Blefarite: epidemiologia, etiologia, apresentações clínicas, tratamento e evolução de nossos pacientes / Blepharitis: epidemiology, etiology, clinical presentations, treatment and evolution of our patients

Resumo Objetivo: A blefarite é uma das condições mais comumente encontradas na prática oftalmológica e se constitui em uma causa frequente de irritação e desconforto ocular. Por ser uma doença de difícil tratamento, os autores buscaram compreender melhor a epidemiologia, etiologia, apresentações clínicas, tratamento e evolução de seus pacientes, visando maior sucesso terapêutico. Métodos: Foram avaliados retrospectivamente e transversalmente o prontuário de 124 pacientes do Centro de Oftalmologia Tadeu Cvintal, os quais apresentavam blefarite e foram submetidos à classificação de gravidade e coleta de secreções palpebrais para cultura bacteriana e antibiograma. Resultados: A media da idade dos pacientes foi de 67,4 anos, o sexo feminino foi responsável por 70 (56,4%) casos e o masculino por 54 (43,5%). Quanto à gravidade da doença, constatou-se 71 casos de blefarite leve (56,8%), 52 (41,6%) com intensidade moderada e 2 (1,6%) casos graves. Avaliando o seguimento do tratamento da doença, foi observado que 103 (82,4%) pacientes não retornaram para avaliar o resultado do tratamento e apenas 22 (17,6%) retornaram. Em relação às culturas realizadas, 82 (66,1%) não apresentaram crescimento microbiano. Dentre as 42 (33,8%) amostras positivas, os Staphylococcus coagulase negativo foram os mais prevalentes, sobretudo os Staphylococcus epidermidis, responsável por 35 (83,3%) delas. Quanto à sensibilidade aos antibióticos, os agentes de nossa amostra demonstraram maior resistência à Penicilina, Eritromicina e Ciprofloxacino e 100% de sensibilidade à Linezolida, Vancomicina e Daptomicina. Conclusão: Conhecendo melhor as características epidemiológicas da blefarite e a sensibilidade antimicrobiana das bactérias envolvidas, é possível oferecer tratamentos mais eficazes.

Abstract Objective: Blepharitis is one of the most commonly encountered conditions in ophthalmic practice and is a frequent cause of eye irritation and discomfort. Being a difficult to treat disease, the authors sought to better understand the epidemiology, etiology, clinical presentations, treatment and evolution of their patients, aiming at greater therapeutic success. Methods: The medical records of 124 patients of Centro de Oftalmologia Tadeu Cvintal who had blepharitis were retrospectively and cross-sectionally evaluated and underwent severity classification and collection of eyelid secretions for bacterial culture and antibiogram. Results: The mean age of the patients was 67.4 years, females accounted for 70 (56.4%) cases and males for 54 (43.5%). Regarding the severity of the disease, there were 71 cases of mild blepharitis (56.8%), 52 (41.6%) with moderate intensity and 2 (1.6%) severe cases. Evaluating the follow-up of treatment of the disease, it was observed that 103 (82.4%) patients did not return to evaluate the treatment outcome and only 22 (17.6%) returned. In respect of the cultures performed, 82 (66.1%) did not show microbial growth. Among the 42 (33.8%) positive samples, coagulase-negative staphylococci were the most prevalent, especially Staphylococcus epidermidis, responsible for 35 (83.3%) of them. As for antibiotic sensitivity, the agents in our sample showed greater resistance to Penicillin, Erythromycin and Ciprofloxacin and 100% sensitivity to Linezolid, Vancomycin and Daptomycin. Conclusion: By better understanding the epidemiological characteristics of blepharitis and the antimicrobial sensitivity of the bacteria involved, it is possible to offer more effective treatments.

