Diagnosis dan manajemen pada blefaritis anterior dan posterior

Gusti Ayu Dian Listyani Utami

doi:10.15562/ism.v12i1.960

Diagnosis dan manajemen pada blefaritis anterior dan posterior

Gusti Ayu Dian Listyani Utami ,

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DOI: https://doi.org/10.15562/ism.v12i1.960 |
Published: 2021-04-30

Abstract

Introduction: Blepharitis is a chronic inflammatory condition of the eyelid margin. Blepharitis can be distinguished based on its location, namely anterior and posterior blepharitis. Anterior blepharitis is bilateral inflammation that occurs in the area around the base of the eyelashes and on the edge of the eyelid. Anterior blepharitis generally has two main types, namely, staphylococcal blepharitis and seborrheic blepharitis. Posterior blepharitis is inflammation of the eyelid on the posterior side due to dysfunction of the meibomian gland, chronic and bilateral.

Aim: The aim of the study is to describe the comprehensive review regarding diagnosis and management of blepharitis

Conclusion: The general management used to relieve symptoms of blepharitis are warm compresses, cleaning the eyelids, including massage of the meibomian glands in cases of posterior blepharitis, antibiotic therapy (topically or systemically), topical anti-inflammatory, combination of antibiotics and topical corticosteroids, calcineuric inhibitor and Intensed Light Pulse (IPL) therapy. The treatment of blepharitis is done in combination to increase its effectiveness and get better treatment results. However, further research is still needed to select the regimen that has the highest efficacy and safety because blepharitis is a chronic disease with a high recurrence rate.

Pendahuluan: Blefaritis merupakan peradangan yang bersifat kronis atau menahun dan pada umumnya berlokasi pada tepi kelopak mata. Blefaritis dapat dibedakan berdasarkan lokasinya yaitu blefaritis anterior dan posterior. Blefaritis anterior adalah peradangan bilateral yang terjadi di daerah sekitar dasar bulu mata dan pada tepi kelopak mata. Blefaritis anterior pada umumnya memiliki dua jenis utama yaitu, blefaritis stafilokokus dan blefaritis seboroik. Blefaritis posterior adalah peradangan kelopak mata pada bagian posterior akibat disfungsi dari kelenjar meibom, bersifat kronis dan bilateral.

Tujuan: Tujuan dari tinjauan pustaka ini adalah untuk memberikan gambaran komperhensif akan diagnosis dan tatalaksanan dari bleparitis posterior.

Simpulan: Manajemen umum yang gunakan untuk meringankan gejala blefaritis adalah kompres hangat, pembersihkan kelopak mata, termasuk didalamnya adalah pemijatan pada kelenjar meibom dalam kasus blefaritis posterior, terapi antibiotika (secara topical maupun sistemik), anti inflamasi topikal, kombinasi antibiotika dan kortikosteroid topikal dan calcineuric inhibitor serta intense light pulse therapy (IPL). Penanganan blefaritis dilakukan secara kombinasi untuk meningkatkan efektifitas dan mendapatkan hasil pengobatan yang lebih baik. Namun masih diperlukan penelitian lebih lanjut guna memilih regimen yang memiliki efikasi dan keamanan yang paling tinggi karena blefaritis merupakan penyakit kronis dengan tingkat kekambuhan yang tinggi.

