What is Blepharitis?Learn the Signs & SymptomsManagement & Treatment
News in ophthalmology : What is Blepharitis?Learn the Signs & SymptomsManagement & Treatment
Indication
Zylet® (loteprednol etabonate 0.5% and tobramycin 0.3% ophthalmic suspension) is a topical anti-infective and steroid combination for steroid-responsive inflammatory ocular conditions for which a corticosteroid is indicated and where superficial bacterial ocular infection or a risk of bacterial ocular infection exists.
Ocular steroids are indicated in inflammatory conditions of the palpebral and bulbar conjunctiva, cornea and anterior segment of the globe such as allergic conjunctivitis, acne rosacea, superficial keratitis, herpes zoster keratitis, iritis, cyclitis, and where the inherent risk of steroid use in certain infective conjunctivitides is accepted to obtain a diminution in edema and inflammation. They are also indicated in chronic anterior uveitis and corneal injury from chemical, radiation or thermal burns, or penetration of foreign bodies. The use of a combination drug with an anti-infective component is indicated where the risk of superficial ocular infection is high or where there is an expectation that potentially dangerous numbers of bacterial will be present in the eye.
The particular anti-infective drug in this product (tobramycin) is active against the following common bacterial eye pathogens: Staphylococci, including S. aureus and S. epidermidis (coagulase-positive and coagulase-negative), including penicillin-resistant strains. Streptococci, including some of the Group A-beta-hemolytic species, some nonhemolytic species, and some Streptococcus pneumonia, Pseudomonas aeruginosa, Escherichia coli, Kledsiella pneumonia, Enterobacter aerogenes, Protoeus mirabilis, Morganella morganii, most Proteus vulgaris strains, Haemophilus influenza, and H. aegyptius, Moraxella lacunata, Acinetobacter calcoaceticus and some Neisseria species.
See full Important Safety Information about Zylet® below.
What is Blepharitis?
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Blepharitis refers to a variety of eyelid conditions characterized by inflammation and bacterial overgrowth or infection (or the risk of infection). As definitions and sub-categories of blepharitis have changed over the years, clear-cut estimates of prevalence have been challenging to obtain,1 but blepharitis is one of the most common disorders that eyecare practitioners encounter.2 Blepharitis affects a broad swath of patients, including younger patients who may have seborrheic dermatitis (Fig. 1) or acne rosacea;2 contact lens wearers;1 candidates for refractive, cataract, or other ocular surgeries;1 and those who are simply bothered by its symptoms. Often chronic and recurring, the types of blepharitis can be distinguished based on anatomical location. Anterior blepharitis affects the anterior lid margin and eyelashes, while posterior blepharitis primarily affects the meibomian glands.2 A detailed history and careful attention to the lids, lashes, and meibomian glands during the slit lamp examination will aid in blepharitis detection and diagnosis. (Fig. 2) Comorbidities, including chalazion and hordeolum, conjunctivitis, keratopathy (from superficial punctuate keratitis to peripheral ulceration),2 and dry eye disease may be present with blepharitis.2
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Untreated blepharitis may, over time, lead to irreversible structural damage, such as eyelid notching and vision-threatening sequelae such as corneal neovascularization and scarring.1 Eyelid hygiene is essential in the management of blepharitis and acute presentations may benefit from combined anti-inflammatory/anti-infective therapy.2 Combined agents can be particularly useful in the treatment of blepharitis.2
References:
- Lemp MA, Nichols KK. Blepharitis in the United States 2009: A survey-based perspective on prevalence and treatment. Ocul. Surf. 2009;7(2) Suppl:A1-A22.
- Jackson WB. Blepharitis: current strategies for diagnosis and management. Can J Ophthalmol. 2008;43:170-9.
Important Risk Information about ZYLET®
- Zylet® is contraindicated in most viral diseases of the cornea and conjunctiva including epithelial herpes simplex keratitis (dendritic keratitis), vaccinia, and varicella, and also in mycobacterial infection of the eye and fungal diseases of ocular structures.
- Prolonged use of corticosteroids may result in glaucoma with damage to the optic nerve, defects in visual acuity and fields of vision. Steriods should be used with caution in the presence of glaucoma. If this product is used for 10 days or longer, intraocular pressure should be monitored.
- Use of corticosteroids may result in posterior subcapsular cataract formation.
- The use of steriods after cataract surgery may delay healing and increase the incidence of bleb formation. In those diseases causing thinning of the cornea or sclera, perforations have been known to occur with the use of topical steroids. The initial prescription and renewal of the medication order should be made by a physician only after examination of the patient with the aid of magnification such as a slit lamp biomicroscopy and, where appropriate, fluorescein staining.
- Prolonged use of corticosteroids may suppress the host response and thus increase the hazard of secondary ocular infections. In acute purulent conditions, steroids may mask infection or enhance existing infections. If signs and symptoms fail to improve after 2 days, the patient should be re-evaluated.
- Employment of corticosteroid medication in the treatment of patients with a history of herpes simplex requires great caution. Use of ocular steroids may prolong the course and exacerbate the severity of many viral infections of the eye (including herpes simplex).
- Fungal infections of the cornea are particularly prone to develop coincidentally with long-term local steroid application. Fungus invasion must be considered in any persistent corneal ulceration where a steroid has been used or is in use.
- Most common adverse reactions reported in patients were injection and superficial punctate keratitis, increased intraocular pressure, burning, and stinging upon instillation.
Please click here to view the ZYLET® full prescribing information.
ZYLET is a registered trademark of Bausch & Lomb Incorporated or its affiliates.
Content © 2014 Bausch & Lomb Incorporated. US/ZYL/14/0011
