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1、170 CAN J OPHTHALMOLVOL. 43, NO. 2, 2008 Blepharitis: current strategies for diagnosis and management W. Bruce Jackson, MD, FRCSC ABSTRACT RSUM Background: The aim of this article is to present a consensus on the appropriate identification and management of patients with blepharitis based on expert
2、clinical recommendations for 4 representative case studies and evidence from well-designed clinical trials. Methods: The case study recommendations were developed at a consensus panel meeting of Canadian ophthalmologists and a guest ophthalmologist from the U.K., with additional input from family do
3、ctors and an infectious disease/medical microbiologist, which took place in Toronto in June 2006. A MEDLINE search was also conducted of English language articles describing randomized controlled clinical trials that involved patients with blepharitis. Results: Blepharitis involving predominantly th
4、e skin and lashes tends to be staphylococcal and (or) seborrheic in nature, whereas involvement of the meibomian glands may be either seborrheic, obstructive, or a combination (mixed). The pathophysiology of blepharitis is a complex interaction of various factors, including abnormal lid-margin secre
5、tions, microbial organisms, and abnormalities of the tear film. Blepharitis can present with a range of signs and symptoms, and is associated with various dermatological conditions, namely, seborrheic dermatitis, rosacea, and eczema.The mainstay of treatment is an eyelid hygiene regimen, which needs
6、 to be continued long term. Topical antibiotics are used to reduce the bacterial load. Topical corticosteroid preparations may be helpful in patients with marked inflammation. Interpretation: Blepharitis can present with a range of signs and symptoms, and its management can be complicated by a numbe
7、r of factors. Expert clinical recommendations and a review of the evidence on treatment supports the practice of careful lid hygiene, possibly combined with the use of topical antibiotics, with or without topical steroids. Systemic antibiotics may be appropriate in some patients. Contexte : Prsentat
8、ion dun consensus dexperts en clinique sur lidentification et le traitement appropris des patients atteints de blpharite. Les recommandations rsultent dun examen de 4 tudes de cas et de donnes dessais cliniques bien penss. Mthodes : Les recommandations rsultant de ltude de cas ont t mises au point p
9、ar consensus lors dune runion dexperts laquelle ont particip en juin 2006, Toronto, un groupe dophtalmologistes canadiens et un ophtalmologiste invit du Royaume-Uni, avec lapport de mdecins de famille et dun microbiologiste mdical et spcialiste en maladies infectieuses. On a aussi effectu sur MEDLIN
10、E une recherche dans les articles publis en anglais et dcrivant des essais cliniques contrls et randomiss chez des patients atteints de blpharite. Rsultats : La blpharite, qui affecte surtout la peau et les cils, a tendance tre de nature staphylococcique et (ou) sborrhique, alors que limplication de
11、s glandes de Mibomius peut tre sborrhique, obstructive, ou une combinaison des deux. La pathophysiologie de la blpharite montre une interaction complexe de divers facteurs comprenant des scrtions anormales sur la marge de la paupire, des organismes microbiens et des anomalies du film lacrymal. La bl
12、pharite peut saccompagner dun ventail de signes et de symptmes et sassocier diverses conditions dermatologiques, notamment la dermatite sborrhique, lacn rosace et leczma. Le traitement de base porte sur lhygine des paupires, quil faut maintenir long terme. Les antibiotiques topiques servent rduire l
13、a charge bactrienne. Les prparations topiques de corticostrodes peuvent aider les patients qui ont une inflammation marque. Interprtation : La blpharite peut prsenter un v entail de signes et de symptmes, et un certain nombre de facteurs peuvent en compliquer le traitement. Les recommandations des e
14、xperts en clinique et une revue des donnes sur le traitement appuie la pratique attentive de lhygine des paupires laquelle on peut ajouter des antibiotiques topiques, avec ou sans strodes topiques. Les antibiotiques systmiques peuvent tre indiqus pour certains patients. From the University of Ottawa
15、 Eye Institute, Ottawa, Ont. Originally received Aug. 22, 2007. Revised Dec. 28, 2007 Accepted for publication Jan. 9, 2008 Published online Mar. 12, 2008 Correspondence to W. Bruce Jackson, MD, University of Ottawa Eye Institute, The Ottawa Hospital, General Campus, 501 Smyth Rd., Suite W6253, Box
16、307, Ottawa ON K1H 8L6; bjacksonohri.ca This article has been peer-reviewed. Cet article a t valu par les pairs. Can J Ophthalmol 2008;43:1709 doi:10.3129/i08-016 CAN J OPHTHALMOLVOL. 43, NO. 2, 2008 171 Management of blepharitis Jackson Table 1 Etiological classification of blepharitis* Inflammator
17、y Infectious Seborrheic Bacterial (most commonly Staphylococcus aureus, S. epidermidis and Propionibacterium acnes) Meibomian gland dysfunction Viral (Molluscum contagiosum, Herpes simplex, varicella-zoster, common warts) Allergic (atopic and contact Fungal (uncommon; immunosuppressed dermatitis) pt
18、s) Associated with dermatosis Parasitic (Demodex folliculorum, (rosacea) Pediculosis pubis) *Adapted with permission from McCulley et al.,3 Mathers et al.,4 and Tasman et al.5 B lepharitis is a generic term for eyelid inflammation but generally refers to different types of inflammation involving the
19、 skin, lashes, and meibomian glands and is among the most frequently encountered ocular diseases. The condition is usually chronic, intermittent (with exac- erbations and remissions), and typically bilateral. It is a complex disorder with a number of causes and overlap- ping signs and symptoms, and
20、its management can be frustrating and challenging.1,2 The aim of this article is to present a consensus on the appropriate identification and management of patients with blepharitis based on expert clinical recommendations for 4 representative case studies and evidence from well- designed clinical t
21、rials. The case study recommendations were developed at a consensus panel meeting of Canadian ophthalmologists and a guest ophthalmologist from the U.K., with addi- tional input from family doctors and an infectious disease/medical microbiologist, which took place in Toronto in June 2006. The member
22、s of the panel are listed in the Acknowledgements section. METHODS Classification and etiology There is no single, universally accepted classification system for the various presentations of blepharitis. The ideal system may eventually be structured according to underlying disease pathophysiology, b
23、ut this is incom- pletely understood. Historically, blepharitis has been divided into anterior forms (affecting the anterior lid margin and eyelashes) and posterior forms (affecting the meibomian glands).1,2 Both forms can be inflammatory or infectious, as shown in Table 1. Alternatively, blephariti
24、s can be classified according to the most commonly presenting signs and symptoms into staphylococcal, seborrheic, mixed staphylococcal and seb- orrheic, and meibomian gland dysfunction (MGD). Pathophysiology The pathophysiology of blepharitis is complex and thought to represent the interaction of va
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