Eyeworld

64 | EYEWORLD | JULY 2023 C ORNEA References 1. Lemp MA, Nichols KK. Bleph- aritis in the United States 2009: a survey-based perspective on prevalence and treatment. Ocul Surf. 2009;7:S1-S14. 2. Rynerson JM, Perry HD. DEBS – a unification theory for dry eye and blepharitis. Clin Ophthalmol. 2016;10:2455–2467. 3.Nelson JD, et al. The Interna- tional Workshop on Meibomian Gland Dysfunction: report of the Definition and Classification Sub- committee. Invest Ophthalmol Vis Sci. 2011;52:1930–1937. 4. Amescua G, et al. Blepharitis Preferred Practice Pattern. Oph- thalmology. 2019;126:P56–P93. 5. Bouchard C. Diagnoses and management of blepharitis. Review of Ophthalmology. 2022. 6. Romero JM, et al. Conservative treatment of meibomian gland dysfunction. Eye Contact Lens. 2004;30:14–19. 7. Shah PP, et al. Update on the management and treatment of Demodex blepharitis. Cornea. 2022;41:934–939. 8. Heczko J, et al. Evaluation of a novel treatment, selenium disul- fide, in killing Demodex folliculo- rum in vitro. Can J Ophthalmol. 2022. Online ahead of print. can show if the patient has significant aqueous deficiency), lissamine green staining (to see if there are changes on the ocular surface), and meibography. "I will frequently express the lower meibomian glands to look at the meibum, and this is usually helpful and somewhat thera- peutic as it often helps increase the flow of the meibum again," he said. Treatments Dr. Perry noted a study that he was a part of where patients with symptomatic blepharitis were treated with warm saltwater soaks and preservative-free tears. 6 This was done for 6 weeks, and patients were reevaluated. Dr. Perry said 88% of patients got better. "It was hearten- ing to realize that patients could get better with non-medicinal therapy," he said. This saltwater method helps with lid hy- giene, he said. The heat helps melt fats in the eyelid, the saline solution is calming for the eye, and the action of the cotton ball on and off cleans the eyelid and debrides some allergens that might be stuck to the eyelid skin. It's helpful to have a non-medicinal option, he said, because corticosteroids can cause thin- ning of the eyelid skin and can lead to the com- plications of glaucoma and cataract formation. For those patients who need additional treatment, Dr. Perry said there are options like Prokera (BioTissue) and several cyclosporine medications. Additionally, Dr. Perry said it's important to consider nutritional therapy. He recommends patients take fish oil supplements. Most patients with severe meibomian gland dysfunction have associated acne rosacea and don't eat any fish, he said. Speaking specifically about staphylococcal blepharitis, Dr. de Luise said it is often chronic and recurrent; patient education is essential as the condition is rarely curable. Therapeutic strategies include warm compresses and saltwa- ter lid scrubs. Do not use shampoos or soaps in lid scrubs as blepharitis is a condition in which the eyelid surface is already saponified, and the shampoos can worsen the condition. Hypo- chlorous acid cleansers can be helpful. In more continued from page 63 Excessive meibum secretions in MGD Source: Henry Perry, MD

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