Dysbiosis of the ocular surface – a new risk factor for ophthalmic diseases? The role of eyelid hygiene Review article
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Published:
Jun 30, 2023
Keywords:
eyelid hygiene, allergic conjunctivitis, blepharitis, dry eye
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Abstract
Quantitative and qualitative disturbances in the composition of the ocular surface microbiome can be a significant risk factor for the development of various ophthalmic disorders, including eyelid inflammation, dry eye syndrome, and allergic conjunctivitis. In this publication, we present a review of the data regarding the association between dysbiosis and these mentioned clinical conditions. Additionally, we provide recommendations for the treatment of dysbiosis, including eyelid hygiene.
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1.
Skrzypecki J. Dysbiosis of the ocular surface – a new risk factor for ophthalmic diseases? The role of eyelid hygiene. Ophthatherapy [Internet]. 2023Jun.30 [cited 2024Nov.23];10(2):97-102. Available from: https://journalsmededu.pl/index.php/ophthatherapy/article/view/2800
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Conservative treatment
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Address reprint requests to: Medical Education, Marcin Kuźma (marcin.kuzma@mededu.pl)
References
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6. Doan T, Akileswaran L, Andersen D et al. Paucibacterial Microbiome and Resident DNA Virome of the Healthy Conjunctiva. Invest Ophthalmol Vis Sci. 2016; 57(13): 5116-26. http://doi.org/10.1167/iovs.16-19803.
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12. Song H, Xiao K, Min H et al. Characterization of Conjunctival Sac Microbiome from Patients with Allergic Conjunctivitis. J Clin Med. 2022; 11(4): 1130. http://doi.org/10.3390/jcm11041130.
13. Prashanthi GS, Jayasudha R, Chakravarthy SK et al. Alterations in the Ocular Surface Fungal Microbiome in Fungal Keratitis Patients. Microorganisms. 2019; 7(9): 309. http://doi.org/10.3390/microorganisms7090309.
14. Jayamanne DG, Dayan M, Jenkins D et al. The role of staphylococcal superantigens in the pathogenesis of marginal keratitis. Eye (Lond). 1997; 11 (Pt 5): 618-21. http://doi.org/10.1038/eye.1997.165.
15. Kernt M, Kampik A. Endophthalmitis: Pathogenesis, clinical presentation, management, and perspectives. Clin Ophthalmol. 2010; 4: 121-35. http://doi.org/10.2147/opth.s6461.
16. Onghanseng N, Ng SM, Halim MS et al. Oral antibiotics for chronic blepharitis. Cochrane Database Syst Rev. 2021; 6(6): CD013697. http://doi.org/10.1002/14651858.CD013697.pub2.
17. Junk AK, Lukacs A, Kampik A. [Topical administration of metronidazole gel as an effective therapy alternative in chronic Demodex blepharitis – a case report]. Klin Monbl Augenheilkd. 1998; 213(1): 48-50. http://doi.org/10.1055/s2008-1034943.
18. McClellan KJ, Noble S. Topical metronidazole. A review of its use in rosacea. Am J Clin Dermatol. 2000; 1(3): 191-9. http://doi.org/10.2165/00128071-200001030-00007.
19. Hirsch-Hoffmann S, Kaufmann C, Banninger PB et al. Treatment options for demodex blepharitis: patient choice and efficacy. Klin Monbl Augenheilkd. 2015; 232(4): 384-7. http://doi.org/10.1055/s-0035-1545780.
20. Barry P, Seal DV, Gettinby G et al. ESCRS study of prophylaxis of postoperative endophthalmitis after cataract surgery: Preliminary report of principal results from a European multicenter study. J Cataract Refract Surg. 2006; 32(3): 407-10. http://doi.org/10.1016/j.jcrs.2006.02.021.
21. Storey P, Dollin M, Pitcher J et al. The role of topical antibiotic prophylaxis to prevent endophthalmitis after intravitreal injection. Ophthalmology. 2014; 121(1): 283-9. http://doi.org/10.1016/j.ophtha.2013.08.037.
