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.

Evaluación in vitro de múltiples agentes antibacterianos para el tratamiento de la blefaritis anterior crónica estafilocócica / In vitro evaluation of multiple antibacterial agents for the treatment of chronic staphylococcal anterior blepharitis

Objetivo Evaluar la eficacia bactericida de varios compuestos utilizados en el tratamiento de la blefaritis anterior estafilocócica crónica mediante un estudio in vitro. Materiales y métodos Se cultivaron cepas comerciales estándar de Staphylococcus aureus (SAu) (ATCC 25923 Culti-Loops) y Staphylococcus coagulasa-negativo (CoNS) (ATCC 12228 Culti-Loops). Se realizaron pruebas de sensibilidad a vancomicina 30μg, netilmicina 30μg, ácido hipocloroso (HOCl) al 0,01% (Ocudox™, Brill®), aceite de hoja de Melaleuca alternifolia (MeAl) (Navyblef® Cuidado diario, NOVAX®) y digluconato de clorhexidina al 1% (DGCH) (Cristalmina™, Salvat®) mediante el método de difusión en disco de agar (Rosco Neo-Sensitabs™). A las 24horas se midieron los halos inducidos con calibradores automáticos. Los resultados se analizaron con las guías EUCAST- y CLSI potency Neo-Sensitabs™. Resultados La vancomicina indujo un halo de 22,37mm y 21,81mm en SAu y CoNS, respectivamente. La netilmicina produjo halos de 24,45mm en SAu y de 32,49mm en CoNS. MeAl indujo halos de 12,65mm en SAu y de 15,83mm en CoNS. Se encontró un halo de 12,11mm en SAu y un halo de 18,38mm en CoNS utilizando HOCl. DGCH produjo halos de 26,55mm y 23,12mm en SAu y CoNS, respectivamente. Conclusión La netilmicina y la vancomicina demostraron actividad antibiótica frente a ambos patógenos, por lo que pueden ser terapias alternativas de rescate para tratar la blefaritis estafilocócica crónica. El DGCH presenta una eficacia frente a ambos comparable a los antibióticos, mientras que el HOCl y la MeAl demuestran menor eficacia (AU)

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 30μg, netilmicin 30μg, 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 24hours, 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 22.37mm and 21.81mm in SAu and CoNS, respectively. Netilmicin produced halos of 24.45mm in SAu and 32.49mm in CoNS. MeAl induced halos of 12.65mm in SAu and 15.83mm in CoNS. A 12.11mm halo was found in SAu and an 18.38mm halo in CoNS using HOCl. DGCH produced halos of 26.55mm and 23.12mm 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 (AU)

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.

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.

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.

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

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

CASO CLÍNICO: Presentamos el caso de una niña de 3 años de edad, quien tenía una placa eritematoedematosa asociada a blefaritis y chalazión en el párpado superior derecho. Recibió tratamiento empírico con corticoide, antifúngico y antibiótico tópicos sin notar mejoría. El cultivo de raspado del párpado reveló Microsporum canis, por lo cual se prescribió terbinafina oral y miconazol-betametasona tópicos consiguiendo la curación clínica y microbiológica. DISCUSIÓN: La infección palpebral por dermatofitos es poco frecuente, pero debemos considerarla dentro de las sospechas diagnósticas de lesiones cutáneas palpebrales. Es clave el estudio microbiológico para su diagnóstico y tratamiento adecuados

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

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.

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.

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.

Alta prevalencia de infestación por Demodex spp. en pacientes con blefaritis posterior: correlación con edad y caspa cilíndrica / High prevalence of Demodex spp. infestation among patients with posterior blepharitis: correlation with age and cylindrical dandruff

Objetivo: Determinar la prevalencia e índice de infestación (II) por Demodex spp. en pacientes con blefaritis en distintos grupos etarios y evaluar su asociación con la presencia de caspa cilíndrica (CC). Materiales y métodos: Estudio prospectivo que incluye a pacientes de la Fundación Oftalmológica Los Andes (Chile), con diagnóstico clínico de blefaritis con compromiso de la lámina posterior entre 2013 y 2015, sin tratamiento acaricida previo. Cuatro pestañas de cada párpado fueron extraídas al azar para la detección del ectoparásito y determinación del II, calculado como el cociente entre el número observado de especímenes de demodex y la totalidad de las pestañas extraídas. Además, se realizó una determinación semicuantitativa de la presencia de CC. Resultados: Se incluyó a 178 pacientes, de los cuales el 51,3% eran hombres. La edad promedio fue de 58,49 ± 20,66 años. El 83,7% de los pacientes resultaron infestados por demodex, con un II promedio de 0,96 ± 0,84 ácaros/pestaña. El II fue significativamente mayor en pacientes sobre los 50 años (p<0,0001). La edad de los pacientes y el II presentaron un coeficiente de correlación lineal de Pearson (R2) de 0,12 (p<0,0001). El 71,4% de los pacientes presentaron CC, con valores significativamente más altos en pacientes mayores de 50 años. Se observó una correlación positiva entre la cantidad de CC y el II (R2=0,33; p<0,0001). Conclusiones: Existe una elevada prevalencia de infestación por demodex en pacientes con blefaritis posterior. El II por Demodex folliculorum se correlaciona positivamente con la edad de los pacientes y con la presencia de CC en el borde palpebral (AU)

Objective: To determine prevalence of Demodex spp. and infestation index (II) by the parasite among patients of different ages with blepharitis and to assess association with occurrence of cylindrical dandruff (CC). Materials and methods: Prospective study including patients diagnosed with posterior blepharitis between 2013 and 2015, without previous acaricide treatment, was conducted by Fundación Oftalmológica Los Andes (Chile). Four eyelashes were randomly extracted from each eyelid for parasite detection. The II was calculated as the ratio between the total number of demodex specimens found in the total number of eyelashes removed. A semi-quantitative determination of the CC was performed. Results: A total of 178 patients (91 men, 87 women), with a mean age of 58.49 ± 20.66 years, were included. It was found that 83.7% of patients were infested with Demodex folliculorum with a mean II of 0.96 ± 0.84 mites/eyelash. The II was significantly higher in patients over 50 years (p<.0001). Patient age and II showed a Pearson correlation coefficient (R2) of 0.12 (p<.0001). CC was observed in 71.4% of patients, with those over 50 years-old showing significantly higher values. A positive correlation was also observed between the amount of CC and the II (R2=.33; p<.0001). Conclusions: The prevalence of infestation by Demodex folliculorum is high in patients with posterior blepharitis. The II by the parasite is positively correlated with age and with the occurrence of CC on the eyelid border (AU)

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.

Recurrent Fungal Keratitis and Blepharitis Caused by Aspergillus flavus.

Aspergillus species produces a wide spectrum of fungal diseases like endophthalmitis and fungal keratitis ophthalmologically, but there has been no report about blepharitis caused by Aspergilus flavus to date. Herein, we report a 61-year-old ethnic Han Taiwanese male who had suffered from pain with burning and foreign body sensation after an insect bite on his left eye. Specimens from bilateral eyelids suggested infection of A. flavus, whereas corneal scraping showed the presence of Gram-negative bacteria. He was admitted for treatment of infectious keratitis with topical antibiotic and antifungal eye drops. Two weeks after discharge, recurrent blepharitis and keratitis of A. flavus was diagnosed microbiologically. Another treatment course of antifungal agent was resumed in the following 6 months, without further significant symptoms in the following 2 years. Collectively, it is possible for A. flavus to induce concurrent keratitis and blepharitis, and combined treatment of keratitis as well as blepharitis is advocated for as long as 6 months to ensure no recurrence.

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.