Blepharitis historical perspective: Difference between revisions
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==Overview== | ==Overview== | ||
Blepharitis was first described in the late 19<sup>th</sup> century as "conjunctivitis meibomianae" in a patient with accumulated sebaceous-like material in the meibomian glands. | |||
==Historical Perspective== | ==Historical Perspective== | ||
===Terminology=== | |||
The terminology for blepharitis has evolved alongside the advance in its pathophysiology and treatment. Early terms used to describe related meibomian gland conditions include ophthalmia tarsi, puriform palpebral flux, polyadenitis meibomiana chronica suppurativa, conjunctivitis meibomianae, meibomian seborrhea, keratitis meibomiana, seborrheic blepharoconjunctivitis, meibomian keratoconjunctivitis, meibomianitis, and meibomitis. | |||
The earliest description of blepharitis dates back to 1894, when Lydston reported the clinical entity "conjunctivitis meibomianae" in a patient with accumulated sebaceous-like material in the meibomian glands.<ref> Lydston, James A. "CONJUNCTIVITIS MEIBOMIANÆ." Journal of the American Medical Association 23.6 (1894): 241-242.</ref> | |||
In 1901, Maklahoff reported another case characterized by dilated meibomian gland openings with pus formation in the glands.<ref>Maklahoff, AA. "Zur Bactderchron eitrigen Entzund der Gland Meib des Lides." Arch fur Augenheilkd. 13.10 (1901).</ref> | |||
In 1908, Elschnig described the symptom of meibomian gland hypersecretion which could be relieved by emptying of the glands and the use of astringents.<ref>Elschnig, A. "Beitrag zur Aethiologie und Therapie der cronischen Konjunctivitis." Deuts Med Wochenschr 26 (1908): 1133-1135.</ref> | |||
In 1921, Gifford isolated ''Staphylococcus aureus'' and ''Bacillus xerosis'' from meibomian gland cultures of young and elderly individuals, respectively.<ref>Gifford, Sanford R. "The etiology of chronic meibomitis." American Journal of Ophthalmology 4.8 (1921): 566-570.</ref> | |||
In 1922, Cowper reported a case of "meibomian seborrhea" treated by astringents, yellow oxide, and radiation with only temporary relief.<ref>Cowper, H. W. "Meibomian seborrhea." American Journal of Ophthalmology 5.1 (1922): 25-30.</ref> | |||
In 1942, Scobee noted frequent isolation of staphylococci from meibomian gland cultures in both conjunctivitis patients and normal controls.<ref>Scobee, Richard G. "The Role of the Meibomian Glands in Recurrent Conjunctivitis: A Review with Experimental Observations." American Journal of Ophthalmology 25.2 (1942): 184-192.</ref> This finding suggested that colonization of microorganisms may play a role in the pathogenesis. Scobee also recommended the use of lid massage and adrenalin in conjunction with antiseptic eyedrops to promote drainage of the meibomian glands. | |||
Several terms indicating the site of involvement have been used extensively in the later studies. The term "meibomian gland dysfunction", suggested by Gutgesell et al. in 1982, gained general acceptance and has been used to describe the spectrum of meibomian gland abnormalities associated with blepharitis.<ref>Gutgesell, Vicki J., George A. Stern, and C. Ian Hood. "Histopathology of meibomian gland dysfunction." American journal of ophthalmology 94.3 (1982): 383-387.</ref> | |||
===Classification=== | |||
Several classifications for blepharitis have been developed on the basis of etiology, anatomy, clinical manifestations, meibography findings, tear osmolarity, and Schirmer testing. | |||
In 1921, Gifford proposed the earliest classification of blepharitis, which divided chronic meibomian gland disease into six categories: 1) hypersecretion, 2) chronic meibomitis, 3) chronic meibomitis with hypertrophy, 4) chronic meibomitis with chalazia, 5) chronic meibomitis secondary to chronic conjunctivitis, and 6) chronic meibomitis with concretions.<ref>Gifford, Sanford R. "Meibomian glands in chronic blepharo-conjunctivitis." American Journal of Ophthalmology 4.7 (1921): 489-494.</ref> | |||
In 1946, Thygeson developed a classification system according to the etiology: 1) seborrheic, 2) staphylococcal, 3) mixed seborrheic and staphylococcal, and 4) blepharitis due to ''Hemophilus duplex''.<ref>Thygeson, Phillips. "Etiology and treatment of blepharitis: a study in military personnel." Archives of Ophthalmology 36.4 (1946): 445-477.</ref> | |||
In 1982, the classification was superseded by a more precise scheme developed by McCulley et al. on the basis of clinical criteria: 1) staphylococcal, 2) seborrheic, 3) mixed seborrheic/staphylococcal, 4) seborrheic with meibomian seborrhea, 5) seborrheic with secondary meibomitis, 6) primary meibomitis (also known as meibomian keratoconjunctivitis), and 7) other including atopic, psoriatic, and fungal.<ref>McCulley, James P., Joel M. Dougherty, and David G. Deneau. "Classification of chronic blepharitis." Ophthalmology 89.10 (1982): 1173-1180.</ref> | |||
