Skip to main content
Log in

A prospective study determining the efficacy of topical 0.5% levofloxacin on bacterial flora of patients with chronic blepharoconjunctivitis

Graefe's Archive for Clinical and Experimental Ophthalmology Aims and scope Submit manuscript

Abstract

Background

To determine the efficacy of conjunctival bacterial eradication following a 1-day, 3-day and 7-day application of topical 0.5% levofloxacin, with and without eyelid scrub, in patients with chronic blepharoconjunctivitis (CBC).

Methods

Patients with CBC (n = 60) were prospectively randomized to three groups (n = 20 in each group): no antibiotic treatment, topical levofloxacin four times per day in both eyes, and eyelid scrub in addition to topical levovofloxacin four times a day in both eyes. Patients without CBC (n = 40) were enrolled as the negative control group. Cultures of the conjunctiva were obtained from both eyes at baseline, 1 day, 3 days, and 7 days following treatment.

Results

The most common bacteria isolated for all groups at baseline were coagulase-negative Staphylococcus. Eight patients did not complete the study. The remaining 52 patients with CBC had a significantly higher rate of positive thioglycolate broth cultures (94%) compared to a 58% positive culture rate in patient without CBC (P < 0.0001). Treatment with at least 3 days of topical antibiotic in patient with CBC resulted in a significant reduction (P < 0.05) in the number of thioglycolate positive cultures (≤ 60%) compared to non-treated eyes (≥ 88%). Following a minimum of a 1-day application of antibiotic, the median colony-forming unit was 0–1 compared to 3–8 for eyes without antibiotic treatment (P < 0.05). Scrubbing of the eyelids did not provide further benefit compared to antibiotic treatment alone.

Conclusions

CBC eyes have a significantly higher number of positive cultures than eyes without CBC. The application of topical 0.5% levofloxacin for at least 3 days provided a significant reduction in the number of positive cultures as well as the number of bacteria harbored on the conjunctival surface.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3
Fig. 4

Similar content being viewed by others

References

  1. Smith RE, Flowers CW Jr (1995) Chronic blepharitis: a review. CLAO J 21:200–207

    PubMed  CAS  Google Scholar 

  2. Raskin EM, Speaker MG, Laibson PR (1992) Blepharitis. Infect Dis Clin North Am 6:777–787

    PubMed  CAS  Google Scholar 

  3. Huber-Spitzy V, Baumgartner I, Bohler-Sommeregger K, Grabner G (1991) Blepharitis—a diagnostic and therapeutic challenge. A report on 407 consecutive cases. Graefes Arch Clin Exp Ophthalmol 229:224–227. doi:10.1007/BF00167872

    Article  PubMed  CAS  Google Scholar 

  4. Bowman RW, Dougherty JM, McCulley JP (1987) Chronic blepharitis and dry eyes. Int Ophthalmol Clin 27:27–35. doi:10.1097/00004397-198702710-00005

    Article  PubMed  CAS  Google Scholar 

  5. McCulley JP, Dougherty JM, Deneau DG (1982) Classification of chronic blepharitis. Ophthalmology 89:1173–1180

    PubMed  CAS  Google Scholar 

  6. Oto S, Aydin P, Ciftcioglu N, Dursun D (1998) Slime production by coagulase-negative staphylococci isolated in chronic blepharitis. Eur J Ophthalmol 8:1–3

    PubMed  CAS  Google Scholar 

  7. Au YK, Jensen HG, Rowsey J, Reynolds M (1993) Coagulase-negative staphylococci in conjunctivitis and blepharitis. Yan Ke Xue Bao 9:129–135

    PubMed  CAS  Google Scholar 

  8. Groden LR, Murphy B, Rodnite J, Genvert GI (1991) Lid flora in blepharitis. Cornea 10:50–53. doi:10.1097/00003226-199110010-00010

    Article  PubMed  CAS  Google Scholar 

  9. Seal D, Ficker L, Ramakrishnan M, Wright P (1990) Role of staphylococcal toxin production in blepharitis. Ophthalmology 97:1684–1688

    PubMed  CAS  Google Scholar 

  10. Dougherty JM, McCulley JP (1986) Bacterial lipases and chronic blepharitis. Invest Ophthalmol Vis Sci 27:486–491

    PubMed  CAS  Google Scholar 

  11. McCulley JP, Dougherty JM (1986) Bacterial aspects of chronic blepharitis. Trans Ophthalmol Soc U K 105(Pt 3):314–318

    PubMed  Google Scholar 

  12. Dougherty JM, McCulley JP (1984) Comparative bacteriology of chronic blepharitis. Br J Ophthalmol 68:524–528. doi:10.1136/bjo.68.8.524

    Article  PubMed  CAS  Google Scholar 

  13. McCulley JP, Shine WE (2004) The lipid layer of tears: dependent on meibomian gland function. Exp Eye Res 78:361–365. doi:10.1016/S0014-4835(03)00203-3

