Oral Azithromycin for Treatment of Posterior Blepharitis

Purpose: To evaluate the effects of oral azithromycin in patients with posterior blepharitis. Methods: Twenty-six eyes of 13 patients with posterior blepharitis diagnosed by a qualified ophthalmologist were enrolled in this study. Patients were instructed to use oral azithromycin 500 mg per day for 3 days in 3 cycles with 7-day intervals. Subjective clinical outcomes were graded and scored 1 day before and 30 days after the end of the treatment (53 days after initiating the treatment) based on severity scores of: (1) eyelid debris; (2) eyelid telangiectasia; (3) swelling of the eyelid margin; (4) redness of the eyelid margin; and (5) ocular mucus secretion. For the assessment of global efficacy, patients were asked by the investigator to rate the subjective symptoms (eyelid itching, ocular itching, eyelid hyperemia, ocular hyperemia, ocular mucus secretion, photophobia, foreign body sensation, and dry eye sensation) on a scale of 0 (no symptoms) to 5 (severe symptoms). Break-up time, Schirmer I test, corneal fluorescein staining score, and rose bengal staining score were also performed in all patients. Results: All clinical outcomes scoring showed statistically significant improvement after oral azithromycin, except for eyelid swelling. Average subjective symptom grading improved statistically after treatment with oral azithromycin, except for eyelid hyperemia, photophobia, and foreign body sensation. Average tear film break-up time values showed statistically significant improvement after the treatment with oral azithromycin. No statistically significant improvement was observed on average values of Schirmer I test, corneal fluorescein staining score, and rose bengal staining score. Conclusions: The combination of multiple clinical parameters shown in this study supports the clinical efficacy of pulsed oral azithromycin therapy for the management of posterior blepharitis.

Blepharitis and trichomegaly induced by cetuximab

This report describes the case of a 41-year old woman in treatment for advanced colorectal cancer who developed severe bilateral blepharitis and trichomegaly after the second dose of cetuximab. Cetuximab-related eyelid toxicity has been described previously; however, its pathogenesis has not yet been clearly established.

Ambient levels of air pollution induce clinical worsening of blepharitis

Background: Even though air pollutants exposure is associated with changes in the ocular surface and tear film, its relationship to the clinical course of blepharitis, a common eyelid disease, had not yet been investigated. Our objective was to investigate the correlation between air pollution and acute manifestations of blepharitis. Method: We recorded all cases of changes in the eyelids and ocular surface, and rated clinical findings on a scale from zero (normal) to two (severe alterations). Daily values of carbon monoxide, particulate matter smaller than 10 mu m in diameter and nitrogen dioxide concentrations and meteorological variables (temperature and relative humidity) in the vicinity of the medical service were obtained. Specific linear regression models for each outcome were constructed including pollutants as independent variables (single pollutant models). Temperature and humidity were included as confounding variables. Results: increases of 28.8 mu g/m(3) in the concentration of particulate matter and 1.1 ppm in the concentration of CO were associated with increases in cases of blepharitis on the day of exposure (5 cases, 95% CI: 1-10 and 6 cases, 95% CI: 1-12, respectively). Conclusion: Exposure to usual air pollutants concentrations present in large cities affects, in a consistent manner, the eyes of residents contributing to the increasing incidence of diseases of the eyelid margin. (C) 2011 Elsevier Inc. All rights reserved.

