Effect of Eyelid Hygiene on Functional Visual Acuity After Cataract Surgery: A Randomized Controlled Study.

Purpose: To evaluate the effect of eyelid hygiene after cataract surgery on eyelid and ocular surface findings, subjective symptoms and visual function, including functional visual acuity (FVA) and higher order aberration, in a randomized controlled study. Methods: Fifty patients who underwent cataract surgery at a single institution were involved. Twenty-five patients were instructed to wipe their eyelids twice a day from one to four weeks postoperatively, whereas the other 25 patients did not perform any eyelid hygiene. Optical measurement, FVA, meibomian glands, the grade of meibum, lid margin findings, fluorescein corneal staining findings, dry eye-related subjective symptoms and surgical satisfaction were assessed both preoperatively and one month postoperatively. Results: In the eyelid hygiene group, the visual maintenance ratio of FVA improved significantly (p = 0.048) and the higher order aberration of the 4th + 6th order deteriorated less (p = 0.027) compared with the control group. Multiple regression analyses showed that the change in visual maintenance ratio was associated with surgical satisfaction (p = 0.003), change in corneal staining score (p = 0.007), history of eye diseases (p = 0.029) and eyelid hygiene (p = 0.048). Conclusions: Eyelid hygiene after cataract surgery may be effective for visual function measured with an FVA test.

Ocular Rosacea: Don't Forget Eyelids and Skin in the Assessment of This Stubborn Ocular Surface Disease.

Ocular rosacea, a subset of rosacea affecting the ocular surface, poses a diagnostic challenge due to its elusive presentation and overlapping symptoms with other ocular surface diseases (OSDs). This report emphasizes the critical role of a comprehensive evaluation, particularly focusing on eyelid and skin assessment, in diagnosing and effectively managing ocular rosacea-related ocular surface symptoms. The case study highlights a 69-year-old female initially diagnosed with common dry eye disease, subsequently identified with ocular rosacea following a meticulous examination revealing subtle ocular and skin manifestations. Treatment encompassed a tailored approach combining systemic and local therapies, emphasizing proper eyelid hygiene. Objective improvements were observed in ocular surface parameters and patient-reported symptom scores, showcasing the significance of an integrated approach addressing ocular and dermatological aspects in managing ocular rosacea. This report underscores the importance of heightened clinical suspicion, thorough assessments, and comprehensive management strategies in optimizing outcomes for patients with OSD, particularly ocular rosacea.

[Acaricidal therapy in chronic demodex blepharitis and meibomian gland dysfunctions]. / Akaritsidnoe lechebnoe vozdeistvie pri khronicheskom demodekoznom blefarite i disfunktsii meibomievykh zhelez.

PURPOSE: The study comparatively evaluates the effectiveness of various approaches to acaricidal treatment in patients with chronic demodex blepharitis and meibomian gland dysfunctions. MATERIAL AND METHODS: The study included 40 patients with chronic blepharitis (CB) of demodicosis etiology in conditions of meibomian gland dysfunction (MGD) and dry eye (DE). The 1st group of patients (20 people) received acaricidal treatment as part of therapeutic eyelid hygiene (TEH; 2 times a day) involving the use of «Blefarogel ochishchenie¼, «Blefarolosion¼, «Blefarogel forte¼ (contains sulfur and metronidazole). Acaricidal treatment in the patients of the 2nd group involved applications of a product containing metronidazole (2 times a day) without TEH. Control points: 1) at inclusion in the study; 2) after a course of therapy (45 days). Evaluation included: patient acarograms, symptoms and signs of CB (points); OSDI; tear film break-up time (TBUT, sec), severity of meibomian gland dysfunction (S-MGD, points). Statistical analysis: calculation of M±SD, Mann-Whitney, and Wilcoxon tests. RESULTS: Acaricidal treatment was effective in both groups (reduction in demodex population, which was more pronounced in the 1st group). Symptoms and signs of CB were significantly less pronounced in the patients of the 1st group after therapy. The patients of the 1st group showed a significant decrease in S-MGD, OSDI and an increase in TBUT, the 2nd group - a significant decrease in OSDI and an increase in TBUT at the second control point. The positive OSDI and TBUT trends were significantly more pronounced in the 1st group. CONCLUSION: Acaricidal treatment as part of TEH showed a significantly more pronounced reduction in demodex population, relief of CB symptoms and sign, OSDI decrease and TBUT increase, compared to the 2nd group. Apparently, this was associated with combined acaricidal effect and significant S-MGD decrease in the patients of the 1st group.