    Article  PubMed  CAS  Google Scholar 

  14. Ta CN, Shine WE, McCulley JP, Pandya A, Trattler W, Norbury JW (2003) Effects of minocycline on the ocular flora of patients with acne rosacea or seborrheic blepharitis. Cornea 22:545–548. doi:10.1097/00003226-200308000-00011

    Article  PubMed  Google Scholar 

  15. Adenis JP, Colin J, Verin P, Riss I, Saint-Blancat P (1996) Ciprofloxacin ophthalmic solution in the treatment of conjunctivitis and blepharitis: a comparison with fusidic acid. Eur J Ophthalmol 6:368–374

    PubMed  CAS  Google Scholar 

  16. Shulman DG, Sargent JB, Stewart RH, Mester U (1996) 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 6:361–367

    PubMed  CAS  Google Scholar 

  17. Bloom PA, Leeming JP, Power W, Laidlaw DA, Collum LM, Easty DL (1994) Topical ciprofloxacin in the treatment of blepharitis and blepharoconjunctivitis. Eur J Ophthalmol 4:6–12

    PubMed  CAS  Google Scholar 

  18. Avisar R, Savir H, Deutsch D, Teller J (1991) Effect of I-Scrub on signs and symptoms of chronic blepharitis. DICP 25:359–360

    PubMed  CAS  Google Scholar 

  19. Jackson WB, Easterbrook WM, Connolly WE, Leers WD (1982) Treatment of blepharitis and blepharoconjunctivitis: comparison of gentamicin-betamethasone, gentamicin alone and placebo. Can J Ophthalmol 17:153–156

    PubMed  CAS  Google Scholar 

  20. Shine WE, McCulley JP, Pandya AG (2003) Minocycline effect on meibomian gland lipids in meibomianitis patients. Exp Eye Res 76:417–420. doi:10.1016/S0014-4835(03)00005-8

    Article  PubMed  CAS  Google Scholar 

  21. Mino de Kaspar H, Shriver EM, Nguyen EV, Egbert PR, Singh K, Blumenkranz MS, Ta CN (2003) Risk factors for antibiotic-resistant conjunctival bacterial flora in patients undergoing intraocular surgery. Graefes Arch Clin Exp Ophthalmol 241:730–733. doi:10.1007/s00417-003-0742-5

    Article  PubMed  Google Scholar 

  22. Scott IU, Flynn HW Jr, Feuer W (1995) Endophthalmitis after secondary intraocular lens implantation. A case-report study. Ophthalmology 102:1925–1931

    PubMed  CAS  Google Scholar 

  23. Ta CN, Sinnar S, He L, Myung D, Mino De Kaspar H (2007) Prospective randomized comparison of 1-day versus 3-day application of topical levofloxacin in eliminating conjunctival flora. Eur J Ophthalmol 17:689–695

    PubMed  CAS  Google Scholar 

  24. Adenis JP, Colin J, Verin P, Saint-Blancat P, Malet F (1995) Ciprofloxacin ophthalmic solution versus rifamycin ophthalmic solution for the treatment of conjunctivitis and blepharitis. Eur J Ophthalmol 5:82–87

    PubMed  CAS  Google Scholar 

  25. Viswalingam M, Rauz S, Morlet N, Dart JK (2005) Blepharokeratoconjunctivitis in children: diagnosis and treatment. Br J Ophthalmol 89:400–403. doi:10.1136/bjo.2004.052134

    Article  PubMed  CAS  Google Scholar 

  26. Faherty B (1992) Chronic blepharitis: easy nursing interventions for a common problem. J Ophthalmic Nurs Technol 11:20–22

    PubMed  CAS  Google Scholar 

  27. McCulley JP, Sciallis GF (1977) Meibomian keratoconjunctivitis. Am J Ophthalmol 84:788–793

    PubMed  CAS  Google Scholar 

  28. Scott I, Flynn H Jr, Feuer W (1995) Endophthalmitis after secondary intraocular lens implantation. A case-report study. Ophthalmology 102:1925–1931

    PubMed  CAS  Google Scholar 

Download references

Acknowledgement

We would like to thank Dr. Klaus Geldsetzer for his contribution in the design of the study.

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Christopher N. Ta.

Additional information

Research supported by Santen GmbH, Germering, Germany; Georg-Hannelore-Zimmermann Foundation, Munich, Germany; bioMérieux Deutschland GmbH, Nürtingen, Germany.

This study was presented in part at the meeting of the Association for Research in Vision and Ophthalmology, Fort Lauderdale, Florida, May 2008.

Clinical Trial Registration at EudraCT, registration number 2006-005075-18

The authors have no proprietary interest in any of the products used in this study. The authors have full control of all primary data, and they agree to allow Graefe’s Archive for Clinical and Experimental Ophthalmology to review their data upon request.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Yactayo-Miranda, Y., Ta, C.N., He, L. et al. A prospective study determining the efficacy of topical 0.5% levofloxacin on bacterial flora of patients with chronic blepharoconjunctivitis. Graefes Arch Clin Exp Ophthalmol 247, 993–998 (2009). https://doi.org/10.1007/s00417-009-1039-0

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00417-009-1039-0

Keywords

Navigation