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Meta-Analysis
. 2012 May 16;2012(5):CD005556.
doi: 10.1002/14651858.CD005556.pub2.

Interventions for chronic blepharitis

Kristina Lindsley  1 , Sueko Matsumura, Elham Hatef, Esen K Akpek
Affiliations
Meta-Analysis

Interventions for chronic blepharitis

Kristina Lindsley et al. Cochrane Database Syst Rev. .

Abstract

Background: Blepharitis, an inflammatory condition associated with itchiness, redness, flaking, and crusting of the eyelids, is a common eye condition 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 sensation, 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 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.

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 metaRegister 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 not identified 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.

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 results: There were 34 studies (2169 participants with blepharitis) included in this review: 20 studies (14 RCTs and 6 CCTs) included 1661 participants with anterior 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.

PubMed Disclaimer

Conflict of interest statement

None known.

Figures

1
1
Flow diagram: Results from searching for studies for inclusion in the review.
2
2
Risk of bias summary: review authors' judgments about each 'Risk of bias' item for each included study.
1.1
1.1. Analysis
Comparison 1 Topical antibiotics versus placebo (anterior/mixed), Outcome 1 Mean change in total sign and/or symptom scores.
1.2
1.2. Analysis
Comparison 1 Topical antibiotics versus placebo (anterior/mixed), Outcome 2 Proportion of cultures eradicated.
1.3
1.3. Analysis
Comparison 1 Topical antibiotics versus placebo (anterior/mixed), Outcome 3 Proportion of total adverse events.
2.1
2.1. Analysis
Comparison 2 Topical ciprofloxacin versus another topical antibiotic (anterior/mixed), Outcome 1 Proportion cured or improved.
2.2
2.2. Analysis
Comparison 2 Topical ciprofloxacin versus another topical antibiotic (anterior/mixed), Outcome 2 Proportion of cultures eradicated.
3.1
3.1. Analysis
Comparison 3 Topical antibiotics versus topical steroids (anterior/mixed), Outcome 1 Proportion of cultures eradicated.
4.1
4.1. Analysis
Comparison 4 Topical steroids versus placebo (anterior/mixed), Outcome 1 Proportion of cultures eradicated.
5.1
5.1. Analysis
Comparison 5 Combined topical antibiotics and steroids versus placebo (anterior/mixed), Outcome 1 Proportion of cultures eradicated.
6.1
6.1. Analysis
Comparison 6 Combined topical antibiotics and steroids versus topical antibiotics alone (anterior/mixed), Outcome 1 Proportion of cultures eradicated.
7.1
7.1. Analysis
Comparison 7 Combined topical antibiotics and steroids versus topical steroids alone (anterior/mixed), Outcome 1 Proportion of cultures eradicated.
See this image and copyright information in PMC

Update of

  • doi: 10.1002/14651858.CD005556

References

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    1. Yactayo‐Miranda Y, Ta CN, He L, Kreutzer TC, Nentwich MM, Kampik A, et al. A prospective study determining the efficacy of topical 0.5% levofloxacin on bacterial flora of patients with chronic blepharoconjunctivitis. Graefe's Archive for Clinical and Experimental Ophthalmology 2009;247(7):993‐8. - PubMed
Zhao 2010 {published data only}
    1. Zhao JY, Lu B, Sun Q, Wang YD, Zhang TS. Clinical evaluation of pranoprofen eye drops for controlling ocular inflammation in dry eye syndrome. International Journal of Ophthalmology 2010;10(3):492‐4.

References to studies awaiting assessment

John 2008 {published data only}
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