Comparison of the effect of tea tree oil eye gel with standard treatment in patients with anterior blepharitis: An open-label clinical trial.

Purpose: Daily cleansing of eyelids is very important to carry out a successful blepharitis treatment. However, there are no therapeutic guidelines for blepharitis. The aim was to compare the symptomatic relief of anterior blepharitis using Blephamed eye gel, a cosmetic product, versus standard treatment. Methods: The study was a prospective, interventional open label clinical trial at a university-based hospital. The test population was subjects aged 18-65 years who presented with mild to moderate anterior blepharitis. Eyelid hygiene was applied twice a day. At each visit, a detailed assessment of symptomatology was carried out. A two-way repeated measure mixed model ANOVA was used to compare two groups by time. Results: In total, 61 patients with mean age of 60.08 ± 16.69 years were enrolled in the study including 30 patients in standard group and 31 patients in Blephamed group. Two groups did not differ in terms of age (P = 0.31) and eye laterality (P = 0.50). The baseline scores of erythema, edema, debris, and symptoms as well as total score were similar between two groups (all P values >0.50). Two groups became different for all these parameters at day 45 (all P values <0.001). Significant interaction was detected between time and intervention groups for all severity parameters of blepharitis as well as total score (all P values <0.001). Conclusion: Eyelid hygiene with Blephamed more significantly decreased symptoms of anterior blepharitis compared to standard treatment.

[Therapeutic hygiene of eyelids in dry eye disease prior to cataract phacoemulsification]. / Terapevticheskaya gigiena vek pri sindrome «sukhogo glaza¼ pered provedeniem fakoemul'sifikatsii katarakty.

PURPOSE: The study evaluates the effectiveness of eyelid hygiene (EH) in correction of the ocular surface (OS) condition in patients with dry eye disease (DED) ahead of cataract phacoemulsification (CPE). MATERIAL AND METHODS: The study included 90 patients with cataract: the first group consisted of 45 DED patients with lipid deficiency, the second group - 45 DED patients with lipid/mucous deficiency. Prior to CPE, all patients were randomized into three subgroups of 15 people each. In subgroups 1.1 and 2.1 patients did not receive any treatment for correction of the state of ocular surface. Patients in subgroups 1.2 and 1.3 were instilled 0.18% sodium hyaluronate (SH); in subgroups 2.2 and 2.3 - fixed combination of 0.15% SH and 3% trehalose. In subgroups 1.3 and 2.3 EH was performed (with «Blefarogel cleansing¼, «Blefarolotion¼, «Blefarogel-1¼ two times a day for one month before CPE). The control points were: 1) at study inclusion; 2) after correction of the ocular surface condition; 3) 30 days after CPE. The following parameters were evaluated: OSDI, TBUT (Norn's test), severity of meibomian gland dysfunction (MGD), patient satisfaction with CPE (CPE-PS). Statistical analysis: M±SD calculation, Mann--Whitney, Kruskal-Wallis and Wilcoxon tests. RESULTS: At the second control point, a statistically significant more pronounced OSDI decrease and bigger increase in TBUT were observed in subgroups 1.3 and 2.3 compared to subgroups 1.2 and 2.2 (Mann-Whitney U-test). Apparently, this was associated with a reduction in MGD severity in patients who received EH. At the third control point, significant lower values of OSDI and MGD severity, higher TBUT values and greater CFE-PS were recorded in subgroups 1.3 and 2.3 (Kruskal-Wallis test, Wilcoxon two-sample test). CONCLUSION: Carrying out EH using the «Blefarogel cleansing¼, «Blefarolotion¼, «Blefarogel-1¼ and artificial tear in patients with DED and cataract can increase the efficiency of correction of ocular surface condition and improve patient satisfaction with the outcome of CPE.

