Untreated eyelid inflammatory disorders pose risk for postoperative complications

Cheryl Guttman
in Orlando

Miguel J Maldonado MD, PhD.

CAREFUL screening for eyelid inflammatory disorders should be performed immediately prior to Lasik surgery, because if left untreated, they can lead to postoperative complications and delays in visual recovery, according to Miguel J. Maldonado MD, PhD.
Dr Maldonado and José Juberías MD, University of Navarra, Spain reviewed data from 724 eyes they operated on for myopia or hyperopia with or without astigmatism to characterise complications of Lasik associated with untreated eyelid inflammatory disorders.

All eyes in the series were examined preoperatively to diagnose and treat any eyelid inflammatory disorder, although the patients did not return for Lasik surgery until three to 76 days later, with a mean of 15 days.
During the immediate postoperative period, the researchers identified an eyelid inflammatory disorder in 54 (7.5%) eyes. With the exception of one case, the achievement of BCVA was delayed anywhere from seven to 45 days, Dr Maldonado told the annual meeting of the American Academy of Ophthalmology.

“The importance of performing Lasik only in eyes with a healthy ocular surface has already been highlighted. However, an eyelid inflammatory condition might go unnoticed during the preoperative examination if it is only mild or even moderately severe, or the disorder may be quiescent at that visit but flare by the time the patient returns for surgery.
“We suggest that screening for eyelid inflammatory conditions should be repeated on the day of surgery to allow necessary treatment and thereby avoid complications which can worsen the surgical outcome,” he advised.

The surgeons used the Hansatome microkeratome and the Technolas 217 excimer laser for all the Lasik procedures. Of the 54 eyes diagnosed with an eyelid inflammatory disorder, 52 had a chronic blepharitis, either meibomian gland dysfunction (six eyes), meibomitis (two eyes), or mixed anterior and posterior chronic blepharitis (44 eyes).
An acute internal hordeola was diagnosed in the remaining two eyes. Both of the latter eyes with acute blepharitis developed extensive corneal ulceration and did not achieve BCVA for two to three weeks after Lasik, while a variety of complications occurred among the eyes with chronic blepharitis.

Forty-two of the 44 eyes with mixed anterior and posterior chronic blepharitis developed persistent punctuate keratopathy, while two showed marginal non-infectious keratitis.
Eyes with localised meibomian gland dysfunction developed corneal epithelial defects (four eyes) or early flap displacement (two eyes).
The two eyes with meibomitis were affected by meibomian deposits in the interface. One of the latter two eyes achieved good BCVA at the one day post-Lasik visit. The other eye with meibomian deposits in the interface as well as in one eye affected by marginal non-infectious keratitis did not achieve BCVA until seven days after surgery.
Other complications were associated with a longer delay in achieving BCVA. Among eyes with corneal epithelial defects, BCVA was achieved at a mean of 16 days postoperatively.

The two cases of early flap displacement were associated with BCVA return at 30 and 45 days after surgery, respectively. The eyes with persistent punctuate keratopathy achieved BCVA in an average of 24 days after Lasik.
For patients who exhibit eyelid inflammatory conditions, both doctors recommend eyelid cleansing performed once or twice daily using an aqueous gel to remove crusts and secretions from the eyelash root in eyes with anterior blepharitis or a solution for removing lipid secretions associated with posterior blepharitis.

In eyes with meibomian gland dysfunction, cleansing should be preceded by the application of warm compresses to liquefy the meibomian secretions followed by eyelid massage to further enhance eyelid hygiene.
Patients with a diagnosis of staphylococcal anterior blepharitis require topical antibiotic treatment. Systemic therapy with an oral tetracycline may be necessary in more severe cases where meibomitis is the predominant feature, Dr Maldonado said.

Miguel J. Maldonado MD, PhD
University of Navarra, Spain
Email: mjmaldonad@unav.es

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