22. Choi Y, Eom Y, Yoon EG et al. Efficacy of Topical Ivermectin 1% in the Treatment of Demodex Blepharitis. Cornea. 2022; 41(4): 427-34. http://doi.org/10.1097/ICO.0000000000002802.
23. Salem DA, El-Shazly A, Nabih N et al. Evaluation of the efficacy of oral ivermectin in comparison with ivermectin-metronidazole combined therapy in the treatment of ocular and skin lesions of Demodex folliculorum. Int J Infect Dis. 2013; 17(5): e343-7. http://doi.org/10.1016/j.ijid.2012.11.022.
24. Filho PA, Hazarbassanov RM, Grisolia AB et al. The efficacy of oral ivermectin for the treatment of chronic blepharitis in patients tested positive for Demodex spp. Br J Ophthalmol. 2011; 95(6): 893-5. http://doi.org/10.1136/bjo.2010.201194.
25. McDonnell G, Russell AD. Antiseptics and disinfectants: activity, action, and resistance. Clin Microbiol Rev. 1999; 12(1): 147-79. http://doi.org/10.1128/CMR.12.1.147.
26. Ali FS, Jenkins TL, Boparai RS et al. Aqueous Chlorhexidine Compared with Povidone-Iodine as Ocular Antisepsis before Intravitreal Injection: A Randomized Clinical Trial. Ophthalmol Retina. 2021; 5(8): 788-96. http://doi.org/10.1016/j.oret.2020.11.008.
27. Evren Kemer O, Karaca EE, Ozek D. Efficacy of cyclic therapy with terpinen-4-ol in Demodex blepharitis : Is treatment possible by considering Demodex’s life cycle? Eur J Ophthalmol. 2021; 31(3): 1361-6. http://doi.org/10.1177/1120672120919085.
28. Tighe S, Gao YY, Tseng SC. Terpinen-4-ol is the Most Active Ingredient of Tea Tree Oil to Kill Demodex Mites. Transl Vis Sci Technol. 2013; 2(7): 2. http://doi.org/10.1167/tvst.2.7.2.
29. Eom Y, Na KS, Hwang HS et al. Clinical efficacy of eyelid hygiene in blepharitis and meibomian gland dysfunction after cataract surgery: a randomized controlled pilot trial. Sci Rep. 2020; 10(1): 11796. http://doi.org/10.1038/s41598-020-67888-5.
30. Peral A, Alonso J, Garcia-Garcia C et al. Importance of Lid Hygiene Before Ocular Surgery:Qualitative and Quantitative Analysis of Eyelid and Conjunctiva Microbiota. Eye Contact Lens. 2016; 42(6): 366-70. http://doi.org/10.1097/ICL.0000000000000221.
31. Chuckpaiwong V, Nonpassopon M, Lekhanont K et al. Compliance with Lid Hygiene in Patients with Meibomian Gland Dysfunction. Clin Ophthalmol. 2022; 16: 1173-82. http://doi.org/10.2147/OPTH.S360377.
32. Grzybowski A, Brona P, Kim SJ. Microbial flora and resistance in ophthalmology: a review. Graefes Arch Clin Exp Ophthalmol. 2017; 255(5): 851-62. http://doi.org/10.1007/s00417-017-3608-y.
2. DeGruttola AK, Low D, Mizoguchi A et al. Current Understanding of Dysbiosis in Disease in Human and Animal Models. Inflamm is. 2016; 22(5): 1137-50. http://doi.org/10.1097/MIB.0000000000000750.
3. Xue W, Li JJ, Zou Y et al. Microbiota and Ocular Diseases. Front Cell Infect Microbiol. 2021; 11: 759333. http://doi.org/10.3389/fcimb.2021.759333.