Clinical Treatment of Ocular Demodex folliculorum by Systemic Ivermectin

PURPOSE: To report clinical outcomes of the treatment of ocular Demodex folliculorum with oral ivermectin. DESIGN: Noncomparative, interventional case series. METHODS: Setting. Institutional. Study Population. Twenty-four eyes of 12 patients (3 male and 9 female; mean age +/- standard deviation, 50.4 +/- 21.0 years) with refractory posterior blepharitis with the presence of D. folliculorum in lash samples were enrolled in this study. Intervention. Patients were instructed to take 1 dose of oral ivermectin (200 mu g/kg). All patients were instructed to repeat the treatment after 7 days. Main outcome measures. Tear meniscus height, Schirmer I test results, noninvasive tear film break-up time (BUT), quantification of the absolute number of D. folliculorum found in the lashes, and corneal fluorescein and rose bengal staining scores were obtained from all patients 1 day before and 28 days after treatment. RESULTS: Statistical improvement was observed in the absolute number of D. folliculorum found in the lashes after the treatment with oral ivermectin. Average values of Schirmer I test results and tear film break-up time improved statistically after the treatment of oral ivermectin. No statistical improvement was observed in average lacrimal meniscus height or value of corneal fluorescein and rose bengal staining after treatment with oral ivermectin. CONCLUSIONS: Ivermectin successfully reduced the number of D. folliculorum found in the lashes of patients with refractory blepharitis. Oral ivermectin may be very useful as a complement in the treatment of D. folliculorum infestation with ocular manifestation, especially in cases of unsuccessful treatment related to patient compliance. (Am J Ophthalmol 2011;151:1030-1034. (C) 2011 by Elsevier Inc. All rights reserved.)

Is Demodex really non-pathogenic?

Although usually considered a non-pathogenic parasite in parasitological textbooks, Demodex folliculorum has been implicated as a causative agent for some dermatological conditions, such as rosacea-like eruptions and some types of blepharitis. Several anecdotal reports have demonstrated unequivocal tissue damage directly related to the presence of the parasite. However, this seems to be exceedingly rare, in contrast with the marked prevalence of this infestation. We have had the opportunity to observe one of such cases. A 38-year-old woman presented with rosacea-like papular lesions in her right cheek. Histopathological examination revealed granulomatous dermal inflammation with a well-preserved mite phagocytized by a multinucleated giant cell. This finding may be taken as an evidence for the pathogenicity of the parasite, inasmuch as it does not explain how such a common parasite is able to produce such a rare disease.

Inflammation palpébrale pseudotumorale. A propos d'une observation anatomo-clinique [Pseudotumoral eyelid inflammation. Apropos of an anatomo-clinical case].

A clinicopathological case of a 76-year-old male patient with a chronic inflammatory change of the inferior left eyelid is reported. The inflammation appeared as a reddish area of the inner part of the eyelid, without sharp limits, but with loss of lashes. Numerous local treatments did not to cure this condition. As some true eyelid tumors may mimic an inflammation during growth and, for example, sebaceous carcinoma may clinically present as chronic unilateral blepharitis, a surgical excisional biopsy was performed on this left eyelid. Its histopathological study showed a granulomatous inflammation, which was typical of a simple chalazion. This case clearly illustrates that the chalazion may not always appear as a limited nodular inflammation of the eyelid, but may have a more diffuse clinical presentation.

Prevalence of biomicroscopic findings in the anterior segment and ocular adnexa among schoolchildren in Natal/Brazil

Objective: To determine the prevalence of ocular findings of the external structures and anterior segment of the eye, detected by biomicroscopic examination in schoolchildren in Natal (RN) - Brazil. Methods: After previous random selection, 1,024 pupils from elementary and secondary public and private schools in the city of Natal were evaluated from March to June 2001. All were submitted to preestablished standard research norms, consisting of identification, demographic information, ophthalmologic biomicroscopic examination, with slit lamp, performed by ophthalmologists from the “Onofre Lopes” University Hospital. Results: Alterations of the conjunctival and palpebral conditions were the most prevalent (10.4% and 6.2% respectively). Follicles (4.2%) and papillae (3.0%) were the frequent conjunctival lesions, while blepharitis (3.5%) and meibomitis (1.1%) were the most detected abnormalities in the eyelids. Upon examining the cornea, iris, lens and anterior vitreous, the most encountered findings were nubecula (0.5%), papillary membrane reliquiae (0.5%), posterior capsula opacity (0.8%) and hyaloid arteria reliquiae (2.0%). Conclusion: The most prevalent findings affecting the external structures of the eye such as eyelids and conjunctiva, consisted of blepharitis followed by follicular reaction of the conjunctiva. The most prevalent abnormalities in the cornea, iris, lens and anterior vitreous were nubecula, papillary membrane reliquiae, posterior capsular opacity and hyaloid arteria reliquiae, in that order