Prevalence and associated factors of external punctal stenosis among elderly patients in Turkey / Prevalência e fatores associados à estenose externa do ponto lacrimal em pacientes idosos na Turquia

ABSTRACT Purpose: To estimate the prevalence of external punctal stenosis (EPS) in the elderly population and investigate associated factors. Methods: A total of 278 patients ≥65 years of age were evaluated for evidence of EPS from January to July 2016. Associated systemic, ocular, demographic, and lifestyle factors were investigated. Multiple logistic regression analyses were applied to evaluate the factors related to having EPS. P values <0.05 were considered statistically significant. Results: The prevalence of EPS in this study population was 63.3%, with a mean age of 70.67 ± 7.85 (65-92 years). The ocular factor that was most commonly related to EPS was chronic blepharitis (48.9%). EPS was also associated with taking glaucoma medications (95% CI, 0.08-0.96, p=0.043), smoking history (95% CI, 0.13-0.84, p=0.021), ectropion (95% CI, 0.004-0.26, p=0.001), complaints of tearing (95% CI, 1.11-3.52, p=0.02), and outdoor occupational activity (95% CI, 3.42-9.97, p<0.05). Conclusions: EPS is more common in elderly patients than in the general population. Outdoor occupational activity, taking antiglaucomatous medications, ectropion, and smoking are significantly associated with EPS. In addition, surgical treatment decisions should be made after complete evaluation and interviewing the patients.

RESUMO Objetivo: Estimar a prevalência de estenose externa do ponto lacrimal (EEPL) na população idosa e investigar os fatores associados. Métodos: Foram avaliados 278 pacientes ≥65 anos com estenose externa do ponto lacrimal de janeiro a julho de 2016. Todos os fatores sistêmicos, oculares, demográficos e de estilo de vida associados foram investigados. Foram utilizadas análises de regressão logística múltipla para avaliar os fatores relacionados a estenose externa do ponto lacrimal, valores de p<0,05 foram considerados estatisticamente significativos. Resultados: A prevalência de estenose externa do ponto lacrimal foi de 63,3%, com idade média de 70,67 ± 7,85 (65-92 anos). O fator ocular mais relacionado com estenose externa do ponto lacrimal foi blefarite crônica. (IC de 95%, 0,08-0,96, p=0,043), história de tabagismo (IC 95%, 0,13-0,84, p=0,021), ectrópio (IC 95%, 0,004-0,26, p=0,001), queixa de lacrimejamento (95% IC, 1,11-3,52, p=0,02) e atividade ocupacional ao ar livre (IC 95%, 3,42-9,97, p<0,05). Conclusão: A estenose externa do ponto lacrimal é um distúrbio mais comum em pacientes idosos do que na população em geral. Atividade ocupacional ao ar livre, medicação antiglaucomatosa, ectrópio e tabagismo foram significativamente associados com estenose externa do ponto lacrimal. A decisão sobre tratamento cirúrgico deve ser dada após a avaliação completas dos fatores associados em cada paciente.

Conceptos actuales en la disfunción de las glándulas de meibomio / Current concepts about the meibomian gland dysfunction

Los científicos han estado interesados en el estudio de las secreciones de las glándulas de Meibomio desde hace muchos años. Enfermedades asociadas, como los cánceres y la blefaritis posterior, se han observado en la literatura médica, desde la primera parte del siglo XX. Sin embargo, el término "disfunción de las glándulas de Meibomio" fue introducida por Korb y Henríquez en 1980. No existía una definición establecida publicada en la literatura hasta que más de 50 expertos internacionales participaron en un taller, que tuvo lugar durante un período de dos años, donde se llegó a definir como una anormalidad crónica y difusa de estas glándulas, comúnmente caracterizada por la obstrucción del conducto terminal y cambios cualitativos/cuantitativos en la secreción de esta. Esto puede resultar en la alteración de la película lagrimal, síntomas de irritación ocular, inflamación clínicamente aparente y enfermedad de la superficie ocular. Es en el mismo Taller Internacional, donde se decide clasificar de acuerdo con los cambios anatómicos, fisiopatológicos, o la gravedad de la enfermedad, donde la forma obstructiva fue la más generalizada. Constituye una afección frecuente con disminución de la calidad de vida y perjuicios potencialmente graves para el bienestar humano.

Scientists have been interested in the study of secretions from meibomian glands for many years. Related illnesses as cancer and posterior blepharitis have been found in the medical literature since the first half of the 20th century. However, the term «meibomian gland dysfunction¼ was introduced by Korb and Henríquez in 1980. There was not a set definition published in the literature until over 50 international experts participated in a workshop held for 2 years. It was there where this disorder was finally defined as a chronic diffuse anomaly occurred in these glands, which is generally characterized by obstructed terminal duct and qualitative/quantitative changes in the gland secretion. This may cause altered lachrymal film, ocular irritation symptoms, clinically apparent inflammation and ocular surface disease. In the same international workshop, it was decided to classify meibomian gland dysfunction according to the anatomical, physiopathological changes or to the severity of the disease, being the obstructive type the most generalized form. This is a frequent illness that reduces the quality of life and causes potentially serious damages for the human wellbeing.

