List of Abbreviations
AB — allergic blepharitis
BB — bacterial blepharitis
BKC — blepharokeratoconjunctivitis
MGD — meibomian gland dysfunction
PB — posterior blepharitis
ICD-10 – International Classification of Diseases 10th Revision
NSAIDs – nonsteroidal anti-inflammatory drugs
AB – anterior blepharitis
PztB – parasitic blepharitis
SB – staphylococcal blepharitis
SebB – seborrheic blepharitis
DED – dry eye disease
** – the trade name of a medicinal product is marked with two asterisks (**) if the recommendation thesis refers to a medicinal product for medical use included in the list of vital and essential drugs for medical use
# – this sign designates a medicinal product used for indications not included in the approved product labeling
Terms and Definitions
Blepharitis is an inflammatory or infectious process of the eyelid margin, typically involving the skin, eyelashes, and meibomian glands, and is usually bilateral.
Meibomian gland dysfunction is a chronic, diffuse abnormality of the meibomian glands, commonly characterized by terminal duct obstruction and/or qualitative/quantitative changes in the glandular secretion.
Chalazion is an acute or inflammatory condition of the meibomian gland resulting from its occlusion, which leads to obstructive impairment of meibum excretion from the ducts. It is currently considered a lipogranuloma.
Hordeolum is an acute inflammation of the sebaceous gland around the eyelash, typically of bacterial etiology.
1. Brief information on the disease or condition
1.1 Definition of the disease or condition
Blepharitis is an inflammatory or infectious process of the eyelid margin, typically involving the skin, eyelashes, and meibomian glands, and is usually bilateral [1; 2].
Bacterial blepharitis (BB) – staphylococci and their exotoxin play a primary role in the development of BB, participating in a type III hypersensitivity reaction. The cornea is quite frequently involved concomitantly in the form of marginal keratitis and peripheral corneal ulcers.
Parasitic blepharitis (PztB) – the role of the ectoparasite Demodex in the pathogenesis of chronic blepharitis remains a subject of debate. Demodex is considered widespread, infecting eyelash follicles and the sebaceous glands of the eyelids. Protozoan infections, which are rare in the Russian Federation, including leishmaniasis and trypanosomiasis, have also been described.
Allergic blepharitis (AB) – inflammation of the eyelids in atopic dermatitis, contact dermatitis, as well as Stevens–Johnson syndrome, Lyell's syndrome, and others.
Meibomian gland dysfunction is a chronic, diffuse abnormality of the meibomian glands, commonly characterized by terminal duct obstruction and/or qualitative/quantitative changes in the glandular secretion [1; 2; 14].
Chalazion is an acute or inflammatory condition of the meibomian gland resulting from its occlusion, which leads to obstructive impairment of meibum excretion from the ducts. It is currently considered a lipogranuloma [2; 3].
Hordeolum is an acute inflammation of the sebaceous gland around the eyelash, typically of bacterial etiology [3].
1.2 Etiology and pathogenesis of the disease or condition (group of diseases or conditions)
RISK FACTORS
Presence of atopic, allergic, or seborrheic dermatitis;
Rosacea;
Tear production deficiency and lacrimal gland dysfunction;
Contact lens wear;
Isotretinoin used for the treatment of severe cystic acne;
Less common risk factors include major immunological disorders such as lupus, eyelid tumors, trauma, and other dermatoses.
PATHOGENESIS
Multifactorial:
– The result of a complex interaction between pathological eyelid margin secretions, eyelid margin microorganisms, and tear film dysfunction.
Infectious blepharitis:
– Bacteria such as Staphylococcus can cause direct infection of the eyelids, provoke an exotoxin-mediated reaction, or trigger an allergic reaction to staphylococcal antigens.
Inflammatory blepharitis:
– Inflammation of the meibomian glands leads to impaired glandular secretion and tear film instability. This condition may exert a direct toxic effect and promotes bacterial growth.
1.3 Epidemiology of the Disease or Condition
According to ROSSTAT data in the Russian Federation for 2023, blepharitis accounts for 14.4% of other primary diseases of the eye and its adnexa among the adult population and 14.29% of cases among children [3].
1.4 Features of Coding the Disease or Condition
H00 Hordeolum and chalazion
H00.0 Hordeolum and other deep inflammations of the eyelid
H00.1 Chalazion
H01 Other inflammations of eyelid
H01.0 Blepharitis
H01.1 Noninfectious dermatoses of eyelid
H01.8 Other specified inflammations of eyelid
H01.9 Inflammation of eyelid, unspecified
1.5 Classification of the disease or condition
Blepharitis is classified by etiology, anatomical location, and clinical course type.
According to etiology, blepharitis is divided into the following groups:
Infectious blepharitis:
Bacterial;
Parasitic or fungal;
Viral.
Noninfectious blepharitis:
Seborrheic;
Allergic;
Associated with meibomian gland dysfunction (MGD);
Associated with rosacea.
Unspecified blepharitis:
By anatomical location of inflammation:
Anterior blepharitis – inflammation of the eyelid tissues anterior to the anatomical grey line along the lash line: eyelid skin, eyelash base, and eyelash follicles, e.g., staphylococcal (SB) or seborrheic (SebB) blepharitis [2; 3; 4; 10; 11; 24];
Posterior blepharitis – inflammation of the eyelid tissues posterior to the anatomical grey line, e.g., meibomian gland dysfunction [2; 3; 4; 10; 11; 24];
Mixed blepharitis (anterior and posterior) [2; 3; 4; 10; 11; 24].
By clinical course type:
Acute blepharitis;
Chronic blepharitis [1; 2; 4; 10; 11; 24].
1.6 Clinical presentation of the disease or condition
There is a significant overlap in symptoms across all types of blepharitis.
Complaints: flaking of the eyelid skin and crusting on the eyelids, eyelid margin redness, burning and itching of the eyelids, irritation, burning, eyelid sticking, blurred or unstable vision, contact lens intolerance, photophobia, frequent blinking [5; 6; 15].
Blepharitis is typically characterized by worsening symptoms in the morning, whereas symptom worsening later in the day is typical of moisture-deficient dry eye syndrome.
Clinical presentation: hyperemia and edema of the eyelids, crusting and scaling along the eyelid margin; crusts may cover ulcerations of the eyelid margin surface, accompanied by microabscesses of the follicles and sebaceous glands, leading to scarring and vascularization of the eyelid margin, and telangiectasias along the eyelid margin. Eyelid loss (madarosis) and corneal involvement are possible, including punctate epithelial erosions in the paraoptic and peripheral zones, marginal infiltrates, and corneal vascularization during recurrent inflammatory processes [4].
Blepharitis with frequent recurrences leads to conjunctivitis, dry eye syndrome, and keratitis, and can also exacerbate the symptoms of allergic conjunctivitis and tear film deficiency [10; 11; 12].