4. Xu S, Zhang H. Bacteriological profile of conjunctiva bacterial Flora in Northeast China: a hospital based study. BMC Ophthalmol. 2022; 22(1): 223. http://doi.org/10.1186/s12886-022-02441-8.
5. Shivaji S, Jayasudha R, Sai Prashanthi G et al. The Human Ocular Surface Fungal Microbiome. Invest Ophthalmol Vis Sci. 2019; 60(1): 451-9. http://doi.org/10.1167/iovs.18-26076.
6. Doan T, Akileswaran L, Andersen D et al. Paucibacterial Microbiome and Resident DNA Virome of the Healthy Conjunctiva. Invest Ophthalmol Vis Sci. 2016; 57(13): 5116-26. http://doi.org/10.1167/iovs.16-19803.
7. Yan Y, Yao Q, Lu Y et al. Association Between Demodex Infestation and Ocular Surface Microbiota in Patients With Demodex Blepharitis. Front Med (Lausanne). 2020; 7: 592759. http://doi.org/10.3389/fmed.2020.592759.
8. Petrillo F, Pignataro D, Lavano MA et al. Current Evidence on the Ocular Surface Microbiota and Related Diseases. Microorganisms. 2020; 8(7): 1033. http://doi.org/10.3390/microorganisms8071033.
9. Fu Y, Wu J, Wang D et al. Metagenomic profiling of ocular surface microbiome changes in Demodex blepharitis patients. Front Cell Infect Microbiol. 2022; 12: 922753. http://doi.org/10.3389/fcimb.2022.922753.
10. Shah PP, Stein RL, Perry HD. Update on the Management of Demodex Blepharitis. Cornea. 2022; 41(8): 934-9. http://doi.org/10.1097/ICO.0000000000002911.
11. An Q, Zou H. Ocular surface microbiota dysbiosis contributes to the high prevalence of dry eye disease in diabetic patients. Crit Rev Microbiol. 2022: 1-10. http://doi.org/10.1080/1040841X.2022.2142090.
12. Song H, Xiao K, Min H et al. Characterization of Conjunctival Sac Microbiome from Patients with Allergic Conjunctivitis. J Clin Med. 2022; 11(4): 1130. http://doi.org/10.3390/jcm11041130.
13. Prashanthi GS, Jayasudha R, Chakravarthy SK et al. Alterations in the Ocular Surface Fungal Microbiome in Fungal Keratitis Patients. Microorganisms. 2019; 7(9): 309. http://doi.org/10.3390/microorganisms7090309.
14. Jayamanne DG, Dayan M, Jenkins D et al. The role of staphylococcal superantigens in the pathogenesis of marginal keratitis. Eye (Lond). 1997; 11 (Pt 5): 618-21. http://doi.org/10.1038/eye.1997.165.
15. Kernt M, Kampik A. Endophthalmitis: Pathogenesis, clinical presentation, management, and perspectives. Clin Ophthalmol. 2010; 4: 121-35. http://doi.org/10.2147/opth.s6461.
16. Onghanseng N, Ng SM, Halim MS et al. Oral antibiotics for chronic blepharitis. Cochrane Database Syst Rev. 2021; 6(6): CD013697. http://doi.org/10.1002/14651858.CD013697.pub2.
17. Junk AK, Lukacs A, Kampik A. [Topical administration of metronidazole gel as an effective therapy alternative in chronic Demodex blepharitis – a case report]. Klin Monbl Augenheilkd. 1998; 213(1): 48-50. http://doi.org/10.1055/s2008-1034943.
18. McClellan KJ, Noble S. Topical metronidazole. A review of its use in rosacea. Am J Clin Dermatol. 2000; 1(3): 191-9. http://doi.org/10.2165/00128071-200001030-00007.
19. Hirsch-Hoffmann S, Kaufmann C, Banninger PB et al. Treatment options for demodex blepharitis: patient choice and efficacy. Klin Monbl Augenheilkd. 2015; 232(4): 384-7. http://doi.org/10.1055/s-0035-1545780.
