, lissamine green staining scores, and Schirmer test results showed improvements after both topical and oral treatments. However, topical treatment was shown to be associated with longer cytological improvements that persist at least 5 weeks and with better stabilization of the tear film, which is well documented by showing longer tear film break up time (TFBUT) in the topical treatment group. CONCLUSIONS: Although both treatment methods are found to be effective, the results of topical treatment group showed some superiority over those of systemic treatment group, which may be associated with a higher ocular tissue concentration of azithromycin after topical administration.

Eyelid tinea with blepharitis due to Microsporum canis. / Tiña palpebral con blefaritis por Microsporum canis.

CASE REPORT: The case is presented of a 3-year-old girl with an erythematous oedematous plaque associated with blepharitis, and chalazion in the right upper eyelid. She received empirical treatment with topical corticosteroids, as well as an antifungal and antibiotic, without observing any improvement. The culture of the eyelid scrape showed Microsporum canis. Therefore, she was prescribed oral terbinafine and topical miconazole-betamethasone, achieving a clinical and microbiological recovery. DISCUSSION: Eyelid infection due to dermatophytes is uncommon, but it should be considered among the diagnostic suspicions of palpebral skin lesions. The microbiological study is a key factor for its diagnosis and appropriate treatment.

Tinea blepharo-ciliaris in a 13-year-old girl caused by Trichophyton benhamiae.

Tinea blepharo-ciliaris is a rare form of dermatophyte infection which involves eyelids and associated eyelashes. We report a 13-year-old girl with type I diabetes mellitus who had right eyelid swelling and eyelash loss for two weeks. The lesions were presented as erythematous patches with scales and tiny pustules on the right upper and lower eyelids with broken eyelashes. Two additional annular erythematous patches with scaly active borders were found on her right forearm and right thigh. Microscopic examination of broken eyelashes demonstrated many chains of arthroconidia and hyaline hyphae in an endothrix invasion pattern. Fungal cultures of right eyelid scales, eyelashes, and right thigh lesions all grew Trichophyton benhamiae, which was diagnosed by both morphological characters and sequencing of internal transcribed spacer region of the ribosomal DNA. The patient had a contact history with rabbits. To the best of our knowledge, this is the first case of tinea blepharo-ciliaris caused by T. benhamiae, and also the first formal report of infection by this fungus in Taiwan.

Spectrum of eye disease caused by methicillin-resistant Staphylococcus aureus.

PURPOSE: To compare the clinical features and antibiotic susceptibility of ocular methicillin-resistant Staphylococcus aureus (MRSA) and methicillin-sensitive Staphylococcus aureus (MSSA). DESIGN: Cross-sectional study. METHODS: The Proctor clinical laboratory database was reviewed to identify all ocular isolates of S. aureus collected between July 1, 1998 and July 31, 2006. RESULTS: Of 915 S. aureus isolates, there were 88 MRSA isolates in 41 different patients. The proportion MRSA increased from 4.1% in 1998 to 1999 to 16.7% in 2005 to 2006. A total of 78.0% of patients with MRSA had blepharoconjunctivitis, 2.4% had cellulitis, 2.4% had dacryocystitis, 14.6% had keratitis, and 2.4% had endophthalmitis. The diagnoses associated with MSSA were not statistically different. A total of 63.6% of MRSA isolates were sensitive to bacitracin, 100% to vancomycin, 14.8% to ciprofloxacin, 14.8% to erythromycin, 97.7% to sulfisoxazole, and 93.2% to tetracycline. CONCLUSIONS: MRSA has become a more common ocular pathogen but, as with MSSA, causes mild disease. MRSA should be treated with vancomycin.