The Approach of Intense Pulsed Light Treatment in Patients with Different Severities of Meibomian Gland Dysfunction.

PURPOSE: To make appropriate therapeutic decisions of intense pulsed light (IPL) for meibomian gland dysfunction (MGD) patients. METHODS: Sixty patients with MGD stage 2-3 were enrolled in IPL Group1 and Self-hygiene Group; 110 patients with MGD stage 3-4 were included in IPL + MGX Group and IPL Group2. Patients in IPL groups received IPL treatment once a month for three times. Meibomian gland expression (MGX) was combined with IPL treatment in IPL + MGX Group. Meibomian gland (MG) functions, MGD stage, associated ocular-surface indexes, and response rate were evaluated. RESULTS: Population characteristics and clinical conditions were comparable between groups. In patients with MGD stage 2-3, both IPL Group1 and Self-hygiene Group improved in MG functions, ocular surface disease index (OSDI) and tear break-up time (TBUT). No statistical difference was found in improvements. Posttreatment response rate was 64.3-66.7% in two groups. In patients with MGD stage 3-4, IPL + MGX Group achieved better improvements in MG expressibility and higher response rate (75.5%) than IPL Group2 (63.3%). Referring to IPL treatment, no statistical difference in MG functions and OSDI improvements was found among MGD patients with different ages, genders, and IPL energy exposure. Patients with higher Fitzpatrick scale improved more in MG expressibility. CONCLUSION: Self-eyelid hygiene is cost-effective for milder MGD stages. Combining MGX with IPL is necessary in more severe stages. Adult patients with all age and different genders can benefit from IPL treatment. Patients with darker skin can benefit more in expressiblity.

How Long to Continue Eyelid Hygiene to Treat Meibomian Gland Dysfunction.

To determine the efficacy duration of eyelid hygiene for meibomian gland dysfunction (MGD) treatment, a total of 1015 participants with primary MGD, followed for at least 6 months, were enrolled. The participants were classified into the eyelid hygiene group and the control group. The participants who had stopped eyelid hygiene at any point in the observation period after the initial 2 months were classified into the withdrawal group. Analysis was conducted with a generalized linear mixed model. Treatment group, age, sex, ocular surface inflammation, anti-inflammatory treatments, and baseline MGD subtype were considered as fixed effects, and the individual factor was considered as a random effect. The MGD stage decreased significantly for the observational period in the eyelid hygiene group (p < 0.001). Approximately 40.1% of the participants continuously maintained eyelid hygiene throughout the observational period. The MGD stage in the eyelid hygiene group continued to decrease for 6 months and was maintained thereafter. After 4 months of stopping eyelid hygiene, the MGD stage in the withdrawal group was worse than in the eyelid hygiene group (p < 0.001) and similar to that in the control group (p = 0.762). Maintaining eyelid hygiene was significantly effective in MGD treatment. Efficacy increased with treatment for 6 months, and the efficacy duration was maintained for 4 months even after stopping eyelid hygiene. Therefore, we recommend that patients with MGD maintain eyelid hygiene, and compliance should be checked continuously.

[Modern approaches to the treatment of meibomian gland dysfunction]. / Sovremennye podkhody k lecheniyu disfunktsii meibomievykh zhelez.

