Transcript Incidence of Blepharitis in Patients Undergoing Phacoemulsification

Incidence of Blepharitis
in Patients Undergoing
Phacoemulsification
Jodi Luchs, MD
Carlos Buznego, MD
William Trattler, MD
The authors of this poster have received research funding and travel expense
reimbursement from Inspire Pharmaceuticals. Jodi Luchs, MD and William
Trattler, MD are consultants for Inspire Pharmaceuticals.
Abstract
TITLE: Prevalence of Blepharitis in Patients Scheduled for Routine Cataract Surgery
Authors: Jodi I. Luchs, Carlos Buznega, William B. Trattler
Purpose: The primary objective of this observational study is to determine the
prevalence of blepharitis in patients preparing to undergo routine cataract surgery.
There are currently no studies available which document the prevalence of blepharitis in
patients who undergo cataract surgery.
Methods: Patients were assessed at one of two study sites prior to the date of their
cataract surgery. Procedures included: Patient-rated assessments of symptoms of
blepharitis, investigator-rated signs of blepharitis, biomicroscopy, fluorescein tear breakup time (TBUT), and fluorescein corneal staining. No investigational drug was utilized in
this study.
Results: A total of 100 patients were evaluated in this study. The overall prevalence rate
of blepharitis in patients preparing to undergo cataract surgery was determined to be 59
out of 100 patients (59%). On average, patient’s signs and symptoms of blepharitis were
determined to be mild to moderate. The tear film break up time was found to be below
the normal range.
Conclusion: In this prospective study, blepharitis was determined to have a high
prevalence in patients preparing to undergo cataract surgery. Blepharitis may be
frequently overlooked in these patients due to mild or moderate signs and symptoms,
although its effect on the ocular surface may have important implications for the
upcoming surgery.
Introduction
• Both Anterior and posterior blepharitis are
common ocular surface disorders, which may be
frequently overlooked, yet may have a
significant impact on the outcomes of ocular
surgery. This study evaluated the prevalence of
blepharitis in patients undergoing routine
cataract surgery.
Methods
• Prospective, multicenter observational study which assessed the
incidence of blepharitis in 100 patients scheduled to undergo
cataract surgery.
• Patients were consented and evaluated at the time that they
presented for pre-operative biometry.
• Outcome measures:
– The presence or absence of blepharitis (presence of at least 2
clinical signs of blepharitis, at least one of which had a severity
score of ≥2)
– Total blepharitis symptom severity score (total symptom scores
for itch, foreign body sensation, dryness, burning or pain, and
swollen/heavy eyelids)
– Blepharitis clinical sign severity scores for lid debris, lid
swelling, meibomian gland plugging, and quality of meibomian
gland secretions.
– Degree of ocular surface fluorescein staining (NEI grading
system1)
– Tear film break up time
Patient Demographics
• 59% of patients were diagnosed with blepharitis
• Mean age was 72.4 years (range: 52-88)
Mean Symptom Score
4
3.5
Mean Score
3
2.5
Blepharitis
No Blepharitis
2.36
2
1.65
1.5
1
0.5
0
Symptom Score
*P=.238
Clinical Signs of Blepharitis
*
*
4
Blepharitis
No Blepharitis
3.5
Mean Score
3
2.5
*
*
2.36
2.24
2
1.5
1.37
1.03
1
0.5
0.22
0.38
0.25
0.09
0.34
0.42
Plugging
Secretion
0
Debris
*P<.001
Redness
Swelling
Mean TBUT
Mean Time (Sec)
10
9
Blepharitis
8
No Blepharitis
7
6
6.73
5.95
5
4
3
2
1
0
TBUT
*P=.076
Distribution of TBUT Scores
100
Blepharitis
No Blepharitis
90
% of Patients
80
70
61
60
50
40
30
89
85
59
P=.026
36
23
20
10
0
< 5 seconds
< 7 seconds
< 9 seconds
Mean Corneal Staining
6
Blepharitis
Mean Score*
5
4
No Blepharitis
3.61
3
2.49
2
1
0
Staining
*P=.082
*Range = 0-15
Discussion
– Blepharitis is one of the most common conditions encountered by eye care professionals,
although it may be frequently overlooked. It is important to recognize and treat this
condition pre-operatively in patients about to undergo ocular surgery in order to
potentially reduce the risk of post-operative infection,2-4 as well as to stabilize the tear
film in order to ensure accurate pre-operative keratometry, topography or wavefront
analysis. Post-operatively, untreated posterior blepharitis may also contribute to
worsening of post-operative dry eye, fluctuating vision or a slower recovery of vision.
– This study found that 59% of patients undergoing routine evaluation for cataract surgery
had clinical signs of blepharitis, making it a commonly occurring condition. However it
should be pointed out that that the overall clinical sign and symptom scores were low for
this cohort of patients with blepharitis , averaging approximately 2 on a scale of 0-4.
Consequently, it is possible that this condition is frequently overlooked due to the fact
that patients with mild symptoms may not complain, and mild clinical signs my be
overlooked the clinician.
– However, there is a real disturbance to the tear film in these patients with blepharitis as
demonstrated by the statistically significant greater number of patients with blepharitis in
this study who had a tear film break-up time of 5 seconds or less. This may have
important implications for patients undergoing ocular surgery.
– While there was a trend towards greater mean corneal staining scores in patients with
blepharitis, the difference was not statistically significant. This difference might have
approached statistical significance with a larger sample size. Furthermore, this
observational study did not control for the presence of other ocular surface
diseases, such as dry eye in either group which might confound these results.
Conclusions
• The incidence of blepharitis is under-reported
– The symptom scores and clinical sign scores are
low, so the condition may be frequently
overlooked
– However, there is a real disturbance of the ocular
surface as evidenced by the more rapid TFBUT in
these patients. This can have potentially
important implications for pre-operative
measurements and post-operative outcomes of
cataract and refractive surgery.
REFERENCES:
MA. Report of National Eye Institute/Industry Work shop on clinical trials in dry eyes. C L A O J 1995;21:221-232
2EVS Study Group: Arch Ophthalmol 1995;113(12):1479-1496
3Solomon et. al.: J Cataract Refract Surg. 2003;29:2001-2006
4Speaker MG et al.: Ophthalmology 1991;98(5):639-649
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