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.

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.

The prevalence of trachomatous trichiasis in Oman (Oman eye study 2005).

PURPOSE: 1. To estimate the prevalence and identify the determinants of Trachomatous Trichiasis (TT) among the > 40 years old Omani population. 2. To compare the results of the present study to those of the survey conducted in 1996 and propose public health policies for eye care in Oman. METHODS: Ophthalmologists randomly selected 75 houses in 24 clusters. The visual status per eye was noted. The anterior segment of the eye was examined to detect TT, using the WHO simplified grading. Frequencies, the age sex standardized prevalence and their 95% Confidence Intervals (unadjusted for clustering) were calculated and the numbers of people with TT in the population were estimated. RESULTS: Persons examined numbered 2,339. The prevalence of TT among the > 40 years old Omani population was 4.14% (CI 95% 3.3 to 4.9). The gender variation [OR = 1.51 (CI 95% 1.01 to 2.37)] and regional variation of TT was significant (p < 0.001). The standardized prevalence of TT in the > 40 years old Omani population had declined from 7.25% in 1996 to 3.96% in 2005. Predictors of TT were female gender, and age > 60 years. CONCLUSIONS: Trichiasis is still a public health problem in Oman. The prevalence is higher than the "< 1 TT case per 1000" target set for the "Ultimate Intervention Goals" for the "Elimination of Blinding Trachoma." The TT surgery rate in Oman should be increased to reach this goal. The underlying causes of low coverage should be identified and addressed through a program approach.

Risk factors for postsurgical trichiasis recurrence in a trachoma-endemic area.

PURPOSE: The World Health Organization recommends trichiasis surgery to prevent blindness caused by trachoma; however, recurrence is common. Risk factors for recurrence have not been widely studied, particularly in trachoma hyperendemic areas. METHODS: Three hundred ninety-four persons with trichiasis in Tanzania were examined. Participants had undergone surgery >18 months before the study. Trichiasis recurrence and active trachoma at study visit were assessed. Ocular swabs were collected and tested for Chlamydia trachomatis. Household members were examined for active trachoma. RESULTS: Of the surgical eyes, 28% had recurrence; 40% of patients had recurrence in one or both eyes. Rates did not vary by time since surgery. Eye-level recurrence rates varied significantly across districts, ranging from 16% to 38%. Current chlamydial infection among surgical cases was low (6%) and was not associated with recurrence. Recurrence was associated with tarsal conjunctival inflammation (OR: 2.4; 95% confidence interval [CI]: 1.6-3.8) and residence in the Kongwa district (OR: 2.3; 95% CI: 1.2-4.6). CONCLUSIONS: Recurrence after trichiasis surgery is high, suggesting that vigilant follow-up in surgical cases is needed to reduce blindness. Recurrence is associated with evidence of inflammation in the tarsal conjunctiva, although it is not clear whether the inflammation contributes to recurrence, or is a result of the recurrence. Longitudinal studies of trichiasis patients after surgery are needed.

Periodic acid-Schiff staining demonstrates fungi in chronic anterior blepharitis.

PURPOSE: To evaluate the presence of fungi in patients with chronic anterior blepharitis with periodic acid-Schiff (PAS) staining of the eyelashes in addition to the conventional methods of fungal cultures and direct microscopy. METHODS: Nineteen patients with chronic anterior blepharitis of seborrheic or mixed seborrheic/staphylococcal type and 11 healthy age- and sex-matched controls were included in this prospective, nonrandomized, cross-sectional study. Blepharitis was diagnosed based on clinical evidence of greasy scales between the cilia, lid margin erythema, conjunctival hyperemia, telangiectasia, thickening, or irregularity of the eyelid margins by slit-lamp biomicroscopy. Eyelash samples were obtained by epilation with a sterile forceps and evaluated with PAS staining, fungal cultures, and direct microscopy. RESULTS: We demonstrated fungal elements with PAS staining in 79% of the blepharitis group (hyphae and/or spores) and 18% of the control group. The difference was statistically significant (P=0.002). Four patients in the blepharitis group (21%) had positive cultures for fungi. The isolated fungi were Penicillium species (2 cases), Candida species (1 case), and Trichophyton verrucosum (1 case). Direct microscopic examination revealed Demodex mites in 42.1% of the blepharitis group. No culture growth or Demodex mites were observed in the control group. CONCLUSIONS: We have shown fungi with PAS staining in the majority of patients with chronic anterior blepharitis. Further controlled studies are necessary to clarify the role of fungi in the etiopathogenesis of blepharitis.

