Comparative efficacy of the ophthalmic gel containing metronidazole, hyaluronic acid, <i>Aloe vera</i> extract, and sulfur preparations in the treatment of patients with chronic blepharitis on the background of meibomian gland dysfunction

BACKGROUND: Meibomian gland dysfunction (MGD) and chronic blepharitis remain significant challenges in ophthalmology. Standard therapy comprises phytoblepharohygiene and eyelid massage, with anti-inflammatory and tear substitutes. However, the efficacy of the sequential use of phytoblepharohygiene and the ophthalmic gel containing metronidazole, hyaluronic acid, Aloe vera extract and sulfur preparations (Blepharogel Forte®; Geltek-Medica, Russia) for chronic blepharitis and MGD, remains underexplored. AIM: To evaluate the therapeutic effect of a sequential regimen comprising a line of phytoblepharohygiene products, including the ophthalmic gel containing metronidazole, hyaluronic acid, Aloe vera extract and sulfur preparations (in patients with prolonged chronic blepharitis and MGD). MATERIALS AND METHODS: The study involved 42 patients (84 eyes) aged 16–73 years, including 30 men (60 eyes, 71.4%) and 12 women (24 eyes, 28.6%), diagnosed with chronic blepharitis, MGD, and dry eye syndrome. Depending on the treatment method, two groups were formed. Patients of control group I (20 subjects, 40 eyes, 47.6%) received eyelid massage and phytoblepharohygiene with the ophthalmic gel containing hyaluronic acid and Aloe vera extract (agent 1) or the ophthalmic gel containing hyaluronic acid, Aloe vera extract, and sulphur preparations (agent 2) (in case of confirmed demodicosis). The comparison group II (22 subjects, 44 eyes, 52.4%) underwent eyelid massage and phytoblepharohygiene, which was completed by applying the ophthalmic gel containing metronidazole, hyaluronic acid, Aloe vera extract, and sulfur preparations (agent 3) (irrespective of a positive or negative test for demodicosis). RESULTS: From the first week onwards, the indices characterizing hyposecretion of meibomian glands in groups I and II were already 1.9±0.2 and 1.1±0.3 points lower than the initial values of 2.6±0.2 and 2.4±0.3 points, respectively (p 0.05). Furthermore, the dynamics of hypersecretion indices exhibited a comparable trend, with values of 1.6±0.2 and 1.5±0.2 points recorded after a week in comparison with the initial values of 2.3±0.3 and 2.2±0.2 points, respectively (p 0.05). The index characterizing eyelid edema at this stage of the study exhibited a statistically significant decrease only in group II of patients who received the ophthalmic gel containing metronidazole, hyaluronic acid, Aloe vera extract and sulfur preparations (1.4±0.2 points after a week in comparison with the initial 2.3±0.2 points) (p 0.05). In group I, only the initial results were maintained, whereas in group II, a stable increase was observed. CONCLUSION: The ophthalmic gel containing metronidazole, hyaluronic acid, Aloe vera extract and sulfur preparations can be effective in the treatment of patients with blepharitis and MGD due to its superior therapeutic effectiveness compared with the standard blepharohygiene and phytoblepharohygiene regimens.