In pediatric practice, blepharitis frequently causes secondary immune-mediated keratitis and conjunctivitis; therefore, this spectrum of clinical manifestations has been termed blepharokeratoconjunctivitis (BKC) [7; 8; 9; 10; 11; 26]. In literature, BKC is also referred to as staphylococcal blepharokeratitis, meibomian-associated keratoconjunctivitis, pediatric ocular rosacea, and phlyctenular keratoconjunctivitis [9]. Decreased visual acuity in a child may be observed in more advanced cases with corneal involvement, including complications such as neovascularization, scarring, and ulceration. These complications potentially contribute to the development of amblyopia. Refractive amblyopia may occur due to induced irregular astigmatism resulting from corneal neovascularization or scarring, while deprivation amblyopia can occur in the presence of dense corneal opacities [7; 8; 9].
Complications of blepharitis.
Complications of blepharitis depend on its clinical form, duration, and treatment, as well as on concomitant diseases (rosacea, seborrhea, atopic dermatitis, psoriasis). Complications of blepharitis include madarosis, trichiasis, tylosis, poliosis, misdirected lacrimal puncta, corneal scarring and vascularization, descemetocele, and corneal perforation [13; 25].
MOST COMMON ASSOCIATED CONDITIONS
Seborrheic dermatitis;
Allergic or contact dermatitis;
Down syndrome (trisomy 21);
Ocular rosacea;
Dry eye (keratoconjunctivitis sicca);
Hordeolum;
Chalazion;
Systemic diseases;
Benign eyelid tumors: squamous papilloma, sebaceous gland hyperplasia, hemangioma, pyogenic granuloma;
Malignant eyelid tumors: basal cell carcinoma, squamous cell carcinoma, Kaposi sarcoma.
Chalazion.
A deep chalazion is caused by inflammation of the meibomian gland. A superficial chalazion is caused by inflammation of the gland of Zeis. A chalazion is generally benign and self-limiting [17; 18]. Recurrent chalazia should be evaluated for malignancy.
In chalazion, lipid breakdown products infiltrate surrounding tissues and provoke a granulomatous inflammatory reaction. For this reason, chalazion is also referred to as a conjunctival granuloma.
Clinical signs: A chalazion typically presents as a painless swelling on the eyelid lasting for several weeks or months. It frequently causes visual impairment or discomfort, as well as inflammation and pain. The patient occasionally has a history of previous similar lesions. As a rule, the size of a chalazion is less than 1 cm. It most commonly presents on the upper eyelid as a single lesion, although multiple lesions are possible. If the history and clinical presentation are consistent, no further evaluation is required. However, if an alternative diagnosis is suspected, a biopsy should be considered.
Hordeolum (stye) — occurs due to staphylococci infecting the eyelash hair follicle. The infection arises from the thickening, drying, or stasis of the secretion of the glands of Zeis and Moll. Purulent localized inflammation develops with leukocyte infiltration, sometimes progressing to an abscess. The patient presents with a painful, red, and swollen eyelid with no history of a foreign body or trauma. Visual acuity may be reduced [20; 22].
The diagnosis is established clinically.
In many cases, a stye may drain spontaneously without any treatment. Eyelid hygiene with saline solution or a mild shampoo (e.g., baby shampoo) can facilitate drainage. Prolonged inflammation or larger lesions may require antibiotic therapy [2; 10; 11; 23].
Complications of hordeolum (stye) — development of an eyelid abscess. Surgical treatment may be required.
2. Diagnostics, medical indications and contraindications for diagnostic methods
Diagnostic criteria for blepharitis, chalazion, and hordeolum include:
- analysis of complaints and medical history;
- ophthalmological examination data;
- results of laboratory diagnostic tests;
- results of instrumental diagnostic tests.
2.1 Complaints and Anamnesis
It is recommended to obtain a medical history and assess complaints in all patients with blepharitis, chalazion, and hordeolum to establish or clarify the diagnosis [5; 8; 10; 11; 16; 23; 24; 27-29; 41].
GDR CLE 5Grade of recommendation C (level of evidence – 5)
Comments:
In blepharitis, complaints include flaking of the eyelid skin and crusting on the eyelids, eyelid margin redness, burning and itching of the eyelids, irritation, burning, eyelid sticking, blurred or unstable vision, contact lens intolerance, photophobia, frequent blinking, eyelash loss, crusts, and ulcers on the eyelids. During the interview, attention should be paid to the onset and progression of the disease, its duration, worsening of the condition towards the evening after visual strain, and the presence of concomitant dermatological pathology or atopy.
In chalazion, complaints include a painless eyelid lesion that appeared over several weeks or months, visual impairment or discomfort, and rarely, pain.
In hordeolum (stye), the patient is troubled by a painful, red, and swollen eyelid with no history of a foreign body or trauma. Visual acuity may be reduced.
In all patients with inflammatory eyelid diseases, the presence of general somatic pathologies and medications prescribed by specialists should be clarified.
Allergy history. For children — and/or the allergy history of the parents.
It is recommended to perform an initial consultation (examination) by a pediatrician (B01.031.001) to rule out helminthiasis, diabetes mellitus, gastrointestinal tract diseases, and other chronic conditions [10; 11; 23; 24; 41].
GDR CLE 5Grade of recommendation C (level of evidence – 5)
2.2 Physical Examination
Physical examination is not indicated.
2.3 Laboratory Diagnostics
Laboratory diagnostic tests are not routinely performed. The diagnosis is established clinically. There are no specific diagnostic tests to confirm a diagnosis of blepharitis. Additional laboratory diagnostic methods are ordered to clarify the diagnosis and to detect systemic and syndromic diseases associated with blepharitis, chalazion, or hordeolum, which is important for the patient's further management strategy. The decision to select and order additional laboratory tests is made by an ophthalmologist based on the results of the baseline examination.
Additional laboratory testing may be ordered at the discretion of the ophthalmologist:
It is recommended that patients with non-infectious blepharitis undergo microscopic examination of skin scrapings for mites to detect/confirm Demodex infestation [10; 11; 12; 21; 22; 23; 24; 42].
GDR CLE 5Grade of recommendation C (level of evidence – 5)
Comments: if mite infestation is detected, specific anti-parasitic therapy is not performed. Personal hygiene rules must be observed, and symptomatic therapy should be prescribed.
2.4 Instrumental Diagnostics
At the diagnosis stage and during follow-up examinations:
It is recommended to perform visometry in all patients with blepharitis, chalazion, and hordeolum to detect decreased visual acuity and evaluate the possibility of its correction [3; 10; 11; 24].
GDR CLE 5Grade of recommendation C (level of evidence – 5)
It is recommended to perform a visual eye examination in all patients with blepharitis, chalazion, and hordeolum to detect changes in facial skin and eyelids, and to assess the condition of eyelashes and meibomian gland orifices [11; 23; 24].
GDR CLE 5Grade of recommendation C (level of evidence – 5)
It is recommended to perform biomicroscopy of the eyelids and anterior segment of the eye in all patients with blepharitis, chalazion, and hordeolum to identify signs of inflammation, degenerative changes, and/or complications [1; 2; 10; 11; 23; 24].