References

American Academy of Ophthalmology Basic and Clinical Science Course Subcommittee. Basic and Clinical Science Course. External Disease and Cornea: Section 8. San Francisco: AAO Publishing; 2018.
Yeotikar NS, Zhu H, Markoulli M, Nichols KK, Naduvilath T, Papas EB. Functional and morphologic changes of meibomian glands in an asymptomatic adult population. Invest Ophthalmol Vis Sci. 2016;57:3996-2007.
Rim TH, Kang MJ, Choi M, Seo KY, Kim SS. Ten-year incidence and prevalence of clinically diagnosed blepharitis in South Korea: a nationwide population-based cohort study. Clinical & Experimental Ophthalmology. 2017;45(5):448–454. doi:10.1111/ceo.12929.
Deepthi KG, Prabagaran SR. Ocular bacterial infections: Pathogenesis and diagnosis. Microb Pathog. 2020;145:104206. doi: 10.1016/j.micpath.2020.104206.
Pérez-Cano HJ, Rubalcava-Soberanis ML, Velázquez Salgado R. Relationship between blepharitis and components of the metabolic syndrome . Arch Soc Esp Oftalmol. 2018;93(10):476-480. doi: 10.1016/j.oftal.2018.06.001. Epub 2018 Jul 19.
American Academy Of Ophthalmology. Blepharitis Preferred Practice Pattern. 2018. San Franciso: American Academy of Ophthalmology; 2018.
AlDarrab A, Alrajeh M, Alsuhaibani AH. Meibography for eyes with posterior blepharitis. Saudi J Ophthalmol. 2017;31(3):131-134. doi: 10.1016/j.sjopt.2017.05.014.
Gostimir M, Allen LH. Is there enough evidence for the routine recommendation of eyelid wipes? A systematic review of the role of eyelid wipes in the management of blepharitis and meibomian gland dysfunction. Canadian Journal of Ophthalmology. CJCO. 2020;55(5):424-436. doi:10.1016/j.jcjo.2020.05.015 .
Muntz A, Sandford E, Claassen M, Curd L, Jackson AK, Watters G, Wang MTM, Craig JP. Randomized trial of topical periocular castor oil treatment for blepharitis. Ocul Surf. 2021;19:145-150. doi: 10.1016/j.jtos.2020.05.007.
Pflugfelder SC, Karpecki PM, Perez VL. Treatment of blepharitis: recent clinical trials. Ocul Surf. 2014;12(4):273-84. doi: 10.1016/j.jtos.2014.05.005.
Fadlallah A, Rami HE, Fahd D, dkk. Azithromycin 1.5% ophthalmic solution: efficacy and treatment modalities in chronic blepharitis. Arq Bras Oftalmol. 2012;75:178-82.
Torkildsen GL, Cockrum P, Meier E, dkk. Evaluation of clinical efficacy and safety of tobramycin/dexamethasone ophthalmic suspension 0.3%/0.05% compared to azithromycin ophthalmic solution 1% in the treatment of moderate to severe acute blepharitis/blepharoconjunctivitis. Curr Med Res Opin. 2011;27:171-8.
Opitz DL, Tyler KF. Efficacy of azithromycin 1% ophthalmic solution for treatment of ocular surface disease from posterior blepharitis. Clin Exp Optom. 2011;94:200-6.
Chen M, Gong L, Sun X, dkk. A multicenter, randomized, parallel-group, clinical trial comparing the safety and efficacy of loteprednol etabonate 0.5%/tobramycin 0.3% with dexamethasone 0.1%/tobramycin 0.3% in the treatment of Chinese patients with blepharokeratoconjunctivitis. Curr Med Res Opin. 2012;28:385-94
Duncan K, Jeng BH. Medical management of blepharitis. Current Opinion in Ophthalmology. 2015;26(4):289–294. doi:10.1097/icu.0000000000000164
Sung J, Wang MTM, Lee SH, Cheung IMY, Ismail S, Sherwin T, Craig JP. Randomized double-masked trial of eyelid cleansing treatments for blepharitis. The Ocular Surface. 2018;16(1):77–83. doi:10.1016/j.jtos.2017.10.005
Wallis EJ, Aakalu VK, Foster JA, Freitag SK, Sobel RK, Tao JP, Yen MT. Intense Pulsed Light for Meibomian Gland Disease: A Report by the American Academy of Ophthalmology. Ophthalmology. 2020;127(9):1227-1233. doi: 10.1016/j.ophtha.2020.03.009.

[1] American Academy of Ophthalmology Basic and Clinical Science Course Subcommittee. Basic and Clinical Science Course. External Disease and Cornea: Section 8. San Francisco: AAO Publishing; 2018.

[2] Yeotikar NS, Zhu H, Markoulli M, Nichols KK, Naduvilath T, Papas EB. Functional and morphologic changes of meibomian glands in an asymptomatic adult population. Invest Ophthalmol Vis Sci. 2016;57:3996-2007.

