Tuesday, September 11, 2012

Abstract: More on lid hygiene (spec. Blephaclean)

OBJECTIVE:
: The principal objective of this investigation was to assess the symptomatic relief associated with eyelid hygiene using Blephaclean eye pads, a cosmetic product, to manage anterior blepharitis or Meibomian gland dysfunction (MGD) associated with dry eye complaints.
METHOD:
: The investigation was a bilateral, prospective, interventional open label investigation of 3-month duration. The test population was made up of dry eye sufferers with at least mild symptoms (Ocular Surface Disease Index [OSDI] ≥13) who presented with mild to moderate anterior blepharitis or MGD. Eyelid hygiene was intensive (twice a day) for the initial 3 weeks and a maintenance regimen (once a day) for the remainder of the study. At each visit, a detailed assessment of symptomatology was carried out. The assessment included the reporting of overall symptomatology with the OSDI questionnaire, of comfort and specific symptoms at the end of the day on 100-point visual analog scales and of specific MGD-related symptoms on forced choice 5-point scales.
RESULT:
: Forty subjects aged 22 to 74 years (54±15 years) were enrolled, of whom 39 completed the investigation. The product usage revealed good overall compliance throughout the study. The results revealed significant improvement in symptomatology. A significant (P<0 .001=".001" 100="100" 21="42," 54="54" 55="55" 90="41).<br" and="and" associated="associated" baseline="55," comfort="comfort" day="day" decrease="decrease" dryness="dryness" ean="ean" end="end" in="in" increase="increase" of="of" osdi:="osdi:" overall="overall" recorded="recorded" score:="score:" significant="significant" status:="status:" symptomatic="symptomatic" symptomatology="symptomatology" the="the" was="was" with="with">CONCLUSIONS:
: The results showed that eyelid hygiene with Blephaclean wipes by subjects with anterior blepharitis or MGD significantly decreased their associated symptomatology and increased their ocular comfort. The data confirmed the efficiency of the clinical methodology, put forward of 3 weeks of intensive use (twice a day) of eyelid wipes followed by maintenance use (once a day); that approach achieved a rapid symptomatic improvement that was maintained over time.

Eye Contact Lens. 2012 Sep;38(5):306-12.
Source
OTG Research and Consultancy (M.G., C.M., S.W.), London, United Kingdom.


Abstract: Bleph, MGD & eyelid hygiene


OBJECTIVE:
: To assess the changes in eyelid margins associated with eyelid hygiene using Blephaclean eye pads to manage anterior blepharitis or meibomian gland dysfunction (MGD) associated with dry eye complaints.
METHOD:
: The investigation was a bilateral, prospective, interventional, open-label investigation of 3-month duration. The test population included dry eye sufferers with at least mild symptoms (Ocular Surface Disease Index ≥ 13) who presented with mild to moderate anterior blepharitis or MGD. Eyelid hygiene was intensive (twice a day) for the initial 3 weeks and a maintenance regimen (once a day) for the remainder of the study. At each visit, a detailed assessment of eyelid margins was performed. This assessment included the rating of lashes contamination, lid margin foam, droplet, redness and staining, and meibomian gland blockage, dropout, and expression.
RESULT:
: Forty subjects aged 22 to 74 years (54 ± 15 years) were enrolled of whom 39 completed the investigation. The product usage revealed good overall compliance throughout the study. The results revealed a significant improvement in eyelid margin status. Significant (P<0 .001=".001" 3-month="3-month" 3-week="3-week" a="a" also="also" and="and" at="at" better="better" blockage="blockage" both="both" br="br" but="but" completion="completion" contamination="contamination" decrease="decrease" during="during" expression="expression" eyelashes="eyelashes" eyelid="eyelid" follow-up="follow-up" functionality="functionality" gland="gland" glands="glands" in="in" indicative="indicative" initial="initial" intensive="intensive" maintained="maintained" maintenance="maintenance" margin="margin" meibomian="meibomian" observed="observed" of="of" only="only" over="over" p="0.001)." phase.="phase." phase="phase" phases="phases" recorded="recorded" significant="significant" significantly="significantly" staining="staining" study="study" the="the" was="was" were="were">CONCLUSION:
: The results showed that eyelid hygiene with Blephaclean wipes by subjects with anterior blepharitis or MGD significantly improved the status of the eyelid margin tissues including the meibomian glands. The data confirmed the efficiency of the clinical methodology put forward of 3 weeks of intensive use (twice a day) of eyelid wipes followed by maintenance use (once a day) and that approach achieved a rapid improvement in tissue status and gland patency.