Adherence of bacteria to intraocular lenses: a prospective study.

AIMS: The study was designed to investigate the bacterial flora of the operating field during routine cataract surgery and the source of intraocular lens contamination during the surgery. METHODS: The normal flora of the external eye and fornices of 17 patients undergoing selective cataract surgery was determined preoperatively. Swabs taken from the eyelid surface and lashes showed coagulase negative staphylococci (CNS) in 90%, Propionibacterium acnes in 62%, Corynebacterium sp in 18%, and Peptostreptococcus in 3% of the patients. The lower fornices of 70% had CNS, 47% P acnes, 6% Staphylococcus aureus, 6% Corynebacterium sp, and 6% Candida. RESULTS: A sterile PMMA intraocular lens was touched on the upper bulbar conjunctiva immediately before the surgery. Eighty two per cent of lenses grew CNS, 18% P acnes, 18% Bacillus sp, 12% S aureus, and 6% Corynebacterium sp. A second sterile PMMA intraocular lens was left on the drape and near the eye during surgery. Forty seven per cent of these cultured CNS, 12% Corynebacterium sp, and 6% Bacillus sp. A high count of bacteria in the operating field, especially CNS and P acnes can contribute to postoperative inflammation and endophthalmitis. CONCLUSION: Special measures are needed before and during the surgery to reduce the chance of intraocular inoculation of these bacteria. Use of proper culture media and techniques are necessary to identify these organisms, especially anaerobes, in postoperative inflammation.

Prevalence of trachoma and its determinants in Dalocha District, Central Ethiopia.

AIM: This community-based cross-sectional study was conducted to determine the prevalence of trachoma in Dalocha District, Central Ethiopia. METHODS: A multistage sampling method was used to identify the peasant associations and households included in the study. The WHO clinical grading method for trachoma was used. RESULTS: Of the 619 sampled persons, 302 (48.8%) males and 317 (51.2%) females, 564 people were available for examination, yielding a response rate of 91.1%. More than half (51.1%) of the children aged 10 years or less had active trachoma (trachomatous inflammation, TI, in 16.5% and trachomatous follicles, TF, in 34.6%). On the other hand, active trachoma and trachomatous trichiasis (TT) were each found in 5.5% of individuals older than 10 years of age. CONCLUSIONS: According to the WHO, the findings of TI and TF in more than 5% and 20%, respectively, of children aged 10 years or less and TT in more than 1% of older individuals indicate that trachoma is a major public health problem in Dalocha community.

[Microsporum canis tinea ciliaris and blepharitis]. / Teigne tondante ciliaire et blépharite à microsporum canis.

INTRODUCTION: The involvement of eyelashes and eyelids by dermatophytes is unfrequent. CASE REPORT: We describe such a case in a 48 year old woman, who presented with unilateral blepharitis, resistant to topical treatments with antiseptics, antibiotics and corticosteroids. Diagnosis was suspected by magnifying lens and Wood's light examination; Microsporum canis was isolated from broken eyelashes and scales of annular lesions of eyelids. CONCLUSION: This case emphasizes the interest of mycological examination of eyelashes and eyelids in front of a persisting unilateral blepharitis.

Blefaritis crónica grave. Evolución tórpida de varios años / Severe chronic blepharitis. Torpid evolution of several years

No disponible

Comparative ocular microbial communities in humans with and without blepharitis.

