Blepharitis

Blepharitis is a common ophthalmic condition characterised by chronic eyelid inflammation and associated symptoms of ocular irritation and dry eye. It can have a profound impact on quality of life. The management of blepharitis involves both the prevention and treatment of intermittent episodes of inflammatory exacerbation and regular eyelid hygiene regimens. Warm compress therapies are commonly advised for long-term symptomatic relief.

The efficacy of a dedicated eyelid cleansing formulation (TheraTears SteriLid) and diluted baby shampoo in blepharitis patients was compared in a recently published, double-masked, randomised trial conducted by the University of Auckland Ocular Surface Laboratory (OSL). A total of 43 participants with clinical signs of blepharitis were recruited and were randomised to apply the dedicated eyelid cleanser to one eye and diluted baby shampoo to the fellow eye (from bottles that were identical other than the marking of right and left eye), twice daily for four weeks. Ocular symptoms, tear film quality, ocular surface characteristics and inflammatory markers were assessed at baseline and following the treatment period.

The results of the trial showed that blepharitis was improved, clinically, by both treatments, including SPEED symptomology scores, superior lid wiper epitheliopathy, seborrhoeic lash crusting and lash misdirection grading. However, improvements in tear film lipid layer thickness, inferior lid wiper epitheliopathy, cylindrical collarette grading and MMP-9 expression (a marker of ocular surface inflammation), as well in SANDE symptom scores, occurred only with the dedicated eyelid cleanser. Furthermore, meibomian gland orifice capping and MUC5AC expression (a marker of goblet cell function) were found to actually worsen with baby shampoo treatment.

Overall, the dedicated eyelid cleansing formulation demonstrated superior efficacy and was the preferred treatment among blepharitis patients. The findings also highlighted potential long-term adverse effects of baby shampoo treatment on goblet cell function that warrant further exploration in future studies.

References

1. Sung J, Wang MT, Lee SH, Cheung IM, Ismail S, Sherwin T, Craig JP. Randomized double-masked trial of eyelid cleansing treatments for blepharitis. Ocular Surface. 2018;16(1):77-83.

By Dr Justin Sung, Dr Michael Wang, Sang Lee, Dr Isabella Cheung, Salim Ismail, Prof Trevor Sherwin and A/Prof Jennifer Craig