Drugs – Do we need them? Applications of non-pharmaceutical therapy in anterior eye disease: A review

Natural products have been in use long before the introduction of modern drug therapies and are still used in various communities worldwide for the treatment of anterior eye disease. The aim of this review is to look at the current non-pharmaceutical modalities that have been tried and assess the body of existing evidence behind them. This includes alternative medicine, existing non-pharmaceutical therapy and more recent low and high tech solutions.A detailed search of all available databases including MEDLINE, Pubmed and Google was made to look for English-language studies for complementary and alternative treatment modalities (CAM), natural therapies and new modalities for anterior eye disease such as blepharitis, dry eye and microbial keratitis. We have included a broad discussion ranging from traditional treatments like honey and aloe vera which have been used for centuries, to the more recent technological advances like Intense Pulsed Light (IPL), LipiFlow and photoactivated chromophore for corneal cross linking in infectious keratitis (PACK-CXL).Alternative management strategies may have a role in anterior eye diseases and have a potential in changing the way we currently approach them. Some of the available CAM could play a role if incorporated in to current management practices of not only chronic diseases like blepharitis and dry eye, but also acute conditions with significant morbidity like microbial keratitis. Further large-scale randomized control trials stratified by disease severity are required to improve our understanding and to evaluate the use of non-pharmaceutical therapy against current practice.     

Topical ivermectin-metronidazole gel therapy in the treatment of blepharitis caused by Demodex spp.: A randomized clinical trial

PurposeTo evaluate the efficacy of topical ivermectin-metronidazole combined therapy in the management of Demodex-associatedblepharitis.MethodsSixty patients with a diagnosis of Demodex-associatedblepharitis were recruited in a randomized clinical trial. Thirty receiving topical ivermectin (0.1%)-metronidazole (1%) gel treatment on days 0, 15 and 30. Thirty additional patients were used as a control group receiving vehicle on days 0, 15 and 30. The primary efficacy measure was the number of Demodex spp. mitesin the eyelashes of patients. The secondary outcomes included clinical improvement of signs and adverse events.ResultsComplete eradication of Demodex spp. was found in 96.6% of patients in the treatment group. Furthermore, a significant reduction of inflammation signs were found in all treated patients versus controls. None of the patients experienced any adverse effects associated with the treatment.ConclusionDemodex infection was controlled satisfactorily with the ivermectin (0.1%)-metronidazole (1%) gel, and no adverse effects were observed. Application of this gel for the treatment of different parasitic infections of the eyelids could be feasible, and this requires further exploration.     

Imaging meibomian glands on a patient with chalazia in the upper and lower lids: A case report

AimTo describe the meibomian gland (MG) appearance in a case of eyelid chalazia, using a novel meibography method.MethodsA 29-year-old female of South Asian origin presented with mild swelling in the lower lid of the left eye. The patient also presented with a history of a recurrent chalazion in the upper lid of the same eye, which later progressed to an active chalazion. A chalazion also developed in the upper lid of the right eye. Meibography was performed using a novel Keratograph (Keratograph 4, OCULUS, Wetzlar, Germany) to evaluate the structure of the MG in the area affected by the chalazia.ResultsThe area of the recurrent chalazion in the upper left lid showed partial and/or complete MG loss. The active chalazia in the lower left lid and the upper right lid showed inflammation and MG drop out at the affected site. The inflammation was found to be reduced during the follow-up visits, however disappearance of MG very specific to the region of the chalazion was observed.ConclusionThe Keratograph 4 was able to image the MG structures clearly, allowing the clinician to monitor the progression of chalazia and the MG loss in the affected areas.     

Safety and efficacy of lotilaner ophthalmic solution, 0.25% for the treatment of blepharitis due to demodex infestation: A randomized,controlled, double-masked clinical trial

PurposeTo evaluate the safety and efficacy of lotilaner ophthalmic solution, 0.25% for the treatment of blepharitis due to Demodex infestation compared to vehicle control.MethodsIn this phase II, randomized, controlled, double-masked clinical trial, 60 eligible participants with Demodex blepharitis were randomly assigned in a 1:1 ratio to receive either topical lotilaner ophthalmic solution, 0.25% (Tarsus Pharmaceuticals, Inc., Irvine, CA) (study group) or the vehicle without lotilaner (control group) bilaterally twice a day for 28 days. Participants were followed at Days 7, 14, 28, 60 and 90. The efficacy parameters were change in collarette grade and Demodex density at Day 28. Safety parameters were adverse events, changes in corrected distance visual acuity (CDVA), intraocular pressure (IOP) and slit-lamp biomicroscopy.ResultsThe study group showed a statistically significant decrease in collarette grade compared to the control group beginning at Day 14 (p = 0.003) in the upper eyelid and at Day 28 (p = 0.003) in the lower eyelid. Decreases in both lids were maintained through Day 90 (p < 0.001). At Day 28, mite eradication was achieved in 66.7% and 25.9% of eyes in the study and control group (p = 0.005); at Day 90, these proportions were 68.2% and 18.5% (p = 0.001), respectively. No serious adverse events or clinically significant changes in CDVA and IOP were observed.ConclusionFor Demodex blepharitis, treatment with lotilaner ophthalmic solution, 0.25% for 4 weeks is safe and effective. The improvement in collarette grade and mite density observed during the treatment period persisted for at least two months following treatment cessation.     

