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Interventions for chronic blepharitis (Review)

Lindsley K, Matsumura S, Hatef E, Akpek EK

This is a reprint of a Cochrane review, prepared and maintained by The Cochrane Collaboration and published in The Cochrane Library

2012, Issue 5

http://www.thecochranelibrary.com


Copyright © 2012 The Cochrane Collaboration. Published by John Wiley & Sons, Ltd.

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7/23/2019 CD005556 Abstract


[Intervention Review]

Interventions for chronic blepharitis

Kristina Lindsley 1, Sueko Matsumura 1 , Elham Hatef 2, Esen K Akpek 3

1Center for Clinical Trials, Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland,

USA. 2 Wilmer Eye Institute, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA. 3 Department of Ophthal-

mology, Johns Hopkins University School of Medicine, Baltimore, MD, USA

Contact address: Kristina Lindsley, Center for Clinical Trials, Department of Epidemiology, Johns Hopkins Bloomberg School of

Public Health, 615 North Wolfe Street, W5010, Baltimore, Maryland, 21205, USA. [email protected].

Editorial group: Cochrane Eyes and Vision Group.

Publication status and date: New, published in Issue 5, 2012.

Review content assessed as up-to-date: 9 February 2012.

Citation: Lindsley K, Matsumura S, Hatef E, Akpek EK. Interventions for chronic blepharitis. Cochrane Database of Systematic Reviews

2012, Issue 5. Art. No.: CD005556. DOI: 10.1002/14651858.CD005556.pub2.


A B S T R A C T

Background

Blepharitis, an inflammatory condition associated with itchiness, redness, flaking, and crusting of the eyelids, is a common eye con-

dition that affects both children and adults. It is common in all ethnic groups and across all ages. Although infrequent, blepharitis

can lead to permanent alterations to the eyelid margin or vision loss from superficial keratopathy (abnormality of the cornea), corneal

neovascularization, and ulceration. Most importantly, blepharitis frequently causes significant ocular symptoms such as burning sen-

sation, irritation, tearing, and red eyes as well as visual problems such as photophobia and blurred vision. The exact etiopathogenesis

is unknown, but suspected to be multifactorial, including chronic low-grade infections of the ocular surface with bacteria, infestations

with certain parasites such as demodex, and inflammatory skin conditions such as atopy and seborrhea. Blepharitis can be categorized inseveral different ways. First, categorization is based on the length of disease process: acute or chronic blepharitis. Second, categorization

is based on the anatomical location of disease: anterior, or front of the eye (e.g. staphylococcal and seborrheic blepharitis), and posterior,

or back of the eye (e.g. meibomian gland dysfunction (MGD)). This review focuses on chronic blepharitis and stratifies anterior and

posterior blepharitis.

Objectives

To examine the effectiveness of interventions in the treatment of chronic blepharitis.

Search methods

We searched CENTRAL (which contains the Cochrane Eyes and Vision Group Trials Register) (The Cochrane Library 2012, Issue

1), MEDLINE (January 1950 to February 2012), EMBASE (January 1980 to February 2012), the meta Register of Controlled Trials

(mRCT) ( www.controlled-trials.com), ClinicalTrials.gov ( www.clinicaltrials.gov ) and the WHO International Clinical Trials Registry

Platform (ICTRP) ( www.who.int/ictrp/search/en). We searched the reference lists of included studies for any additional studies notidentified by the electronic searches. There were no date or language restrictions in the electronic searches for trials. The electronic

databases were last searched on 9 February 2012.

Selection criteria

We included randomized controlled trials (RCTs) and quasi-randomized controlled trials (CCTs) in which participants were adults aged

16 years or older and clinically diagnosed with chronic blepharitis. We also included trials where participants with chronic blepharitis

were a subset of the participants included in the study and data were reported separately for these participants. Interventions within

the scope of this review included medical treatment and lid hygiene measures.



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Data collection and analysis

Two authors independently assessed search results, reviewed full-text copies for eligibility, examined risk of bias, and extracted data. Data

were meta-analyzed for studies comparing similar interventions and reporting comparable outcomes with the same timing. Otherwise,

results for included studies were summarized in the text.

Main resultsThere were 34 studies (2169 participants with blepharitis) included in this review: 20 studies (14 RCTs and 6 CCTs) included 1661

participants withanterior or mixed blepharitis and 14 studies (12 RCTs and 2 CCTs) included 508 participants with posterior blepharitis

(MGD). Due to the heterogeneity of study characteristics among the included studies, with respect to follow-up periods and types of

interventions, comparisons, and condition of participants, our ability to perform meta-analyses was limited. Topical antibiotics were

shown to provide some symptomatic relief and were effective in eradicating bacteria from the eyelid margin for anterior blepharitis.

Lid hygiene may provide symptomatic relief for anterior and posterior blepharitis. The effectiveness of other treatments for blepharitis,

such as topical steroids and oral antibiotics, were inconclusive.

Authors’ conclusions

Despite identifying 34 trials related to treatments for blepharitis, there is no strong evidence for any of the treatments in terms of

curing chronic blepharitis. Commercial products are marketed to consumers and prescribed to patients without substantial evidence

of effectiveness. Further research is needed to evaluate the effectiveness of such treatments. Any RCT designed for this purpose should

separate participants by type of condition (e.g. staphylococcal blepharitis or MGD) in order to minimize imbalances between groups(type I errors) and to achieve statistical power for analyses (prevent type II errors). Medical interventions and commercial products

should be compared with conventional lid hygiene measures, such as warm compresses and eyelid margin washing, to determine

effectiveness, as well as head-to-head to show comparative effectiveness between treatments. Outcomes of interest should be patient-

centered and measured using validated questionnaires or scales. It is important that participants be followed long-term, at least one

year, to assess chronic outcomes properly.

P L A I N L A N G U A G E S U M M A R Y

Interventions for blepharitis

Blepharitis, defined as inflammation of the eyelids, is a common eye condition and affects both children and adults. Blepharitis can

be categorized in several different ways. First, categorization is based on the length of disease process: acute or chronic blepharitis.Second, categorization is based on the anatomical location of disease: anterior, or front of the eye (e.g. staphylococcal and seborrheic

blepharitis), and posterior, or back of the eye (e.g. meibomian gland dysfunction (MGD)). This review focuses on chronic blepharitis

and stratifies anterior and posterior blepharitis. There were 34 studies (2169 participants with blepharitis) included in the review, 20

of which included participants with anterior blepharitis and 14 of which included participants with posterior blepharitis. For anterior

blepharitis, topical antibiotics provided some symptomatic relief and were effective in clearing bacteria from the eyelid margins. There

was no difference between the types of topical antibiotics used. Topical steroids also provided some symptomatic relief; however, they

were ineffective in eliminating bacteria. Lid hygiene, including warm compresses and lid scrubs, showed some symptomatic relief in

both anterior and posterior blepharitis. Overall, there was no strong evidence for any of the treatments in terms of curing chronic

blepharitis. Further research should be done to evaluate the effectiveness of treatments for blepharitis, with particular attention paid to

adequate diagnosis and classification of the disease.



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