1
|
Ceylan A, Onal I, Aydin FO, Mergen B, Yildirim Y. Improvement of Clinical Findings, Meibography and Tear Film Parameters in Pediatric Ocular Rosacea Patients After a Standard Treatment Protocol. Ocul Immunol Inflamm 2024:1-8. [PMID: 38512290 DOI: 10.1080/09273948.2024.2328791] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2023] [Accepted: 03/05/2024] [Indexed: 03/22/2024]
Abstract
PURPOSE The objective of this study was to illustrate the changes in ocular findings, meibography, and tear break-up time (TBUT) values in pediatric patients with ocular rosacea following a standardized treatment. METHODS The study included consecutive patients diagnosed with ocular rosacea, referred to a tertiary hospital between 2021 and 2023. Each patient underwent biomicroscopic examinations, non-invasive TBUT assessments, corneal fluorescein staining (evaluated using the Oxford scoring system), and meibography. The standard treatment protocol involved warm compresses, eyelid hygiene, preservative-free sodium hyaluronate eye drops (administered four times daily), topical azithromycin 1.5% (twice daily for 3 days), topical steroids (loteprednol 0.5%, four times daily for 2 weeks), and either doxycycline 100 mg/day for 14 days or oral suspension of azithromycin 10 mg/kg for 3 days followed by an additional three-day course of treatment administered 10 days later (for patients above and below 14 years of age, respectively). RESULTS The study included 18 patients, with 10 (55.5%) being female and 8 (44.4%) being male, with a mean age of 9.7 ± 4.5 years (range: 3-18). Four patients displayed cutaneous involvement. The treatments resulted in significant improvements in the Oxford scores, reduction in corneal neovascularization, and increased TBUT (p < 0.001, p = 0.016, p < 0.001, respectively). Meibomian gland loss area also significantly improved post-treatment (27.4 ± 6.7% vs 39.2 ± 13.4%, p = 0.001). CONCLUSION This study demonstrated that pediatric ocular rosacea patients may exhibit improved meibomian gland function, regression of corneal neovascularization, and enhanced tear film parameters following a standardized treatment protocol that includes both topical and systemic approaches.
Collapse
Affiliation(s)
- Ali Ceylan
- Department of Ophthalmology, University of Health Sciences, Basaksehir Cam and Sakura City Hospital, Istanbul, Turkey
| | - Irem Onal
- Department of Ophthalmology, University of Health Sciences, Basaksehir Cam and Sakura City Hospital, Istanbul, Turkey
| | - Fahri Onur Aydin
- Department of Ophthalmology, University of Health Sciences, Basaksehir Cam and Sakura City Hospital, Istanbul, Turkey
| | - Burak Mergen
- Department of Ophthalmology, University of Health Sciences, Basaksehir Cam and Sakura City Hospital, Istanbul, Turkey
| | - Yusuf Yildirim
- Department of Ophthalmology, University of Health Sciences, Basaksehir Cam and Sakura City Hospital, Istanbul, Turkey
| |
Collapse
|
2
|
Morales-Mancillas NR, Velazquez-Valenzuela F, Kinoshita S, Suzuki T, Dahlmann-Noor AH, Dart JKG, Hingorani M, Ali A, Fung S, Akova YA, Doan S, Gupta N, Hammersmith KM, Tan DTH, Paez-Garza JH, Rodriguez-Garcia A. Definition and Diagnostic Criteria for Pediatric Blepharokeratoconjunctivitis. JAMA Ophthalmol 2024; 142:39-47. [PMID: 38127333 PMCID: PMC10797454 DOI: 10.1001/jamaophthalmol.2023.5750] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2023] [Accepted: 10/24/2023] [Indexed: 12/23/2023]
Abstract
Importance Pediatric blepharokeratoconjunctivitis (PBKC) is a chronic, sight-threatening inflammatory ocular surface disease. Due to the lack of unified terminology and diagnostic criteria, nonspecific symptoms and signs, and the challenge of differentiation from similar ocular surface disorders, PBKC may be frequently unrecognized or diagnosed late. Objective To establish a consensus on the nomenclature, definition, and diagnostic criteria of PBKC. Design, Setting, and Participants This quality improvement study used expert panel and agreement applying the non-RAND modified Delphi method and open discussions to identify unified nomenclature, definition, and definitive diagnostic criteria for PBKC. The study was conducted between September 1, 2021, and August 14, 2022. Consensus activities were carried out through electronic surveys via email and online virtual meetings. Results Of 16 expert international panelists (pediatric ophthalmologists or cornea and external diseases specialists) chosen by specific inclusion criteria, including their contribution to scientific leadership and research in PBKC, 14 (87.5%) participated in the consensus. The name proposed was "pediatric blepharokeratoconjunctivitis," and the agreed-on definition was "Pediatric blepharokeratoconjunctivitis is a frequently underdiagnosed, sight-threatening, chronic, and recurrent inflammatory eyelid margin disease associated with ocular surface involvement affecting children and adolescents. Its clinical spectrum includes chronic blepharitis, meibomitis, conjunctivitis, and corneal involvement ranging from superficial punctate keratitis to corneal infiltrates with vascularization and scarring." The diagnostic criteria included 1 or more suggestive symptoms accompanied by clinical signs from 3 anatomical regions: the eyelid margin, conjunctiva, and cornea. For PBKC suspect, the same criteria were included except for corneal involvement. Conclusions and Relevance The agreements on the name, definition, and proposed diagnostic criteria of PBKC may help ophthalmologists avoid diagnostic confusion and recognize the disease early to establish adequate therapy and avoid sight-threatening complications. The diagnostic criteria rely on published evidence, analysis of simulated clinical cases, and the expert panel's clinical experience, requiring further validation with real patient data analysis.
