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X. Q. Werdich, T. Ruez, R. P. Singh; Prevalence and Severity of Blepharitis Symptoms and Signs Amongst Patients With Age-Related Macular Degeneration. Invest. Ophthalmol. Vis. Sci. 2010;51(13):5122.
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It has been recommended that prior to intravitreal injections, the ophthalmologist should identify and treat patients with comorbidities that predispose to endophthalmitis, specifically patients with active blepharitis. However, little is known on the rates of blepharitis within this treatment population. The purpose of this study was to determine the prevalence and severity of blepharitis amongst patients with age-related macular degeneration (AMD). This group of patients may require frequent intravitreal injections.
This IRB approved study included 50 patients (21 male, 29 female, age 78.1 ± 8.48 years) with both dry (n = 21) and wet (n = 29) AMD. Common ocular surface symptoms and signs associated with blepharitis were evaluated and scored (0-4) with a self-reported survey and a clinical examination by a masked investigator. Total symptom and total sign scores were calculated and then normalized to a scale of 0-10. Severity of symptoms and signs were categorized as normal (0), mild (0.1-3.3), moderate (3.4-6.6), severe (6.7-10). The incidences and severity of blepharitis symptoms and signs were calculated and compared.
In this AMD patient population, 32% had a history of dry eye or blepharitis prior to examination and 26% had a history of rosacae. Self-reported patient surveys and masked investigator examinations demonstrated similar-high prevalence of blepharitis (86% and 94% respectively). Fourteen percent of total patients reported no symptoms, and six percent had no clinical signs of blepharitis. Most patients had mild to moderate disease. The incidences were 50% and 36% for mild, 32% and 50% for moderate, and only 4% and 8% for severe symptoms and signs of blepharitis, respectively. Self-reported symptom scores were generally lower than clinical examination scores.
The prevalence of blepharitis is very high in the AMD patient population who may require frequent intravitreal injections. Prompt evaluation and control of blepharitis and close adherence to intravitreal injection guidelines are strongly recommended to minimize possible complication with endophthalmitis.
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