Management and outcomes of proteasome inhibitor associated chalazia and blepharitis: a case series

Abstract

Background The purpose of this case series was to further characterize proteasome inhibitor associated chalazia and blepharitis, to investigate outcomes of different management strategies, and to propose a treatment algorithm for eyelid complications in this patient population. Methods This retrospective case series included sixteen patients found to have chalazia and/or blepharitis while receiving proteasome inhibitors for plasma cell disorders at Mount Sinai Hospital in New York, NY from January 2010 through January 2017. Main outcomes were complete resolution of eyelid complications and time to resolution. Student’s t-test was used to compare average values and Fisher’s exact test was used to compare proportions. Results Fourteen patients had chalazia and 10 had blepharitis. Chalazia averaged 5.4 mm, and 11 patients with chalazia experienced two or more lesions. Median follow-up time was 17 months. Average time from bortezomib exposure to onset of first eyelid complication was 3.4 months. Chalazia episodes were more likely to completely resolve than blepharitis episodes ( p = 0.03). Ocular therapy alone was trialed for an average of 1.8 months before proceeding to bortezomib omission. Average time to eyelid complication resolution using ocular therapy alone was 1.8 months versus 3.1 months after bortezomib omission. In this series, the combination of ocular therapy and bortezomib omission led to complete resolution of eyelid complications more often than ocular therapy alone. Conclusion Proteasome inhibitor associated eyelid complications were identified in sixteen patients with plasma cell disorders. Eyelid complications may be treated with a 2-month trial of conservative ocular therapies alone, followed by continuation of ocular therapy in combination with bortezomib omission if eyelid signs persist.

Molecular Insight Into the IRE1α-Mediated Type I Interferon Response Induced by Proteasome Impairment in Myeloid Cells of the Brain

“…Notwithstanding, the described mechanism, in particular the IRE1α activity, that links proteotoxic stress to type I IFN production should be taken into consideration as a novel therapeutic target for patients with CANDLE/PRAAS and for those suffering from a growing spectrum of autoinflammatory diseases caused by proteasome inhibition therapies (116,117).…”

Influence of gut microbiota on eye diseases: an overview

“…It is defined as the simultaneous or subsequent occurrence of multiple chalazia, which can be sporadic or recurring. Several factors are involved in the pathogenesis of chalaziosis—constitutional atopic and seborrhoeic dermatitis; hormonal imbalance; immunological factors; irritable bowel disease; iatrogenic infections [ 73 , 74 ]. (especially related to S. aureus and Propionibacterium acnes ); demodicosis (Demodex mite infestation) [ 75 ].…”

Resolution of bortezomib-associated chalazia/blepharitis after switch to ixazomib: A case report

“…Recently, case reports of successfully treated bortezomib-induced blepharitis with oral doxycycline in combination with topical antibiotics have been reported, allowing continuation of bortezomib [17]. In 2019, Sklar and colleagues proposed a treatment algorithm for such eyelid complications, limiting use of incision and drainage [18].…”