Blepharitis historical perspective
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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 1942, Scobee noted frequent isolation of staphylococci from meibomian gland cultures in both patients and normal controls.[5] 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 leading to blepharitis.[6]
Classification
Several classification systems have been developed based on etiology and findings in meibography, tear osmolarity, or 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.[7]
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.[8]
In 1982, the classification was superseded by a more precise scheme based on 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.[9]
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.[10] Bron et al. divided meibomian gland diseases by morphologic features in biomicroscopy.[11]
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.
- ↑ 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.