PURPOSE: The aims of our study were to compare the ocular microbial communities of humans with and without blepharitis in an attempt to elucidate which microorganisms may cause blepharitis. METHODS: Bacterial 16S rRNA genes of eyelash and tear samples from seven blepharitis patients and four healthy controls were sequenced using a pyrosequencing method, and their bacterial community structures were compared bioinformatically. RESULTS: Phylotypic analysis demonstrated that eyelash and tear samples had highly diverse bacterial communities with many previously undescribed bacteria. Bacterial communities in eyelash samples from subjects with blepharitis were less diverse than those from healthy controls, while the bacterial communities of tear subjects with blepharitis were more diverse than those of healthy subjects. Statistical analyses using UniFrac and a principle coordinate analysis showed that the bacterial communities of tear samples from subjects with blepharitis were well clustered, regardless of individual, while the bacterial communities of all eyelash samples and healthy tear samples were not well clustered due to high interpersonal variability. Bioinformatic analysis revealed that Propionibacterium, Staphylococcus, Streptophyta, Corynebacterium, and Enhydrobacter were the common ocular bacteria. An increase of Staphylococcus, Streptophyta, Corynebacterium, and Enhydrobacter, and a decrease of Propionibacterium were observed from blepharitis subjects, in terms of the relative abundances. CONCLUSIONS: Higher abundances of Streptophyta, Corynebacterium, and Enhydrobacter in blepharitis subjects suggested that human blepharitis might be induced by the infestations of pollens, dusts, and soil particles. These results will provide valuable information for the prevention and treatment of human blepharitis based on ocular microbial flora.

Bacillus oleronius and Demodex mite infestation in patients with chronic blepharitis.

To better recognize the pathogenicity of ocular Demodex mites, we analysed Bacillus oleronius infection in patients with Demodex-related chronic blepharitis. The studies were conducted on 68 adult patients, in whom ophthalmological and parasitological tests permitted the distinction of a group of 38 patients with a diagnosis of Demodex-related chronic blepharitis (group 1, including a subgroup 1a with moderate blepharitis and a subgroup 1b with severe blepharitis) and a group of 30 healthy individuals (group 2). In every person studied six eyelashes were epilated from each eye and the number of Demodex per eyelash was scored. In parallel, bacterial culture and isolation allowed their phenotypic and molecular identification. The drug sensitivity of the isolates was tested using E-tests. Intensity of Demodex infestation showed no significant differences between subgroups 1a and 1b. From the epilated eyelashes 23 bacterial isolates were obtained, identified as being B. oleronius. All the studied strains were sensitive to ciprofloxacin, doxycycline and gentamicin. The Demodex mite represents an independent aetiopathogenetic factor in blepharitis. In parallel, the parasite may act as a carrier of B. oleronius bacteria, which most probably function as a co-pathogen in the development of severe forms of blepharitis.

The effect of surgical preparation technique on the bacterial load of surgical needles and suture material used during strabismus surgery.

PURPOSE: To investigate the effectiveness of 3 surgical preparation techniques in decreasing bacterial contamination of needles and suture material during strabismus surgery. METHODS: Consecutive patients requiring 2-muscle strabismus surgery were randomized into 1 of 3 groups. In Group A, patients' periocular skin and bulbar conjunctivae underwent preparation with 5% povidone-iodine; the drape was placed without regard to eyebrows; and an open wire-loop lid speculum was used. Group B patients underwent the same preparation as Group A patients; however, the eyelashes and eyebrows were scrubbed with 5% povidone-iodine on cotton tip applicators, and the drape was placed to exclude the eyebrows from the surgical field. Group C patients underwent the same preparation as Group B patients; however, a bladed lid speculum was used during surgery to exclude some of the eyelashes from the surgical field. After the procedure, all needles and suture materials were sent separately for aerobic culture. The data were analyzed for differences in contamination rates between the groups. RESULTS: Of 77 patients, 24 (31.4%) had either a needle and/or suture contaminant. Groups A, B, and C had mean contamination rates of 29.6%, 34.6%, and 29.2%, respectively. There was no significant statistical variation in contamination among the 3 groups. The most common organism identified was a coagulase-negative staphylococcus strain. CONCLUSIONS: More meticulous sterile preparation of the surgical field did not result in a meaningful reduction in suture or needle contamination rates during strabismus surgery.

Common features of periocular tinea.