The eyelids are a delicate and complex dynamic structure with primary function to protect the eye surface. The term «meibomian gland dysfunction¼ (MGD) first appeared in the mid-1980s. This lesion is known to result in a disturbance of the tear film, eye irritation symptoms, clinically significant inflammation and diseases of the eye surface. The progression of MGD leads to hyperosmolarity of the tear film, its instability, an increase in the bacterial load of the eyelid margin, blepharitis and generalized inflammation of the ocular surface. For patients who require surgical treatment, a healthy eyelid is very important. Despite postoperative functional recovery, most of these patients experience dry eye syndrome (DES), which can lead to symptoms of eye irritation and deterioration of visual acuity due to instability of the tear film. In the early stages of MGD, it is advisable to begin treatment with a conversation about correct frequent blinking, rest during visual activity, adequate water intake, and a specific diet. Later, patients are advised to use an ultrasonic air humidifier, warm dry compresses, practice proper eyelid hygiene and perform massages, apply preservative-free lubricants, azithromycin, omega-3 preparations, and undergo local anti-inflammatory therapy. In case of a tick-borne infestation, the International Expert Group recommends the use of scrubs with 50% tea tree oil for treating the eyelids. In order to achieve a long-term effect or permanent remission, it is necessary to practice daily eyelid hygiene with the help of gels, special napkins and shampoos over a long period of time. Correctly selected medical treatment in accordance with the stage of the disease supplemented with massages and warm dry compresses lead to a significant improvement in the quality of life of patients with MGD and DES. The simplicity of eyelid hygiene is currently ensured by the availability of tools specially designed for the safe treatment of its edges, which have a complex histological and anatomical structure.

Assessing public awareness of daily eyelid hygiene habits in Saudi Arabia: An online survey study.

PURPOSE: Incidences of ocular conditions, including meibomian gland dysfunction (MGD), blepharitis, and dry eye have been increasing globally. Eyelid hygiene is key to maintaining ocular surface health and improving ocular symptoms. This study investigated the awareness of eyelid hygiene among the Saudi population. METHODS: This cross-sectional survey was conducted between April 2020 and May 2020 across all regions of Saudi Arabia through the distribution of an electronic self-administered questionnaire among the Saudi population. RESULTS: A total of 1102 responses were received (women, 76.3%; men, 23.7%). Only 33.2% respondents reported consciously washing their eyelids, while 70.1% had never heard about MGD; however, most of the respondents (93.2%) had heard about dry eye. Based on the questionnaire results, the Saudi population had suboptimal (18.4%) level of awareness of eyelid hygiene. At least one ocular symptom was reported by 98.1% of the respondents. CONCLUSION: The level of awareness of eyelid hygiene in Saudi Arabia was found to be suboptimal, particularly among patients with MGD and dry eyes. Poor knowledge about the benefits of daily eyelid hygiene was the primary barrier to its practice. We recommend that ophthalmologists raise awareness of good eyelid hygiene among patients with MGD and eye dryness. Despite the current findings, further studies and evidence are required before recommending daily eyelid hygiene practices in the general population, including those without clinical symptoms of MGD or eye dryness.

[Pediatric ocular rosacea effectively treated with topical 1.5% azithromycin eye drops]. / Erfolgreiche Behandlung der okulären Rosazea im Kindesalter mit 1,5 % Azithromycin-Augentropfen.

Ocular rosacea in children is a rare but often underdiagnosed condition. It is typically associated with chronic blepharoconjunctivitis, chalazia, corneal opacity and corneal neovascularization. The recommended treatment consists of topical (eyelid hygiene, steroids, cyclosporin, lubricants) and systemic (antibiotics e.g. erythromycin) measures. This case series of 8 children demonstrates the efficacy of local 1.5% azithromycin treatment together with eyelid hygiene in pediatric ocular rosacea. A further advantage of this topical treatment is that the required application of only twice daily for 3 days followed by 7 days without treatment is convenient and improves adherence to treatment.

