tetracycline and Eyelid-Diseases

Meibomian gland dysfunction (MGD) is a chronic disease, usually caused by obstruction of the secretory Meibomian glands. The subsequent reduction of gland secretion results in a decreased amount of lipids in the tear film. This results in a faster evaporation of the tear film and thus an evaporative dry eye. MGD alone is responsible for about 60% of all cases in combination with aqueous deficiency for a further 20% of dry eyes. While in Europe up to 20% of the population are suffering from MDD, this is true in Asia for over 60% of the population. MGD is more common in women and it incidence increases with age. It is influenced by the hormonal status as well as chemical and mechanical noxious stimuli. Additional risk factors include various skin diseases such as rosacea, acne or atopy. To diagnose MGD, particular attention should be paid to changes in the lid margin such as plugging or pouting of the ducts, thickening and telangiectasia. However, most important is the diagnostic expression of the glands. At first it should be assessed whether secretion can be caused by pressure to the eyelid against the globe and secondly the quality of the expressed secretions should be evaluated. MGD should be treated according to the severity of the disease. While in mild stages instructions for lid margin hygiene, warming and massage in combination with artificial tears might be sufficient, in more severe stages oral tetracyclin derivatives and anti-inflammatory eye drops such as steroids or CSA are necessary for successful treatment.

Topics: Anti-Bacterial Agents; Anti-Inflammatory Agents; Eyelid Diseases; Female; Humans; Hyperthermia, Induced; Male; Massage; Meibomian Glands; Ophthalmic Solutions; Tetracycline

Several studies of trichiasis recurrence suggest an association between surgical factors and long-term recurrence, yet data on short-term risk factors are limited. This study was conducted to evaluate risk factors for early trichiasis recurrence and other unfavorable short-term outcomes.. Trichiasis patients presenting for surgery were evaluated for presence of active trachoma and signs of cicatricial outcomes of trachoma, including number of trichiatic lashes, epilation, and entropion. Surgical factors recorded included incision length, surgery duration, and the surgeon performing the operation. Participants were followed up for 6 weeks after surgery and evaluated for eyelid closure defect and trichiasis recurrence; in addition, in two thirds of the patients, eyelid contour abnormality and granuloma formation were evaluated.. First-time trichiasis surgery was performed on 2615 eyelids. Of these, 2601 eyelids without surgical failure were followed up 6 weeks after surgery. Of the eyelids treated, 2.3% had recurrent trichiasis and 1.3% had an eyelid closure defect. Data on eyelid contour abnormalities and granuloma formation were recorded for 1881 eyes, with rates of 1.2% and 10.5%, respectively. Associated risk factors differed by outcome. Surgeon was predictive of eyelid closure defect and granuloma formation. Eyelids with short incisions were nearly four times more likely to have recurrent trichiasis (95% confidence interval, 1.7-9.3). Baseline trichiasis severity was predictive of eyelid contour abnormalities and recurrent trichiasis. Epilation was associated with granuloma formation, but was protective against eyelid closure defect.. Surgical factors are important predictors of unfavorable outcomes in the weeks immediately after surgery. Although the overall rate of serious uncorrectable unfavorable outcomes was very low, the high rate of granuloma formation, which can be treated by removal, highlights the need for follow-up of patients after trichiasis surgery. (ClinicalTrials.gov number, NCT00347776.).

Topics: Adult; Aged; Anti-Bacterial Agents; Azithromycin; Cicatrix; Ethiopia; Eyelid Diseases; Female; Granuloma, Pyogenic; Humans; Male; Middle Aged; Recurrence; Risk Factors; Tetracycline; Time Factors; Trachoma; Treatment Outcome; Trichiasis

To determine the effect of trichiasis surgery on visual acuity.. A total of 439 participants in the Surgery for Trichiasis, Antibiotics to Prevent Recurrence (STAR) trial had visual and subjective concerns measured before and 6 months after surgery. Trichiasis surgery was performed in at least 1 eye by integrated eye care workers. Visual acuity was measured using illiterate E versions of Early Treatment Diabetic Retinopathy Study charts with standardized, forced-choice procedures. Improvement was defined as improvement in visual acuity greater than 1 line (5 letters).. The mean improvement in visual acuity for the eyes that had surgery was 0.129 logMAR units (P < .001). Surgery was associated with improvement in visual acuity compared with no surgery (odds ratio, 1.68; 95% confidence interval, 1.04-2.70). Independent predictors of visual acuity improvement in the eyes that had surgery included the number of lashes touching the globe prior to surgery and baseline visual acuity. Among patients, 93.8% described significant pain and 90.4% significant photophobia at baseline compared with only 1.4% and 0.9%, respectively, following surgery.. Surgery to correct trichiasis appears to provide significant visual acuity improvement as well as a decrease in subjective concerns in patients with trachomatous trichiasis.. clinicaltrials.gov Identifier: NCT00347776.