GDR CLE 5Grade of recommendation C (level of evidence – 5)
2.5 Other Procedures
It is recommended that patients with suspected reduced tear production in non-infectious blepharitis undergo the Schirmer test to determine tear production metrics [2; 10; 11; 24].
GDR CLE 5Grade of recommendation C (level of evidence – 5)
Comments: performing the Schirmer test is recommended for patients with suspected reduced tear production in non-infectious blepharitis [2; 10; 11; 24].
Differential diagnosis
Differential diagnosis between various types of blepharitis, as well as dermatitis and conjunctivitis. In addition, for blepharitis, chalazion, and hordeolum, differential diagnosis of neoplastic diseases of the eyelids and conjunctiva is required.
3. Treatment, including drug and non-drug therapies, diet therapy, and pain management
3.1 Conservative Treatment
The goal of treatment is the elimination of the pathogen if present, relief of active inflammation based on local and systemic administration of medications, achieving clinical recovery and/or prolonged, preferably non-pharmacological remission, and preservation of visual functions.
Treatment tactics are determined by the etiology of the inflammatory process, the risk of complications from blepharitis and reduced visual functions, the presence of associated systemic and syndromic pathology, and concomitant diseases.
Treatment of blepharitis, chalazion, and hordeolum is carried out by an ophthalmologist; in the presence of an associated systemic or syndromic disease, in close contact with relevant specialists (rheumatologist, dermatovenereologist, allergist-immunologist, pediatrician).
The ophthalmologist performs local therapy, determines the indications for prescribing and adjusting systemic treatment, and monitors the development of potential local and systemic complications of therapy in cases where there is no systemic disease.
General practitioners, in accordance with established etiological causes, conduct therapy in accordance with the Federal Clinical Guidelines for the treatment of the underlying disease, monitor the somatic status of patients and adverse events of systemic therapy.
Patients (or patients' parents) must be informed about the benefits and potential side effects of therapy.
It is recommended to prescribe topical antibiotics (S01A Anti-infectives) – fluoroquinolone antibacterial drugs (ofloxacin** for adults and children from 1 year of age, instillation into the affected eye(s) 1-2 drops every 2-4 hours for 2 days; then 1-2 drops 4 times a day for 5 days; levofloxacin** for adults and children from 1 year of age, instillation into the affected eye(s) 1-2 drops every 2 hours up to 8 times a day for the first 2 days, then 1-2 drops 4 times a day for 3-5 days) [2; 10; 11; 20-24; 28; 32-34; 46].
GCR CLEL 5Grade of Recommendation C (Level of Evidence – 5)
Comments: topical antibiotic therapy is administered as etiotropic therapy for the treatment of infectious blepharitis (bacterial), chalazion, and hordeolum for antibacterial purposes.
Information on the route of administration in accordance with the instructions for medical use of S01A Anti-infectives – fluoroquinolone antibacterial drugs (ofloxacin**, levofloxacin**) [2; 10; 11; 20-24; 28; 32-34; 46].
It is recommended to prescribe topical antibiotics (S01A Anti-infectives) – aminoglycoside antibacterial drugs (netilmicin for adults and children from 3 years of age, instillation of eye drops into the affected eye(s) 1-2 drops 3 times a day; apply eye ointment into the conjunctival sac of the affected eye 0.5-1 cm 3-4 times a day; in combination with drops – once a day at bedtime; tobramycin** for adults and children from 2 months of age for mild to moderate blepharitis – instillation of eye drops into the affected eye(s) 1-2 drops every 4 hours for 7 days; for severe eye involvement – instillation of eye drops into the affected eye(s) 2 drops every 60 min. for 3-5 days [34; 52; 53; 65; 66].
GCR CLEL 5Grade of Recommendation C (Level of Evidence – 5)
Comments: topical therapy with antibiotics of the aminoglycoside group is carried out as etiotropic therapy for the treatment of infectious blepharitis (bacterial), chalazion, and hordeolum caused by flora sensitive to this drug for antibacterial purposes [34; 52; 53].
It is recommended to prescribe topical antibiotics (S01A Anti-infectives) – tetracycline group antibiotics (tetracycline** for adults and children from 8 years of age for blepharitis, apply eye ointment behind the lower eyelid of the affected eye 0.5-1 cm 3-4 times a day for 5-7 days [26].
GCR CLEL 5Grade of Recommendation C (Level of Evidence – 5)
Comments: topical therapy with tetracycline group antibiotics is carried out as etiotropic therapy for the treatment of infectious blepharitis (bacterial) caused by flora sensitive to this drug for antibacterial purposes [54; 55].
It is recommended to prescribe topical antibiotics (S01A Anti-infectives) for blepharitis – macrolide group antibacterial drugs (erythromycin – for adults and children from 0 years of age, apply eye ointment behind the lower eyelid of the affected eye 0.5-1 cm 3 times a day for 14 days [56-60; 73].
GCR CLEL 5Grade of Recommendation C (Level of Evidence – 5)
Comments: topical therapy with macrolide group antibiotics is carried out as etiotropic therapy for the treatment of infectious blepharitis (bacterial) caused by flora sensitive to this drug for antibacterial purposes [56-60; 73].
It is recommended to prescribe topical anti-infectives S01AX – other anti-infectives (picloxidine) for adults and children with infectious blepharitis (bacterial) or blepharitis of another etiology when bacterial flora is suspected to be superimposed, as monotherapy or as part of combination therapy with antibacterial and antiviral drugs, 1 drop 2 to 6 times/day. The course of treatment may last 10 days. For children – instillations of 1 drop 6 times/day. The course of treatment may last 7-10 days in accordance with the instructions for medical use for the indication of bacterial infections of the anterior segment of the eye [2; 10; 11; 23; 24; 28].
Level of Recommendations CLevel of Evidence 5 Level of recommendation certainty C (level of evidence – 5)
It is recommended to prescribe corticosteroid combinations (S01CA Corticosteroids, antiseptics in combination) for adults and children with blepharitis for anti-inflammatory and antibacterial purposes when the use of corticosteroids and prophylactic antibacterial therapy is required: Dexamethasone + Neomycin + Polymyxin B 1 mg/ml + 3500 IU/ml + 6000 IU/ml for adults and children 1-2 drops 6 times a day [61; 62; 63; 64; 67-72; 74-75].
GCR CLEL 5Grade of Recommendation C (Level of Evidence – 5)
It is recommended to prescribe corticosteroid combinations (S01CA Corticosteroids, antiseptics in combination) for adults and children with blepharitis for anti-inflammatory and antibacterial purposes: dexamethasone + tobramycin 1 mg/ml + 3 mg/ml for adults and children from 2 years of age, 1-2 drops 4 times a day in accordance with the instructions [61; 62; 63; 64; 67-72; 74-75].
GCR CLEL 5Grade of Recommendation C (Level of Evidence – 5)
It is recommended to prescribe antiallergic drugs (S01GX Other antiallergics) (#olopatadine 0.1%) to all adults and children with non-infectious blepharitis (allergic). Information on the route of administration of the medicinal product #olopatadine 0.1%; 0.2%, dose, and duration of administration: 1 drop 2 times/day. Course of treatment – up to 4 months [10; 24; 25].