Prevalencia de infección por Demodex folliculorum en pacientes que acuden a consulta general de oftalmología / The prevalence of Demodex folliculorum infection in patients attending a general ophthalmological consultation

Objetivos Determinar la prevalencia de infección por Demodex folliculorum en pacientes que asisten a consulta general de oftalmología, y su asociación con blefaritis. Métodos Estudio descriptivo de prevalencia. En forma aleatoria se seleccionaron 128 sujetos que asistieron al Centro Oftalmológico Virgilio Galvis y se determinó la presencia de Demodex folliculorum en 4 pestañas de cada uno. Resultados La prevalencia de infección por Demodex folliculorum fue 42,1 % (n= 54). Se diagnosticó blefaritis en el 38,3 % de los pacientes (n=49) y el 63,2 % de ellos (n=31) fueron positivos para D. folliculorum. En el grupo sin blefaritis (n=79) solo el 29,2 % de los individuos tenían el ácaro (n=23) (p=0.0003). Además se encontró una mayor cantidad de parásitos en los pacientes con blefaritis (índice de carga parasitaria 12,7 vs 5,1 (p=0.0001). El 25 % (n=32) de los participantes presentaban descamación en forma de cilindros y en estos el 96,9 % tenían el ácaro (n= 31), mientras que en los sujetos que no tenían cilindros (n=96) el ácaro estuvo presente solo en el 24 % (n=23). Conclusiones El Demodex folliculorum es un parásito que se encuentra en personas sin lesiones oculares, pero que es más frecuente y presenta una mayor carga parasitaria en pacientes con blefaritis. Nuestros resultados sugieren la necesidad de investigar la presencia de Demodex folliculorum en todo paciente con blefaritis y especialmente en los casos en que se observe presencia de descamación en forma de cilindros en las pestañas.

Objectives Determining Demodex folliculorum infection prevalence in patients attending general ophthalmological consultation and such infection's association with blepharitis. Methods This was a descriptive study of such prevalence. 128 subjects who attended the Virgilio Galvis Eye Centre were randomly selected and the presence of D. folliculorum was determined in 4 eyelashes taken from each of them. Results D. folliculorum infection prevalence was 42.1 % (n=54); blepharitis was diagnosed in 38.3 % of the patients (n=49) and 63.2 % of them (n=31) were positive for D. folliculorum. Only 29.2 % of the individuals in the group without blepharitis (n=79) had mites (n=23) (p=0.0003). A higher number of parasites was found in patients with blepharitis (12.7 parasitic load index cf 5.1; p=0.0001); 25 % (n=32) of the participants had scaling in the form of cylinders and 96.9 % of these had the mites (n=31), whereas the mite was only present in 24 % (n=23) of subjects who had no cylinder-type scaling (n=96). Conclusions Demodex folliculorum is a parasite found in people without ocular lesions; however, it is more frequent and has a higher parasite burden in patients with blepharitis. Our results suggested the need for investigating the presence of D. folliculorum in all patients suffering from blepharitis, especially in cases where cylinder-type scaling has been observed in their eyelashes.

A study of ocular infections amongst primary school children in Delhi.

The present study of ocular infections was conducted amongst primary school children residing in an urban slum and rural area of Delhi. A total of four schools were selected, two from urban slum in Central Delhi Rouse Avenue and two from a peripheral village on the outskirts of Delhi. All the children studying in the above mentioned schools and residing in the same area were covered. All the study subjects were interviewed, clinically examined and given a proforma to be filled by their parents. Of the total 775 subjects only 91 (11.74%) had ocular infections. Conjunctivitis was the most prevalent infection followed by trachoma, stye, blepharitis and chalazion. The type and prevalence of infection was similar, in both sexes and both areas, rural and urban. There was a significant rising trend of ocular infection with increase in age. A significant association was found between ocular infections and religion but the association with per capita income was not significant.