Eye Contact Lens. 2012 Sep;38(5):319-25.
Source
OTG Research & Consultancy, London, United Kingdom.

Abstract: Sodium hyaluronate plus diquafosol


Purpose
To assess the additive effect of diquafosol tetrasodium on sodium hyaluronate monotherapy in patients with dry eye syndrome.
Methods
This study evaluated 64 eyes of 32 patients (age: 62.6±12.8 years (mean±SD)) in whom treatment with 0.1% sodium hyaluronate was insufficiently responsive. The eyes were randomly assigned to one of the two regimens in each patient: topical administration of sodium hyaluronate and diquafosol tetrasodium in one eye, and that of sodium hyaluronate in the other. Before treatment, and 2 and 4 weeks after treatment, we determined tear volume, tear film break-up time (BUT), fluorescein and rose bengal vital staining scores, subjective symptoms, and adverse events.
Results
We found a significant improvement in BUT (P=0.049, Dunnett test), fluorescein and rose bengal staining scores (P=0.02), and in subjective symptoms (P=0.004 for dry eye sensation, P=0.02 for pain, and P=0.02 for foreign body sensation) 4 weeks after treatment in the diquafosol eyes. On the other hand, we found no significant change in these parameters after treatment in the control eyes.
Conclusions
In dry eyes, where sodium hyaluronate monotherapy was insufficient, diquafosol tetrasodium was effective in improving objective and subjective symptoms, suggesting its viability as an option for the additive treatment of such eyes.

Eye (Lond). 2012 Aug 10. doi: 10.1038/eye.2012.166. [Epub ahead of print]
Source
Department of Ophthalmology, University of Kitasato School of Medicine, Kanagawa, Japan.



Abstract: Daytime variations of tear osmolarity and tear meniscus volume


OBJECTIVES:
: The aim of this study was to determine the pattern of variations in tear osmolarity and tear meniscus volume in patients with dry eyes and in healthy control subjects over an 8-hr daytime period.
METHODS:
: Ten normal subjects (5 men and 5 women with a mean age of 27±7 years) and 10 dry eye patients (4 men and 6 women with a mean age of 36±12 years) who had been diagnosed on the basis of having an ocular surface discomfort index >12 and a tear breakup time of <10 2="2" 4:30="4:30" 8:30="8:30" am="am" and="and" at="at" beginning="beginning" both="both" br="br" by="by" coherence="coherence" conducted="conducted" each="each" ending="ending" every="every" eye="eye" first="first" followed="followed" hrs="hrs" imaging="imaging" included.="included." measured="measured" measurements="measurements" meniscus="meniscus" mm="mm" oct="oct" of="of" on="on" optical="optical" or="or" osmolarity="osmolarity" participant="participant" participants="participants" performed="performed" pm.="pm." protocols="protocols" resolution="resolution" right="right" schirmer="schirmer" score="score" sec="sec" system.="system." tear="tear" tearlab="tearlab" test="test" testing.="testing." the="the" tomography="tomography" ultrahigh="ultrahigh" using="using" volumes="volumes" was="was" were="were">RESULTS:
: The mean tear osmolarity of the dry eye patients was 304.0±10.8 mOsm/L, and the mean tear osmolarity of the normal subjects was 298.0±14.2 mOsm/L (P>0.05). Over the course of 8 hrs, the average measured osmolarities of the dry eye group varied by approximately 21.9±13.5 mOsm/L (range, 6-43 mOsm/L), and the average measured tear osmolarities of the normal group varied by approximately 21.0±9.2 mOsm/L (range, 8-35 mOsm/L). At 2:30 PM, the average volume of the tear menisci in the dry eye group was significantly lower than that of the subjects in the normal group (P<0 .05=".05" and="and" between="between" br="br" correlations="correlations" either="either" group="group" meniscus="meniscus" no="no" observed.="observed." of="of" osmolarities="osmolarities" tear="tear" the="the" volumes="volumes" were="were">CONCLUSIONS:
: Variations in the tear osmolarities of individual dry eye patients and healthy normal control subjects were documented over the course of 8 daytime hours. No relationships between tear osmolarities and tear meniscus volumes were observed.

Eye Contact Lens. 2012 Sep;38(5):282-7.
Source
Bascom Palmer Eye Institute (M.L., D.Z., M.S., L.C., J.W.); Electrical and Computer Engineering (J.W.), University of Miami, Miami, FL; School of Ophthalmology and Optometry (M.L., D.Z., L.C.), Wenzhou Medical College, Wenzhou; First Affiliated Hospital (C.D.), Zhejiang University, Hangzhou, Zhejiang, China.


