Incidence of Blepharitis in Patients Undergoing PhacoemulsificationJodi Luchs, MDCarlos Buznego, MDWilliam Trattler, MD

The authors of this poster have received research funding and travel expense reimbursement from Inspire Pharmaceuticals. Jodi Luchs, MD and William Trattler, MD are consultants for Inspire Pharmaceuticals.

AbstractTITLE: Prevalence of Blepharitis in Patients Scheduled for Routine Cataract Surgery

Authors: Jodi I. Luchs, Carlos Buznega, William B. Trattler

Purpose: The primary objective of this observational study is to determine the prevalence of blepharitis in patients preparing to undergo routine cataract surgery. There are currently no studies available which document the prevalence of blepharitis in patients who undergo cataract surgery.

Methods: Patients were assessed at one of two study sites prior to the date of their cataract surgery. Procedures included: Patient-rated assessments of symptoms of blepharitis, investigator-rated signs of blepharitis, biomicroscopy, fluorescein tear break-up time (TBUT), and fluorescein corneal staining. No investigational drug was utilized in this study.

Results: A total of 100 patients were evaluated in this study. The overall prevalence rate of blepharitis in patients preparing to undergo cataract surgery was determined to be 59 out of 100 patients (59%). On average, patient’s signs and symptoms of blepharitis were determined to be mild to moderate. The tear film break up time was found to be below the normal range.

Conclusion: In this prospective study, blepharitis was determined to have a high prevalence in patients preparing to undergo cataract surgery. Blepharitis may be frequently overlooked in these patients due to mild or moderate signs and symptoms, although its effect on the ocular surface may have important implications for the upcoming 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. This study evaluated the prevalence of blepharitis in patients undergoing routine cataract surgery.

Methods• Prospective, multicenter observational study which assessed the

incidence of blepharitis in 100 patients scheduled to undergo cataract surgery.

• Patients were consented and evaluated at the time that they presented for pre-operative biometry.

• Outcome measures:– 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)

– Total blepharitis symptom severity score (total symptom scores for itch, foreign body sensation, dryness, burning or pain, and swollen/heavy eyelids)

– Blepharitis clinical sign severity scores for lid debris, lid swelling, meibomian gland plugging, and quality of meibomian gland secretions.

– Degree of ocular surface fluorescein staining (NEI grading system1)

– Tear film break up time

Patient Demographics

• 59% of patients were diagnosed with blepharitis

• Mean age was 72.4 years (range: 52-88)

Mean Symptom Score

2.36

1.65

0

0.5

1

1.5

2

2.5

3

3.5

4

Symptom Score

Mea

n Sc

ore

BlepharitisNo Blepharitis

*P=.238

Clinical Signs of Blepharitis

1.031.37

0.25

2.36 2.24

0.220.38

0.090.34 0.42

0

0.5

1

1.5

2

2.5

3

3.5

4

Debris Redness Swelling Plugging Secretion

Mea

n Sc

ore

BlepharitisNo Blepharitis

**

**

*P<.001

Mean TBUT

5.956.73

0

1

2

3

4

5

6

7

8

9

10

TBUT

Mea

n Ti

me

(Sec

)

BlepharitisNo Blepharitis

*P=.076

Distribution of TBUT Scores

36

61

89

23

59

85

0

10

20

30

40

50

60

70

80

90

100

5 seconds 7 seconds 9 seconds

% o

f Pati

ents

BlepharitisNo Blepharitis

< < <

P=.026P=.026

Mean Corneal Staining

3.61

2.49

0

1

2

3

4

5

6

Staining

Mea

n Sc

ore*

BlepharitisNo Blepharitis

*P=.082 *Range = 0-15

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 pre-operatively in patients about to undergo ocular surgery in order to potentially reduce the risk of post-operative infection,2-4 as well as to stabilize the tear film in order to ensure accurate pre-operative 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.

– This study found that 59% of patients undergoing routine evaluation for cataract surgery had clinical signs of blepharitis, making it a commonly occurring condition. However it should be pointed out that that the overall clinical sign and symptom scores were low for this cohort of patients with blepharitis , averaging approximately 2 on a scale of 0-4. Consequently, it is possible that this condition is frequently overlooked due to the fact that patients with mild symptoms may not complain, and mild clinical signs my be overlooked the clinician.

– However, there is a real disturbance to the tear film in these patients with blepharitis as demonstrated by the statistically significant greater number of patients with blepharitis in this study who had a tear film break-up time of 5 seconds or less. This may have important implications for patients undergoing ocular surgery.

– While there was a trend towards greater mean corneal staining scores in patients with blepharitis, the difference was not statistically significant. This difference might have approached statistical significance with a larger sample size. Furthermore, 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• The incidence of blepharitis is under-reported

– The symptom scores and clinical sign scores are low, so the condition may be frequently overlooked

– However, there is a real disturbance of the ocular surface as evidenced by the more rapid TFBUT in these patients. This can have potentially important implications for pre-operative measurements and post-operative outcomes of cataract and refractive surgery.

REFERENCES:1Lemp MA. Report of National Eye Institute/Industry Work shop on clinical trials in dry eyes. C L A O J 1995;21:221-2322EVS Study Group: Arch Ophthalmol 1995;113(12):1479-14963Solomon et. al.: J Cataract Refract Surg. 2003;29:2001-20064Speaker MG et al.: Ophthalmology 1991;98(5):639-649