Collapse
Affiliation(s)
- Nallely R Morales-Mancillas
- Tecnologico de Monterrey, School of Medicine and Health Sciences, Institute of Ophthalmology and Visual Sciences, Pediatric and Strabismus Service, Monterrey, Mexico
| | - Fabiola Velazquez-Valenzuela
- Tecnologico de Monterrey, School of Medicine and Health Sciences, Institute of Ophthalmology and Visual Sciences, Cornea, External Disease and Ocular Immunology Service, Monterrey, Mexico
| | - Shigeru Kinoshita
- Department of Frontier Medical Science and Technology for Ophthalmology, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Tomo Suzuki
- Department of Ophthalmology, Kyoto Prefectural University of Medicine, Kyoto, Japan
- Department of Ophthalmology, Kyoto City Hospital Organization, Kyoto, Japan
| | - Annegret H Dahlmann-Noor
- National Institute of Health Research's Biomedical Research Centre at Moorfields Eye Hospital and the UCL Institute of Ophthalmology, London, United Kingdom
- Children's Service, Moorfields Eye Hospital National Health Service Foundation Trust, London, United Kingdom
| | - John K G Dart
- Corneal Service, Moorfields Eye Hospital National Health Service Foundation Trust, London, United Kingdom
| | - Melanie Hingorani
- Children's Service, Moorfields Eye Hospital National Health Service Foundation Trust, London, United Kingdom
- Corneal Service, Moorfields Eye Hospital National Health Service Foundation Trust, London, United Kingdom
| | - Asim Ali
- Department of Ophthalmology & Vision Sciences, Hospital for Sick Children, Toronto, Ontario, Canada
| | - Simon Fung
- Department of Ophthalmology, University of California, Los Angeles
| | - Yonca A Akova
- Department of Ophthalmology, Bayındır Hospital, Ankara, Turkey
| | - Serge Doan
- Department of Ophthalmology, Fondation Ophtalmolologique A. de Rothschild, Paris, France
| | - Noopur Gupta
- Cornea, Cataract & Refractive Surgery Services, Dr. Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, India
| | | | - Donald T H Tan
- Eye & Cornea Surgeons, Eye & Retina Surgeons, Camden Medical and Mount Elizabeth Novena Specialist Centre, Singapore
- Singapore Eye Research Institute, Singapore National Eye Centre, Singapore
- Department of Ophthalmology and Visual Science, Duke-NUS Graduate Medical School, Singapore
| | - J Homar Paez-Garza
- Tecnologico de Monterrey, School of Medicine and Health Sciences, Institute of Ophthalmology and Visual Sciences, Pediatric and Strabismus Service, Monterrey, Mexico
| | - Alejandro Rodriguez-Garcia
- Tecnologico de Monterrey, School of Medicine and Health Sciences, Institute of Ophthalmology and Visual Sciences, Cornea, External Disease and Ocular Immunology Service, Monterrey, Mexico
| |
Collapse
|
3
|
Moon J, Lee J, Kim MK, Hyon JY, Jeon HS, Oh JY. Clinical Characteristics and Therapeutic Outcomes of Pediatric Blepharokeratoconjunctivitis. Cornea 2023; 42:578-583. [PMID: 36036680 DOI: 10.1097/ico.0000000000003120] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2022] [Accepted: 07/07/2022] [Indexed: 11/26/2022]
Abstract
PURPOSE The purpose of this study was to determine the clinical characteristics, disease course, therapeutic outcomes, and prognostic factors for pediatric patients with blepharokeratoconjunctivitis (BKC). METHODS A retrospective medical chart review was performed for patients aged 15 years or younger who had been diagnosed with BKC between 2004 and 2020 at 2 tertiary hospitals in Korea. The following data were collected: demographics, medical history, ocular findings, geometric profiling of corneal lesion, medical management, and outcomes. RESULTS A total of 137 patients (90 female and 47 male) were included. The patients' mean age was 8.3 ± 3.8 years at disease onset. Both eyes were involved in 57.7% of cases. The most common corneal lesion was corneal neovascularization (77.4%), followed by clinically visible corneal infiltration (51.8%) and stromal scarring (43.1%). Most of the corneal lesions involved a single quadrant, most commonly the inferior quadrant. After treatment, disease remission was achieved in 95% of patients, and visual acuities improved from 0.2 ± 0.3 logarithm of minimal angle of resolution at disease presentation to 0.1 ± 0.3 logarithm of minimal angle of resolution at final follow-up ( P = 0.001). Recurrence occurred in 52.6% of patients. Cylinder power was significantly higher in patients with recurrence than in those without. The number of cases of recurrence was positively associated with final cylinder power. CONCLUSIONS Although the treatment induced disease remission in 95% of children with BKC, recurrence occurred in 52.6% of those cases. Because recurrence resulted in significant astigmatism, careful observation for recurrence and prompt management are warranted for preservation of vision in pediatric patients with BKC.
Collapse
Affiliation(s)
- Jayoon Moon
- Department of Ophthalmology, Seoul National University College of Medicine, Seoul, Republic of Korea
- Laboratory of Ocular Regenerative Medicine and Immunology, Biomedical Research Institute, Seoul National University Hospital, Seoul, Republic of Korea; and
| | - Junseok Lee
- Department of Ophthalmology, Seoul National University College of Medicine, Seoul, Republic of Korea
- Department of Ophthalmology, Seoul National University Bundang Hospital, Seongnam, Gyeonggi, Republic of Korea
| | - Mee Kum Kim
- Department of Ophthalmology, Seoul National University College of Medicine, Seoul, Republic of Korea
- Laboratory of Ocular Regenerative Medicine and Immunology, Biomedical Research Institute, Seoul National University Hospital, Seoul, Republic of Korea; and
| | - Joon Young Hyon
- Department of Ophthalmology, Seoul National University College of Medicine, Seoul, Republic of Korea
- Department of Ophthalmology, Seoul National University Bundang Hospital, Seongnam, Gyeonggi, Republic of Korea
| | - Hyun Sun Jeon
- Department of Ophthalmology, Seoul National University College of Medicine, Seoul, Republic of Korea
- Department of Ophthalmology, Seoul National University Bundang Hospital, Seongnam, Gyeonggi, Republic of Korea
| | - Joo Youn Oh
- Department of Ophthalmology, Seoul National University College of Medicine, Seoul, Republic of Korea
- Laboratory of Ocular Regenerative Medicine and Immunology, Biomedical Research Institute, Seoul National University Hospital, Seoul, Republic of Korea; and
| |
Collapse
|
4
|
Nabih O, Hamdani H, El Maaloum L, Allali B, El Kettani A. Spontaneous corneal perforation complicating ocular rosacea: Case report. Int J Surg Case Rep 2022; 90:106597. [PMID: 34920319 PMCID: PMC8683723 DOI: 10.1016/j.ijscr.2021.106597] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2021] [Revised: 11/04/2021] [Accepted: 11/09/2021] [Indexed: 11/29/2022] Open
Abstract
Introduction Ocular rosacea is a multifactorial disease. Its pathophysiology remains unclear. The ocular manifestations of rosacea are not specific and can range from simple blepharoconjunctivitis to sight-threatening such as corneal perforation. Case report We report the case of a 10-year-old child who presented with a red painful right eye. Based on the clinical findings, we concluded that she had a corneal perforation on ocular rosacea. She benefited from an ipsilateral lamellar autokeratoplasty by lamellar autograft. The evolution was marked by a good healing and a good visual recovery despite a corneal scar. Discussion Ocular rosacea is a multifactorial disease, with an unclear physiopathology. Corneal involvement remains the least common, but the most challenging since serious complications can occur. Corneal perforation is the most severe. Several techniques have been reported and used in the management of corneal perforations such as conjunctival flap, amniotic membrane grafting, and the use of a corneal patch. The later, corneal autografting, remains a simple and effective technique with satisfactory anatomical results. Conclusion Ocular rosacea is a pathology that is still poorly understood and of delayed diagnosis. It can lead to serious vision-threatening complications such as corneal perforation. The corneal patch is a simple, effective and efficient technique that has given good results in our case. Ocular rosacea is a multifactorial disease Various clinical presentation ranging from blepharitis to severe and sight threatening such as corneal perforation Surgical treatment: ipsilateral lamellar autokeratoplasty
Collapse
Affiliation(s)
- Omar Nabih
- Pediatric Ophthalmology Department, Hôpital 20 Août 1953, Casablanca, Morocco.
