Офтальмохирургия (Apr 2017)
EVALUATION OF PATHOGENETIC COMPONENT OF LACRIMAL SUBSTITUTIVE THERAPY IN THE COMPLEX STAGE-BY-STAGE TREATMENT OF POSTERIOR BLEPHARITIS, ASSOCIATED WITH DEMODECTIC LESIONS OF THE EYELID MARGINS
Abstract
Purpose. To assess the impact efficacy of a lacrimal substitutive component in the comlex treatment of posterior blepharitis combined with demodecosis lesions of the eyelid margins.Material and methods. The study performed examinations of 150 patients with posterior blepharitis combined with demodicosis of eyelids (PBDEL). The patients were divided into 4 main groups and a control group 30 individuals in each. The following investigations were performed: Norn test, Schirmer test 1, compression test and biometry of lacrimal meniscus; as well as the laboratory test of eyelashes for a Demodex presence. A stage-by-stage treatment was carried out: DEXAGentamicin 2 times a day for 10 days (the 1st stage); eyelid massage with hygiene procedures – warm compresses and Tea-gel 2 times a day for 1.5 months (the 2nd stage); Glycodem 2 times a day for 45 days (the 3rd stage). Lacrimal substitutive medications (LSM) of different viscosity were administered 4 times a day for 6 months at all stages of treatment. The group 1 used LSM medicines on the basis of Hydroxypropilger, the group 2 – on the basis of Carmellose sodium (Trehalose), the group 3 – on the basis of Carbomer 984 and the group 4 – on the basis of Hypromellose. The LS medications were not prescribed in the control group.Results. The stage-by-stage treatment combined with pathogenetic lacrimal substitutive therapy in PBDEL patients achieves the best results. Application of multi-component LSM (systain balance and optiv) compared to the single component LSM (oftagel and natural tears), leads to a long-term remission of subjective and objective PBDEL symptoms. The 1st and 2nd stages of treatment (anti-inflammatory therapy, massage of the eyelids combined with hygiene procedures using tear substitutes) already reduce the quantity of Demodex mites up to the threshold values, as well as create conditions for efficiency of the third stage of antiparasitic therapy. Norn test and biometry of lacrimal meniscus is the most significant (in comparison with Schirmer test 1) for a control of treatment results.Conclusion. The performed study showed that pathogenetic lacrimal substitutive therapy contributes to a liquefaction of the meibomian glands secretion, which in turn promotes a restoration of the tear film and a prolonged remission of symptoms of posterior blepharitis and also in some cases leads to the exit of Demodex mites from the meibomian glands to the eyelid margins that increases the efficiency of anti-parasitic therapy. In addition to hygiene procedures, the LSM application should be an obligatory component at all stages of treatment of patients with posterior blepharitis combined with demodicosis of eyelids.
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