Effects of ethyl-cyanoacrylate and octyl-cyanoacrylate on experimental corneal lesions in rabbits

Conselho Nacional de Desenvolvimento Científico e Tecnológico (CNPq)

Alterações da margem palpebral associadas ao ectrópio

OBJETIVO: Investigar alterações da margem palpebral em portadores de ectrópio. MÉTODOS: Foi feito estudo observacional, do qual participaram 53 portadores de ectrópio palpebral e 25 portadores de dermatocálase (grupo controle), estudando-se, a partir de imagens digitais, a posição dos cílios e a presença de inflamações na margem palpebral. Os dados foram submetidos a análise estatística. RESULTADOS: Os portadores de ectrópio apresentaram com maior freqüência diminuição do número de cílios, perda da convexidade, triquíase e distiquíase quando comparados aos indivíduos do grupo controle. CONCLUSÃO: O portador de ectrópio possui alterações da margem palpebral provavelmente decorrentes do processo inflamatório crônico que ocorre na região.

Paracoccidioidomycosis: study of six cases with ocular involvement

We present 6 patients with ocular involvement due to paracoccidioidomycosis. All cases were confirmed by the finding of Paracoccidioides brasiliensis in histopathological or direct mycologic examination of material from the lesion in the eyelid or conjunctiva. In two cases the bulbar conjunctiva was also involved, in another the cornea, and still another patient developed endophthalmitis. The presence of this mutilating disease which may lead to blindness should be suspected when chronic blepharitis or palpebral ulcerated papular lesions are detected in patients from endemic areas of paracoccidioidomycosis. This etiology should also be suspected in patients with anterior and posterior uveitis after discarding the most frequent causes of this condition. © 1988 Kluwer Academic Publishers.

Afecções oculares em crianças de 2 a 8 anos da rede pública municipal de Piracicaba - SP

Study model: observacional, retrospective. Objective: to determine the frequence of the ametropic errors and other ocular problems in children with 2 to 8 year-old at Piracicaba - SP. Patients and Method: During the school year of 2000, 1001 children enrolled at the public schools of Piracicaba - SP, age ranged from 2 to 8 years old, were referred to complete ophthalmological exam. Visual acuity was previously determined using Snellen chart, applied by school teachers. Those children presenting visual acuity equal or less than 0.8, visual complaints or visual disorders were selected to appointment. Results: 51 children (5.09%) did not attended to examination. 950 children were submitted to complete ophthalmological exam. Ametropic errors were found 70.84% of the children. The most prevalent refractive errors were Hypermetropic Astigmatism (49.62%) and Hypermetropia (32,98%). Anisometropia was found in 1.78% children. Other ocular disabilities accounted for 10.21% of the examined children, such as strabismus (3.36%), eyelid changes, allergic conjunctivitis, congenital dacryostenosis, optic atrophy, corioretinitis and congenital glaucoma. Conclusion: The frequence of ocular problems observed let us to conclude the screening programs are valid surveys on decreasing rates of preventable blindness in our country.

Ectrópio palpebral: Características e relação com alterações óculo-palpebrais

Objective: To evaluate the gender and the characteristics of the ectropion carriers in our region. Methods: A retrospective study was done evolving 112 ectropion carriers. The sex, race, eyelashes alterations (trichiasis and distichiasis), anterior and posterior blepharitis, conjunctival redness, íris color and pterygium presence were evaluated. Gender data were correlated to ectropion classification (involutional, cicatricial, mechanic or paralytic) and submitted to statiscal analysis. Results: The eyelid ectropion occurred more between 71 and 80 years old.The involutional ectropion was the most frequently observed (66,07%), followed by the cicatricial, mechanic, associated types and paralytic. The majority of the patients were male (70,53%), with White skin. Trichiasis (21,42%) and distichiasis (4,46%) were associated to the ectropion eyelid and mainly in the involutional ectropion carriers. Half of the sample had blepharitis and the majority of the patients had red eye (60%) and brown iris (63,39%). Perygium was absent in the majority of the patients. Conclusion: The involutional ectropium is the most frequently observed in our region, mainly in elderly, male, White skin, brown iris and associated to trichiasis, blepharitis and red eyes.