[Eyelid hygiene in preparing dry eye patients for cataract surgical treatment]. / Gigiena vek v podgotovke patsientov s sindromom «sukhogo glaza¼ k operativnomu lecheniyu katarakty.

PURPOSE: To evaluate the effectiveness of complex treatment, including eyelid hygiene, on the condition of ocular surface in dry eye patients before cataract surgery. MATERIAL AND METHODS: The study included 56 female age-related cataract patients (64±4.3 years old) with dry eye caused by Meibomian gland dysfunction (MGD). The main group patients (n=28) underwent eyelid hygiene therapy (2 times a day, 1 month) that involved Blefarogel cleansing, Blefarolotion, Blefarogel-1. The main and control (n=28) group patients performed (during the month): «fat-water¼ type nanoemulsion instillation (3 times a day); preservative free vitamin-A application (at night). Methods included dry eye symptoms assessment (OSDI scale); TBUT; Shirmer-1 test; lissamine green vital staining with xerosis indicator calculation (van Bijsterveld scale); "lid wipers" symptom evaluation; Norn compression test. Statistical evaluation included: mean and standard deviation calculation (M±s); significance of differences assessment (Mann-Whitney U-test; Wilcoxon's T-test). RESULTS: The main group patients (artificial tear, keratoprotection, eyelid hygiene) showed a statistically significant more pronounced decrease in OSDI (from 33.2±3.1 points to 15.2±1.8 points) and a significantly more pronounced increase in TBUT (from 4.8±0.5 s to 6.9±0.4 s) than in control group patients (artificial tear, keratoprotection; respectively, from 32.7±3.2 to 20.8±3.1 points and from 4.85±0.5 to 5.8±0.4 s; p<0.05). Apparently, this was associated with a significantly more pronounced relief of the MGD signs in main group patients (from 2.1±0.1 to 1.1±0.2 points; p<0.05) as a result of eyelid hygiene. In the control group, the dynamics of MGD severity (from 2.08±0.3 to 2.11±0.5 points) was statistically insignificant. CONCLUSION: Eyelid hygiene (based on Blefarogel cleansing, Blefarolotion, Blefarogel-1) increases the effectiveness of dry eye treatment in MGD patients, compared with isolated tear substitution and keratoprotection.

Therapeutic Instruments Targeting Meibomian Gland Dysfunction.

The most prevalent type of meibomian gland dysfunction (MGD), which is obstructive, is the main cause of evaporative dry eye and is characterized by changes in the meibum composition and duct obstruction. Eyelid hygiene has usually been the most common clinical approach. However, alternative therapies for MGD are emerging on the market. Some warming and humidity devices have led to an improvement in the signs and symptoms in MGD patients. Likewise, eyelid massaging and cleaning devices are also beneficial for ocular signs and symptoms; however, patients usually need more than one session to maintain the therapeutic effect. Thermal pulsation has been reported to be more efficient than other strategies, and the effects can last up to 12 months. Moreover, intense pulsed light therapy has been demonstrated to improve ocular signs and symptoms alone and in combination with other therapies. Proper counseling of clinicians considering MGD status and patient compliance will help patients to undergo the adequate technique that best suits their condition.

Improvement in ocular symptoms and signs in patients with Demodex anterior blepharitis using a novel terpinen-4-ol (2.5%) and hyaluronic acid (0.2%) cleansing wipe.