OBJECTIVE: To present the common features of periocular tinea to aid physicians in future diagnosis and therapy of this condition, because superficial fungal infections on the face are often misdiagnosed owing to the diverse morphologies that they manifest. This is especially true of dermatophytoses involving the periocular region. METHODS: A retrospective review was performed of patients with a diagnosis of periocular tinea who were seen between January 2003 and September 2009 in the pediatric dermatology clinic at St. Louis Children's Hospital. RESULTS: Ten cases of periocular tinea were identified (6 male patients and 4 female patients). Common features included prolonged misdiagnosis (all 10 cases), a normal ophthalmologic examination (all 10 cases), and inappropriate corticosteroid application (7 cases). Loss of the eyelashes occurred in all 10 patients. No cases had evidence of other tinea infections on examination. Only 2 cases had the central clearing classically associated with tinea corporis. Seven patients had a potassium hydroxide preparation and/or culture positive for fungal elements. Lesions improved with topical and oral antifungal treatment in all cases, and patients were able to regrow their eyelashes. CONCLUSION: Periocular tinea should be considered in the differential diagnosis for periocular inflammation, especially in those patients refractory to therapy for more common conditions. Loss of the eyelashes is characteristic of these fungal infections, similar to the hair loss that occurs in kerions associated with tinea capitis.

Paciente con blefaritis crónica resistente a los tratamientos oftalmológicos habituales / Resistance to routine ophthalmological treatments in a patient with chronic blepharitis

No disponible

Risk factors for trachomatous trichiasis in children: cross-sectional household surveys in Southern Sudan.

We have previously documented blinding trachoma to be a serious public health problem in Southern Sudan, with an unusually high prevalence of trachomatous trichiasis (TT) among children. We aimed to investigate risk factors for TT in children in Southern Sudan. Cross-sectional surveys were undertaken in 11 districts between 2001 and 2006, and eligible participants were examined for trachoma signs. Risk factors were assessed through interviews and observations. Using logistic regression, associations between TT in children and potential risk factors were investigated. In total, 11155 children aged 1-14 years from 3950 households were included in the analysis. Overall prevalence of TT was 1.5% (95% CI 1.1-2.1). Factors independently associated with increased odds of TT in children aged 1-14 years were: increasing age (P(trend)<0.001); female gender (odds ratio=1.5; 95% CI 1.1-2.1); increasing proportion of children in the household with trachomatous inflammation-intense (TI) (P(trend)=0.002); and increasing number of adults in the household with TT (P(trend)<0.001). Our study revealed risk factors for TT in children consistent with those previously reported for TT in adults. While the associations of TT in children with TI in siblings and TT in adult relatives merit further investigation, there is an urgent need for trachoma prevention interventions and trichiasis surgery services that are tailored to cater for young children in Southern Sudan.

Microbial contamination associated with mascara use.

BACKGROUND: Microbial organisms are normally present on human eyelashes. Application of mascara to lashes has the potential to inoculate the mascara tube with microbes. This pilot study of a real-world situation investigated the microbial contamination of 2 brands of mascara used daily for 3 months. METHODS: Forty women between the ages of 18 and 39 were randomly assigned to use 1 of 2 brands of nonwaterproof mascara. All mascara tubes were unexpired and purchased on the same day. Subjects were instructed to use the mascara on both the upper and lower lids every day for 3 months. After 3 months, the mascara tubes were collected, cultured, and examined for microbial growth. RESULTS: Mascara tubes were collected from 33 of 40 (82.5%) subjects who began the study. Microbial growth was found in 36.4% of the subject tubes. Based on growth on selective media, most of the organisms were determined to be Staphylococcus epidermidis, Streptococcus species, or fungi. We did not attempt to quantify the numbers of bacteria or fungi present within the tubes. CONCLUSIONS: Because microbial presence was found in 36.4% of the mascara tubes cultured after 3 months of use, we recommend a maximum 3-month use of a mascara tube used on a daily basis. More frequent replacement may be warranted with further study.

A case report of demodicosis.

We report on a patient who had an excessive number of mites (Demodex folliculorum) on his eye lashes, i.e. 10 mites on eight lashes examined. A review of three previous reports suggested that one mite for every two lashes represents an over population of this nearly ubiquitous mite. Greasy scales on the lashes and foamy tears suggested that seborrhea was present as well as demodicosis. The primary symptoms of itching was relieved after one week of treatment with mercuric oxide ointment and lid scrubs, although the number of mites was not reduced. Treatment for an additional two weeks did reduce the mite number. We therefore recommend continuing treatment for demodicosis for at least three weeks even if symptoms abate sooner.