Transcript Asymptomatic or Minimally Symptomatic Blepharitis in Patients

Asymptomatic or
Minimally Symptomatic
Blepharitis in Patients
Having Cataract Surgery
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 , Carlos
Buznego, MD and William Trattler, MD are consultants for Inspire
Pharmaceuticals.
Abstract
• Title: Asymptomatic or Minimally Symptomatic Blepharitis in Patients Having Cataract
Surgery
• Authors: Jodi I. Luchs, Carlos Buznego, William B. Trattler
• Purpose: This sub-analysis of previously reported data analyzed the prevalence of asymptomatic
or minimally symptomatic blepharitis and the tear film status in patients preparing to undergo
cataract surgery.
•
Methods: A sub-analysis of our previously reported cohort of 100 Patients was performed to
assess the prevalence of minimally or asymptomatic blepharitis (mean symptom score or 1 or 0),
and the tear film break-up time (TFBUT) in those patients.
•
Results: 59/100 (59%) of patients had blepharitis. 45 of the 100 patients (45%) were
asymptomatic or minimally symptomatic for ocular surface disease (mean symptom scores or 0 or
1), 26 of which had blepharitis (44.1%). 15/45(33.3%) of these patients had TFBUT scores of ≤5
seconds in at least one eye. Of these, 12 of the 15(80%) had blepharitis. Similarly, 31/45(68.9%)
had TFBUT scores of ≤7 seconds in at least one eye. Of these, 19 of the 31 (61.3%) had blepharitis.
19/ 26 patients (73.0%) with minimally or asymptomatic blepharitis had TFBUT of 7 seconds or
less.
•
Conclusion: This sub-analysis reveals that minimally symptomatic/asymptomatic blepharitis is
common in patients undergoing cataract surgery. The mild or absent symptoms may contribute to
the condition being overlooked. However, this condition may have important effects on the
TFBUT/ocular surface, which may have important pre/post-operative implications for patients
undergoing ocular 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. Our previously
reported data1 suggests that there is a high
prevalence of blepharitis in patients preparing to
undergo cataract surgery, yet the average clinical
sign and symptom scores were mild-moderate. This
sub-analysis evaluated the prevalence of minimally
symptomatic or asymptomatic blepharitis and the
status of the tear film in patients undergoing routine
cataract surgery.
Methods
• A sub-analysis of data from a previously performed prospective,
multicenter observational study which assessed the incidence of blepharitis
in 100 patients scheduled to undergo cataract surgery was performed1.
• Minimally symptomatic patients were defined as those with a mean clinical
symptom score of 1 (scale 0-4)
• Asymptomatic patients were defined as those with a symptom score of 0
• Primary outcome measures in the original study:
– 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 on
a scale of 0-4)
– Total blepharitis symptom severity score (summed symptom scores for
itch, foreign body sensation, dryness, burning or pain, and
swollen/heavy eyelids (scale 0-4 for each symptom))
– Blepharitis clinical sign severity scores for lid debris, lid swelling,
meibomian gland plugging, and quality of meibomian gland secretions
(scale 0-4)
– Degree of ocular surface fluorescein staining (NEI grading system1)
– Tear film break up time (TFBUT)
Patient Demographics
• 59% of patients were diagnosed with blepharitis
• Mean age was 72.4 years (range: 52-88)
Percent of Patients (%)
Prevalence of Blepharitis in the
Study Population
100
Min/No Symptoms
Symptomatic
80
59
60
41
40
26
20
33
0
Blepharitis
No Blepharitis
Percent of Patients (%)
Prevalence of Blepharitis in
Symptomatic and
Min/Asymptomatic Subjects
100
80
Blepharitis
No Blepharitis
57.8
(n=26)
60.0
(n=33)
42.2
(n=19)
40.0
(n=22)
60
40
20
0
Min/No Symptoms
Symptomatic
TFBUT Distribution of
Asymptomatic/Minimally
Symptomatic Subjects
Percent of Subjects (%)
100
80
80
61
60
39
40
20
20
0
 5 Seconds
 7 Seconds
Blepharitis
No Blepharitis
Percent of Patients (%)
Rapid TFBUT (≤ 7 Seconds) in Symptomatic
and Min/Asymptomatic Blepharitis Subjects
100
80
73
78
60
40
20
0
Min/No Symptoms
Symptomatic
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 preoperatively in patients about to undergo ocular surgery in order to potentially reduce the risk of
post-operative infection,3-5 as well as to stabilize the tear film in order to ensure accurate preoperative 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.
– Our original study found that 59% of patients undergoing routine evaluation for cataract surgery
had clinical signs of blepharitis, making it a commonly occurring condition. However, the overall
clinical sign and symptom scores were low for this cohort of patients, suggesting that this
condition may be frequently overlooked.
– In this sub-analysis, we determined that almost half (45%) of the patients in the original study
were asymptomatic or minimally symptomatic for ocular surface disease, yet more than half of
those patients (26 of 45, 57.8%) had blepharitis. Conversely, of the 59% of patients who had
blepharitis in this study, almost half (26 of 59, 44.1%) had minimal or no symptoms.
– However, there is a real disturbance to the tear film, even in these patients with minimal or no
symptoms. One third of patients with minimal or no symptoms (15 of 45, 33.3%) had a TFBUT of 5
seconds or less in at least one eye. Of these, 12 of the 15 (80%) had blepharitis. Similarly, 68.9% of
patients with little or no symptoms had a TFBUT of ≤ 7 seconds in at least one eye, and most of
these patients (61.3%) also had blepharitis. Of the 26 patients with minimally or asymptomatic
blepharitis, 73% had a TFBUT of ≤ 7 seconds. This suggests an association between the presence of
blepharitis and a disturbance of the tear film, even in the presence of little or no symptoms. This
may have important implications for patients undergoing ocular surgery.
– It should be noted that 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
• Blepharitis is common in patients preparing to undergo
cataract surgery.
• Mild or absent symptoms may contribute to the
condition being frequently overlooked.
• However, there is a real disturbance of the ocular
surface as evidenced by the more rapid TFBUT in these
minimally symptomatic or asymptomatic patients.
– This can have potentially important implications for
pre-operative measurements and post-operative
outcomes of cataract and refractive surgery.
REFERENCES:
JI, Buznego C, Trattler W: Prevalence of Blepharitis in Patients Scheduled for Routine Cataract Surgery. Poster
presented at the American Society of Cataract and Refractive Surgery annual meeting, Boston, MA 2010
2Lemp MA. Report of National Eye Institute/Industry Work shop on clinical trials in dry eyes. C L A O J 1995;21:221-232
3EVS Study Group: Arch Ophthalmol 1995;113(12):1479-1496
4Solomon et. al.: J Cataract Refract Surg. 2003;29:2001-2006
5Speaker MG et al.: Ophthalmology 1991;98(5):639-649
1Luchs