Purpose: To evaluate the clinical improvement in ocular symptoms and signs in patients suffering from Demodex anterior blepharitis after using a novel cleansing wipe impregnated with 2.5% terpinen-4-ol and 0.2% hyaluronic acid. Study design: This was an exploratory, multicenter, open, randomized, two-parallel group comparative study. Methods: Forty-eight patients with Demodex anterior blepharitis were randomly assigned to apply the sterile wipe T1172 (Blephademodex®), either once daily (n=24, Group 1) or twice daily (n=24, Group 2) for 29 days. Overall ocular discomfort and other individual symptoms were measured using a 0-10 numeric rating scale at Day 8 and Day 29. Ocular signs, including eyelid margin hyperemia and number of cylindrical dandruff, were examined at slit lamp. Overall treatment performance by investigator, patient satisfaction and tolerance were evaluated with questionnaires. Results: Overall ocular discomfort was significantly reduced from baseline (p<0.0001) in both groups at Day 8 (-3.6±0.3 in Group 1 and -4.0±0.4 in Group 2) and Day 29 (-5.7±0.4 and -6.8±0.7, respectively), with no difference between groups (D8: p=0.718; D29: p=0.505). Each ocular symptom associated with Demodex blepharitis was improved in both groups. Eyelid margin hyperemia was significantly reduced at Day 8 (-0.7±0.7; p<0.001) and Day 29 (-1.1±0.7; p<0.0001) in Group 1. Similar results were observed in Group 2 (Day 8: p<0.001; Day 29: p<0.0001). Total disappearance of cylindrical dandruff was reported in 30.4% of patients in Group 1 and 43.5% in Group 2. Improvements in other ocular signs were observed in both groups. The product was well tolerated. All patients were satisfied or very satisfied and would continue using it. Conclusion: Daily eyelid hygiene using this cleansing wipe impregnated with 2.5% terpinen-4-ol and 0.2% hyaluronic acid during a 4-week period led to a rapid and marked reduction in ocular symptoms and signs associated with Demodex anterior blepharitis and was well tolerated.

Investigating the subjective cooling effect of eyelid cleansing gel on eyelid and ocular surface temperature.

PURPOSE: To investigate if the application of Blephagel, an eyelid cleansing gel, causes subjective and/or objective cooling effects by measuring ocular symptomology and temperature. METHODS: Twenty-five healthy subjects underwent baseline non-invasive temperature measurements on the closed upper eyelid (centrally, nasally, and temporally) and ocular surface temperature (OST) on both eyes using an infrared camera. A standard application of Blephagel was then applied to the closed upper eyelid and eyelashes with a sterile cotton-wool to one eye selected at random. Temperature measures were then repeated on both eyes after 30-60, 120-150, and 180-210 s. At each interval, subjects rated the comfort and any cooling sensation of each eye on a 0-10 scale. RESULTS: After application of the gel, there was a significant difference in temperature at all locations on the eyelid between the test and control eyes over time (F = 9.322, p < 0.001). Post hoc analysis revealed this was significant from 30 to 60 s interval (36.3 ± 1.1 °C versus 37.2 ± 0.7 °C; p < 0.001) and the 120-150 s interval (36.8 ± 0.8 °C versus 37.2 ± 0.6 °C; p < 0.001). There was no significant variation between the OST locations over time (F = 3.350, p = 0.07). With respect to symptoms, there was a significant increase in cooling sensation in the test eye compared to the control eye over time (F = 10.438, p < 0.001), that remained throughout the experiment. CONCLUSIONS: Blephagel produces a reduction in temperature of the eyelids that is accompanied with a subjective cooling sensation.

Comparing the in vitro effects of MGO™ Manuka honey and tea tree oil on ocular Demodex viability.

PURPOSE: To compare the in vitro antiparasitic effects of MGO™ Manuka honey and tea tree oil against ocular Demodex. METHODS: Fifty-two viable Demodex mites were acquired from the epilated eyelashes of 9 participants with blepharitis and symptomatic dry eye. Viable mites were randomised to one of five treatment groups: cyclodextrin-complexed and uncomplexed Manuka Honey, 100% and 50% tea tree oil, and no treatment. Following treatment application, mite viability was assessed for 240 min, based on limb and body movement and/or the development of a crenated/translucent appearance. Kaplan-Meier survival analysis was then performed. RESULTS: The log-rank test demonstrated a significant treatment effect on the survival distribution of Demodex mites (p < 0.001). Bonferroni-corrected post-hoc pairwise analysis showed that all treatments except for uncomplexed honey effected lower survival probabilities than the untreated group (all p < 0.001). Among the four treatments, survival probabilities were lowest with 100% tea tree oil (all p < 0.001), and highest with uncomplexed honey (all p ≤ 0.001). No difference was observed between complexed honey and 50% tea tree oil (p = 0.81). CONCLUSIONS: The in vitro efficacy of cyclodextrin-complexed Manuka honey was comparable with 50% tea tree oil, an established treatment for ocular Demodex. The findings support future clinical trials investigating the therapeutic effects of complexed honey in demodectic blepharitis patients.