In 1991, Mathers et al. classified meibomian gland dysfunction based on meibomian gland morphology, tear osmolarity, and Schirmer test: 1) seborrheic, 2) obstructive, 3) obstructive with sicca, and 4) sicca.<ref>Mathers, William D., et al. "Meibomian gland dysfunction in chronic blepharitis." Cornea 10.4 (1991): 277-285.</ref> Bron et al. utilized morphologic features on slit-lamp biomicroscopy to categorize meibomian gland diseases.<ref>Bron, A. J., L. Benjamin, and G. R. Snibson. "Meibomian gland disease. Classification and grading of lid changes." Eye 5.Pt 4 (1991): 395-411.</ref> | |||
In 1992, Wilhelmus described a clinically useful approach to classify blepharitis based on the affected location of the lid margin delineated by the gray line (the muscle of Riolan): anterior blepharitis vs. posterior blepharitis.<ref>Wilhelmus, K. R. "Inflammatory disorders of the eyelid margins and eyelashes." Ophthalmol Clin North Am 5.2 (1992): 187.</ref> | |||
In 2003, Foulks and Bron devised a classification for meibomian glad dysfunction that integrated anatomic changes, gland expressibility, biochemical alterations of meibomian gland lipids, and the underlying etiology.<ref>Foulks, Gary N., and Anthony J. Bron. "Meibomian gland dysfunction: a clinical scheme for description, diagnosis, classification, and grading." The ocular surface 1.3 (2003): 107-126.</ref> | |||
In 2011, the International Workshop on Meibomian Gland Dysfunction presented a detailed classification system that distinguishes among the subgroups by the level of secretions and further subdivides those categories by potential consequences and manifestations.<ref>Nelson, J. Daniel, et al. "The international workshop on meibomian gland dysfunction: report of the definition and classification subcommittee." Investigative ophthalmology & visual science 52.4 (2011): 1930-1937.</ref> | |||
==References== | ==References== | ||
{{reflist|2}} | {{reflist|2}} | ||
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[[Category:Ophthalmology]] | [[Category:Ophthalmology]] | ||
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Sara Mehrsefat, M.D. [2]
Overview
Blepharitis was first described in the late 19th century as "conjunctivitis meibomianae" in a patient with accumulated sebaceous-like material in the meibomian glands.
Historical Perspective
Terminology
The terminology for blepharitis has evolved alongside the advance in its pathophysiology and treatment. Early terms used to describe related meibomian gland conditions include ophthalmia tarsi, puriform palpebral flux, polyadenitis meibomiana chronica suppurativa, conjunctivitis meibomianae, meibomian seborrhea, keratitis meibomiana, seborrheic blepharoconjunctivitis, meibomian keratoconjunctivitis, meibomianitis, and meibomitis.
The earliest description of blepharitis dates back to 1894, when Lydston reported the clinical entity "conjunctivitis meibomianae" in a patient with accumulated sebaceous-like material in the meibomian glands.[1]
In 1901, Maklahoff reported another case characterized by dilated meibomian gland openings with pus formation in the glands.[2]
In 1908, Elschnig described the symptom of meibomian gland hypersecretion which could be relieved by emptying of the glands and the use of astringents.[3]
In 1921, Gifford isolated Staphylococcus aureus and Bacillus xerosis from meibomian gland cultures of young and elderly individuals, respectively.[4]
In 1922, Cowper reported a case of "meibomian seborrhea" treated by astringents, yellow oxide, and radiation with only temporary relief.[5]
In 1942, Scobee noted frequent isolation of staphylococci from meibomian gland cultures in both conjunctivitis patients and normal controls.[6] This finding suggested that colonization of microorganisms may play a role in the pathogenesis. Scobee also recommended the use of lid massage and adrenalin in conjunction with antiseptic eyedrops to promote drainage of the meibomian glands.
Several terms indicating the site of involvement have been used extensively in the later studies. The term "meibomian gland dysfunction", suggested by Gutgesell et al. in 1982, gained general acceptance and has been used to describe the spectrum of meibomian gland abnormalities associated with blepharitis.[7]
Classification
Several classifications for blepharitis have been developed on the basis of etiology, anatomy, clinical manifestations, meibography findings, tear osmolarity, and Schirmer testing.