GCR CLEL 5Grade of Recommendation C (Level of Evidence – 5)
Comments: topical antiallergic therapy is etiotropic treatment in patients with non-infectious blepharitis (allergic).
It is recommended to prescribe antiallergic and anti-inflammatory drugs (S01BA Corticosteroids) (dexamethasone 0.1%; hydrocortisone** 0.5%) to all adults in accordance with the instructions for medical use for non-infectious blepharitis (allergic). Information on the route of administration of dexamethasone 0.1%, dose, and duration of administration: 1 drop every 4 hours until clinical symptoms disappear. Course of treatment – no more than 3 weeks. Information on the route of administration of hydrocortisone** 0.5%, dose, and duration of administration: 1 cm is injected into the conjunctival sac 2-3 times/day. Course of treatment – 1-2 weeks. Upon the physician's recommendation, the course of treatment may be extended [2; 10; 11; 23; 24; 43-45; 50].
GCR CLEL 5Grade of Recommendation C (Level of Evidence – 5)
Comments: topical antiallergic and anti-inflammatory therapy is etiotropic treatment in adults with non-infectious blepharitis (allergic). When using topical corticosteroids, monitoring of intraocular pressure is necessary to prevent its elevation, and monitoring of the anterior segment of the eye is required to prevent complications [43-45].
It is recommended to prescribe S01XA20 Artificial tears and other indifferent preparations – hypromellose** for adults and children in accordance with the instructions for medical use for non-infectious blepharitis (meibomian gland dysfunction) and clinical manifestations of dry eye syndrome for the purpose of symptom relief [2; 11; 23; 37-39].
GCR CLEL 5Grade of Recommendation C (Level of Evidence – 5)
3.2 Surgical Treatment
It is recommended to perform surgical treatment for patients with inflammatory diseases of the eye and its adnexa when conservative therapy fails [47-49].
GCR CLEL 5Grade of Recommendation C (Level of Evidence – 5)
Comment: removal of chalazion (A16.26.013); removal of molluscum contagiosum, incision of small retention cysts of the eyelids and conjunctiva, hordeolum, eyelid abscess (A16.26.014); excision of calcified meibomian gland (A16.26.015).
4. Medical Rehabilitation and Sanatorium-Resort Treatment
Not required.
5. Prevention and Dispensary Observation
Not required.
6. Organization of Medical Care
Routine medical care is provided in an outpatient setting.
Stages of medical care delivery
a. Outpatient/polyclinic.
Medical indications for hospitalization in a medical organization
Not required.
Grounds for discharging a patient from a medical organization: not required.
7. Additional Information
Patients should be warned that frequent manipulation of the eyelid can lead to irritation of the eyelid skin and conjunctiva; eyelid cleansing procedures may be required for a prolonged period as symptoms frequently recur after treatment is discontinued.
The prognosis for the course of blepharitis is favorable and is largely determined by the etio-pathogenetic form of the disease. Predictors of a favorable functional prognosis include daily eyelid hygiene, dietary compliance, treatment of the underlying condition, and timely administration of local therapy.
Predictors of a poor functional prognosis include: severe disease course and the development of blepharitis complications, multiple or recurrent chalazia, hordeola (styes), resistance to ongoing therapy, prolonged disease duration, and the presence of severe comorbid pathology.
Criteria for Evaluating the Quality of Medical Care
№ | Quality criteria | Performance evaluation |
|---|---|---|
1. | Visometry was performed | Yes/No |
2. | Ocular biomicroscopy performed | Yes/No |
3. | Prescribed drug therapy: | |
S01A Anti-infectives for topical use for antibacterial purposes: fluoroquinolone antibacterial agents (ofloxacin**, levofloxacin** for adults and children aged 1 year and older for bacterial blepharitis and/or aminoglycoside antibiotic antibacterial agents — netilmicin and tobramycin**, for adults and children aged 3 years and older for bacterial blepharitis and/or tetracycline antibiotic antibacterial agents — tetracycline** for adults and children aged 8 years and older for bacterial blepharitis and styes and/or macrolide antibiotic antibacterial agents — erythromycin for adults and children from 0 years of age for bacterial blepharitis | Yes/No | |
S01CA Corticosteroids in combination with anti-infectives: dexamethasone + tobramycin for adults and children aged 2 years and older or dexamethasone + neomycin + polymyxin B for adults and children for blepharitis with anti-inflammatory and antibacterial purposes | Yes/No | |
S01GX Antiallergic agent (#olopatadin 0.1 %) for antiallergic purposes in all adults and children with non-infectious blepharitis (allergic) | Yes/No | |
S01BA Corticosteroids (dexamethasone, hydrocortisone**) for anti-inflammatory and antiallergic purposes in all adults and children with non-infectious blepharitis (allergic) | Yes/No | |
For non-infectious blepharitis (meibomian gland dysfunction) and clinical manifestations of dry eye syndrome S01XA20 Artificial tears and other indifferent preparations (hypromellose**) to moisturize the ocular surface | Yes/No |
References
Show references
Nichols, KK ∙ Foulks, GN ∙ Bron, AJ. The International Workshop on Meibomian Gland Dysfunction: executive summary Invest Ophthalmol Vis Sci. 2011; 52:1922-1929.
Kanski J.J. Clinical Ophthalmology: A Systematic Approach. 6th ed. Edinburgh: Butterworth-Heinemann, 2007.
Report by Academician of the Russian Academy of Sciences V.V. Neroev, "Features of Ophthalmological Morbidity in the Russian Federation", 2024.
Lindsley K, Matsumura S, Hatef E, Akpek EK. Interventions for chronic blepharitis. Cochrane Database Syst Rev. 2012(5):CD005556.
Riks I.A., Trufanov S.V., Butaba R. Modern approaches to the treatment of meibomian gland dysfunction. Annals of Ophthalmology. 2021;137(1):130–136.
Schaumberg DA, Nichols JJ, Papas EB, Tong L, Uchino M, Nichols KK. The International Workshop on Meibomian Gland Dysfunction: report of the subcommittee on the epidemiology of, and associated risk factors for, MGD. Invest Ophthalmol Vis Sci. 2011;52(4):1994-2005.
Wallace DK, Morse CL, Melia M, et al. Pediatric eye evaluations Preferred Practice Pattern®: I. Vision screening in the primary care and community setting; II. Comprehensive ophthalmic examination. Ophthalmology. 2018;125(1):P184-P227.
Daniel MC, O'Gallagher M, Hingorani M, Dahlmann-Noor A, Tuft S. Challenges in the management of pediatric blepharokeratoconjunctivis / ocular rosacea. Expert Rev Ophthalmol. 2016;11(4):299-309.
Viswalingam M, Rauz S, Morlet N, Dart JK. Blepharokeratoconjunctivitis in children: diagnosis and treatment. Br J Ophthalmol. 2005;89(4):400-403.