Antimicrobial Activity of a New Aloe Vera Formulation for the Hygiene of the Periocular Area.

PURPOSE: The aim of this study was to evaluate the antimicrobial activity of a novel preservative-free lid wipe formulation containing Aloe vera gel and hyaluronic acid that is commercialized for the hygiene of the periocular area. METHODS: In vitro susceptibility testing of the solution contained in wipes against bacteria and fungi commonly colonizing the periocular area, both reference strains and multidrug-resistant (MDR) clinical isolates, was assessed following the CLSI M07-A9 and M27-A3 broth methods, respectively. The solution was 2-fold serially diluted in broth from 25 µL (25% v/v) to 0.012 µL (0.012% v/v) in microtiter plates. Plates were incubated and minimal inhibitory concentrations (MICs) were read visually. The antimicrobial effectiveness test was performed by inoculating the wipe solution with microbial suspensions at the initial concentration of 105-106 CFU/mL, as recommended by the international Pharmacopoeias. At different time intervals, samples were tested for microbial count. RESULTS: The MIC value of the solution ranged from 25% to 12.5% for bacteria and was 6.25% for Candida albicans. The MIC for MDR isolates was 12.5%. By assessing antimicrobial effectiveness, we found that the solution meets the criteria reported by the European Pharmacopoeia and United States Pharmacopeia for its preservative effect. CONCLUSIONS: This study demonstrates that the novel wipes herein tested possess antimicrobial activity against bacteria and yeast commonly found in the periocular area, and against MDR clinical isolates. The microbial death curves obtained following deliberate contamination of the wipe solution revealed potent bactericidal and fungicidal activity of the formulation.

In vitro anti-demodectic effects and terpinen-4-ol content of commercial eyelid cleansers.

PURPOSE: To compare the in vitro anti-demodectic activity of four commercially available dedicated eyelid cleansers (Cliradex® towelette cleanser, Oust™ Demodex® cleanser, Blephadex™ eyelid foam, TheraTears® SteriLid® eyelid cleanser), tea tree oil, undiluted terpinen-4-ol and linalool; and to assess the terpinen-4-ol content of the commercial cleansers and tea tree oil. METHODS: In vitro anti-demodectic efficacy assessment: 93 viable Demodex mites were acquired from the epilated eyelashes of 10 participants, and were randomised to application with one of the four eyelid cleansers, 100% and 50% tea tree oil, undiluted terpinen-4-ol and linalool, or no treatment. Following treatment application, mite viability was assessed for 300 min, based on limb/body movement and/or the development of a crenated/translucent appearance. Kaplan-Meier survival analysis was then performed. MASS SPECTROMETRY ANALYSIS: The absolute concentration of terpinen-4-ol and the relative abundance of linalool in the four eyelid cleansers and tea tree oil were determined. RESULTS: In vitro anti-demodectic efficacy assessment: No significant differences were observed between undiluted tea tree oil, terpinen-4-ol and linalool (all p > 0.05). Although all commercial eyelid cleansers effected lower mite survival probabilities than the untreated group, Cliradex® was the only eyelid cleanser that demonstrated comparable antiparastic activity to 50% tea tree oil (p = 0.36). MASS SPECTROMETRY ANALYSIS: Among the four eyelid cleansers, Cliradex® contained the highest concentration of terpinen-4-ol, while linalool was present in TheraTears® SteriLid® only. CONCLUSIONS: Of the four commercial eyelid cleansers, Cliradex® demonstrated the highest levels of in vitro anti-demodectic activity and terpinen-4-ol content. Undiluted linalool and terpenin-4-ol showed comparable antiparasitic efficacy, and the use of linalool in the management of demodectic blepharitis warrants further investigation.

