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    Complex processes drive ocular surface disease

    Numerous interactions, cascades exist in disease states


    ·      the only statistically significant bacterium identified was Staphylococcus aureus in the staphylococcal and mixed staphylococcal/seborrheic groups;

    ·      coagulase-negative staphylococcus and S. aureus frequently produced lipolytic exoenzymes that can break down meibomian gland secretions;

    ·      chemical analysis of meibum showed a complex of nonpolar and polar lipids with statistically significant decreases in splingomyelin and phosphatidylethanolamine in patients with associated aqueous deficient dry eyes;

    ·      all patients with associated aqueous deficient dry eyes had excessive aqueous tear evaporation and meibomian gland drop out compared with normal patients.

    This analysis resulted in one unexpected observation, according to Dr. McCulley, namely, that 25% to 50% of all types of patients with chronic blepharitis had keratoconjunctivitis sicca with possible contributions from hyposecretion, hyperevaporation, and/or molecular surface toxicity.

    He cited a detergent effect of OXFFA, FUFA, PA on the lipid layer leading to loss of integrity and a direct detergent effect on epithelial cell membrane leading to cell death and dry spot formation with inflammation and possible contribution to an aqueous deficient dry eyes component.


    James McCulley, MD

    E: [email protected]

    Dr. McCulley has no financial interest in any aspect of this report.


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