| | - Hind Hamdani
- Pediatric Ophthalmology Department, Hôpital 20 Août 1953, Casablanca, Morocco
| | - Loubna El Maaloum
- Pediatric Ophthalmology Department, Hôpital 20 Août 1953, Casablanca, Morocco
| | - Bouchra Allali
- Pediatric Ophthalmology Department, Hôpital 20 Août 1953, Casablanca, Morocco
| | - Asmaa El Kettani
- Pediatric Ophthalmology Department, Hôpital 20 Août 1953, Casablanca, Morocco
| |
Collapse
|
5
|
Abstract
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.
Collapse
|
6
|
Al‐Hayouti H, Daniel M, Hingorani M, Calder V, Dahlmann‐Noor A. Meibography and corneal volume optical coherence tomography to quantify damage to ocular structures in children with blepharokeratoconjunctivitis. Acta Ophthalmol 2019; 97:e981-e986. [PMID: 31021059 DOI: 10.1111/aos.14124] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2018] [Accepted: 04/03/2019] [Indexed: 01/31/2023]
Abstract
PURPOSE To evaluate non-contact infrared meibography and anterior segment optical coherence tomography (AS-OCT) to detect meibomian gland (MG) and corneal changes in children with blepharokeratoconjunctivitis (BKC). METHODS We acquired infrared meibography images of upper and lower lids and AS-OCT corneal scans. One masked observer graded meiboscore, full/partial MG dropout, and measured total corneal volume and differential corneal volume per quadrant and central corneal thickness (CCT). RESULTS We enrolled 63 children, 31 with BKC and 32 without ocular surface inflammation; median (interquartile range) age BKC 10.6 (7.2-13.9) years, healthy volunteers (HV) 11.4 (9.5-13.8) years. Likert scale scores for meibography and OCT indicate no to low discomfort. Meiboscores for upper and lower lids as well as the total meiboscore were significantly higher in children with BKC than in HV. Subscores for full and partial MG dropout were also significantly higher in children with BKC than in healthy volunteers. There was no statistically significant difference between upper and lower lid for meiboscore nor full/partial MG dropout scores. The corneal volume in the superior quadrant was significantly higher in children with BKC than in HV, whereas the corneal volume in the nasal and inferior quadrants was significantly lower. CONCLUSIONS Non-contact imaging technologies objectively demonstrate damage to meibomian glands and changes in corneal volume secondary to BKC. The tests are well tolerated by children with mild/moderate ocular surface inflammation and can detect changes without the requirement for routine eversion of the upper lid. These parameters may be useful both for clinical follow-up and clinical trials.
Collapse
Affiliation(s)
- Huda Al‐Hayouti
- NIHR Moorfields Biomedical Research Centre at Moorfields Eye Hospital UCL Institute of Ophthalmology London UK
| | - Moritz Daniel
- NIHR Moorfields Biomedical Research Centre at Moorfields Eye Hospital UCL Institute of Ophthalmology London UK
- Eye Center Medical Center – University of Freiburg Faculty of Medicine University of Freiburg Freiburg Germany
| | | | | | - Annegret Dahlmann‐Noor
- NIHR Moorfields Biomedical Research Centre at Moorfields Eye Hospital UCL Institute of Ophthalmology London UK
- Paediatric Service Moorfields Eye Hospital London UK
| |
Collapse
|
7
|
de Paula A, Oliva G, Barraquer RI, de la Paz MF. Prevalence and antibiotic susceptibility of bacteria isolated in patients affected with blepharitis in a tertiary eye centre in Spain. Eur J Ophthalmol 2019; 30:991-997. [PMID: 31232091 DOI: 10.1177/1120672119854985] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
PURPOSE To describe which bacteria can be found on lid margins in patients affected with blepharitis, to show their antibiotic susceptibility pattern, and to evaluate the antibiotic resistance trend of coagulase-negative Staphylococcus through time. MATERIALS AND METHODS Consecutive cases of 198 eyes affected with blepharitis between 2012 and 2018 were reviewed. A sample was collected by rubbing a swab against the base of the eyelashes of both the eyes of all patients. The samples were inoculated in blood agar and chocolate agar. The susceptibility of the identified bacteria to common antibiotics was tested. In addition, the antibiotic susceptibility pattern of coagulase-negative Staphylococcus detected from year 2016 to 2018 was compared with that of 4 years before. RESULTS The most common isolated bacterium was coagulase-negative Staphylococcus (89%) and Staphylococcus aureus (28%). Coagulase-negative Staphylococcus showed highest susceptibility to vancomycin (100%), neomycin (94%) and chloramphenicol (91%). Coagulase-negative Staphylococcus and Staphylococcus aureus were the most resistant to penicillin and erythromycin (resistance in 92%, 91% for coagulase-negative Staphylococcus, 86% and 43% of eyes for Staphylococcus aureus). Corynebacterium was resistant to oxacillin and erythromycin. Streptococcus viridans showed resistance to gentamycin and tobramycin. Moraxella was susceptible to most antibiotics. Bacillus was resistant to oxacillin. The antibiotic resistance trend of coagulase-negative Staphylococcus showed that the resistance to rifampicin increased through the years 2012-2018. CONCLUSION Coagulase-negative Staphylococcus and Staphylococcus aureus were the most isolated bacteria in patients affected by blepharitis in our tertiary eye centre. Both bacteria were resistant to erythromycin. Through the years, it seems that coagulase-negative Staphylococcus gained resistance to penicillin, erythromycin, ciprofloxacin and rifampicin.
