In this prospective, non-randomised cross-sectional study the authors demonstrate the presence of fungi in patients with chronic anterior blepharitis of at least two years duration. Eyelash samples were obtained by epilation with sterile forceps and evaluated with PAS staining, fungal cultures and microscopy. Nineteen patients (11 male and eight females) with seborrheic or mixed seborrheic / staphylococcal blepharitis and 11 healthy controls (six male and five females) were enrolled. Mean ages of patients with blepharitis and control group were 50.74+/- 20.93 years (median 58, range 18-80) and 55.73+/-17.33 years (median 58, range 27-80 years). Fungal hyphae or spores were demonstrated in 79% of blepharitis and 18% of the control group. The difference was statistically significant (P=0.002). The isolated fungi were Penicillum species (two cases), Candida species (one case) and Trichophyton verrucosum (one case). Fungi are implied as the primary pathogen of blepharitis. This might account for the chronicity of the disease. Alternatively, long-term use of antibiotics +/- steroids may have also contributed to the chronic clinical course of the disease adding to unresponsiveness and increase in virulence of the fungi. The authors advocate PAS staining for demonstrating fungi – an easy, rapid and inexpensive method. The authors’ emphasis of fungal aetiology in chronic blepharitis may change the therapeutic approach of the disease to include antifungals in future. Further randomised control trials (RCTs) are required in this direction. A limitation of the study was the small sample size. 

Periodic acid-Schiff Staining demonstrates fungi in patients with chronic blepharitis.
Dadaci Z, Kilinc F, Ozer TT, et al.
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Sofia Rokerya

MBBS MRCOphth FRCSI, King's College University Hospital, UK.

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