{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,3,13]],"date-time":"2026-03-13T15:26:42Z","timestamp":1773415602166,"version":"3.50.1"},"reference-count":41,"publisher":"MDPI AG","issue":"5","license":[{"start":{"date-parts":[[2024,2,23]],"date-time":"2024-02-23T00:00:00Z","timestamp":1708646400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Diagnostics"],"abstract":"<jats:p>Meibomitis-related keratoconjunctivitis (MRKC) is characterized by meibomitis with corneal epithelial abnormalities, and can be divided into two types: MRKC accompanied with phlyctenular keratitis, and MRKC accompanied with keratoepitheliopathy that is similar to superficial punctate keratopathy (SPK). The purpose of this retrospective study was to investigate the characteristic features of keratoepitheliopathy and treatment outcomes for MRKC. This study involved 27 eyes of 18 MRKC patients (3 males and 15 females). National Eye Institute (NEI) scores and visual acuity were compared at pre and post treatment. All subjects were treated with a small-dose administration of clarithromycin. Keratoepitheliopathy characteristic to MRKC, yet different in appearance from SPK, was noted in 24 of the 27 eyes. Fluorescein staining revealed granular epithelial lesions generally larger than SPK that coexisted with small dark spots. In 17 eyes, keratoepitheliopathy was located within the pupillary zone, and the visual acuity in 12 eyes was less than 1.0. Our findings showed significant improvement in the NEI score in MRKC (p &lt; 0.0001) and in visual acuity (p = 0.0157) post treatment, and the characteristic features of keratoepitheliopathy in MRKC that are often associated with decreased visual acuity were elucidated. The treatment of clarithromycin was found to be effective for MRKC with keratoepitheliopathy.<\/jats:p>","DOI":"10.3390\/diagnostics14050487","type":"journal-article","created":{"date-parts":[[2024,2,26]],"date-time":"2024-02-26T08:59:01Z","timestamp":1708937941000},"page":"487","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["The Features and Treatment Effects on Keratoepitheliopathy for Meibomitis-Related Keratoconjunctivitis"],"prefix":"10.3390","volume":"14","author":[{"given":"Yukiko","family":"Sonomura","sequence":"first","affiliation":[{"name":"Department of Ophthalmology, Kyoto Prefectural University of Medicine, Kyoto 602-8566, Japan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4839-3416","authenticated-orcid":false,"given":"Norihiko","family":"Yokoi","sequence":"additional","affiliation":[{"name":"Department of Ophthalmology, Kyoto Prefectural University of Medicine, Kyoto 602-8566, Japan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Aoi","family":"Komuro","sequence":"additional","affiliation":[{"name":"Department of Ophthalmology, Kyoto Prefectural University of Medicine, Kyoto 602-8566, Japan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Hiroaki","family":"Kato","sequence":"additional","affiliation":[{"name":"Department of Ophthalmology, Kyoto Prefectural University of Medicine, Kyoto 602-8566, Japan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Chie","family":"Sotozono","sequence":"additional","affiliation":[{"name":"Department of Ophthalmology, Kyoto Prefectural University of Medicine, Kyoto 602-8566, Japan"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1968","published-online":{"date-parts":[[2024,2,23]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"347","DOI":"10.1016\/j.exer.2003.09.019","article-title":"Functional aspects of the tear film lipid layer","volume":"78","author":"Bron","year":"2004","journal-title":"Exp. Eye Res."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"1922","DOI":"10.1167\/iovs.10-6997a","article-title":"The international workshop on meibomian gland dysfunction: Executive summary","volume":"52","author":"Nichlos","year":"2011","journal-title":"Investig. Ophthalmol. Vis. Sci."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"445","DOI":"10.1001\/archopht.1946.00890210453002","article-title":"Etiology and treatment of blepharitis. A study in military personnel","volume":"36","author":"Thygeson","year":"1946","journal-title":"Arch. Ophthalmol."},{"key":"ref_4","first-page":"1133","article-title":"Conjunctivits meibomiana","volume":"34","author":"Elschnig","year":"1908","journal-title":"Med. Wochenschr."},{"key":"ref_5","first-page":"494","article-title":"Chronic conjunctivitis","volume":"67","author":"Thygeson","year":"1963","journal-title":"Trans. Am. Acad. Ophthalmol. Otolaryngol."},{"key":"ref_6","first-page":"85","article-title":"Seborrheic blepharon-kerato-conjunctivitis","volume":"87","author":"Keith","year":"1967","journal-title":"Trans. Ophthalmol. Soc. UK"},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"788","DOI":"10.1016\/0002-9394(77)90497-4","article-title":"Meibomian keratoconjunctivitis","volume":"84","author":"McCulley","year":"1977","journal-title":"Am. J. Ophthalmol."