Collapse
Affiliation(s)
- Alessandro de Paula
- Ophthalmology Unit, NESMOS Department St. Andrea Hospital, Faculty of Medicine and Psychology, University of Rome 'Sapienza', Rome, Italy
| | - Gloria Oliva
- Centro de Oftalmología Barraquer, Barcelona, Spain.,Instituto Universitario Barraquer, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Rafael Ignacio Barraquer
- Centro de Oftalmología Barraquer, Barcelona, Spain.,Instituto Universitario Barraquer, Universitat Autònoma de Barcelona, Barcelona, Spain.,Universitat Internacional de Catalunya, Barcelona, Spain
| | - Maria Fideliz de la Paz
- Centro de Oftalmología Barraquer, Barcelona, Spain.,Instituto Universitario Barraquer, Universitat Autònoma de Barcelona, Barcelona, Spain
| |
Collapse
|
8
|
Blepharitis Preferred Practice Pattern®. Ophthalmology 2018; 126:P56-P93. [PMID: 30366800 DOI: 10.1016/j.ophtha.2018.10.019] [Citation(s) in RCA: 57] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2018] [Accepted: 10/09/2018] [Indexed: 12/19/2022] Open
|
9
|
O'Gallagher M, Bunce C, Hingorani M, Larkin F, Tuft S, Dahlmann‐Noor A. Topical treatments for blepharokeratoconjunctivitis in children. Cochrane Database Syst Rev 2017; 2:CD011965. [PMID: 28170093 PMCID: PMC6464561 DOI: 10.1002/14651858.cd011965.pub2] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
BACKGROUND Blepharokeratoconjunctivitis (BKC) is a type of inflammation of the surface of the eye and eyelids that involves changes of the eyelids, dysfunction of the meibomian glands, and inflammation of the conjunctiva and cornea. Chronic inflammation of the cornea can lead to scarring, vascularisation and opacity. BKC in children can cause significant symptoms including irritation, watering, photophobia and loss of vision from corneal opacity, refractive error or amblyopia.Treatment of BKC is directed towards modification of meibomian gland disease and the bacterial flora of lid margin and conjunctiva, and control of ocular surface inflammation. Although both topical and systemic treatments are used to treat people with BKC, this Cochrane review focuses on topical treatments. OBJECTIVES To assess and compare data on the efficacy and safety of topical treatments (including antibiotics, steroids, immunosuppressants and lubricants), alone or in combination, for BKC in children from birth to 16 years. SEARCH METHODS We searched CENTRAL (which contains the Cochrane Eyes and Vision Trials Register) (2016, Issue 6), Ovid MEDLINE, Ovid MEDLINE In-Process and Other Non-Indexed Citations, Ovid MEDLINE Daily, Ovid OLDMEDLINE ( January 1946 to 11 July 2016), Embase (January 1980 to 11 July 2016), the ISRCTN registry (www.isrctn.com/editAdvancedSearch), ClinicalTrials.gov (www.clinicaltrials.gov) and the World Health Organization (WHO) International Clinical Trials Registry Platform (ICTRP) (www.who.int/ictrp/search/en). We did not use any date or language restrictions in the electronic searches for trials. We last searched the electronic databases on 11 July 2016. We searched the reference lists of identified reports and the Science Citation Index to identify any additional reports of studies that met the inclusion criteria. SELECTION CRITERIA We searched for randomised controlled trials that involved topical treatments in children up to 16 years of age with a clinical diagnosis of BKC. We planned to include studies that evaluated a single topical medication versus placebo, a combination of treatments versus placebo, and those that compared two or multiple active treatments. We planned to include studies in which participants received additional treatments, such as oral antibiotics, oral anti-inflammatories, warm lid compresses and lid margin cleaning. DATA COLLECTION AND ANALYSIS Two review authors independently screened the results of the literature search (titles and abstracts) to identify studies that met the inclusion criteria of the review and applied standards as expected for Cochrane reviews. We graded the certainty of the evidence using GRADE. MAIN RESULTS We included one study from the USA that met the inclusion criteria. In the study, 137 children aged zero to six years old with blepharoconjunctivitis were randomised to treatment in one of four trial arms (loteprednol etabonate/tobramycin combination, loteprednol etabonate alone, tobramycin alone or placebo) for 15 days, with assessments on days 1, 3, 7 and 15. We judged the study to be at high risk of attrition bias and bias due to selective outcome reporting. The study did not report the number of children with improvement in symptoms nor with total or partial success as measured by changes in clinical symptoms.All children showed a reduction in blepharoconjunctivitis grade score, but there was no evidence of important differences between groups. Visual acuity was not fully reported but the authors stated that there was no change in visual acuity in any of the treatment groups. The study reported ocular and non ocular adverse events but was underpowered to detect differences between the groups. Ocular adverse events were as follows: loteprednol/tobramycin 1/34 (eye pain); loteprednol 4/35 (eye pain, conjunctivitis, eye discharge, eye inflammation); tobramycin 0/34; placebo (vehicle) 0/34. The evidence was limited for all these outcomes and we judged it to be very low certainty.There was no information on clinical signs (aside from grade score), disease progression or quality of life. AUTHORS' CONCLUSIONS There is no high-quality evidence of the safety and efficacy of topical treatments for BKC, which resulted in uncertainty about the indications and effectiveness of topical treatment. Clinical trials are required to test efficacy and safety of current and any future treatments. Outcome measures need to be developed which can capture both objective clinical and patient-reported aspects of the condition and treatments.