Randomized double-masked trial of eyelid cleansing treatments for blepharitis.

PURPOSE: To compare the efficacy of a dedicated eyelid cleanser and diluted baby shampoo in the management of blepharitis. METHODS: Forty-three participants with clinical blepharitis signs were enrolled in a prospective, randomized, double-masked, paired-eye trial. A dedicated eyelid cleanser (TheraTears® SteriLid®) was applied to the eyelids of one eye (randomized) and diluted baby shampoo (Johnson's® No More Tears®) to the fellow eye, twice daily for 4 weeks. Tear film parameters, ocular surface characteristics, symptomology and cytology markers were assessed at baseline and day 28. RESULTS: Baseline measurements did not differ between treatments (all p > 0.05). The eyelid cleanser was preferred over baby shampoo by the majority of participants (p < 0.001). Improvements in the tear lipid layer, inferior lid wiper epitheliopathy (LWE), cylindrical collarettes, and MMP-9 expression were limited to the dedicated eyelid cleanser (all p < 0.05), and a greater decrease in SANDE symptoms score was also observed (p = 0.04). Meibomian gland capping and MUC5AC expression worsened with baby shampoo treatment (both p < 0.05). SPEED symptoms score, superior LWE, seborrhoeic lash crusting, and trichiasis decreased significantly following application of both treatments (all p < 0.05), but did not differ between treatments (all p > 0.05). CONCLUSION: Clinical improvements in blepharitis occurred with both treatments. However, only the dedicated eyelid cleanser proved effective in reducing ocular surface inflammation, and was the preferred therapy. Long term impact of decreased goblet cell function secondary to baby shampoo treatment requires further exploration.

Changes in the Meibomian Gland After Exposure to Intense Pulsed Light in Meibomian Gland Dysfunction (MGD) Patients.

PURPOSE: To observe (1) changes in meibomian gland (MG) after exposure to intense pulsed light (IPL) and (2) to understand the mechanism by which IPL treats meibomian gland dysfunction (MGD) in patients. METHODS: A cohort study, including 35 MGD patients, was conducted. IPL treatment was administered in one group (IPL group; n = 18), and eyelid hygiene in another (control group; n = 17) for 3 months. All patients were given artificial tears during the treatment period. Associated ocular-surface indexes (ocular surface disease index, OSDI; tear breakup time, TBUT, Schirmer 1Test, corneal staining, and conjunctival staining), MG function, MG macro-morphology, and MG micro-morphology were examined before and after treatment. The relationships between the change in symptom score and the change in the other indexes (related ocular-surface indexes, MG functional indexes, and MG morphological indexes) were evaluated. RESULTS: There was no statistical difference in pretreatment between the IPL and the control groups in terms of age, gender, related medical history, MGD stage, and all examined indexes, with the exception of conjunctival staining. OSDI, TBUT, meibum quality, MG expressibility, and MG dropout improved after treatment in both of the two groups (all P < 0.05). The MG microstructure indexes, including the MG acinar longest diameter (ALD), MG acinar unit density (AUD), and the positive rate of inflammatory cells (ICs) around glandular structures were significantly improved in the IPL group. No improvements of microstructure were found in the control group. CONCLUSION: IPL treatment improves the symptom score of patients, associated ocular-surface indexes, MG function, and MG macrostructure as well as eyelid hygiene. And IPL treatment particularly improves MG microstructure and decreases MG inflammation in MGD patients.