Somov E.E., Brzheskiy V.V. Selected Sections of Pediatric Clinical Ophthalmology. St. Petersburg: Chelovek, 2016. – 308 p.
Somov E.E., Kononov V.M., Prozornaya L.P. Diagnosis and treatment of demodectic blepharitis in children. Oftalmol. Zhurnal. 2001; (4):70-72.
Hykin PG, Bron AJ. Age-related morphological changes in lid margin and meibomian gland anatomy. Cornea. 1992;11(4):334-342.
Yeotikar NS, Zhu H, Markoulli M, Nichols KK, Naduvilath T, Papas EB. Functional and morphologic changes of meibomian glands in an asymptomatic adult population. Invest Ophthalmol Vis Sci. 2016;57(10):3996-4007.
Martin NF, Rubinfeld RS, Malley JD, Manzitti V. Giant papillary conjunctivitis and meibomian gland dysfunction blepharitis. CLAO J. 1992;18(3):165-169.
Hammersmith KM, Cohen EJ, Blake TD, Laibson PR, Rapuano CJ. Blepharokeratoconjunctivitis in children. Arch Ophthalmol. 2005;123(12):1667-1670.
Gilberg S, Tse D. Malignant eyelid tumors. Ophthalmol Clin North Am. 1992;5:261-285.
Fukuoka S, Arita R, Shirakawa R, Morishige N. Changes in meibomian gland morphology and ocular higher-order aberrations in eyes with chalazion. Clin Ophthalmol. 2017;11:1031-1038.
Wu AY, Gervasio KA, Gergoudis KN, Wei C, Oestreicher JH, Harvey JT. Conservative therapy for chalazia: is it really effective? Acta Ophthalmol. 2018 Jun;96(4):e503-e509.
Bragg KJ, Le PH, Le JK. Hordeolum. 2023 Jul 31. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2024 Jan.
Navel V, Mulliez A, Benoist d'Azy C, Baker JS, Malecaze J, Chiambaretta F, Dutheil F. Efficacy of treatments for Demodex blepharitis: A systematic review and meta-analysis. Ocul Surf. 2019 Oct;17(4):655-669. doi: 10.1016/j.jtos.2019.06.004. Epub 2019 Jun 20.
Kakharova D.M., Shadmanov V.A. et al. Application of the preparation Floxal in treatment of acute and chronic diseases of the lid and conjunctivitis. The American Journal of Medical Sciences and Pharmaceutical Research. June 30, 2021; p. 122-126; doi: 10.37547/TAJMSPR/Volume03lssue06-19.
Trubilin V.N., Polunina E.G., Anzhelova D.V. et al. Treatment algorithm for meibomianitis, hordeolum, and chalazion. Ophthalmology. 2019; 16(4): 515-521. doi.org/10.18008/1816-5095-2023-4-515-521.
Ophthalmology: National Guidelines / ed. by S.E. Avetisov, E.A. Egorov, L.K. Moshetova, V.V. Neroev, Kh.P. Takhchidi. - Moscow: GEOTAR-Media, 2008. - pp. 342-347
Maychuk Yu.F. Blepharitis. A Brief Guide for Physicians. 2nd expanded ed. Moscow. 2013. 24 p.
Egorov E.A. Ophthalmic Pharmacology: A Guide for Physicians / E.A. Egorov, Zh.G. Oganezova, T.V. Stavitskaya. - 4th ed., rev. and supp. - Moscow: GEOTAR-Media, 2025. - 576 p. - ISBN 978-5-9704-8637-5, DOI: 10.33029/9704-8637-5-OFT-2025-1-576
Trubilin V.N., Polunina E.G., Markova E.Yu., Kurenkov V.V., Kapkova S.G. Therapeutic eyelid hygiene in prevention and treatment algorithms for ocular surface diseases. Part II. Ophthalmology. 2016;13(3):205–212 doi: 10.18008/1816–5095–2016–3–205–212.
Prozornaya L.P. New possibilities of using fluoroquinolones in the combination therapy of chronic blepharoconjunctivitis caused by Staphylococcus aureus in children. RMJ. Clinical Ophthalmology. 2013; 13(3): 108–113.
Tariq F. Allergic Conjunctivitis: Review of Current Types, Treatments and Trends. Life. 2024, 14,650. Doi.org/10.3390/life14060650.
Hashida N, Hirose R. et al. Efficacy of Epinastine Eyelid Cream in Pediatric vernal Keratoconjunctivitis: A Case Report. Cureus 16(11):e74268. Doi 10.7759/ cureus.74268
Mimura T, Fukagawa K.(June 26, 2025) Topical Innovation: A Report on Epinastine Eyelid Cream for Patients With Mild Atopic Keratoconjunctivitis. Cureus 17(6):e86792. Doi 10.7759/ cureus.86792
Efimova E.L., Brzheskiy V.V. New possibilities of antibacterial therapy for blepharoconjunctivitis in children. Ophthalmology. 2021;18(4):932–937. https://doi.org/10.18008/1816-5095-2021-4-932-937.
Gwon A. Ofloxacin vs tobramycin for the treatment of external ocular infection. Ofloxacin Study Group II. Arch Ophthalmol. 1992 Sep;110(9):1234-7. doi: 10.1001/archopht.1992.01080210052022.
Yanchenko S.V., Malyshev A.V., Teshayev Sh.Zh., Petrosyan L.M., Ramazonova Sh.Sh. Efficacy and safety of chronic blepharitis therapy. Ophthalmology. 2023;20(4):772–779. https://doi.org/10.18008/1816-5095- 2023-4-772–77.
Hosseini K, Lindstrom RL, Foulks G, Nichols KK. A randomized, double-masked, parallel-group, comparative study to evaluate the clinical efficacy and safety of 1 % azithromycin-0.1 % dexamethasone combination compared to 1 % azithromycin alone, 0.1% dexamethasone alone, and vehicle in the treatment of subjects with blepharitis. Clin Ophthalmol. 2016 Aug 10;10:1495-503. doi: 10.2147/OPTH.S110739.
Arrúa M, Samudio M, Fariña N, Cibils D, Laspina F, Sanabria R, Carpinelli L, Mino de Kaspar H. Comparative study of the efficacy of different treatment options in patients with chronic blepharitis. Arch Soc Esp Oftalmol. 2015 Mar;90(3):112-8. doi: 10.1016/j.oftal.2013.09.003. Epub 2014 Dec 23
Auw-Hädrich C, Reinhard T. Blepharitis component of dry eye syndrome. Ophthalmologe. 2018 Feb;115(2):93-99. doi: 10.1007/s00347-017-0606-8.
Herwig-Carl MC, Loeffler KU. Differential diagnoses of dry eye syndrome and blepharitis. Ophthalmologe. 2018 Feb;115(2):107-113. doi: 10.1007/s00347-017-0631-7.
