Clinical efficacy of eyelid hygiene in blepharitis and meibomian gland dysfunction after cataract surgery: a randomized controlled pilot trial

Abstract

The purpose of this randomized clinical trial is to evaluate the effect of eyelid hygiene on subjective symptoms, anterior blepharitis, and meibomian gland dysfunction (MGD) after cataract surgery. Subjects with obstructive MGD who underwent cataract surgery were randomly divided into two groups. In the eyelid hygiene group, eyelid hygiene was performed twice a day for 10 days from 3 days before to 1 week after cataract surgery. The control group did not perform eyelid hygiene. A subjective symptom questionnaire of SPEED, anterior blepharitis grade, and meibum quality and quantity was evaluated at baseline and at postoperative 1 and 4 weeks. The eyelid hygiene group (n = 36) showed decreased SPEED score after cataract surgery and the control group (n = 33) did not. Anterior blepharitis grade was worse 1 week after surgery in the control group but not in the eyelid hygiene group. The control group had significantly decreased meibum quality and quantity in both the upper and lower eyelids after cataract surgery, but the eyelid hygiene group did not. Eyelid hygiene before/ after cataract surgery improved postoperative subjective symptoms and prevented postoperative exacerbation of anterior blepharitis and MGD. Thus, perioperative eyelid hygiene is recommended for patients with obstructive MGD who undergo cataract surgery. Blepharitis is divided into anterior and posterior blepharitis according to anatomic location. Meibomian gland dysfunction (MGD) is the main cause of posterior blepharitis. MGD is characterized by abnormal meibomian gland secretion, qualitative/quantitative changes in meibum, dry eye symptoms, and ocular surface inflammation 1-3. Anterior blepharitis and MGD are important factors that may cause evaporative dry eye syndrome 4,5. They cause deficiency or imbalance of the tear film lipid layer secreted from meibomian glands to increase tear evaporation even if aqueous tear secretion is normal 6,7. On the other hand, another study reported that the tear film lipid layer itself may not inhibit the rate of tear evaporation 8. Nevertheless, an important function of the tear film lipid layer is to spread tears to the ocular surface between blinks, helping to maintain tear film homeostasis on the ocular surface. Previous studies have reported that the signs of blepharitis can worsen after cataract surgery, and the degree of dry eye syndrome and MGD is worse than before surgery 9-12. More significant worsening of MGD was observed

Composition and Diversity of the Ocular Surface Microbiota in Patients With Blepharitis in Northwestern China

“…The results revealed that the microbiota of the eyelid margin and conjunctiva were influenced by each other, which could explain why blepharitis tends to cause ocular surface inflammation such as conjunctivitis, keratitis, and even postoperative infection after inner eye surgery such as cataract surgery. It also reminds clinicians to pay attention to the health of eyelid margins when diagnosing and treating ocular surface inflammation or before intraocular surgery ( 44 – 47 ).…”

Clinical features of anterior blepharitis after cataract surgery

“…It had been reported that cataract surgery can worsen blepharitis and meibomian gland function during the postoperative period to result in increased ocular discomfort and decreased vision and patient satisfaction 6 – 11 . However, most of these reports describe posterior blepharitis/MGD and little is known about anterior blepharitis after cataract surgery.…”

“…Due to the improved surgical outcomes and extremely elevated patient expectations in recent cataract surgery, postoperative discomfort is often a major disappointment to the patients 6 . As stated earlier, MGD (posterior blepharitis) involvement in postoperative discomfort after cataract surgery is well documented.…”

Association of Meibomian Gland Dysfunction with Oral Statin Use

“…MGD can be considered a cause of posterior blepharitis and evaporative dry eye, resulting in excess free cholesterol and cholesterol esters in tears [ 43 , 44 , 45 , 46 ]. Changes in tear composition disrupt the meibum layer, resulting in inflammatory cell infiltration of the ocular surface epithelium, along with an increase in the expression of proinflammatory cytokines including IL-1β, IL-6, IL-17, IFN-γ, tumor necrosis factor (TNF)-α, and matrix metalloproteinase (MMP)-9 [ 47 , 48 , 49 ].…”