Collapse
Affiliation(s)
| | - Catey Bunce
- Kings College LondonDepartment of Primary Care & Public Health Sciences4th Floor, Addison HouseGuy's CampusLondonUKSE1 1UL
| | - Melanie Hingorani
- Moorfields Eye Hospital NHS Foundation Trust162 City RoadLondonUKEC1V 2PD
| | - Frank Larkin
- Moorfields Eye Hospital NHS Foundation TrustCornea and External Disease Department162 City RoadLondonUKEC1V 2PD
| | - Stephen Tuft
- Moorfields Eye Hospital NHS Foundation TrustCornea and External Disease Department162 City RoadLondonUKEC1V 2PD
| | - Annegret Dahlmann‐Noor
- NIHR Biomedical Research Centre at Moorfields Eye Hospital NHS Foundation Trust and UCL Institute of Ophthalmology162 City RoadLondonUKEC1V 2PD
| | | |
Collapse
|
10
|
O'Gallagher M, Banteka M, Bunce C, Larkin F, Tuft S, Dahlmann‐Noor A. Systemic treatment for blepharokeratoconjunctivitis in children. Cochrane Database Syst Rev 2016; 2016:CD011750. [PMID: 27236587 PMCID: PMC9257284 DOI: 10.1002/14651858.cd011750.pub2] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
Abstract
BACKGROUND Blepharokeratoconjunctivitis (BKC) is a type of inflammation of the surface of the eye and eyelids which can affect children and adults. BKC involves changes of the eyelids, dysfunction of the meibomian glands, and inflammation of the conjunctiva and cornea. Chronic inflammation of the cornea can lead to scarring, vascularisation and opacity. BKC in children can cause significant symptoms which include irritation, watering, photophobia and loss of vision. Loss of vision in children with BKC may be due to corneal opacity, refractive error or amblyopia.BKC treatment is directed towards the obstruction of meibomian gland openings, the bacterial flora of lid margin and conjunctiva, and ocular surface inflammation. Dietary modifications that involve increased intake in essential fatty acids (EFAs) may also be beneficial. Both topical and systemic treatments are used; this Cochrane review focuses on systemic treatments. OBJECTIVES To assess and compare data on the efficacy and safety of systemic treatments (including antibiotics, nutritional supplements and immunosuppressants), alone or in combination, for BKC in children aged between zero to 16 years. SEARCH METHODS We searched CENTRAL (which contains the Cochrane Eyes and Vision Trials Register) (2016, Issue 3), Ovid MEDLINE, Ovid MEDLINE In-Process and Other Non-Indexed Citations, Ovid MEDLINE Daily, Ovid OLDMEDLINE (January 1946 to April 2016), EMBASE (January 1980 to April 2016), the ISRCTN registry (www.isrctn.com/editAdvancedSearch), ClinicalTrials.gov (www.clinicaltrials.gov) and the World Health Organization (WHO) International Clinical Trials Registry Platform (ICTRP) (www.who.int/ictrp/search/en). We did not use any date or language restrictions in the electronic searches for trials. We last searched the electronic databases on 21 April 2016. SELECTION CRITERIA We searched for randomised controlled trials that involved systemic treatments in children aged between zero to 16 years with a clinical diagnosis of BKC. We planned to include studies that evaluated a single systemic medication versus placebo, and studies that compared two or multiple active treatments. We planned to include studies in which participants receive additional treatments, such as topical antibiotics, anti-inflammatories and lubricants, warm lid compresses and lid margin cleaning. DATA COLLECTION AND ANALYSIS Two review authors independently screened the literature search results (titles and abstracts) to identify studies that possibly met the inclusion criteria of the review. We divided studies into 'definitely include', 'definitely exclude' and 'possibly include' categories. We made a final judgement as to the inclusion or exclusion of studies in the 'possibly include' category after we obtained the full text of each article. MAIN RESULTS No report or trial met the inclusion criteria of this Cochrane review; no randomised controlled trials have been carried out on this topic. There is a lack of standardised outcome measures. AUTHORS' CONCLUSIONS There is currently no evidence from clinical trials regarding the safety and efficacy of systemic treatments for BKC. Trials are required to test efficacy and safety of current and future treatments. Outcome measures need to be developed which can capture both objective clinical and patient-reported aspects of the condition and treatments.
Collapse
Affiliation(s)
| | - Marina Banteka
- NIHR Biomedical Research Centre at Moorfields Eye Hospital NHS Foundation Trust and UCL Institute of Ophthalmology162 City RoadLondonUKEC1V 2PD
| | - Catey Bunce
- NIHR Biomedical Research Centre at Moorfields Eye Hospital NHS Foundation Trust and UCL Institute of OphthalmologyResearch and Development DepartmentCity RoadLondonUKEC1V 2PD
| | - Frank Larkin
- Moorfields Eye Hospital NHS Foundation TrustCornea and External Disease Department162 City RoadLondonUKEC1V 2PD
| | - Stephen Tuft
- Moorfields Eye Hospital NHS Foundation TrustCornea and External Disease Department162 City RoadLondonUKEC1V 2PD
| | - Annegret Dahlmann‐Noor
- NIHR Biomedical Research Centre at Moorfields Eye Hospital NHS Foundation Trust and UCL Institute of Ophthalmology162 City RoadLondonUKEC1V 2PD
| | | |
Collapse
|
11
|
Rodríguez-García A, González-Godínez S, López-Rubio S. Blepharokeratoconjunctivitis in childhood: corneal involvement and visual outcome. Eye (Lond) 2016; 30:438-46. [PMID: 26634709 PMCID: PMC4791702 DOI: 10.1038/eye.2015.249] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2015] [Accepted: 10/21/2015] [Indexed: 12/16/2022] Open
Abstract
PURPOSE The main objective of this study is to describe the prevalence, degree and risk of corneal involvement, and visual impact in a pediatric population with blepharokeratoconjunctivitis (BKC). METHODS Retrospective, observational, case-control study. Clinical records of patients ≤16 years old with BKC seen between 2006 and 2012 were reviewed. The prevalence and relative risk of corneal involvement was evaluated between patients with and without corneal affection through a univariate and multivariate analysis with logistic regression. Visual acuity at presentation and at last follow-up visit was also analyzed. RESULTS One hundred and fourteen children with BKC, with a male-to-female ratio of 1 : 1 and a mean age at diagnosis of 9.13 years. The mean follow-up time was 26.4 (±25) months. Corneal involvement was present in 39.5% of patients, varying from superficial punctate keratitis to perforation. Corneal changes were not seen in children under 4 years old. The risk of corneal affection was greater in patients with photophobia, hordeolum, female gender and asymmetric disease (OR of 2.69, 11.6, 2.35 and 2.77, respectively). The mean best-corrected visual acuity at presentation was 0.20 (corneal affected group), compared to 0.11 (unaffected group; P=0.02). CONCLUSIONS Our study showed an older age at time of diagnosis and a worse visual outcome in patients with BKC and corneal disease compared with previous reports. Early diagnosis and detection of risk factors for corneal involvement, as well as adequate treatment, is mandatory to prevent serious long-term visual repercussions in children with BKC.