},{"key":"ref_8","first-page":"1151","article-title":"Investigation of the causative bacterium of phlyctenular keratitis","volume":"15","author":"Suzuki","year":"1998","journal-title":"Atarashii Ganka (J. Eye)"},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"812","DOI":"10.1097\/00003226-200211000-00017","article-title":"Ocular surface inflammation induced by Propionibacterium acnes","volume":"21","author":"Suzuki","year":"2002","journal-title":"Cornea"},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"77","DOI":"10.1016\/j.ajo.2005.02.039","article-title":"Phlyctenular keratitis associated with meibomitis in young patients","volume":"140","author":"Suzuki","year":"2005","journal-title":"Am. J. Ophthalmol."},{"key":"ref_11","first-page":"1143","article-title":"Systemic antibiotic therapy against phlyctenular keratoconjunctivitis","volume":"15","author":"Suzuki","year":"1998","journal-title":"Atarashii Ganka (J. Eye)"},{"key":"ref_12","first-page":"423","article-title":"Clinical study of corneal epithelial damage related to meibomitis (meibomitis-related keratopathy)","volume":"17","author":"Suzuki","year":"2000","journal-title":"Atarashii Ganka (J. Eye)"},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"S41","DOI":"10.1097\/ICO.0b013e31826a04dd","article-title":"Meibomitis-related keratoconjunctivitis: Implications and clinical significance of meibomian gland inflammation","volume":"31","author":"Suzuki","year":"2012","journal-title":"Cornea"},{"key":"ref_14","first-page":"389","article-title":"Clinical features meibomitis-related keratoconjunctivitis in elderly patients","volume":"35","author":"Suzuki","year":"2018","journal-title":"Atarashii Ganka (J. Eye)"},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"133","DOI":"10.1016\/j.jtos.2014.12.002","article-title":"Meibomian glands and ocular surface inflammation","volume":"13","author":"Suzuki","year":"2015","journal-title":"Ocul. Surf."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"27","DOI":"10.1097\/00004397-198702710-00005","article-title":"Chronic blepharitis and dry eyes","volume":"27","author":"Bowman","year":"1987","journal-title":"Int. Ophthalmol. Clin."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"107","DOI":"10.1016\/S1542-0124(12)70139-8","article-title":"Meibomian gland dysfunction: A clinical scheme for description, diagnosis, classification, and grading","volume":"1","author":"Foulks","year":"2003","journal-title":"Ocul. Surf."},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"149","DOI":"10.1016\/S1542-0124(12)70150-7","article-title":"The contribution of meibomian disease to dry eye","volume":"2","author":"Bron","year":"2004","journal-title":"Ocul. Surf."},{"key":"ref_19","first-page":"221","article-title":"Report of the National Eye Institute\/Industry workshop on Clinical Trials in Dry Eyes","volume":"21","author":"Lemp","year":"1995","journal-title":"CLAO J."},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"1173","DOI":"10.1016\/S0161-6420(82)34669-2","article-title":"Classification of chronic blepharitis","volume":"89","author":"McCulley","year":"1982","journal-title":"Ophthalmology"},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"373","DOI":"10.1001\/archopht.1937.00850090041006","article-title":"Bacterial factors in chronic catarrhal conjunctivitis. Role of toxin forming staphylococci","volume":"18","author":"Thygeson","year":"1937","journal-title":"Arch. Ophthalmol."},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"641","DOI":"10.1016\/S0002-9394(38)92585-1","article-title":"Staphylococcus conjunctivitis","volume":"21","author":"Allen","year":"1938","journal-title":"Am. J. Ophthalmol."},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"446","DOI":"10.1016\/0002-9394(69)90711-9","article-title":"Complication of staphylococcic blepharitis","volume":"68","author":"Thygeson","year":"1969","journal-title":"Am. J. Ophthalmol."},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"159","DOI":"10.1097\/00004397-198502510-00010","article-title":"Blepharitis associated with acne rosacea and seborrheic dermatitis","volume":"25","author":"McCulley","year":"1985","journal-title":"Int. Ophthalmol. Clin."},{"key":"ref_25","first-page":"65","article-title":"Blepharoconjunctivitis","volume":"24","author":"McCulley","year":"1984","journal-title":"Int. Ophthalmol. Clin."},{"key":"ref_26","first-page":"2970","article-title":"The role of tetracycline in chronic blepharitis. Inhibition of lipase production in staphylococci","volume":"32","author":"Dougherty","year":"1991","journal-title":"Investig. Ophthalmol. Vis. Sci."