Blepharitis and Disorders of the eyelid Flashcards
this structure secretes sebum and contributes to the outermost oily layer of the tear film
Meibomian glands
modified sweat glands that either open between two eyelashes or into a gland of Zeis
glands of moll
modified sebaceous glands that are attached directly to eyelash follicles
glands of zeis
Chronic eyelid condition: bilateral presentation with conjunctival redness and inflammation around the eyelid margins
Blepharitis
What causes blepharitis?
underlying medical conditions (rosacea, dermatitis, dry eye)
bacterial infections (S. aureus, s. epidermidis)
parasitic infestations (demodex spp, mites)
other ( cig smoking, contact lenses)
What are the two components of blepharitis?
- Anterior blepharitis
2. Posterior blepharitis
What location is the anterior margin of the eyelid?
outer portion of the eyelid
What is anterior blepharitis and is it less or more common than posterior blepharitis?
inflammation along the eyelashes
less common than posterior blepharitis
What are the two types of anterior blepharitis?
- staphylococcal-type
2. seborrheic type
What causes staphylococcal type blepharitis?
S. aureus, and S. epidermidis organisms
- through direct infection of the eyelids
- exotoxin
- allergic response
Signs and symptoms of staphylococcal-type blepharitis
inflammation and redness around the anterior of the eyelids
HARD and CRUSTY SCALES on the eyelash
conjunctival redness
What causes seborrheic-type blepharitis
occurs in ppl with seborrheic dermatitis
Signs and symptoms of seborrheic type blepharitis
inflammation and redness around the anterior margin of the eyelids
OILY and GREASY SCALES around the eyelashes
conjunctival redness
What type of blepharitis affects the inner portion of the eyelid?
posterior blepharitis
What causes posterior blepharitis?
meibomian gland dysfunction
What are the 2 types of meibomian gland dysfunction?
- meibomian seborrhea
- meibomianitis
composition of tear film is changed or blockage of meibomian ducts
Signs and symptoms of meibomian seborrhea
little to no inflammation of the posterior lid margin
conjunctival redness
SENSITIVITY TO LIGHT, BURNING SENSATION
OILY, FOAMY, FROTHY, TEAR FILM
signs and symptoms of meibomianitis
inflammation of the posterior lid margin
partial or complete obstruction of the meibomian glands;
applying pressure = THICK, WAXY SECRETION released
Main tip of non-pharm therapy?
good eyelid hygiene for all types
What treatment for mild to moderate symptoms?
non-pharm therapy alone
what treatment for severe symptoms or recurrent blepharitis?
non-pharm AND pharmacological therapy together
List 3 non-pharm measures to treat blepharitis
- Warm compress and eyelid massage
- circular motion
- heat softens secretions and massage = clear blockages - Eyelid Washing
- dilute baby shampoo, eyelid cleaner, light tough
- removes buildup and debris - Artificial Tears
- symptomatic relief
- dry eye or for ppl that smoke or use contact lenses
Why are ointments preferred instead of drops for the treatment of anterior blepharitis?
easier to use
leads to increased contact time
Pharmacological treatment for anterior blepharitis?
- erythromycin 0.5% qhs 1 x week
2. Fucithalmic 1% viscous drops 1 gtt q12h x 1 week (viscous = longer contact time)
Pharmacological treatment for posterior blepharitis
- doxycycline 100 mg po daily
- minocycline 50-100 mg po daily
- tetracycline 250 mg po qid
- erythromycin 250 mg po qid
- azithromycin 1000 mg po weekly or 500 mg po daily x 3 days per week
How long is the pharmacological treatment for posterior blepharitis?
2-4 weeks depending on symptoms
what is the formal name for a stye?
hordeolum
What causes hordeolum (stye)
bacterial infection
S. aureus
What are the two types of hordeolum?
- external hordeolum
2. internal hordeolum
this type of stye typically involves the glands of moll and/or Zeis and tend to be smaller in size
External hordeolum
this type of style involves the meibomian gland and tend to be larger in size with more pronounced swelling
internal hordeolum
What are contributing factors to stye
underlying medical conditions
other (eye makeup )
Signs and symptoms for a stye?
single PAINFUL lesion
unilateral
LOCALIZED REDNESS and INFLAMMATION
ACUTE ONSET
lesion that occurs due to meibomian gland blockage?
chalazion
T or F: chalazion lesion is sterile
TRUE
it points inwards and causes conjunctival irritation
What can contribute to chalazion
underlying medical condition (blepharitis, rosacea, seborrheic dermatitis)
Signs and symptoms of chalazion
single PAINLESS lesion
GRADUAL onset
unilateral, localized swelling
Timeline of hordeolum and chalazion being resolved by
external hordeolum: ____
internal hordeolum: _____
chalazia: ____________ (depending on size)
external: 2 days
internal: 1 week
chalazia: several days to 1 week
Non-pharm measures for the treatment of chalazia and styes
- warm compress and eyelid massage
2. Eyelid washing
What do you do when a stye doesn’t resolve in that time frame?
refer to physician
they can surgically incise and drain the lesion + topical antibiotic AFTER the surgical incision
Erythromycin ung 05% qhs x7/7
When are oral antibiotics used in the treatment of styes?
only when cellulitis is suspected
T or F: antibiotics are indicated for chalaziion
no antibiotics are not indicated for chalazion because chalazion are sterile
Topical antibiotics are used when dr incises the chalazion lesion and are used for after that. Erythromycin ointment
+ corticosteroid injection
