Blepharitis as an early sign of metabolic syndrome: a nationwide population-based study

The Degrees of Coronary Heart Disease and the Degrees of New-Onset Blepharitis: A Nationwide Cohort Study

In this study, we aimed to evaluate the association between the severity of coronary heart disease (CHD) and the subsequent severity of blepharitis. This retrospective population-based cohort study was conducted using the National Health Insurance Research Database (NHIRD) of Taiwan. The participants with a CHD diagnosis were divided into mild CHD and severe CHD groups at a 1:2 ratio, according to whether percutaneous coronary intervention (PCI) was performed. The main outcomes were the development of blepharitis and severe blepharitis with the application of antibiotics. Cox proportional hazard regression was performed to obtain the adjusted hazard ratio (aHR) for blepharitis, with a 95% confidence interval (CI) between the groups. There were 22,161 and 15,369 blepharitis events plus 9597 and 4500 severe blepharitis episodes in the mild and severe CHD groups, respectively. The severe CHD group showed a significantly higher incidence of blepharitis development (aHR, 1.275; 95% CI: 1.051-1.912, p = 0.0285), whereas the incidence of severe blepharitis was not significantly different between the groups (aHR, 0.981; 95% CI: 0.945-1.020, p = 0.3453). The cumulative probability of blepharitis was significantly higher in the severe CHD group than in the mild CHD group (p < 0.001). In the subgroup analyses, the correlation between severe CHD and blepharitis was more significant in patients older than 70 years compared to the younger group (p = 0.0115). In conclusion, severe CHD is associated with a higher incidence of blepharitis than mild CHD, and this correlation is more prominent in individuals older than 70 years.

TFOS Lifestyle: Impact of nutrition on the ocular surface

Nutrients, required by human bodies to perform life-sustaining functions, are obtained from the diet. They are broadly classified into macronutrients (carbohydrates, lipids, and proteins), micronutrients (vitamins and minerals) and water. All nutrients serve as a source of energy, provide structural support to the body and/or regulate the chemical processes of the body. Food and drinks also consist of non-nutrients that may be beneficial (e.g., antioxidants) or harmful (e.g., dyes or preservatives added to processed foods) to the body and the ocular surface. There is also a complex interplay between systemic disorders and an individual's nutritional status. Changes in the gut microbiome may lead to alterations at the ocular surface. Poor nutrition may exacerbate select systemic conditions. Similarly, certain systemic conditions may affect the uptake, processing and distribution of nutrients by the body. These disorders may lead to deficiencies in micro- and macro-nutrients that are important in maintaining ocular surface health. Medications used to treat these conditions may also cause ocular surface changes. The prevalence of nutrition-related chronic diseases is climbing worldwide. This report sought to review the evidence supporting the impact of nutrition on the ocular surface, either directly or as a consequence of the chronic diseases that result. To address a key question, a systematic review investigated the effects of intentional food restriction on ocular surface health; of the 25 included studies, most investigated Ramadan fasting (56%), followed by bariatric surgery (16%), anorexia nervosa (16%), but none were judged to be of high quality, with no randomized-controlled trials.

Statin Use Is Associated With a Lower Risk of Blepharitis: A Population-Based Study

Background

Blepharitis is a common eye disorder that may be overlooked by patients and clinical practitioners. The symptoms of blepharitis often manifest as irritation, a burning sensation, grittiness, and itchiness and may decrease visual acuity if not treated promptly. Meibomian gland dysfunction (MGD), a common cause of blepharitis, is believed to be associated with increased inflammatory marker levels that may disrupt the composition of lipids produced by the sebaceous glands in the eyelids and ultimately cause tear film instability.

Methods

This is a retrospective, population-based study using National Health Insurance Research Database (NHIRD) data from a 14-year period (2000–2015). Pearson chi-squared and Student's t-tests were used to assess the differences in categorical and continuous variables, respectively, between statin users and non-statin users. Univariate and multivariate Cox regression analyses were performed to calculate the hazard ratios (HRs) after adjusting for confounders. Kaplan-Meier analysis was used to assess the cumulative risk of blepharitis between the two cohorts.

Results

A total of 67,014 patients who used statins were enrolled as the study cohort, and 268,056 patients who did not use statins were enrolled as the comparison cohort. The incidence of blepharitis was 3.04% with statin treatment and 3.72% without statin treatment (p < 0.001). Patients who used statins had a lower risk of developing blepharitis [adjusted hazard ratio (aHR): 0.746, p < 0.001] than those who did not. In addition, diabetes mellitus (DM), hypertension, coronary heart disease (CHD), stroke, chalazion, rosacea, Sjogren syndrome, psoriasis and atopy were found to be possible risk factors for blepharitis.

Conclusion

Statin use can decrease the risk of developing blepharitis. However, further prospective studies are needed to evaluate statin treatment for various subtypes of blepharitis and to identify the associated mechanism.

Ocular Surface Diseases in Patients With Diabetes

Purpose

Diabetes is a major cause of ocular morbidity as multiple mechanisms play a role in inducing inflammatory changes in the eye. Diabetic retinopathy is the most common complication and is well-documented. However, in the era of modern medicine, attention is also being focused on ocular surface changes in diabetes. Therefore, this study aimed to determine the association between diabetes and ocular surface diseases.

