3: Eyelids- Blepharitis Flashcards
anterior blepharitis
chronic inflammation of the eyelid margin anterior to the mucocutaneous junction
anterior blepharitis etiology
- staphylococcal: inflammatory reaction to a colony of bacteria on the eyelid margin (biofilm); biofilm migrates into the lash follicle –> low grade inflammation
- seborrheic: excessive sebum released by sebaceous glands
anterior blepharitis demographics
more common in adults
anterior blepharitis laterality
bilateral
anterior blepharitis symptoms
- crusty debris along the eyelid margins
- eyelid margin redness (may extend beyond the margin)
- ocular irritation (e.g., burning, FBS)
- tearing
anterior blepharitis signs
- scurf within the eyelashes and on the skin surrounding the lashes
- if seborrheic, greasy appearance to the eyelid margin (as well as the scalp, nasolabial folds, behind the ears)
- eyelid margin erythema and edema
- madarosis (mechanical, not malignant)
- tear film debris
anterior blepharitis management
- lid hygiene: warm cloth and baby shampoo to soften crusty debris
- topical lubrication
- eyelid cleanser
- hypochlorous acid eyelid spray (neutralizes bacteria, toxins, and inflammatory mediators)
- for moderate to severe cases, antibiotic or antibiotic/steroid ung
- BlephEx with eyelid cleanser in office; Rx antibiotic/steroid ung following the treatment
demodicosis, aka demodex
specific type of anterior blepharitis due to Demodex infection
demodicosis (demodex) etiology
overpopulation of demodex folliculorum or demodex brevis (obligatory human ectoparasite that resides in or near the pilosebaceous units)
demodicosis (demodex) demographics
more common in the elderly
demodicosis (demodex) laterality
bilateral
demodicosis (demodex) symptoms
- eyelid margin itching, especially in the morning (mites are more active in the dark)
- crusty debris along the eyelid margins
- eyelid margin redness (may extend beyond the margin)
- ocular irritation (e.g., burning, FBS)
- tearing
demodicosis (demodex) signs
- cylindrical dandruff (clear tubular cuff that is attached to the eyelid margin and encircles the eyelash base)
- mite attached to lash base (epilate lash and view under microscope for definitive diagnosis; mites are semi-transparent and 0.1-0.4 mm in length)
- eyelid margin erythema and edema
- madarosis (mechanical, not malignant)
- tear film debris
demodicosis (demodex) management
- eyelid cleanser with tea tree oil bid x1 month (as maintenance, 2x/week)
- BlephEx with eyelid cleanser and tea tree oil in office; Rx antibiotic/steroid ung following tx; repeat in 2 weeks (1st application kills adults, 2nd kills eggs)
- recommend discarding old makeup and discontinuing wear x1 month
- recommend spouse/partner evaluation for infestation
demodicosis (demodex) clinical pearls:
- _____ is the most active ingredient to kill demodex mites
- caution against using _____
4-terpineol (found in tea tree oil);
100% tea tree oil
posterior blepharitis, meibomitis
chronic inflammation of the eyelid margin posterior to the mucocutaneous junction (i.e., meibomian glands)
posterior blepharitis, meibomitis etiology
- inflammatory reaction to a colony of bacteria on the eyelid margin (biofilm); biofilm migrates into the MG and causes low-grade inflammation; as the biofilm thickens, bacteria release exotoxins –> more inflammation –> causes thickening and stasis of meibum
- may be associated with acne rosacea
posterior blepharitis, meibomitis demographics
more common in adults
posterior blepharitis, meibomitis laterality
bilateral
posterior blepharitis, meibomitis symptoms
- eyelid margin redness (may extend beyond the margin)
- ocular irritation (e.g., burning, FBS, mild pain)
- tearing
posterior blepharitis, meibomitis signs
- eyelid margin erythema and edema
- meibomian gland inspissation (capping)
- turbid, viscous, or toothpaste-like meibum upon expression of the MG (apply pressure to the MG to evaluate the expression of meibum)
- telangiectasia
- MG atrophy (can evaluate using transillumination or meibography; may give the lid margin a scalloped appearance)
- decreased TBUT
- tear film debris
posterior blepharitis, meibomitis management
- eyelid cleanser
- hypochlorous acid eyelid spray (neutralizes bacteria, toxins, and inflammatory mediators)
- warm compresses to liquefy meibum
- topical lubrication with lipid supplements
- omega 3 fatty acid supplement (fish oil); improves meibum production
- oral doxycycline if blepharitis is refractory to eyelid hygiene and warm compress
- for moderate to severe cases, antibiotic or antibiotic/steroid ung
- BlephEx with eyelid cleanser in office; Rx antibiotic/steroid ung following Tx
- meibomian gland expression in office
- meibomian gland probing in office
- LipiFlow in office
- intense pulsed light (IPL) therapy in office
posterior blepharitis, meibomitis clinical pearls:
- primary cause of ____
- frequently occurs in conjunction with _____
evaporative dry eye (85% of dry eye cases have MGD as its primary cause or at least contributory);
anterior blepharitis
angular blepharitis
infection of the epidermis at the temporal canthus
angular blepharitis etiology
- most commonly staphylococcus aureus or moraxella lacunata
- less commonly herpes simplex
angular blepharitis demographics
more common in adults
angular blepharitis laterality
unilateral
angular blepharitis symptoms
- redness at the temporal canthus
- crusting or white discharge at the temporal canthus
- itching of the skin at the temporal canthus
angular blepharitis signs
- erythema at the temporal canthus
- crusting or whitish frothy discharge at the temporal canthus (moraxella produces stickier, frothier presentation)
- fissured skin at the temporal canthus
angular blepharitis management
- eyelid cleanser
- hypochlorous acid eyelid spray (neutralizes bacteria, toxins, and inflammatory mediators)
- antibiotic or antibiotic/steroid ung
