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    Complex processes drive ocular surface disease

    Numerous interactions, cascades exist in disease states

     

    When Dr. McCulley began to delve into this area of research more than four decades ago, he found that patients with chronic blepharitis often had superficial punctate epithelial erosions. This was especially true of the patients with meibomianitis and seemed to be secondary to a tear lipid abnormality and not staphylococcal exotoxins.

    Though this observation resulted in extended research funding by the National Eye Institute/National Institutes of Health, there is still no surgical treatment available for these patients, Dr. McCulley noted.

    In their later work, in the early 1980s, Dr. McCulley and colleagues published a classification of chronic blepharitis (Ophthalmology 1982;89:1173-1180)—staphylococcus, seborrhea (alone, with staphylococcal superinfection, with meibomian seborrhea, or with secondary meibomianitis), primary meibomianitis, meibomian gland dysfunction with seborrhea sicca, and others such as atopic, psoriatic, and fungal causes.

    Dr. McCulley recently focused his research to identify an association among the different types of chronic blepharitis, changes in meibomian secretions, and underlying causes of aqueous deficiency in dry eyes.

    Initially, he and his colleagues classified patients with chronic blepharitis based on his classification system. The investigators then cultured lid and conjunctival cul-de-sac aerobic and anaerobic pathogens and assessed the frequently recovered bacteria for production of lipolytic exoenzymes.

    They also performed in-depth lipid biochemical analyses of the meibomian sections of each patient, determined the presence of associated aqueous deficient dry eyes clinically, measured the tear evaporative rate using an evaporometer, and performed meibography to assess the anatomic changes in the meibomian glands.

    NEXT: Dr. McCulley reported the following key findings...

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