Topics: Administration, Oral; Adult; Age Distribution; Anti-Bacterial Agents; Azithromycin; Ethiopia; Eyelashes; Eyelid Diseases; Female; Hair Diseases; Humans; Male; Middle Aged; Ophthalmologic Surgical Procedures; Sex Distribution; Single-Blind Method; Tetracycline; Trachoma; Visual Acuity

Trichiasis recurrence following surgery is a serious problem for trachoma programs.. To determine if postoperative treatment with azithromycin compared with topical tetracycline reduces recurrence up to 1 year, and if azithromycin treatment of household members provides additional benefit compared with treating only the surgical patient.. A randomized, single-masked, clinical trial was conducted in Ethiopia. A total of 1452 patients with trichiasis were randomized 1:1:1 to the following 3 arms: single-dose (1 g) oral azithromycin alone, single-dose azithromycin for household members (20 mg/kg up to 1 g) plus the patient, or topical tetracycline (twice per day for 6 weeks).. Trichiasis recurrence within 1 year following surgery.. The combined azithromycin groups had significantly fewer recurrences, 6.9 of 100 person-years overall, compared with topical tetracycline, 10.3 of 100 person-years (P = .047). There was no additional reduction in the arm that also treated household members, 8.1 of 100 person-years, compared with treating the surgical patients alone, 5.8 of 100 person-years (P = .19).. In trachoma-endemic areas, a single dose of azithromycin reduced postoperative trichiasis recurrence rates by one third compared with topical tetracycline. Application to Clinical Practice In countries where azithromycin is part of the Trachoma Control Program, patients with trachomatous trichiasis should be treated postoperatively to prevent recurrence.

Topics: Administration, Oral; Anti-Bacterial Agents; Azithromycin; Ethiopia; Eyelashes; Eyelid Diseases; Female; Hair Diseases; Humans; Male; Middle Aged; Postoperative Complications; Secondary Prevention; Single-Blind Method; Tetracycline

In order to determine the relationship between meibomian gland dysfunction and tear film abnormalities in rosacea, tear film flow and stability and meibomian gland function were assessed in 43 consecutive patients. Schirmer, tear film break-up time, and meibomian gland function values in patients with ocular rosacea (n = 28) were found to be significantly decreased as compared with those of the patients with only cutaneous involvement and control patients (p > 0.05). In patients with dermatologic rosacea (n = 15) these values were not different from those of the age- and sex-matched controls (p > 0.05). The effects of tetracycline and meibomian gland expression therapy also were investigated in patients with ocular rosacea. Neither meibomian gland expression therapy nor tetracycline administration had beneficial effects on decreased tear secretion, but tetracycline improved the break-up time values. Our findings showed a positive relationship between tear film abnormalities and meibomian gland dysfunction in patients with rosacea. Decreased tear secretion in patients with ocular rosacea would seem to be a result of structural changes secondary to meibomian gland dysfunction, and short break-up time might be due to an abnormal meibum composition.

Topics: Adult; Eyelid Diseases; Female; Humans; Lacrimal Apparatus Diseases; Male; Meibomian Glands; Rosacea; Tears; Tetracycline

Paraffin has been used as a liquid prosthesis for medical purposes, and is still the base material in some ointments. However, it sometimes causes foreign-body reaction resulting in paraffinoma. We present a case of paraffinoma in a 64-year-old woman, which occurred in the eyelid after endoscopic sinus surgery for chronic sinusitis. During surgery, a small perforation developed in the left lamina papyracea, and therefore tetracycline ointment gauze was inserted. Two days after discharge, her left eyelid became swollen. The result of an open biopsy was paraffinoma. Total resection of the tumor was performed, and at the time of writing there has been no recurrence for 1 year after surgery.