Collapse
Affiliation(s)
- A Rodríguez-García
- Cornea and Ocular Surface Service, Ophthalmology and Visual Sciences Institute, School of Medicine, Tecnológico de Monterrey, Monterrey, Mexico
| | - S González-Godínez
- Ophthalmology and Visual Sciences Institute, School of Medicine, Tecnológico de Monterrey, Monterrey, Mexico
| | - S López-Rubio
- Ophthalmology and Visual Sciences Institute, School of Medicine, Tecnológico de Monterrey, Monterrey, Mexico
| |
Collapse
|
12
|
Banteka M, O'Gallagher M, Bunce C, Larkin F, Tuft S, Dahlmann-Noor A. Systemic treatment for blepharokeratoconjunctivitis in children. THE COCHRANE DATABASE OF SYSTEMATIC REVIEWS 2015. [DOI: 10.1002/14651858.cd011750] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
|
13
|
Medsinge A, Nischal KK. Managing blepharokeratoconjunctivitis in children: a review. EXPERT REVIEW OF OPHTHALMOLOGY 2014. [DOI: 10.1586/17469899.2013.848791] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
|
14
|
Doan S, Gabison E, Chiambaretta F, Touati M, Cochereau I. Efficacy of azithromycin 1.5% eye drops in childhood ocular rosacea with phlyctenular blepharokeratoconjunctivitis. J Ophthalmic Inflamm Infect 2013; 3:38. [PMID: 23514194 PMCID: PMC3605085 DOI: 10.1186/1869-5760-3-38] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2012] [Accepted: 09/12/2012] [Indexed: 01/09/2023] Open
Abstract
Background The purpose of this study is to report the efficacy of azithromycin 1.5% eye drops in children with ocular rosacea and phlyctenular blepharokeratoconjunctivitis. This retrospective study from January 2009 to March 2010 included 16 children treated with lid hygiene plus azithromycin 1.5% eye drops (Azyter®): 3-day treatments (1 drop twice a day) every 10 days, reduced based on efficacy to one treatment every 15 days and then to one treatment per month. Results Nineteen eyes of six boys and ten girls, aged 4 to 16 years (mean, 9.3 ± 4.0) were included. The disease was previously resistant to lid hygiene (all the patients), oral erythromycin (one patient), and intermittent topical steroids (six patients). The median duration of each phase of azithromycin treatment (i.e., three, two, and one treatments per month) was 2 months. Ocular inflammation was controlled by azithromycin alone in 15 patients. In one uncontrolled case, cyclosporine 2% eye drops was added at month 5. Bulbar conjunctival hyperemia resolved completely within 1 month in all eyes, whereas conjunctival phlyctenules and corneal inflammation took longer to improve, with a complete resolution within 3 to 10 months. Blepharitis grade decreased from 2.31 ± 0.79 to 1.50 ± 0.73. Treatment was stopped after a median of 6 months (from 4 to 10 months) without recurrence of corneoconjunctival inflammation (median follow-up without treatment, 11 months). Six cases of ocular irritation were reported, two of which led to treatment withdrawal. Conclusion Azithromycin 1.5% eye drops is an effective treatment for phlyctenular keratoconjunctivitis complicating childhood ocular rosacea.
Collapse
Affiliation(s)
- Serge Doan
- Department of Ophthalmology, Hôpital Bichat and Fondation A, de Rothschild, 75018, Paris, France.
| | | | | | | | | |
Collapse
|
15
|
Choi DS, Djalilian A. Oral azithromycin combined with topical anti-inflammatory agents in the treatment of blepharokeratoconjunctivitis in children. J AAPOS 2013; 17:112-3. [PMID: 23360914 PMCID: PMC3703820 DOI: 10.1016/j.jaapos.2012.10.015] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/24/2012] [Revised: 10/22/2012] [Accepted: 10/24/2012] [Indexed: 10/27/2022]
Abstract
We report 3 children referred for recurrent blepharokeratoconjunctivitis, despite the application of topical antibiotic and anti-inflammatory treatments. Oral azithromycin combined with anti-inflammatory treatment was effective in controlling the disease.
Collapse
Affiliation(s)
- Daniel S Choi
- Department of Ophthalmology and Visual Sciences, University of Illinois at Chicago, Chicago, IL 60612, USA
| | | |
Collapse
|
16
|
Nemet AY, Vinker S, Kaiserman I. Associated Morbidity of Blepharitis. Ophthalmology 2011; 118:1062-8. [DOI: 10.1016/j.ophtha.2010.10.015] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2010] [Revised: 10/09/2010] [Accepted: 10/11/2010] [Indexed: 01/18/2023] Open
|
17
|
Geerling G, Tauber J, Baudouin C, Goto E, Matsumoto Y, O'Brien T, Rolando M, Tsubota K, Nichols KK. The international workshop on meibomian gland dysfunction: report of the subcommittee on management and treatment of meibomian gland dysfunction. Invest Ophthalmol Vis Sci 2011; 52:2050-64. [PMID: 21450919 DOI: 10.1167/iovs.10-6997g] [Citation(s) in RCA: 408] [Impact Index Per Article: 31.4] [Reference Citation Analysis] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023] Open
Affiliation(s)
- Gerd Geerling
- Department of Ophthalmology, Heinrich-Heine University, Düsseldorf, Germany
| | | | | | | | | | | | | | | | | |
Collapse
|
18
|
Asbell PA, Stapleton FJ, Wickström K, Akpek EK, Aragona P, Dana R, Lemp MA, Nichols KK. The international workshop on meibomian gland dysfunction: report of the clinical trials subcommittee. Invest Ophthalmol Vis Sci 2011; 52:2065-85. [PMID: 21450920 DOI: 10.1167/iovs.10-6997h] [Citation(s) in RCA: 46] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Affiliation(s)
- Penny A Asbell
- Department of Ophthalmology, Mount Sinai Medical Center, New York, New York, USA
| | | | | | | | | | | | | | | |
Collapse
|
19
|
Abstract
PURPOSE To report Demodex infestation in pediatric blepharoconjunctivitis. METHODS A retrospective review of 12 patients, with ages from 2.5-11 years, with chronic blepharoconjunctivitis who failed to respond to conventional treatments. Demodex was detected by lash sampling and microscopic examination. Patients were treated with 50% tea tree oil (TTO) eyelid scrubs or 5% TTO ointment eyelid massages for 4-6 weeks. RESULTS Demodex mites were found in all, but 1 case had cylindrical dandruff in the lashes. After 1 week of TTO treatment, all patients showed dramatic resolution of ocular irritation and inflammation while Demodex counts dropped. All corneal signs resolved within 2 weeks except for a residual anterior stromal scar in 1 eye. During a follow-up period of 8.3 ± 4.6 months, 1 patient showed recurrent inflammation, which was successfully managed by a second round of TTO treatment. CONCLUSIONS Demodicosis should be considered as a potential cause of pediatric refractory blepharoconjunctivitis. Eyelid scrubs or massage with TTO could be an effective treatment regimen in these cases.
