Abstract
A double masked, placebo controlled clinical trial, of topical 2% ketoconazole cream with lid hygiene, for the treatment of seborrhoeic and mixed seborrhoeic/staphylococcal blepharitis was conducted.
Forty patients with symptomatic blepharitis, 20 randomly allocated to ketoconazole, 20 to placebo were entered.
Treatment efficacy was assessed by improvement of symptoms using visual analogue scales, appearance of the eyelids and reduction in numbers of pityrosporum yeasts on the eyelids.
Both groups showed a similar reduction in symptoms, and signs of inflammation. The overall clinical impression in the ketoconazole group was better at week five than in the placebo group. Sixty nine per cent were either normal or markedly improved, as compared to 42% in the placebo group, although this was not statistically significant (p<0.1, one-sided Mann-Whitney). Pityrosporum numbers were reduced significantly in both groups during the treatment period.
Ketocanazole was no better than placebo at improving the symptoms of blepharitis. More ketoconazole treated patients had normal or markedly improved lids after treatment than the placebo group. Pityrosporum yeasts may play a role in blepharitis, and treatment with an antifungal has some advantages over conventional therapy.
Similar content being viewed by others
Article PDF
References
Dougherty JM and McCulley JP : Comparative bacteriology of chronic blepharitis. Br J Ophthalmol 1984, 68: 524–8.
McCulley JP, Dougherty JM, Deneau DG : Classification of chronic blepharitis. Ophthalmology 1982, 89: 1173–80.
Galin MA : Bacteriological aspects of blepharitis. Arch Ophthalmol 1962, 67: 746–9.
Smolin G and Okumoto M : Staphylococcal blepharitis. Arch Ophthalmol 1977, 95: 812–6.
McCulley JP and Dougherty JM : Bacterial aspects of chronic blepharitis. Trans Ophthalmol Soc UK 1986, 105: 314–18.
Ford GP, Farr PM, Ive FA, Shuster S : The response of seborrhoeic dermatitis to ketoconazole. Br J Dermatol 1984, 111: 603–7.
Hay RJ and Midgley G : Pathogenic mechanisms of Piyrosporum infection. In Seborrhoeic dermatitis and dandruff-a fungal disease. International Congress and Symposium Series Number 132, Editors Shuster S and Blatchford N, Royal Society of Medicine Services, London and New York 1988, pp. 13–19.
Carr MM, Pryce DM, Ive FA : Treatment of seborrhoeic dermatitis with ketoconazole I. Br J Dermatol 1987, 116: 213–6.
Green CA, Farr PM, Shuster S : Treatment of seborrhoeic dermatitis with ketoconazole II. Br J Dermatol 1987, 116:217–21.
Thygeson P : Aetiology and treatment of blepharitis. Arch Ophthalmol 1956, 36: 445–77.
Gots JS, Thygeson P, Waisman M : Observations on Pityrosorum ovale in seborrhoeic blepharitis and conjunctivitis. Am J Ophthalmol 1947, 30: 1485–95.
Parunovic A and Halde C : Pityrosporum orbiculare; Its possible role in seborrhoeic blepharitis. Am J Ophthalmol 1967, 63: 815–20.
Polack FM and Goodman DF : Experience with a new detergent lid scrub in the management of chronic blepharitis. Arch Ophthalmol 1988, 106: 719–20.
Leibowitz HM and Capino D : Treatment of chronic blepharitis. Arch Ophthalmol 1988, 106: 720.
Cohen MM : A simple procedure for staining tinea versicolor (M. furfur) with fountain pen ink. J Invest Dermatol 1954, 22: 9–10.
Van Abbe NJ : The investigation of dandruff. J Soc Cosmet Chem 1964, 15: 609–30.
Seal DV : Bacterial classification and diagnosis. Trans Ophthalmol Soc UK 1986, 105: 32-6.
Seal DV, McGill JI, Jacobs P, Liakos GM, Goulding NJ : Microbial and immunological investigation of chronic non-ulcerative blepharitis and meibon mianitis. Br J Ophthalmol 1985, 69: 604–11.
Dougherty JM and McCulley JP : Bacterial lipasei and chronic blepharitis. J Invest Ophthalmol Vi Sci 1986, 27: 486–91.
Keith CG : Seborrhoeic blepharo-kerato-conjunctivitis. Trans Ophthalmol Soc UK 1967, 87: 85–103.
McCulley JP and Sciallis GF : Meibomian keratoconjunctivitis. Am J Ophthalmol 1977,84: 788–93.
Gutgesell VJ, Stern GA, Hood CI : Histopathology of meibomian gland dysfunction. Am J Ophthalmol 1982, 94: 383–7.
Midgley G : The diversity of Pityrosporum (Malassezia) yeasts in vivo and in vitro. Mycopathologica (1989 in press).
Shuster S : The aetiology of dandruff and the mode of action of therapeutic agents. Br J Dermatol 1984, 111: 235–42.
Neumann HAM and Berretty PJM : Treatment of Pityrosporum folliculitis with ketoconazole. Mykosen 1981, 24: 167–71.
Ford GP, Ive FA, Midgley G : Pityrosporum folliculitis and ketoconazole. Br J Dermatol 1982, 107: 691–5.
Nazzaro-Porro M, Passi S, Picardo M, Mercantini R, Breathnach AS : Lipoxygenase activity of Pityrosporum in vitro and in vivo. J Invest Dermatol 1986, 87: 108–12.
Mondino BJ, Caster AI, Dethlefs B : A rabbit model of staphylococcal blepharitis. Arch Opthalmol 1987, 105: 409–12.
Author information
Authors and Affiliations
Rights and permissions
About this article
Cite this article
Nelson, M., Midgley, G. & Blatchford, N. Ketoconazole in the treatment of blepharitis. Eye 4, 151–159 (1990). https://doi.org/10.1038/eye.1990.20
Issue Date:
DOI: https://doi.org/10.1038/eye.1990.20