Comparing the in vitro effects of MGO™ Manuka honey and tea tree oil on ocular Demodex viability

Purpose

To compare the in vitro antiparasitic effects of MGO^? Manuka honey and tea tree oil against ocular Demodex.

In vitro anti-demodectic effects and terpinen-4-ol content of commercial eyelid cleansers

Purpose

To compare the in vitro anti-demodectic activity of four commercially available dedicated eyelid cleansers (Cliradex^® towelette cleanser, Oust? Demodex^® cleanser, Blephadex? eyelid foam, TheraTears^® SteriLid^® eyelid cleanser), tea tree oil, undiluted terpinen-4-ol and linalool; and to assess the terpinen-4-ol content of the commercial cleansers and tea tree oil.

The efficacy of tea tree face wash, 1, 2-Octanediol and microblepharoexfoliation in treating Demodex folliculorum blepharitis

Purpose

To compare the efficacy of Dr Organic Tea Tree Face Wash, OcuSoft Lids Scrub Plus and the BlephEx? device at treating of Demodex folliculorum blepharitis.

Interventions for Demodex blepharitis and their effectiveness: A systematic review and meta-analysis

PurposeA systematic review and meta-analysis was performed to evaluate the effectiveness of interventions in the treatment ofDemodex blepharitis in adult patients.MethodsA systematic review and meta-analysis of studies reporting the efficacy of treatments forDemodex blepharitis in the main databases (PubMed / Scopus / Cochrane / EMBASE / Science Direct / WOS / Scielo / Google Scholar / metaRegister of Controlled Trials / ClinicalTrials.gov/ WHO ICTRP) until November 24, 2020 was performed according to the PRISMA statement for meta-analysis.ResultsOverall, 18 studies were included for 29 different interventions in 1195 participants with 1574 eyes that were positive for Demodex Spp. Demodex counts, total eradication, clinical improvement, Ocular Surface Disease Index, Tear Break-Up Time, cylindrical dandruff, Schirmer test, osmolarity and adverse reactions were analysed, and stratified sub-analyses conducted. The overall effects for Demodex count (mean difference), total eradication (risk ratio) and adverse reactions (risk difference) were -2.07 (95 % CI -3.99 to -0.15) p = 0.03, 1.84 (95 % CI 1.27–2.66) p = 0.001 and 0.24 (95 % CI 0.08 to 0.41) p = 0.005, respectively. The most frequent interventions evaluated in the included studies were tea tree oil (TTO) and its derivatives, such as terpinen 4-ol.ConclusionMultiple therapeutic choices were evaluated in this meta-analysis. Pharmacological interventions were superior to non-pharmacological (mechanical, thermal and pulsed light) interventions. It was not possible to establish significant differences between TTO and non-TTO-derived treatments. Adverse reactions were more frequent in TTO-derived treatments, however all were mild. It is necessary to execute studies with longer follow-up times to determine whether re-infestation occurs after the administration of different treatments.     

Trace elements and blephar?t?s

Introduct?on

Investigating the relationship between the serum levels of zinc and copper with blepharitis.

Methods

Twenty seven patients with blepharitis and 24 control group patients were evaluated for Schirmer, fluorescein break up time (FBUT) scores and serum levels of zinc and copper. Symptoms and clinical examination scores of blepharitis patients were also assessed.

Results

The serum level of zinc (65.78 ± 15.51 in patients with blepharitis and 65.71 ± 10.43 in patients without blepharitis, normal values in the laboratory: 70-127 μg/dl) and copper (67.17 ± 22.24 in patients with blepharitis and 69.35 ± 14.44 in patients without blepharitis, normal values in the laboratory: 70-150 μg/dl) were not different between the two groups. The symptom and clinical examination scores of blephraritis patients were not correlated with the serum levels of either zinc or copper.

D?scuss?on

The zinc and copper levels in serum do not seem to be related to blepharitis. Their tear levels and sensory status of cornea should also be evaluted to better evaluate a possible relation.