Sabeti S, Kheirkhah A, Yin J, Dana R. Management of meibomian gland dysfunction: a review. Surv Ophthalmol. 2020 Mar-Apr;65(2):205-217. doi: 10.1016/j.survophthal.2019.08.007. Epub 2019 Sep 5.
Amin P.P., Abramson E.L. Blepharitis / in: The 5-Minute Pediatric Consult / ed. by M.D. Cabana; Russ. transl. ed. by D.O. Ivanov, S.A. Sayganov, I.Yu. Melnikova, V.P. Novikova. – Moscow: GEOTAR-Media, 2022. – 896 p.
Markova E.Yu., Lobanova I.V., Venediktova L.V., Gorbunova E.D., Kulkova A.G. Inflammatory eyelid diseases in children. Effective Pharmacotherapy. 2013; (3):32-34.
Kanograt Pornpanich, Panitee Luemsamran et al. Microbiology of primary acquired nasolacrimal duct obstruction: simple epiphora, acute dacryocystitis, and chronic dacryocystitis. Clinical Ophthalmol. 2016; 2016(10):337-342. doi: 10.2147/OPTH.S100280.
Ghauri AJ, Valenzuela AA. et al. Periorbital discoid lupus erythematosus. Ophthalmology. 2012;119(10):2193-2194.e11.
Day A., Abramson AK. et al. The spectrum of oculocutaneous disease: Part II. Neoplastic and drug-related causes of oculocutaneous disease. J Am Acad Dermatol. 2014;70(5):821.e1-821.e19.
Polosyants O.B. Use of hydrocortisone ointment in ophthalmology. Review. Clin. Med. 1999. PMID: 10635632
Arestova N.N., Katargina L.A., Yani E.V. Conjunctivitis and dacryocystitis in children: clinical characteristics, modern treatment options. Russian Pediatric Ophthalmology. 2016;4:200–206.
Loth C, Miller CV, Haritoglou C, Messmer ESBM. Hordeolum und Chalazion : (Differenzial )Diagnose und Therapie [Hordeolum and chalazion : (Differential) diagnosis and treatment]. Ophthalmologe. 2022 Jan;119(1):97-108. German. doi: 10.1007/s00347-021-01436-y. Epub 2021 Aug 11. PMID: 34379160.
BrinerAM. Surgical treatment of a chalazion or hordeolum internum. Aust Fam Physician. 1987 Jun;16(6):834-5. PMID: 3675336.
Shin HJ, Yoon JS, Choung H, Lew H. Management Practice for Hordeolum and Chalazion: A Survey of the Korean Society of Ophthalmic Plastic and Reconstructive Surgery (KSOPRS) Members. Korean J Ophthalmol. 2025 Jun;39(3):222-240. doi: 10.3341/kjo.2025.0024. Epub 2025 Apr 23. PMID: 40267992; PMCID: PMC12178684.
Trubilin V.N., Polunina E.G., Markova E.Yu., Kurenkov V.V., Kapkova S.G. Therapeutic eyelid hygiene in prevention and treatment algorithms for ocular surface diseases. Part 1. Ophthalmology. 2016;13(2):122–127. DOI: 10.18008/1816-5095-2016-2-122-127
S.V. Yanchenko, A.V. Malyshev, Sh.Zh. Teshayev, L.M. Petrosyan, Sh.Sh. Ramazonova. Efficacy and safety of chronic blepharitis therapy. Ophthalmology. 2023;20(4):772–779. doi.org/10.18008/1816-5095-2023-4-772-779
G.Yu. Knorring. New aspects of antibiotic use in ophthalmology: a clinical pharmacologist's perspective. Ophthalmology. 2024;21(3):451–455. doi.org/10.18008/1816-5095-2024-3-451-455
E.A. Kleshcheva, G.M. Chernakova, N.V. Melnikova, A.E. Kleshchev. The role of eyelid and conjunctival bacterial flora in the development of inflammatory pathology of the anterior eye segment. Russian Journal of Clinical Ophthalmology. 2024;24(4):211–216 (in Russ.). DOI: 10.32364/2311-7729-2024-24-4-8
Olson CL. Bacterial flora of the conjunctiva and lid margin. Effects of parenteral trisulfapyramidines and topical tetracycline and erythromycin. Arch Ophthalmol. 1969 Aug;82(2):197-202. doi: 10.1001/archopht.1969.00990020199009. PMID: 4894275.
Arita R. Targeted therapies for meibomian gland dysfunction - The role of antibiotics in meibomian gland dysfunction management. Taiwan J Ophthalmol. 2025 Nov 7;15(4):516-525. doi: 10.4103/tjo.TJO-D-25-00109. PMID: 41523132; PMCID: PMC12782519.
Bragg KJ, Le PH, Le JK. Hordeolum (Archived). 2023 Jul 31. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2025 Jan
Pflipsen M, Massaquoi M, Wolf S. Evaluation of the Painful Eye. Am Fam Physician. 2016 Jun 15;93(12):991-8
John AM, John ES, Hansberry DR, Thomas PJ, Guo S. Analysis of online patient education materials in pediatric ophthalmology. J AAPOS. 2015 Oct;19(5):430-4.
Machalińska A, Zakrzewska A, Safranow K, Wiszniewska B, Machaliński B. Risk Factors and Symptoms of Meibomian Gland Loss in a Healthy Population. J Ophthalmol. 2016;2016:7526120
Willmann D, Guier CP, Patel BC, Melanson SW. Hordeolum (Stye). 2024 Dec 11. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2025 Jan
Comstock TL, DeCory HH. Loteprednol Etabonate 0.5 % / Tobramycin 0.3 % Compared with Dexamethasone 0.1 % / Tobramycin 0.3 % for the Treatment of Blepharitis. Ocul Immunol Inflamm. 2017 Apr;25(2):267-274. doi: 10.3109/09273948.2015.1115879. Epub 2016 Jan 20
Torkildsen GL, Cockrum P, Meier E, Hammonds WM, Silverstein B, Silverstein S. Evaluation of clinical efficacy and safety of tobramycin/dexamethasone ophthalmic suspension 0.3 % / 0.05 % compared to azithromycin ophthalmic solution 1 % in the treatment of moderate to severe acute blepharitis/blepharoconjunctivitis. Curr Med Res Opin. 2011 Jan;27(1):171-8. doi: 10.1185/03007995.2010.539603. Epub 2010 Dec 7.
Arrúa M, Samudio M, Fariña N, Cibils D, Laspina F, Sanabria R, Carpinelli L, Mino de Kaspar H. Comparative study of the efficacy of different treatment options in patients with chronic blepharitis. Arch Soc Esp Oftalmol. 2015 Mar;90(3):112-8. English, Spanish. doi: 10.1016/j.oftal.2013.09.003. Epub 2014 Dec 23. PMID: 25542616.
Shulman DG, Sargent JB, Stewart RH, Mester U. Comparative evaluation of the short-term bactericidal potential of a steroid-antibiotic combination versus steroid in the treatment of chronic bacterial blepharitis and conjunctivitis. Eur J Ophthalmol. 1996 Oct-Dec;6(4):361-7. doi: 10.1177/112067219600600403.
