Eyeworld

JULY 2023 | EYEWORLD | 65 C Relevant disclosures de Luise: None Perry: Azura Ophthalmics, BlephEx, Novaliq, Tarsus Pharmaceuticals severe cases in which the patient is not a steroid responder, the short-term use of an antibiotic- steroid ointment or drop can be effective. 4,5 In terms of new therapies in development, Dr. Perry said that Novaliq is working on a cyc- losporine product with a new type of excipient (fluorinated alkanes) that will also treat mei- bomian dysfunction. Dr. Perry is studying some new drugs that are similar to Oxervate (ceneg- ermin-bkbj, Dompé) that have healing qualities on the ocular surface. "We're looking at two other agents, one with germ cell properties and one with a different growth factor compound," he said. Are some types of blepharitis harder to treat? Anterior blepharitis due to staphylococcal over- growth can be recurrent, Dr. de Luise said. Addi- tionally, posterior blepharitis due to meibomian gland dysfunction can be chronic and recalci- trant to treatment. These types of blepharitis may require ongoing episodic treatment over months to years. Complex cases of blepharitis, Dr. de Luise said, include blepharitis from neoplastic etiolo- gies, such as sebaceous cell carcinoma or basal cell carcinoma. These cases require individual- ized treatment including cryosurgical or surgical removal with wide margins and eyelid plastic reconstruction. Blepharitis from Stevens-John- son syndrome is often cicatrizing. Stevens-John- son syndrome is often associated with cica- trizing conjunctivitis and requires coordinated management of the eyelids and the conjunctival sequelae. Oculocutaneous rosacea can be asso- ciated with blepharitis. Topical corticosteroids should be used with caution in the management of rosacea keratitis as corneal melts can occur. What about Demodex? Acarid mites in the genus Demodex can be associated with anterior blepharitis or posterior blephari- tis, meibomian gland dysfunction, oculocutaneous rosacea, and keratitis. Whether Demodex mites are causative or just correlative is debated, Dr. de Luise said. Demodex blepharitis should be suspected in cases of symptomatic patients who are non-responsive to treat- ment of other anterior segment conditions, he added. Demodex infestation is termed demodicosis and is common. It has been estimated that almost half of adults with some type of blepharitis harbor Demodex mites, Dr. de Luise said. Symptoms and signs of demodicosis include eyelid irritation, blurry vision, ocular discomfort, itching, burning, foreign body sensation, collarettes around eyelash bases, crusting, or matting of eyelashes and tearing. Misdiagnosis can occur because of the poor correlation between Demodex infestation and symp- toms. Demodex mites are found in both symptomatic and asymptomatic individuals. The ocular symptom that correlates most directly with Demodex is lid irritation. Demodex mites can cause ocu- lar inflammation by direct mechanisms as well as indirectly. 7 The overarching goal in the treatment of Demodex infestation is to reduce eyelid margin mite popu- lations, which in turn reduces ocular surface inflammation. There is no current FDA-approved agent for demodicosis. Demodicosis does not respond to hot compresses or antibiotic-steroid ointment. There are many topical treatment strategies for demodicosis, none of which are curative, Dr. de Luise said. One of the more efficacious strategies is the use of topical tea tree oil. Cliradex is a lid wipe that contains terpinen-4-ol, which is the most active ingredient in tea tree oil. Another option for demodicosis is the use of OCuSOFT Lid Scrub Plus or TheraTears scrubs. Several companies are analyzing pipeline medications for demodicosis. Two companies in this domain are Tarsus Pharmaceuticals, which is looking at an ophthalmic formulation of the acaricide lotilaner, and Azura Ophthalmics, which is investigating a selenium sulfide component, AZR-MD-001. 8 Contact de Luise: vdeluisemd@gmail.com Perry: hankcornea@gmail.com

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