Efficacy and safety of travoprost 0.004%/timolol 0.5% fixed combination as transition therapy in patients previously on prostaglandin analog monotherapy

Purpose: To assess the safety and efficacy of transitioning patients whose intraocular pressure (IOP) had been insufficiently controlled on prostaglandin analog (PGA) monotherapy to treatment with travoprost 0.004%/timolol 0.5% fixed combination with benzalkonium chloride (TTFC). Methods: This prospective, multicenter, open-label, historical controlled, single-arm study transitioned patients who had primary open-angle glaucoma, pigment dispersion glaucoma, or ocular hypertension and who required further IOP reduction from PGA monotherapy to oncedaily treatment with TTFC for 12 weeks. IOP and safety (adverse events, corrected distance visual acuity, and slit-lamp biomicroscopy) were assessed at baseline, week 4, and week 12. A solicited ocular symptom survey was administered at baseline and at week 12. Patients and investigators reported their medication preference at week 12. Results: Of 65 patients enrolled, 43 had received prior travoprost therapy and 22 had received prior nontravoprost therapy (n = 18, bimatoprost; n = 4, latanoprost). In the total population, mean IOP was significantly reduced from baseline (P = 0.000009), showing a 16.8% reduction after 12 weeks of TTFC therapy. In the study subgroups, mean IOP was significantly reduced from baseline to week 12 (P = 0.0001) in the prior travoprost cohort (19.0% reduction) and in the prior nontravoprost cohort (13.1% reduction). Seven mild, ocular, treatment-related adverse events were reported. Of the ten ocular symptom questions, eight had numerically lower percentages with TTFC compared with prior PGA monotherapy and two had numerically higher percentages with TTFC (dry eye symptoms and ocular stinging/burning). At week 12, TTFC was preferred over prior therapy for 84.2% of patients (48 of 57) by the patients themselves, and for 94.7% of patients (54 of 57) by their physicians. Conclusion: When TTFC replaced PGA monotherapy in patients whose IOP had been uncontrolled, the outcome was a significant reduction in IOP and an acceptable safety and tolerability profile. Most patients and investigators preferred TTFC to prior PGA monotherapy. © 2012 Costa et al, publisher and licensee Dove Medical Press Ltd.

Emprego do etil-cianoacrilato ou do octil-cianoacrilato no preenchimento de lesões corneais, após ceratectomia lamelar em coelhos

Conselho Nacional de Desenvolvimento Científico e Tecnológico (CNPq)

Manifestações oculares na leishmaniose

The Canine Visceral Leishmaniasis is a chronic disease of endemic character, caused by Leishmania Chagasi in Americas. The inoculation of the promastigote form in the individual triggers a local and widespread immune reaction with formation of inflammatory infiltrates and deposition of immune complexes in tissues. Initial clinical symptoms of the disease are: weight reduction, hepatomegaly, splenomegaly and, according to the disease chronicity, signs such as alopecia, erythema, onychogryphosis, arthropathies, renal diseases, pyoderma, seborrheic dermatitis, muscle atrophy and Ocular diseases. Ocular diseases are often reported and are result of the direct parasitism or immune-mediated mechanisms caused by the disease. The Leishmania spp have greater affinity for the anterior segment, so that anterior uveitis is one of the most frequently diagnosed injuries. Blepharitis diffuse and Keratoconjunctivitis also appear as important ocular changes. In histological section, inflammatory infiltrates and macrophages with amastigote form are observed in all ocular tissues, with the exception of the retina and optical nerve. In the clinical analysis and disease diagnosis, should be considered the differential diagnosis, such as Ehrlichiosis and systemic hypertension, because these may cause some ocular manifestations similar to those observed in leishmaniasis