Rationale for the treatment of chronic blepharoconjunctivitis and meibomian gland dysfunction

Chronic blepharoconjunctivitis, often combined with meibomian gland dysfunction (MGD), disrupts the homeostasis of the ocular surface. Traditional diagnostics of microbiocenosis is insufficient, therefore gas chromatography-mass spectrometry (GC-MS according to Osipov) was used in the study.

The purpose of the study: to substantiate the tactics of treatment of blepharoconjunctivitis and MGD based on the results of the analysis of the conjunctival cavity microbiocenosis.

Material and methods. The prospective comparative study included 48 patients (96 eyes), divided into 3 groups of 16 people (32 eyes), matched for age and gender: Group 1 — patients with combined pathology — chronic blepharoconjunctivitis and MGD; Group 2 — patients with isolated chronic blepharoconjunctivitis without severe MGD. Group 3 included patients with isolated MGD without clinical signs of active blepharoconjunctivitis. In addition to a standard ophthalmological examination, the conjunctival microbiota was analyzed using GC-MS, and combination therapy was prescribed based on this analysis. Follow-up was performed after 14 days and 1 month.

Results. Significant differences in the microbiota structure were found between the groups. Patients in Group 1 had a high total bacterial load (TBL) with a predominance of anaerobes (Clostridium spp.) and pyogenic cocci (Staphylococcus aureus). In patients in Group 2, TBL was lower. The microbial profile was characterized by mixed flora with the presence of both opportunistic (Streptococcus mutans) and certain representatives of normal flora (Lactobacillus spp., Propionibacterium freudenreichii). In patients of Group 3, dysbiosis with a deficiency of saprophytes (Bifidobacterium spp., Lactobacillus spp., Eubacterium spp.) and the growth of resistant microorganisms (Bacillus cereus) was detected. Combination therapy with moxifloxacin (Moxioftan®) and a moisturizing preparation (Optinol® Soft Recovery) led to a decrease in TBL in patients of all groups by 1 month of follow-up, with the greatest dynamics in patients of Groups 1 and 3. Clinical improvement correlated with the normalization of microbiological parameters.

Conclusion. Identification of specific microbial markers and TBL levels allows for the prescription of targeted antimicrobial therapy and the application of methods aimed at restoring the microbial and functional homeostasis of the ocular surface using modern tear substitutes.

1. Mergen B, Onal I, Gulmez A, Caytemel C, Yildirim Y. Conjunctival microbiota and blepharitis symptom scores in patients with ocular rosacea. Eye Contact Lens. 2023; 49 (8): 339–43. https://doi.org/10.1097/ICL.0000000000001008

2. Watters GA, Turnbull PR, Swift S, Petty A, Craig JP. Ocular surface microbiome in meibomian gland dysfunction. Clin Exp Ophthalmol. 2017; 45 (2): 105–11. https://doi.org/10.1111/ceo.12810

3. Chiang MC, Chern E. Ocular surface microbiota: Ophthalmic infectious disease and probiotics. Front Microbiol. 2022; 13: 952473. https://doi.org/10.3389/fmicb.2022.952473

4. Doularamani M, Murthy SI. Role of ocular surface microbiome in health and disease. Indian J Ophthalmol. 2023; 71 (6): 2595. https://doi.org/10.4103/ijo.IJO_8_23_1;26

5. Atkova E.L., Safonova T.N., Zaitseva G.V., Medvedeva E.S., Yartsev V.D. Method for treating meibomian gland dysfunction. Patent RU No. 2783655, 2022 (In Russ.).

6. Safonova T.N., Zabegailo A.O., Makarov I.A. Method for treating inflammatory conditions of the anterior eye segment. Patent RU No. 2513597, 2014 (In Russ.).

7. Zhu M, Cheng C, Yi H, Lin L, Wu K. Quantitative analysis of the bacteria in blepharitis with demodex infestation. Front Microbiol. 2018; 9: 1719. https://doi.org/10.3389/fmicb.2018.01719

8. Groden LR, Murphy B., Rodnite J., Genvert G.I. Lid flora in blepharitis. Cornea. 1991; 10: 50–3. https://doi.org/10.1097/00003226-199110010-00010

9. Bezza Benkaouha I, Le Brun C, Pisella PJ, Chandenier J, Lanotte P. La flore bactérienne dans les blépharites [Bacterial flora in blepharitis]. J Fr Ophtalmol. 2015; 38: 723–8. https://doi.org/10.1016/j.jfo.2015.01.012

10. Dong X, Wang Y, Wang W, Lin P, Huang Y. Composition and diversity of bacterial community on the ocular surface of patients with meibomian gland dysfunction. Invest Ophthalmol Vis Sci. 2019; 60 (14): 4774–83. https://doi.org/10.1167/iovs.19-27719

11. Sakhnov S.N., Yanchenko S.V., Rudashova A.S., Malyshev A.V. Non-infectious chronic blepharitis pharmacotherapy. Ophthalmology in Russia. 2013; 10 (3): 75–9 (In Russ.). https://doi.org/10.18008/1816-5095-2013-3-75-79

12. Garza A, Diaz G, Hamdan M, et al. Homeostasis and defense at the surface of the eye. The conjunctival microbiota. Curr Eye Res. 2021; 46 (1): 16. https://doi.org/10.1080/02713683.2020.1788100

13. Wang C, Dou X, Li J, et al. Composition and Diversity of the ocular surface microbiota in patients with blepharitis in Northwestern China. Front Med (Lausanne). 2021; 8: 768849. https://doi.org/10.3389/fmed.2021.768849

14. Sakhovskaya N.A., Frolov M.A., Simonova A.V. Conjunctival sac microbiome status and the use of picloxidine dihydrochloride in children with infectious conjunctivitis. Medical council. 2024; (11): 221–7 (In Russ.). https://doi.org/10.21518/ms2024-332

15. Safonova T.N., Zaitseva G.V., Timoshenkova E.I. Chemical analysis of meibum composition of type 2 diabetes mellitus. Ophthalmology reports. 2024; 17 (1): 89–102 (In Russ.). https://doi.org/10.17816/OV488056

16. Jing D, Jiang X, Ren X, et al. Metagenomic nanopore sequencing of ocular microbiome in patients with meibomian gland dysfunction. Front Med (Lausanne). 2022; 9: 1045990. https://doi.org/10.3389/fmed.2022.1045990

17. Shokirova M.M., Kopaeva V.G., Malysheva Z.G., Simonova T.A. Condition of the eyelid margins depending on the identified bacterial flora in patients with posterior blepharitis combined with demodicosis of the eyelids. Practical medicine. 2017; 110 (9): 259–62 (In Russ.).

18. Jiang X, Deng A, Yang J, et al. Pathogens in the Meibomian gland and conjunctival sac: microbiome of normal subjects and patients with Meibomian gland dysfunction. Infect Drug Resist. 2018; 11: 1729–40. https://doi.org/10.2147/IDR.S162135

19. Bikbov M.M., Orenburkina O.I., Babushkin A.E. Microbiota of the ocular surface in infectious/ inflammatory eye diseases. Russian ophthalmological journal. 2024; 17 (4): 107–10 (In Russ.). https://doi.org/10.21516/2072-0076-2024-17-4-107-110

20. Kleshcheva E.A., Chernakova G.M., Melnikova N.V., Kleshchev A.E. Bacterial flora of the eyelids and conjunctiva in the development of inflammatory pathology in the anterior part of the eye. Russian journal of clinical ophthalmology. 2024; 24 (4): 211–6 (In Russ.). https://doi.org/10.32364/2311-7729-2024-24-4-8