Materials and Methods

This is a cross-sectional study examining 320 eyes of 160 patients with diabetes who were grouped according to their duration of diabetes. The symptoms were evaluated using the ocular surface disease index (OSDI) questionnaire. Their recent hemoglobin (Hb) A1c value was recorded. Their external or internal hordeolum, blepharitis, meibomian gland dysfunction, and corneal sensitivity were also evaluated. The tear film was examined using tests, such as Schirmer's test, tear film breakup time (TBUT), tear film meniscus height (TFMH), fluorescein stain, and rose bengal stain. The results were correlated with the duration and control of diabetes.

Results

The mean age of the study population was 56.60 years comprising 56% (n=89) females and 44% (n=71) males. The mean OSDI scores were 7.9 ± 3.55 and 57 ± 19.22 in patients without dry eye and with severe dry eye, respectively. The study observed OSDI scores were consistently high with diabetes severity. About 67% (n=24) of patients with HbA1c of >8% had dry eyes. Dry eye was found in 68% (n=59) of patients with the duration of diabetes being >10 years. About 23.7% (n=38) had blepharitis, whereas only 4% (n=7) had external or internal hordeolum and 44% (n=86) had different grades of meibomian gland dysfunction. Corneal sensitivity was abnormal in only 12% (n=12) of patients. About 55% (n=86) of patients had varying degrees of dry eye. A statistically significant correlation was found between the severity of dry eye and TBUT, TFMH values, and grades of corneal staining (P < 0.0001).

Conclusion

This study observed that the incidence of dry eyes was found to be higher when patients had uncontrolled diabetes and diabetes for a longer period. The OSDI scoring system is an important diagnostic tool while examining patients with dry eye. In an ophthalmology clinic, patients with diabetes should always be evaluated for any ocular surface changes when being screened for diabetic retinopathy, and proper guidelines should be implemented to detect changes in the ocular surface system as early as possible so that any long-term complications such as infectious or neurotrophic keratitis may be avoided at an early stage.

Posterior Blepharitis and Associated Potential Factors: A Study among Pregnant Women

Purpose: This study evaluates in a cross-section of pregnant women the frequency of posterior blepharitis, its predisposing factors and how lipid profile impacts the occurrence of posterior blepharitis in pregnancy.Methods: This was a hospital-based cross-sectional study of pregnant women.Results: In this study, 201 pregnant women were recruited and included in the study's analysis. The participants' mean age was 29.96 (±4.74) years, with a median age of 30 and a range of 17 to 40 years. The frequency of posterior blepharitis among this cohort was 13.4% (95% confidence interval, 9.0% to 18.4%). The frequencies of MGD-associated posterior blepharitis and non-MGD associated posterior blepharitis were 6.0% and 7.4%, respectively. There was no statistically significant difference in the mean fluorescein tear breakup time and SPEED scores between non-MGD associated posterior blepharitis and MGD-associated posterior blepharitis, however, the mean tear breakup time(t = 3.999, p < .001) and SPEED scores (t = 6.76, p < .0001) showed a statistically significant difference in posterior blepharitis pregnant women compared to non-posterior blepharitis pregnant women. There was a statistically significant difference in the mean corneal staining scores between non-MGD-associated posterior blepharitis and MGD-associated posterior blepharitis (t = 3.99, p = .001). There was no association between lipid profile and posterior blepharitis in binary logistic regression analysisConclusion: The study showed that posterior blepharitis occurs in pregnancy, but it is not associated with cholesterol levels.

Risk factors for the occurrence of visual-threatening posterior capsule opacification

Background

To evaluate the potential risk factor of visual-threatening posterior capsule opacification (PCO) via the analysis of National Health Insurance Research Database in Taiwan.

Patients and methods

A total of 8571 patients (3767 male and 4804 female) were recruited in the study group and 17,142 patients (7534 male and 9608 female) in the control group. Patients undergoing cataract surgery, acrysof single-piece intraocular lens implantation and Nd:YAG capsulotomy were selected as the study group. After exclusion which aimed to standardize the ocular condition and exclude the possibility that patients undergoing cataract surgery and Nd:YAG capsulotomy in different eyes, each patient in the study group was age-gender matched to two patients undergoing cataract surgery but without Nd:YAG capsulotomy. The demographic data, systemic disease, and ocular co-morbidities were obtained and analyzed. Adjusted odds ratio (OR) of each demographic data and co-morbidities to the development of visual-threatening PCO, and adjusted OR of co-morbidities to visual-threatening PCO develop within 1 year postoperatively.

Results

The dry eye disease (DED), glaucoma, uveitis, age-related macular degeneration (AMD), hyperlipidemia, peptic ulcer disease and liver disease showed significant crude OR while the DED, glaucoma, AMD, hyperlipidemia and peptic ulcer disease revealed a significant adjusted OR. In the subgroup analysis, the DED, glaucoma, AMD, and hyperlipidemia still illustrated a higher adjusted OR to develop visual-threatening PCO within 1 year after the cataract surgery.

Conclusion

The DED, glaucoma, AMD, hyperlipidemia and peptic ulcer disease may serve as the risk factor for the developing of visual-threatening PCO.