Wilhelmus KR, Gilbert ML, Osato MS. Tobramycin in ophthalmology. Surv Ophthalmol. 1987 Sep-Oct;32(2):111-22. doi: 10.1016/0039-6257(87)90103-2. PMID: 3317953.
Leibowitz HM, Hyndiuk RA, Smolin GR, Nozik RA, Hunter GJ, Cagle GD, Davis DS. Tobramycin in external eye disease: a double-masked study vs. gentamicin. Curr Eye Res. 1981;1(5):259-66. doi: 10.3109/02713688108999445. PMID: 7030632.
Raskin EM, Speaker MG, Laibson PR. Blepharitis. Infectious Disease Clinics of North America 1992;6(4):777-87.
Chen M, Gong L, Sun X, Gu Y, He X, Qu J, et al. A multicenter, randomized, parallel-group, clinical trial comparing the safety and eIicacy of loteprednol etabonate 0.5 % / tobramycin 0.3 % with dexamethasone 0.1 % / tobramycin 0.3 % in the treatment of Chinese patients with blepharokeratoconjunctivitis. Current Medical Research and Opinion 2012;28(3):385-94.
Torkildsen GL, Cockrum P, Meier E, Hammonds WM, Silverstein B, Silverstein S. Evaluation of clinical eIicacy and safety of tobramycin/dexamethasone ophthalmic suspension 0.3 % / 0.05 % compared to azithromycin ophthalmic solution 1 % in the treatment of moderate to severe acute blepharitis/blepharoconjunctivitis. Current Medical Research and Opinion 2011;27(1):171-8.
Viswalingam M, Rauz S, Morlet N, Dart JK. Blepharokeratoconjunctivitis in children: diagnosis and treatment. British Journal of Ophthalmology 2005;89(4):400-3.
Hamada S, KhanI, Denniston AK, Rauz S. Childhood blepharokeratoconjunctivitis: characterising a severe phenotype in white adolescents. British Journal of Ophthalmology 2012;96(7):949-55.
Jones SM, Weinstein JM, Cumberland P, Klein N, Nischal KK. Visual outcome and corneal changes in children with chronic blepharokeratoconjunctivitis. Ophthalmology 2007;114(12):2271-80.
Eberhardt M, Zeppieri M, Rammohan G. Blepharitis. [Updated 2025 Feb 3]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2025 Jan-. Available from
Chernyakova T.V., Kuroedov A.V., Volobueva T.M. Blepharitis and conjunctivitis: what you need to know about the most common diseases of the anterior eye segment. Clinical Ophthalmology. 2025;25(2):103-108. DOI: 10.32364/2311-7729-2025-25-2-4;
Wang C, Zeng A, Saeed HN, Djalilian AR, Mocan MC. Advances in the Medical Management of Pediatric Blepharokeratoconjunctivitis. Adv Ther. 2026 Jan;43(1):109-126. doi: 10.1007/s12325-025-03417-y. Epub 2025 Nov 21. PMID: 41269518; PMCID: PMC12858537.https://www.ncbi.nlm.nih.gov/books/NBK459305/
Appendix A1. Working Group Composition
Arestova N.N., MD, PhD, Leading Researcher, Department of Pediatric Eye Pathology, National Medical Research Center of Eye Diseases named after Helmholtz of the Russian Ministry of Health, member of the Association of Ophthalmologists, member of the Russian Ophthalmological Society.
Brzheskiy V.V., MD, PhD, Professor, Head of the Department of Ophthalmology, St. Petersburg State Pediatric Medical University, member of the Association of Ophthalmologists, member of the Russian Ophthalmological Society.
Grishina E.E., MD, PhD, Professor, Professor at the Department of Ophthalmology and Optometry, Faculty of Advanced Medical Training, Moscow Regional Research Clinical Institute named after M.F. Vladimirsky, member of the Association of Ophthalmologists, member of the Russian Ophthalmological Society.
Drozdova E.A., MD, PhD, Associate Professor, Professor at the Department of Eye Diseases, South Ural State Medical University of the Russian Ministry of Health, member of the Association of Ophthalmologists, member of the Russian Ophthalmological Society.
Kasparova E.A., PhD, Leading Researcher, Department of Ocular Optic Media Pathology, Research Institute of Eye Diseases, member of the Association of Ophthalmologists, member of the Russian Ophthalmological Society.
Lebedev O.I., MD, PhD, Professor, Head of the Department of Ophthalmology, Omsk State Medical Academy, member of the Association of Ophthalmologists, member of the Russian Ophthalmological Society.
Maychuk D.Yu., MD, PhD, Head of the Department of Therapeutic Ophthalmology, S.N. Fyodorov Eye Microsurgery Federal State Institution of the Russian Ministry of Health.
Markova E.Yu., MD, PhD, Head of the Department of Microsurgery and Functional Rehabilitation of the Eye in Children, S.N. Fyodorov Eye Microsurgery Federal State Institution of the Russian Ministry of Health, member of the Association of Ophthalmologists, member of the Russian Ophthalmological Society.
Obrubov A.S., PhD, Associate Professor at the Department of Ophthalmology, Russian Medical Academy of Continuous Professional Education of the Russian Ministry of Health; ophthalmologist at the inpatient unit of the Moscow City Ophthalmological Center, S.P. Botkin City Clinical Hospital, member of the Association of Ophthalmologists, member of the Russian Ophthalmological Society.
Panova I.E., MD, PhD, Professor, Deputy Director for Research, St. Petersburg Branch of the S.N. Fyodorov Eye Microsurgery Federal State Institution of the Russian Ministry of Health, member of the Association of Ophthalmologists, member of the Russian Ophthalmological Society.
Polovinkina G.V., Ophthalmologist, Ophthalmology Department, Diagnostic Center No. 7 of Saint Petersburg; expert in the quality control of medical care provided to patients by the Physicians of Department No. 1 (Pathology of the Anterior Segment of the Eye); member of the Association of Ophthalmologists, member of the Russian Ophthalmologists Society.
Riks I.A., Candidate of Medical Sciences, Head of the Ophthalmology Department, Nashe Zdorovie Multidisciplinary Clinic; member of the Association of Ophthalmologists, member of the Russian Ophthalmologists Society.
Sydasheva E.I., Doctor of Medical Sciences, Professor at the Department of Ophthalmology, North-Western State Medical University named after I.I. Mechnikov of the Ministry of Health of the Russian Federation; Chief Pediatric Ophthalmologist of the Ministry of Health of the Russian Federation in the Northwestern Federal District; member of the Presidium of the Association of Ophthalmologists; member of the Russian Ophthalmologists Society; Honored Doctor of the Russian Federation.
Safonova T.N., Candidate of Medical Sciences, Leading Researcher, Scientific Research Institute of Eye Diseases named after M.M. Krasnov; member of the Association of Ophthalmologists, member of the Russian Ophthalmologists Society.
