Blepharitis Flashcards
signs & symptoms:
chronic, bilateral, usually symmetric
staphylococcal — collarettes, increased vascularization, trichiasis, irregular lid margin
seborrhoeic — greasy anterior lid margins, stuck together lashes, soft scales
anterior blepharitis
what is irritation & inflammation at the base of the eyelashes caused by bacteria called?
anterior blepharitis
what are treatments of anterior blepharitis?
- eyelid therapy
- topical antibiotic ointment — (erythromycin or bacitracin oph ung QHS OU)
if no response to standard anterior blepharitis treatment, what should you consider?
demodex, pediculosis, phthiriasis palpebrarum, sebaceous carcinoma of the eyelid
other treatment options for blepharitis
- artificial tears,
- omega-3 supplements 1g/d (FDA max 3g/d)
- LipiFlow
- pulse light application
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)
posterior blepharitis (meibomitis)
what is caused by meibomian gland dysfunction & changes in meibum?
posterior blepharitis
what are treatments of posterior blepharitis?
warm compresses/eyelid massages
oral tetracycline —
- doxycyline 50 mg qd
- tetracycline 250-500 mg qd
how does oral tetracyclines help treat posterior blepharitis?
reduces lid & conj. bacteria load
decreases keratinization & bacterial lipase production
reduce matrix metalloproteinase activity
what is the contradiction in posterior blepharitis treatment? what treatment should be considered?
contraindicated in pregnant/nursing woman & children <12 y/o
consider erythromycin 200 mg BID
natural parasites that live in hair follicles; mites
demodex folliculitis
what are signs & symptoms of demodex folliculitis?
cylindrical dandruff-like scaling around eyelash base
what is associated w/ demodex folliculitis?
common in pts, esp those w/ rosacea
what is treatment for demodex folliculitis?
eyelid hygiene —
- tea tree oil (Cliradex)
- oral methronidazole, oral ivermectin
- hypochlorous acid (OcuSOFT Hypochlor, avenoma)
best visualized thru epilation then slide microscopy
what 2 conditions are round, translucent parasite that infest hair-bearing areas and uncommon eyelid affliction?
pediculosis & phthiriasis
head & body, lice
signs —
~0.5mm in length at eyelid base
accompanied by nits (eggs) & black lice excrement
symptoms —
conjunctivitis
regional lymphadenopathy
pediculosis
what is treatment for pediculosis?
- 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
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
phthiriasis
what is treatment for phthiriasis?
- 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
what are these signs & symptoms indicative of?
intractable, unilateral, asymmetrical
loss of eyelashes & destruction of the orifices of meibomian gland may occur
sebaceous carcinoma (eyelid)
what is treatment for sebaceous carcinoma (eyelid)?
potentially lethal -> refer to oculoplastics for biopsy
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
ocular rosacea
symptoms:
- bilateral, chronic ocular irritation
- dry eyes
- redness, burning
- photophobia
- foreign body sensation
ocular rosacea
idiopathic, but signs & symptoms are often induced by certain environmental factors (hot beverages, tobacco, vasodilators, alc, stress)
ocular rosacea
what is treatment for ocular rosacea?
- 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
what are ocular rosacea findings in an SL examination?
- look for telangiectasias & meibomitis on eyelids
- conjunctival injection
- corneal scarring & vascularization
what are ocular rosacea findings in an external examination?
look at face for characteristic findings