Topics: Anti-Bacterial Agents; Chronic Disease; Endoscopy; Eyelid Diseases; Female; Foreign-Body Reaction; Humans; Middle Aged; Ointment Bases; Paranasal Sinuses; Petrolatum; Sinusitis; Tetracycline

This report describes two cases of palpebral localisation of Tunga penetrans.. Two Congolese patients (a 17-year-old black man and a 12-year-old black girl) presented with a history of itching and oedema of the left upper eyelid.. On inspection and slit lamp examination, the patients manifested the characteristic lesion of a white translucent papule with a central black pit. Scraping of the lesion revealed a gravid adult female flea, allowing the diagnosis of infection with the flea T. penetrans. After removal of the parasite, a complete local recovery occurred over a 1-week period with local application of tetracycline.. With the increase in international travelling, it is useful to know that eyelid localisation of T. penetrans is possible.

Topics: Adolescent; Animals; Child; Ectoparasitic Infestations; Edema; Eyelid Diseases; Eyelids; Female; Humans; Male; Ophthalmologic Surgical Procedures; Pruritus; Siphonaptera; Tetracycline

The fight against blinding trachoma is being addressed with an integrated strategy of surgery, antibiotics, hygiene promotion, and environmental improvement-the SAFE strategy, but its cost-effectiveness is largely unknown. This paper estimates the cost effectiveness of surgery and antibiotics in trachoma-endemic areas in seven world regions.. A population model was applied to follow the lifelong impact on individuals receiving trachoma control. Intervention costs and effectiveness estimates were based on a combination of primary data collection and literature review.. Providing trichiasis surgery to 80% of those who need it would avert over 11 million DALYs per year globally, with cost effectiveness ranging from I$13 to I$78 per DALY averted across regions. Mass antibiotic treatment of all children using azythromycin at prevailing market prices would avert more than 4 million DALYs per year globally with cost-effectiveness ranging between I$9,000 and I$65,000 per DALY averted. The intervention is only cost-effective if azythromycin is donated or becomes available at reduced prices. Mass treatment of all children with tetracycline and targeted treatment with azythromycin are not cost-effective.. As individual components of the SAFE strategy, trichiasis surgery for trachoma is a cost-effective way of restoring sight in all epidemiological sub-regions considered, as is the use of azythromycin, if donated or at reduced prices. Large study uncertainties do not change study conclusions. The results should be interpreted in the context of the overall SAFE strategy to address issues of sustainability.

Topics: Adolescent; Adult; Aged; Aged, 80 and over; Anti-Bacterial Agents; Azithromycin; Blindness; Combined Modality Therapy; Cost-Benefit Analysis; Eyelid Diseases; Female; Geography; Global Health; Hair Diseases; Humans; Male; Middle Aged; Ophthalmologic Surgical Procedures; Tetracycline; Trachoma

Trachoma is the leading infectious cause of blindness worldwide. Surgery is available to correct trichiasis, which results from repeated episodes of infection with C. trachomatis. However, trichiasis recurrence rates post-surgery are very high. Methods for reducing post-surgical trichiasis recurrence need to be explored. This paper outlines the design of the Surgery for Trichiasis, Antibiotics to prevent Recurrence (STAR) Clinical Trial currently underway in Ethiopia. The STAR trial, funded by The National Eye Institute, is a randomized, controlled clinical trial of antibiotic use at time of trichiasis surgery, comparing topical tetracycline to single-dose azithromycin for the surgical patient and single-dose azithromycin for the surgical patient and all household members. The primary outcome is trichiasis recurrence at one-year. Data from this trial will be critical in helping to determine future policy on antibiotic treatment for C. trachomatis following surgery.

Topics: Adolescent; Adult; Anti-Bacterial Agents; Azithromycin; Chlamydia trachomatis; Combined Modality Therapy; Ethiopia; Eyelashes; Eyelid Diseases; Hair Diseases; Humans; Ophthalmologic Surgical Procedures; Randomized Controlled Trials as Topic; Secondary Prevention; Single-Blind Method; Tetracycline; Trachoma

The common preventive therapy in our department for newborns' eyes is tetracycline ophthalmic ointment. Due to temporary shortage of tetracycline ophthalmic ointment for one week in December 1991, the preventive therapy given to seventy-one newborns was gentamicin sulfate ophthalmic ointment. Five babies (7 percent of all newborns) experienced marked edema of the eyelids, foci of erythema, and serous exudate within the first days of life. The lesions regressed gradually and disappeared entirely within two to three weeks without any complications. These lesions represent the first description of orbital irritant contact dermatitis in newborns, most probably caused by topical gentamicin preparation. However, one cannot exclude sensitivity to paraben, which is the preservative used in gentamicin ointment, or a synergistic action of both agent and preservative.