Slonimsky A.Yu., Doctor of Medical Sciences, Professor, Moscow Eye Clinic; member of the Association of Ophthalmologists, member of the Russian Ophthalmologists Society.
Trufanov S.V., Doctor of Medical Sciences, Deputy Director for Research, Nashe Zdorovie Multidisciplinary Clinic; member of the Association of Ophthalmologists, member of the Russian Ophthalmologists Society.
Chernakova G.M., Candidate of Medical Sciences, Associate Professor, Head of the Consultative Department, Moscow City Ophthalmological Center at the Botkin City Clinical Hospital; member of the Association of Ophthalmologists, member of the Russian Ophthalmologists Society.
Yani E.V., Candidate of Medical Sciences, Head of the Department of Infectious and Allergic Eye Diseases, National Medical Research Center of Eye Diseases named after Helmholtz of the Ministry of Health of the Russian Federation; member of the Association of Ophthalmologists, member of the Russian Ophthalmologists Society.
Yanchenko S.V., Doctor of Medical Sciences, Associate Professor, Professor at the Department of Ophthalmology of the Bashkir State Medical University, highest-category physician; member of the Association of Ophthalmologists, member of the Russian Ophthalmologists Society.
Conflict of interest: none.
Appendix A2. Methodology for Developing Clinical Guidelines
Target audience for these clinical guidelines:
• Ophthalmologists;
• Pediatricians;
• General practitioners / physicians.
Methods used for collecting/selecting evidence: search in electronic databases, analysis of modern scientific developments on the problem of conjunctivitis in Russia and abroad; synthesis of practical experience of Russian and foreign specialists; library resources. Description of methods used for collecting/selecting evidence: the evidence base for the recommendations includes publications from the Cochrane Library, EMBASE, and MEDLINE databases, as well as monographs and articles in leading specialized peer-reviewed domestic medical journals on this topic. The search depth was 10 years. Methods used for assessing the quality and strength of evidence: expert consensus, significance assessment in accordance with the rating scheme.
Table 1. Scale for assessing levels of evidence (LE) for diagnostic methods (diagnostic interventions)
LoE | Definition |
|---|---|
1 | Systematic reviews of studies with reference standard control or systematic review of randomized clinical trials using meta-analysis |
2 | Individual studies with reference standard control or individual randomized clinical trials and systematic reviews of studies of any design, except for randomized clinical trials, using meta-analysis |
3 | Studies without consecutive reference standard control or studies with a reference standard not independent of the test method, or non-randomized comparative studies, including cohort studies |
4 | Non-comparative studies, case report |
5 | Only justification of mechanism of action or expert opinion is available |
Table 2. Scale for assessing the levels of evidence (LE) for prevention, treatment, and medical rehabilitation methods, including those based on natural therapeutic factors (preventive, therapeutic, and rehabilitation interventions)
LoE | Definitions |
|---|---|
1 | Systematic review of randomized controlled trials with meta-analysis |
2 | Individual randomized clinical trials and systematic reviews of studies of any design, except for randomized clinical trials using meta-analysis |
3 | Non-randomized comparative studies, including cohort studies |
4 | Non-comparative studies, case reports or case series, case-control studies |
5 | Only justification of the mechanism of action of the intervention (preclinical studies) or expert opinion is available |
Table 3. Scale for assessing grades of recommendation (GR) for prevention, diagnostic, treatment, and medical rehabilitation methods, including those based on natural therapeutic factors (preventive, diagnostic, therapeutic, and rehabilitative interventions)
GoR | Definition |
|---|---|
A | Strong recommendation (all considered efficacy criteria (outcomes) are important, all studies are of high or acceptable methodological quality, and their conclusions on the outcomes of interest are consistent) |
C | Conditional recommendation (not all considered efficacy criteria (outcomes) are important, not all studies are of high or acceptable methodological quality, and/or their conclusions on the outcomes of interest are inconsistent) |
C | Weak recommendation (lack of adequate quality evidence (all considered efficacy criteria (outcomes) are unimportant, all studies are of low methodological quality, and their conclusions on the outcomes of interest are inconsistent) |
Procedure for updating clinical guidelines.
The clinical guidelines update mechanism provides for their systematic revision—at least once every three years, as well as upon the emergence of new evidence-based data regarding the diagnosis, treatment, prevention, and rehabilitation of specific diseases, or the presence of justified additions/comments to previously approved clinical guidelines, but no more frequently than once every 6 months.
Appendix A3. Reference Materials
Current package leaflets for the drugs mentioned in these clinical guidelines can be found on the website http://grls.rosminzdrav.ru
International Statistical Classification of Diseases and Related Health Problems (10th revision).
Nomenclature of medical services. Order of the Russian Ministry of Health dated October 13, 2017, No. 804n "On approval of the nomenclature of medical services".
Federal Law No. 323-FZ dated November 21, 2011 «On the Fundamentals of Protecting the Health of Citizens in the Russian Federation».
Procedure for providing medical care to the adult population with diseases of the eye, its adnexa, and orbit. Order of the Russian Ministry of Health dated November 12, 2012, No. 902n "On approval of the Procedure for providing medical care to the adult population with diseases of the eye, its adnexa, and orbit".
List of vital and essential drugs for medical use. Order of the Government of the Russian Federation dated October 12, 2019, No. 2406-r "On approval of the list of vital and essential drugs, as well as lists of drugs for medical use and the minimum assortment of drugs required for the provision of medical care".
Appendix B. Physician Action Algorithms
Appendix C. Patient Information
Blepharitis, a chronic inflammation of the eyelid, if not diagnosed and treated in a timely manner, can lead to corneal involvement and a significant decrease in visual acuity.
Blepharitis is a group of diseases caused by infectious and non-infectious processes of the eyelids.
Chalazion is an acute or chronic inflammation of the eyelids that, in the absence of timely diagnosis and treatment, can lead to eyelid deformity and ocular complications.
Hordeolum (stye) is an acute inflammation of the sebaceous gland, typically of bacterial etiology. In the absence of timely diagnosis and treatment, it can lead to the development of an eyelid abscess with subsequent eyelid deformity, as well as ocular complications.
The patient must be informed about the possible symptoms of blepharitis, chalazion, hordeolum, and their complications, and the need to consult an ophthalmologist in a timely manner.
The patient should be warned that frequent manipulation of the eyelid can cause irritation of the eyelid skin and conjunctiva; eyelid hygiene procedures may be required for a long time, as symptoms often recur after treatment is stopped.
Immediate medical attention from an ophthalmologist is required if any of the following symptoms appear: photophobia, pain, decreased and/or blurred vision, change in iris color, pupil size, or shape.
Strict adherence to all prescriptions by the ophthalmologist and related specialists (rheumatologist, dermatovenereologist, general practitioner, pediatrician, etc.) is mandatory.
The patient must be aware of the potential side effects of therapy and the need to seek immediate medical attention from an ophthalmologist (or related specialists) if they develop.
Appendix G. Assessment Scales, Questionnaires, and Other Evaluation Tools
None.