},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"545","DOI":"10.1097\/00003226-200308000-00011","article-title":"Effect of minocycline on the ocular flora of patients with acne rosacea or seborrheic blepharitis","volume":"22","author":"Ta","year":"2003","journal-title":"Cornea"},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"417","DOI":"10.1016\/S0014-4835(03)00005-8","article-title":"Minocycline effect on meibomian gland lipids in meibomianitis patients","volume":"76","author":"Shine","year":"2003","journal-title":"Exp. Eye Res."},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"121","DOI":"10.1001\/jamaophthalmol.2013.5295","article-title":"Oral azithromycin for the treatment of meibomitis","volume":"132","author":"Greene","year":"2014","journal-title":"JAMA Ophthalmol."},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"1358","DOI":"10.1016\/S0161-6420(93)31475-2","article-title":"Effective treatment of phlyctenular keratoconjunctivitis with oral tetracycline","volume":"100","author":"Culbertson","year":"1993","journal-title":"Ophthalmology"},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"178","DOI":"10.1016\/0002-9394(81)90766-2","article-title":"Orally administered tetracycline for phlyctenular keratoconjunctivitis","volume":"92","author":"Zaidman","year":"1981","journal-title":"Am. J. Ophthalmol."},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"22","DOI":"10.3928\/0191-3913-19810501-06","article-title":"Phlyctenular keratoconjunctivitis","volume":"18","author":"Beauchamp","year":"1981","journal-title":"J. Pediatr. Ophthalmol. Strabismus"},{"key":"ref_33","first-page":"632","article-title":"Clinical effects of low-dose long-term erythromycin chemotherapy on diffuse panbronchiolitis","volume":"25","author":"Kudoh","year":"1987","journal-title":"Nihon Kyobu Shikkan Gakkai Zasshi"},{"key":"ref_34","doi-asserted-by":"crossref","first-page":"469","DOI":"10.1007\/s40257-017-0267-z","article-title":"Oral antibacterial therapy for acne vulgaris: An evidence-based review","volume":"18","author":"Bienenfeld","year":"2017","journal-title":"Am. J. Clin. Dermatol."},{"key":"ref_35","doi-asserted-by":"crossref","first-page":"131","DOI":"10.1016\/j.anl.2015.08.014","article-title":"Past, present and future of macrolide therapy for chronic rhinosinusitis in Japan","volume":"43","author":"Shimizu","year":"2016","journal-title":"Auris Nasus Larynx"},{"key":"ref_36","first-page":"647","article-title":"Multicenter study of isolate from bacterial conjunctivitis in Japan","volume":"24","author":"Matsumoto","year":"2007","journal-title":"Atarashii Ganka (J. Eye)"},{"key":"ref_37","doi-asserted-by":"crossref","first-page":"540","DOI":"10.1111\/j.1365-2249.2007.03299.x","article-title":"Differing effects of clarithromycin and azithromycin on cytokine production by murine dendritic cells","volume":"147","author":"Sugiyama","year":"2007","journal-title":"Clin. Exp. Immunol."},{"key":"ref_38","doi-asserted-by":"crossref","first-page":"53","DOI":"10.1016\/S0924-8579(01)00457-5","article-title":"Modulatory effect of macrolide antibiotics on the Th1-and Th2-type cytokine production","volume":"19","author":"Morikawa","year":"2002","journal-title":"Int. J. Antimicrob. Agents"},{"key":"ref_39","doi-asserted-by":"crossref","first-page":"121","DOI":"10.1016\/S0924-8579(98)00091-0","article-title":"Effects of clarithromycin and azithromycin on production of cytokines by human monocytes","volume":"11","author":"Khan","year":"1999","journal-title":"Int. J. Antimicrob. Agents"},{"key":"ref_40","doi-asserted-by":"crossref","first-page":"1930","DOI":"10.1128\/AAC.45.6.1930-1933.2001","article-title":"Azithromycin inhibits quorum sensing in Pseudomonas aeruginosa","volume":"45","author":"Tateda","year":"2001","journal-title":"Antimicrob. Agents Chemother."},{"key":"ref_41","first-page":"474","article-title":"Comparison of the anti-angiogenic and anti-inflammatory effects of two antibiotics: Clarithromycin versus Moxifloxacin","volume":"41","author":"Uehara","year":"2016","journal-title":"Curr. Eye Res."}],"container-title":["Diagnostics"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2075-4418\/14\/5\/487\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,10]],"date-time":"2025-10-10T14:04:08Z","timestamp":1760105048000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2075-4418\/14\/5\/487"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2024,2,23]]},"references-count":41,"journal-issue":{"issue":"5","published-online":{"date-parts":[[2024,3]]}},"alternative-id":["diagnostics14050487"],"URL":"https:\/\/doi.org\/10.3390\/diagnostics14050487","relation":{},"ISSN":["2075-4418"],"issn-type":[{"value":"2075-4418","type":"electronic"}],"subject":[],"published":{"date-parts":[[2024,2,23]]}}}