Collapse
|
20
|
Cehajic-Kapetanovic J, Kwartz J. Augmentin duo™ in the treatment of childhood blepharokeratoconjunctivitis. J Pediatr Ophthalmol Strabismus 2010; 47:356-60. [PMID: 20143765 DOI: 10.3928/01913913-20100118-01] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/10/2008] [Accepted: 08/04/2009] [Indexed: 11/20/2022]
Abstract
PURPOSE To report the use of Augmentin Duo 400/57 (GlaxoSmithKline, Middlesex, UK) in the treatment of childhood blepharokeratoconjunctivitis (BKC). METHODS This is a retrospective interventional case series. The case notes of 7 consecutive patients treated with Augmentin Duo 400/57 for BKC during 18 months were reviewed. Diagnostic criteria for BKC were blepharitis including recurrent chalazia and meibomian gland dysfunction, eyelid margin telangiectasia and facial rosacea, recurrent episodes of chronic red eye, photophobia, watering, punctate superficial keratopathy, corneal neovascularization, and corneal ulcers. RESULTS Seven children (age range: 6 to 14 years) were diagnosed as having BKC. All children received systemic Augmentin Duo 400/57 and showed considerable improvement within the first month of therapy. Six children had no recurrences during a mean follow-up of 6 months. No patients experienced any side effects from this treatment. CONCLUSIONS Augmentin Duo 400/57 has not previously been reported in the treatment of BKC in children. In this case series, Augmentin Duo 400/57 proved to be at least as effective as current treatments with systemic erythromycin or doxycycline with the advantage of a twice-daily dosage and a superior side-effect profile.
Collapse
|
21
|
Blepharitis. Ophthalmology 2009. [DOI: 10.1016/b978-0-323-04332-8.00028-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
|
22
|
Jones SM, Weinstein JM, Cumberland P, Klein N, Nischal KK. Visual outcome and corneal changes in children with chronic blepharokeratoconjunctivitis. Ophthalmology 2007; 114:2271-80. [PMID: 18054641 DOI: 10.1016/j.ophtha.2007.01.021] [Citation(s) in RCA: 49] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2006] [Revised: 01/26/2007] [Accepted: 01/26/2007] [Indexed: 12/11/2022] Open
Abstract
OBJECTIVE To describe the cause, management, and effect of chronic blepharokeratoconjunctivitis (BKC) on the cornea and visual function in children. DESIGN Noncomparative, interventional, retrospective case series. PARTICIPANTS Twenty-seven children with BKC. METHODS Presenting age, best-corrected visual acuity (BCVA), refractive error, and any corneal or eyelid pathologic features were recorded. Treatment included modified lid hygiene, topical antibiotics, and steroids. Systemic therapy included oral antibiotics and, from 2003 onward, flaxseed oil as an alternative to long-term antibiotics. Amblyopia therapy included refractive correction, occlusion, or atropine therapy. MAIN OUTCOME MEASURES Corneal and eyelid status, visual acuity (VA), and refractive error at final examination. RESULTS Mean age at presentation was 6.9 years (range, 7 months-15.9 years), and mean follow-up was 2.3 years (range, 5 months-6.1 years). All patients had discomfort, conjunctival injection, and signs of posterior blepharitis at presentation. Photophobia was reported in 14 patients (52%), whereas anterior eyelid inflammation was noted in 6 (22%). Acne rosacea was confirmed in 3 patients (11%). Corneal involvement occurred in 44 eyes (81%), and a history of recurrent chalazia was seen in 18 patients (67%). Median monocular BCVAs in affected eyes were 0.28 logarithm of the minimum angle of resolution (logMAR) units (interquartile range [IqR], 0.02-0.40) at presentation and 0.02 logMAR units (IqR, 0.00-0.18) at last visit. Best-corrected VA improved in 70% of affected eyes and remained unchanged in 30%. Superimposed amblyopia was present and treated in 15 patients (48%). All 8 patients (20%) who failed to achieve VA of 0.2 logMAR units or better at the final examination had bilateral corneal involvement at presentation. One child experienced a systemic side effect from oral antibiotics. No child had significant side effects from topical treatment. Twelve patients (44%) received flaxseed oil as part of their tapering regimen. A 2-year lag between symptom onset and treatment resulted, on average, in a reduction of 0.06 logMAR units of VA (95% confidence interval, 0.00-0.12; P = 0.054). CONCLUSIONS These findings suggest that visual loss may be significant in BKC and that delayed treatment may result in decreased final BCVA. Adequate management needs both topical and systemic treatment. Flaxseed oil may be an effective antiinflammatory nutritional therapy alternative to long-term antibiotics.
Collapse
Affiliation(s)
- Sophie M Jones
- Department of Ophthalmology, Great Ormond Street Hospital for Children, London, United Kingdom
| | | | | | | | | |
Collapse
|
23
|
|
24
|
Cetinkaya A, Akova YA. Pediatric ocular acne rosacea: long-term treatment with systemic antibiotics. Am J Ophthalmol 2006; 142:816-21. [PMID: 17056363 DOI: 10.1016/j.ajo.2006.06.047] [Citation(s) in RCA: 44] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2006] [Revised: 05/19/2006] [Accepted: 06/16/2006] [Indexed: 01/11/2023]
Abstract
PURPOSE To report our experience with four cases of pediatric ocular acne rosacea, including responses to long-term systemic treatment. DESIGN Retrospective interventional case series. METHODS The medical records of four consecutive cases diagnosed with pediatric ocular acne rosacea over a period of 36 months were reviewed. Diagnostic criteria were meibomian gland dysfunction, blepharitis, lid margin telangiectasia, punctate superficial keratopathy, and conjunctival hyperemia with or without inferior corneal vascularization. RESULTS The patients, aged between four and 12, were all females with bilateral disease. Meibomitis, blepharitis, conjunctival hyperemia, and punctuate epitheliopathy was evident in each case. Cutaneous involvement was seen in two cases (50%), and limbal vascularization with subepithelial or stromal infiltrates was present in three cases (75%). One case showed corneal ulceration at presentation. All four children received systemic doxycycline or erythromycin for at least 12 months and showed considerable improvement within the first month of therapy. No recurrence was noted within the mean 25.5 months of follow-up. None of the girls experienced any side effects during the long treatment duration. CONCLUSIONS Ophthalmologists should consider acne rosacea as a potential diagnosis for any child who has any combination of meibomian disease, chronic blepharitis, recurrent chalazia, and chronic symptoms of photophobia, ocular irritation, and redness that does not respond to routine medical treatment. Such patients respond very well to long-term treatment with systemic erythromycin/doxycycline.