Abstract: Punctal stenosis


This is just a very brief tidbit but I thought it might possibly be of interest to some of you with epiphora:


Acquired punctal stenosis is a condition in which the external opening of the lacrimal canaliculus is narrowed or occluded. This condition is a rare cause of symptomatic epiphora, but its incidence may be higher in patients with chronic blepharitis, in those treated with various topical medications, including antihypertensive agents, and especially in patients treated with taxanes for cancer. The purpose of this review is to cover the medical literature, focusing in particular on definition, incidence, risk factors, etiology and treatment options.

Clin Ophthalmol. 2012;6:1011-8. Epub 2012 Jul 3.
Source
Division of Oculoplastic and Orbital Surgery, Department of Ophthalmology, Tel-Aviv Medical Center, Tel-Aviv University, Tel-Aviv, Israel.

Abstract: Smoking and the ocular surface

BACKGROUND:
Smoking, both active and passive, creates a plethora of health-related problems, which primarily affect the cardiovascular and respiratory systems. There is very little evidence on the effects of tobacco smoke on the eye, especially regarding anterior ocular surface related pathology. This study was undertaken to determine the effects of smoking on the ocular surface and the tear film in smokers.
METHODS:
A total of 51 (102 eyes) smokers and 50 (100 eyes) age-and gender-matched healthy non-smokers were included in this study. The ocular surface was evaluated by measuring tear film break-up time, surface staining with fluorescein, and corneal and conjunctival sensitivities, and by completing the Schirmer's II test. Data was analysed using Statistical Package for Social Sciences (SPSS) version 11.5. A p value less than 0.05 was considered statistically significant.
RESULTS:
The smoker group had significantly lower tear film break-up time, and corneal and conjunctival sensitivity than the nonsmoker group. Punctate staining was significantly higher in the smoker group than the non-smoker group. There was no statistically significant difference in Schirmer's II test results between the smoker and non-smoker group.
CONCLUSION:
Smoking caused adverse effects on the precorneal tear film and there was strong association between smoking and tear film instability. Although a causative relationship could not be determined, there is a need for further longitudinal studies.

Australas Med J. 2012;5(4):221-6. Epub 2012 Apr 30.
Source
Manipal College of Allied Health Sciences, Manipal University, Manipal, India.


Abstract: Diquafosol



OBJECTIVE:
To investigate the dose-dependent efficacy and safety of diquafosol ophthalmic solution for the treatment of dry eye syndrome.
DESIGN:
Randomized, double-masked, multicenter, parallel-group, placebo-controlled trial.
PARTICIPANTS:
A total of 286 Japanese patients with dry eye who were prescribed topical diquafosol (1%, n = 96; 3%, n = 96) or placebo ophthalmic solution (n = 94).
METHODS:
After a washout period of 2 weeks, qualified subjects were randomized to receive a single drop of 1% or 3% diquafosol or placebo ophthalmic solutions 6 times per day for 6 weeks.
MAIN OUTCOME MEASURES:
The primary outcome measure was fluorescein corneal staining score assessment. The secondary outcome measures were Rose Bengal corneal and conjunctival staining scores, tear break-up time (BUT), and subjective symptom assessment. Safety measures were clinical blood and urine examination and recording of adverse events.
RESULTS:
Fluorescein corneal staining scores significantly improved with both 1% and 3% topical diquafosol compared with placebo at 4 weeks, respectively (P = 0.037, P = 0.002). There was a dose-dependent effect among the groups. Rose Bengal corneal and conjunctival staining scores also improved significantly with both 1% and 3% diquafosol compared with placebo (P = 0.007 and P = 0.004, respectively). Subjective dry eye symptom scores significantly improved with both diquafosol ophthalmic solutions (P ≤ 0.033), although there were no significant differences in BUT compared with placebo. No significant differences between the treatment groups were observed in relation to the occurrence of adverse events.
CONCLUSIONS:
Both 1% and 3% diquafosol ophthalmic solutions are considered effective and safe for the treatment of dry eye syndrome.
FINANCIAL DISCLOSURE(S):
Proprietary or commercial disclosure may be found after the references.

Ophthalmology. 2012 Jun 25. [Epub ahead of print]
Source
Department of Ophthalmology, Keio University School of Medicine, Tokyo, Japan.

Abstract: Which microorganisms may cause 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.

Invest Ophthalmol Vis Sci. 2012 Aug 15;53(9):5585-93. Print 2012 Sep.
Source
School of Biological Sciences, Research Center for Biomolecules and Biosystems, Chung-Ang University, Seoul, Republic of Korea.