Topics: Anti-Bacterial Agents; Dermatitis, Irritant; Drug Eruptions; Edema; Erythema; Exudates and Transudates; Eyelid Diseases; Follow-Up Studies; Gentamicins; Humans; Infant, Newborn; Ointments; Ophthalmic Solutions; Orbital Diseases; Parabens; Preservatives, Pharmaceutical; Tetracycline

The objective was to describe the complications and outcomes of herpes zoster ophthalmicus in a population of young Africans with a high seroprevalence of human immunodeficiency virus type 1 in which treatment often is delayed and in which antiviral drugs are not available.. Twenty-seven patients with herpes zoster ophthalmicus presenting consecutively to a large urban hospital were examined and followed. Treatment was limited to that which was locally available.. Visual outcomes were poor. Sixty-six percent of eyes had final visual acuity less than 20/60. Forty percent had light perception or no light perception visual acuity. Severe keratouveitis and corneal perforation were common and responsible for most poor visual outcomes.. Young Africans with herpes zoster ophthalmicus are at a high risk for significant visual loss.

Topics: Adolescent; Adrenal Cortex Hormones; Adult; Chloramphenicol; Corneal Diseases; Eyelid Diseases; Female; Follow-Up Studies; Herpes Zoster Ophthalmicus; Hospitals, Urban; Humans; Malawi; Male; Middle Aged; Ointments; Ophthalmic Solutions; Tetracycline; Time Factors; Uveitis; Vision Disorders; Visual Acuity

We describe the clinicopathologic features of the papular form of granulomatous acne rosacea of the eyelids. This unusual cutaneous disorder is typified by painless eruptions of reddish to yellowish brown, occasionally ulcerative papules symmetrically distributed around the eyelids, lower part of the forehead, nasolabial folds, and upper lip. Histopathologically, the lesions display caseating and noncaseating dermal granulomas that mimic those seen in tuberculosis, tuberculoid leprosy, sarcoidosis, and other diseases. The disorder responds well to systemic tetracycline therapy but may involute spontaneously during a period of months to years. The distinction of this disorder from other dermal granulomatous diseases, such as tuberculosis, leprosy, syphilis, and foreign bodies, is important because of the different therapeutic implications.

Topics: Aged; Eyelid Diseases; Female; Granuloma; Humans; Rosacea; Tetracycline

Topics: Blepharitis; Dexamethasone; Drug Eruptions; Eyelid Diseases; Humans; Male; Middle Aged; Sarcoidosis; Tetracycline

A persistent periocular dermatitis resulting from the prolonged use of topical fluorinated corticosteroids that resembled the perioral variety was observed in three patients. All topical therapy was ineffective until systemic tetracycline was administered.

Topics: Drug Eruptions; Eyelid Diseases; Facial Dermatoses; Female; Granuloma; Humans; Male; Skin; Steroids, Fluorinated; Tetracycline

Ocular rosacea was diagnosed in 6.3% of a cornea/external disease referral practice where more than half of the patients referred are for corneal surgery. The most common signs and symptoms are also common to many patients in the general practice of ophthalmology, i.e., foreign body sensation, burning, superficial punctate erosions, chalazia and blepharitis. Less common but dangerous to the vision was corneal thinning, vascularization and infiltrates. Three new associated symptoms were described. These were map dot subepithelial opacities, recurrent erosions and moderately severe foreign body sensation, pain or burning with minimal associated signs. Oral tetracycline 250 mg q.i.d. resulted in improvement in almost all patients from 4 to 17 days after initiation of therapy. Although most of the patients have been able to taper and stop therapy, those with foreign body sensation, burning and pain have had recurrences of their symptoms with all attempts at stopping therapy.

Topics: Adult; Aged; Conjunctival Diseases; Corneal Diseases; Eyelid Diseases; Female; Humans; Male; Middle Aged; Rosacea; Tetracycline; Time Factors

Topics: Acute Disease; Asia, Western; Blindness; Conjunctivitis; Diptera; Disease Models, Animal; Doxycycline; Endophthalmitis; Eyelid Diseases; Humans; Insect Control; Tetracycline; Trachoma

Topics: Adolescent; Adult; Animals; Aqueous Humor; Cellulitis; Child; Cornea; Corneal Ulcer; Eye; Eye Diseases; Eyelid Diseases; Female; Hordeolum; Humans; Infections; Male; Microbial Sensitivity Tests; Middle Aged; Rabbits; Staphylococcus; Tetracycline