In 1921, Gifford proposed the earliest classification of blepharitis, which divided chronic meibomian gland disease into six categories: 1) hypersecretion, 2) chronic meibomitis, 3) chronic meibomitis with hypertrophy, 4) chronic meibomitis with chalazia, 5) chronic meibomitis secondary to chronic conjunctivitis, and 6) chronic meibomitis with concretions.[8]
In 1946, Thygeson developed a classification system according to the etiology: 1) seborrheic, 2) staphylococcal, 3) mixed seborrheic and staphylococcal, and 4) blepharitis due to Hemophilus duplex.[9]
In 1982, the classification was superseded by a more precise scheme developed by McCulley et al. on the basis of clinical criteria: 1) staphylococcal, 2) seborrheic, 3) mixed seborrheic/staphylococcal, 4) seborrheic with meibomian seborrhea, 5) seborrheic with secondary meibomitis, 6) primary meibomitis (also known as meibomian keratoconjunctivitis), and 7) other including atopic, psoriatic, and fungal.[10]
In 1991, Mathers et al. classified meibomian gland dysfunction based on meibomian gland morphology, tear osmolarity, and Schirmer test: 1) seborrheic, 2) obstructive, 3) obstructive with sicca, and 4) sicca.[11] Bron et al. utilized morphologic features on slit-lamp biomicroscopy to categorize meibomian gland diseases.[12]
In 1992, Wilhelmus described a clinically useful approach to classify blepharitis based on the affected location of the lid margin delineated by the gray line (the muscle of Riolan): anterior blepharitis vs. posterior blepharitis.[13]
In 2003, Foulks and Bron devised a classification for meibomian glad dysfunction that integrated anatomic changes, gland expressibility, biochemical alterations of meibomian gland lipids, and the underlying etiology.[14]
In 2011, the International Workshop on Meibomian Gland Dysfunction presented a detailed classification system that distinguishes among the subgroups by the level of secretions and further subdivides those categories by potential consequences and manifestations.[15]
References
- ↑ Lydston, James A. "CONJUNCTIVITIS MEIBOMIANÆ." Journal of the American Medical Association 23.6 (1894): 241-242.
- ↑ Maklahoff, AA. "Zur Bactderchron eitrigen Entzund der Gland Meib des Lides." Arch fur Augenheilkd. 13.10 (1901).
- ↑ Elschnig, A. "Beitrag zur Aethiologie und Therapie der cronischen Konjunctivitis." Deuts Med Wochenschr 26 (1908): 1133-1135.
- ↑ Gifford, Sanford R. "The etiology of chronic meibomitis." American Journal of Ophthalmology 4.8 (1921): 566-570.
- ↑ Cowper, H. W. "Meibomian seborrhea." American Journal of Ophthalmology 5.1 (1922): 25-30.
- ↑ Scobee, Richard G. "The Role of the Meibomian Glands in Recurrent Conjunctivitis: A Review with Experimental Observations." American Journal of Ophthalmology 25.2 (1942): 184-192.
- ↑ Gutgesell, Vicki J., George A. Stern, and C. Ian Hood. "Histopathology of meibomian gland dysfunction." American journal of ophthalmology 94.3 (1982): 383-387.
- ↑ Gifford, Sanford R. "Meibomian glands in chronic blepharo-conjunctivitis." American Journal of Ophthalmology 4.7 (1921): 489-494.
- ↑ Thygeson, Phillips. "Etiology and treatment of blepharitis: a study in military personnel." Archives of Ophthalmology 36.4 (1946): 445-477.
- ↑ McCulley, James P., Joel M. Dougherty, and David G. Deneau. "Classification of chronic blepharitis." Ophthalmology 89.10 (1982): 1173-1180.
- ↑ Mathers, William D., et al. "Meibomian gland dysfunction in chronic blepharitis." Cornea 10.4 (1991): 277-285.
- ↑ Bron, A. J., L. Benjamin, and G. R. Snibson. "Meibomian gland disease. Classification and grading of lid changes." Eye 5.Pt 4 (1991): 395-411.
- ↑ Wilhelmus, K. R. "Inflammatory disorders of the eyelid margins and eyelashes." Ophthalmol Clin North Am 5.2 (1992): 187.
- ↑ Foulks, Gary N., and Anthony J. Bron. "Meibomian gland dysfunction: a clinical scheme for description, diagnosis, classification, and grading." The ocular surface 1.3 (2003): 107-126.
- ↑ Nelson, J. Daniel, et al. "The international workshop on meibomian gland dysfunction: report of the definition and classification subcommittee." Investigative ophthalmology & visual science 52.4 (2011): 1930-1937.