[3] Rim TH, Kang MJ, Choi M, Seo KY, Kim SS. Ten-year incidence and prevalence of clinically diagnosed blepharitis in South Korea: a nationwide population-based cohort study. Clinical & Experimental Ophthalmology. 2017;45(5):448–454. doi:10.1111/ceo.12929.

[4] Deepthi KG, Prabagaran SR. Ocular bacterial infections: Pathogenesis and diagnosis. Microb Pathog. 2020;145:104206. doi: 10.1016/j.micpath.2020.104206.

[5] Pérez-Cano HJ, Rubalcava-Soberanis ML, Velázquez Salgado R. Relationship between blepharitis and components of the metabolic syndrome . Arch Soc Esp Oftalmol. 2018;93(10):476-480. doi: 10.1016/j.oftal.2018.06.001. Epub 2018 Jul 19.

[6] American Academy Of Ophthalmology. Blepharitis Preferred Practice Pattern. 2018. San Franciso: American Academy of Ophthalmology; 2018.

[7] AlDarrab A, Alrajeh M, Alsuhaibani AH. Meibography for eyes with posterior blepharitis. Saudi J Ophthalmol. 2017;31(3):131-134. doi: 10.1016/j.sjopt.2017.05.014.

[8] Gostimir M, Allen LH. Is there enough evidence for the routine recommendation of eyelid wipes? A systematic review of the role of eyelid wipes in the management of blepharitis and meibomian gland dysfunction. Canadian Journal of Ophthalmology. CJCO. 2020;55(5):424-436. doi:10.1016/j.jcjo.2020.05.015 .

[9] Muntz A, Sandford E, Claassen M, Curd L, Jackson AK, Watters G, Wang MTM, Craig JP. Randomized trial of topical periocular castor oil treatment for blepharitis. Ocul Surf. 2021;19:145-150. doi: 10.1016/j.jtos.2020.05.007.

[10] Pflugfelder SC, Karpecki PM, Perez VL. Treatment of blepharitis: recent clinical trials. Ocul Surf. 2014;12(4):273-84. doi: 10.1016/j.jtos.2014.05.005.

[11] Fadlallah A, Rami HE, Fahd D, dkk. Azithromycin 1.5% ophthalmic solution: efficacy and treatment modalities in chronic blepharitis. Arq Bras Oftalmol. 2012;75:178-82.

[12] Torkildsen GL, Cockrum P, Meier E, dkk. Evaluation of clinical efficacy and safety of tobramycin/dexamethasone ophthalmic suspension 0.3%/0.05% compared to azithromycin ophthalmic solution 1% in the treatment of moderate to severe acute blepharitis/blepharoconjunctivitis. Curr Med Res Opin. 2011;27:171-8.

[13] Opitz DL, Tyler KF. Efficacy of azithromycin 1% ophthalmic solution for treatment of ocular surface disease from posterior blepharitis. Clin Exp Optom. 2011;94:200-6.

[14] Chen M, Gong L, Sun X, dkk. A multicenter, randomized, parallel-group, clinical trial comparing the safety and efficacy of loteprednol etabonate 0.5%/tobramycin 0.3% with dexamethasone 0.1%/tobramycin 0.3% in the treatment of Chinese patients with blepharokeratoconjunctivitis. Curr Med Res Opin. 2012;28:385-94

[15] Duncan K, Jeng BH. Medical management of blepharitis. Current Opinion in Ophthalmology. 2015;26(4):289–294. doi:10.1097/icu.0000000000000164

[16] Sung J, Wang MTM, Lee SH, Cheung IMY, Ismail S, Sherwin T, Craig JP. Randomized double-masked trial of eyelid cleansing treatments for blepharitis. The Ocular Surface. 2018;16(1):77–83. doi:10.1016/j.jtos.2017.10.005

[17] Wallis EJ, Aakalu VK, Foster JA, Freitag SK, Sobel RK, Tao JP, Yen MT. Intense Pulsed Light for Meibomian Gland Disease: A Report by the American Academy of Ophthalmology. Ophthalmology. 2020;127(9):1227-1233. doi: 10.1016/j.ophtha.2020.03.009.

Diagnosis dan manajemen pada blefaritis anterior dan posterior

Abstract

References

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