20. Barry P, Seal DV, Gettinby G et al. ESCRS study of prophylaxis of postoperative endophthalmitis after cataract surgery: Preliminary report of principal results from a European multicenter study. J Cataract Refract Surg. 2006; 32(3): 407-10. http://doi.org/10.1016/j.jcrs.2006.02.021.
21. Storey P, Dollin M, Pitcher J et al. The role of topical antibiotic prophylaxis to prevent endophthalmitis after intravitreal injection. Ophthalmology. 2014; 121(1): 283-9. http://doi.org/10.1016/j.ophtha.2013.08.037.
22. Choi Y, Eom Y, Yoon EG et al. Efficacy of Topical Ivermectin 1% in the Treatment of Demodex Blepharitis. Cornea. 2022; 41(4): 427-34. http://doi.org/10.1097/ICO.0000000000002802.
23. Salem DA, El-Shazly A, Nabih N et al. Evaluation of the efficacy of oral ivermectin in comparison with ivermectin-metronidazole combined therapy in the treatment of ocular and skin lesions of Demodex folliculorum. Int J Infect Dis. 2013; 17(5): e343-7. http://doi.org/10.1016/j.ijid.2012.11.022.
24. Filho PA, Hazarbassanov RM, Grisolia AB et al. The efficacy of oral ivermectin for the treatment of chronic blepharitis in patients tested positive for Demodex spp. Br J Ophthalmol. 2011; 95(6): 893-5. http://doi.org/10.1136/bjo.2010.201194.
25. McDonnell G, Russell AD. Antiseptics and disinfectants: activity, action, and resistance. Clin Microbiol Rev. 1999; 12(1): 147-79. http://doi.org/10.1128/CMR.12.1.147.
26. Ali FS, Jenkins TL, Boparai RS et al. Aqueous Chlorhexidine Compared with Povidone-Iodine as Ocular Antisepsis before Intravitreal Injection: A Randomized Clinical Trial. Ophthalmol Retina. 2021; 5(8): 788-96. http://doi.org/10.1016/j.oret.2020.11.008.
27. Evren Kemer O, Karaca EE, Ozek D. Efficacy of cyclic therapy with terpinen-4-ol in Demodex blepharitis : Is treatment possible by considering Demodex’s life cycle? Eur J Ophthalmol. 2021; 31(3): 1361-6. http://doi.org/10.1177/1120672120919085.
28. Tighe S, Gao YY, Tseng SC. Terpinen-4-ol is the Most Active Ingredient of Tea Tree Oil to Kill Demodex Mites. Transl Vis Sci Technol. 2013; 2(7): 2. http://doi.org/10.1167/tvst.2.7.2.
29. Eom Y, Na KS, Hwang HS et al. Clinical efficacy of eyelid hygiene in blepharitis and meibomian gland dysfunction after cataract surgery: a randomized controlled pilot trial. Sci Rep. 2020; 10(1): 11796. http://doi.org/10.1038/s41598-020-67888-5.
30. Peral A, Alonso J, Garcia-Garcia C et al. Importance of Lid Hygiene Before Ocular Surgery:Qualitative and Quantitative Analysis of Eyelid and Conjunctiva Microbiota. Eye Contact Lens. 2016; 42(6): 366-70. http://doi.org/10.1097/ICL.0000000000000221.
31. Chuckpaiwong V, Nonpassopon M, Lekhanont K et al. Compliance with Lid Hygiene in Patients with Meibomian Gland Dysfunction. Clin Ophthalmol. 2022; 16: 1173-82. http://doi.org/10.2147/OPTH.S360377.
32. Grzybowski A, Brona P, Kim SJ. Microbial flora and resistance in ophthalmology: a review. Graefes Arch Clin Exp Ophthalmol. 2017; 255(5): 851-62. http://doi.org/10.1007/s00417-017-3608-y.