Collapse
Affiliation(s)
- Altuğ Cetinkaya
- Başkent University Faculty of Medicine, Department of Ophthalmology, Ankara, Turkey
| | | |
Collapse
|
25
|
Viswalingam M, Rauz S, Morlet N, Dart JKG. Blepharokeratoconjunctivitis in children: diagnosis and treatment. Br J Ophthalmol 2005; 89:400-3. [PMID: 15774912 PMCID: PMC1772603 DOI: 10.1136/bjo.2004.052134] [Citation(s) in RCA: 63] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/29/2004] [Indexed: 01/11/2023]
Abstract
AIM Blepharokeratoconjunctivitis (BKC) is a poorly described entity in children. This study characterises this syndrome in childhood and evaluates epidemiology, clinical grading, and treatment strategies. METHODS 44 children (20 white, 22 Asian, 2 Middle Eastern, median age 5.4 (range 1-14) years) with a diagnosis of BKC were followed for a median of 7 years. Diagnostic criteria included recurrent episodes of chronic red eye, watering, photophobia, blepharitis including recurrent styes or meibomian cysts, and a keratitis. Clinical features were graded as mild, moderate, or severe. The lids and conjunctiva were cultured. The treatment regimen incorporated lid hygiene, topical and/or systemic antibiotics, and topical corticosteroids. RESULTS The disease was most severe in the Asian and Middle Eastern children (p <0.001), who had a statistically higher risk of subepithelial punctate keratitis (p = 0.008), corneal vascularisation (p <0.001), and marginal corneal ulcerations (p = 0.003), than the white group. 15 children had culture positive lid swabs. Most children had a reduction in symptoms and signs with treatment, and progression of disease after the age of 8 was rare. CONCLUSIONS BKC in children can be defined as "a syndrome usually associated with anterior or posterior lid margin blepharitis, accompanied by episodes of conjunctivitis, and a keratopathy including punctate erosions, punctate keratitis, phlyctenules, marginal keratitis, and ulceration." BKC is common in children in a tertiary referral corneal and external diseases clinic, with the more severe manifestations in the Asian and Middle Eastern populations. Therapy is effective and loss of sight can be prevented in most cases.
Collapse
Affiliation(s)
- M Viswalingam
- Corneal and External Diseases Service, Moorfields Eye Hospital NHS Trust, 162 City Road, London EC1V 2PD, UK
| | | | | | | |
Collapse
|
26
|
Ayalasomayajula SP, Kompella UB. Retinal delivery of celecoxib is several-fold higher following subconjunctival administration compared to systemic administration. Pharm Res 2005; 21:1797-804. [PMID: 15553225 DOI: 10.1023/b:pham.0000045231.51924.e8] [Citation(s) in RCA: 56] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
PURPOSE We have previously demonstrated that celecoxib, a selective COX-2 inhibitor, reaches the retina following repeated oral administrations and inhibits diabetes-induced vascular endothelial growth factor (VEGF) mRNA expression and vascular leakage in a rat model. The aim of this study was to quantify the relative retinal bioavailability of celecoxib from the subconjunctival route compared to a systemic route. METHODS The plasma and ocular tissue distribution of celecoxib was determined in male Sprague-Dawley rats following subconjunctival and intraperitoneal administrations of drug suspension at a dose of 3 mg/rat. The animals were sacrificed at 0.5, 1, 2, 3, 4, 8, and 12 h post-dosing, the blood was collected, and the eyes were enucleated and frozen. The plasma, sclera, retina, vitreous, lens, and the cornea were isolated and celecoxib levels were determined using an HPLC method. The tissue exposure of the drug was measured as the area under the curve (AUC(0-infinity)) of the concentration vs. time profiles. The relative bioavailability was estimated as the AUC(0-infinity) ratio between subconjunctival and intraperitoneal groups. RESULTS For the subconjunctivally dosed (ipsilateral) eye, the AUC(0-infinity) ratios between subconjunctival and intraperitoneal groups were 0.8 +/- 0.1, 53 +/- 4, 54 +/- 8, 145 +/- 21, 61 +/- 16, and 52 +/- 6 for plasma, sclera, retina, vitreous, lens, and cornea, respectively. For the contralateral ocular tissues, the AUC0-infinity ratios were 1.2 +/- 03, 11 +/- 0.3, 1.1 +/- 0.4, 1.0 +/- 0.3, and 1.2 +/- 0.3 in the sclera, retina, vitreous, lens, and the cornea, respectively, between the subconjunctival and the intraperitoneal groups. Assuming that the drug AUCs in contralateral eye were equal to the systemic pathway contribution to AUCs in the ipsilateral eye, the percent contribution of local pathways as opposed to systemic circulation for celecoxib delivery to the ipsilateral eye tissues was estimated to be 98% or greater. CONCLUSIONS The retinal delivery of celecoxib was substantially higher following subconjunctival administration compared to the intraperitoneal route. The transscleral pathway almost completely accounts for the retinal celecoxib delivery following subconjunctival administration.
Collapse
Affiliation(s)
- Surya P Ayalasomayajula
- Department of Pharmaceutical Sciences, University of Nebraska Medical Center, Omaha, Nebraska, USA
| | | |
Collapse
|
27
|
Abstract
The tear film lipid layer is the major barrier to evaporation from the ocular surface. A decrease in its thickness or functional integrity may cause evaporative dry eye (EDE). Obstructive meibomian gland dysfunction (MGD) is the most common cause of EDE and occurs as a primary disorder or secondary to acne rosacea, seborrheic or atopic dermatitis, and with cicatrizing conjunctival disorders, such as trachoma, erythema multiforme, and cicatricial pemphigoid. MGD may be an incidental finding in asymptomatic eyes, or it may be responsible for irritative lid symptoms in the absence of dry eye. MGD-dependent EDE is diagnosed on the basis of a defined degree of MGD in a symptomatic patient showing typical ocular surface damage in the absence of an aqueous tear deficiency. When MGD occurs in a background of aqueous tear deficiency (ATD), then an additional evaporative component may assumed, depending on the extent of meibomian obstruction. However, definitive criteria are not yet established. The clinical severity of dry eye is greatest when ATD and EDE occur together, particularly in Sjogren syndrome. A hypothesis is proposed to explain the steps leading to primary, simple MGD and subsequent EDE.
Collapse
Affiliation(s)
- A J Bron
- Nuffield Laboratory of Ophthalmology, University of Oxford, Oxford, UK
| | | |
Collapse
|