Lids, lipids and dry eyes

Session Details

Session Title: Cornea Medical

Session Date/Time: Tuesday 16/09/2014 | 14:00-16:00

Paper Time: 14:00

Venue: Capital Hall A

First Author: : J.McCulley USA

Co Author(s): :                  

Abstract Details

Purpose:

To assess the association between different types of chronic blepharitis, changes in Meibomian secretions, and underlying causes of aqueous deficient dry eyes.

Setting:

Ophthalmology Faculty Practice Referral Clinic in an academic setting, UT Southwestern Medical School, Dallas, Texas.

Methods:

Patients with chronic blepharitis were classified using the published classification system of McCulley. Lid and conjunctival cul-de-sac aerobic and anaerobic cultures were done. Frequently recovered bacteria were assessed for production of lipolytic exoenzymes. In depth lipid biochemical analysis of individual patients meibomian sections was done. The presence of associated aqueous deficient dry eyes (ADDE) was clinically determined. Tear evaporative rate was measured with an evaporometer. Meibography was done to assess anatomical meibomian gland changes.

Results:

The only statistically significant bacterial recovery was of Staphylococcus Aureus (SA) in the Staphyloccal and Mixed Staphyloccal/Seborrheic groups. Coagulase Negative Staph (CNS) and SA were found to frequently produce lipolytic exoemymes capable of breaking down meibomian gland secretions. Chemical analysis of meibum revealed a complex of nonpolar and polar lipids with a statistically significant decrease in patients with ADDE of splingomyelin and phosphatidylethanolamine. All patients with ADDE demonstrated excessive aqueous tear evaporation and meibomian gland drop out compared to normals.

Conclusions:

Patients with chronic blepharitis with associated aqueous deficient dry eyes did not have an identifiable bacterial pathogen, but did have evidence of bacterial lipolytic exoenzyme activity with a decreased in critical polar lipids with associated excessive aqueous tear evaporation and meibomian gland drop out.

Financial Interest:

NONE