Blepharitis

Question 1

signs & symptoms:

chronic, bilateral, usually symmetric

staphylococcal — collarettes, increased vascularization, trichiasis, irregular lid margin

seborrhoeic — greasy anterior lid margins, stuck together lashes, soft scales

Answer 1

anterior blepharitis

Question 2

what is irritation & inflammation at the base of the eyelashes caused by bacteria called?

Answer 2

anterior blepharitis

Question 3

what are treatments of anterior blepharitis?

Answer 3

• eyelid therapy

- topical antibiotic ointment — (erythromycin or bacitracin oph ung QHS OU)

Question 4

if no response to standard anterior blepharitis treatment, what should you consider?

Answer 4

demodex, pediculosis, phthiriasis palpebrarum, sebaceous carcinoma of the eyelid

Question 5

other treatment options for blepharitis

Answer 5

• artificial tears,
• omega-3 supplements 1g/d (FDA max 3g/d)
• LipiFlow
• pulse light application

Question 6

what are these signs & symptoms indicative of?

• burning, grittiness, assoc. dry eye symptoms
• expressibility (% gland secreting)
• secretion quality (clear vs white)
• ocular surface irritation
• increased tear evaporation
• hyperosmolarity
• unstable tear film (TBUT)

Answer 6

posterior blepharitis (meibomitis)

Question 7

what is caused by meibomian gland dysfunction & changes in meibum?

Answer 7

posterior blepharitis

Question 8

what are treatments of posterior blepharitis?

Answer 8

warm compresses/eyelid massages

oral tetracycline —

• doxycyline 50 mg qd
• tetracycline 250-500 mg qd

Question 9

how does oral tetracyclines help treat posterior blepharitis?

Answer 9

reduces lid & conj. bacteria load
decreases keratinization & bacterial lipase production
reduce matrix metalloproteinase activity

Question 10

what is the contradiction in posterior blepharitis treatment? what treatment should be considered?

Answer 10

contraindicated in pregnant/nursing woman & children <12 y/o

consider erythromycin 200 mg BID

Question 11

natural parasites that live in hair follicles; mites

Answer 11

demodex folliculitis

Question 12

what are signs & symptoms of demodex folliculitis?

Answer 12

cylindrical dandruff-like scaling around eyelash base

Question 13

what is associated w/ demodex folliculitis?

Answer 13

common in pts, esp those w/ rosacea

Question 14

what is treatment for demodex folliculitis?

Answer 14

eyelid hygiene —

• tea tree oil (Cliradex)
• oral methronidazole, oral ivermectin
• hypochlorous acid (OcuSOFT Hypochlor, avenoma)

best visualized thru epilation then slide microscopy

Question 15

what 2 conditions are round, translucent parasite that infest hair-bearing areas and uncommon eyelid affliction?

Answer 15

pediculosis & phthiriasis

Question 16

head & body, lice

signs —
~0.5mm in length at eyelid base
accompanied by nits (eggs) & black lice excrement

symptoms —
conjunctivitis
regional lymphadenopathy

Answer 16

pediculosis

Question 17

what is treatment for pediculosis?

Answer 17

• examine & treat family members
• thoroughly cleanse clothing, towels, bedding
• optimize hygiene

prevent respiration of lice — petroleum jelly, topical antibiotic ointment BID x 8-10 days

epilation

Question 18

public lice (crabs) — may be a sign of sexual abuse if seen in children

signs —
~0.5mm in length at eyelid base
accompanied by nits (eggs) & black lice excrement

symptoms —
conjunctivitis
regional lymphadenopathy

Answer 18

phthiriasis

Question 19

what is treatment for phthiriasis?

Answer 19

• examine & treat family members
• thoroughly cleanse clothing, towels, bedding
• optimize hygiene

prevent respiration of lice — petroleum jelly, topical antibiotic ointment BID x 8-10 days

epilation

Question 20

what are these signs & symptoms indicative of?

intractable, unilateral, asymmetrical

loss of eyelashes & destruction of the orifices of meibomian gland may occur

Answer 20

sebaceous carcinoma (eyelid)

Question 21

what is treatment for sebaceous carcinoma (eyelid)?

Answer 21

potentially lethal -> refer to oculoplastics for biopsy

Question 22

signs:

• telangiectasias/pustules/papules/erythema of cheeks, forehead, & nose
• deep corneal vascularization particularly in inferior cornea may be seen
• blepharitis
• history of recurrent chalazia
• conjunctival injection
• SPK

Answer 22

ocular rosacea

Question 23

symptoms:

• bilateral, chronic ocular irritation
• dry eyes
• redness, burning
• photophobia
• foreign body sensation

Answer 23

ocular rosacea

Question 24

idiopathic, but signs & symptoms are often induced by certain environmental factors (hot beverages, tobacco, vasodilators, alc, stress)

Answer 24

ocular rosacea

Question 25

what is treatment for ocular rosacea?

Answer 25

• warm compress & eyelid hygiene for blepharitis & meibomitis
• treat dry eye if present
• avoid exacerbating foods, beverages, & environmental factors

-doxycycline 100mg PO BID for 1-2 weeks then daily → taper
—erythromycin or oral azithromycin if contraindicated

Question 26

what are ocular rosacea findings in an SL examination?

Answer 26

• look for telangiectasias & meibomitis on eyelids
• conjunctival injection
• corneal scarring & vascularization

Question 27

what are ocular rosacea findings in an external examination?

Answer 27

look at face for characteristic findings