Blepharitis And Dry Eye

Question 1

Difference between anterior and posterior bleph

Answer 1

Anterior
- inflammation of glands of Zeus’s or moll, bacterial or seborrhoeic

Posterior
- inflammation of meibomian glands

Question 2

Differences between staphylococcal and seborrhoeic

Answer 2

Staphylococcal
- bacterial exotoxins released by bacteria, causing inflammatory response
- irritation worse in the morning
- scales around base of eyelashes
- hyperaemia and Telangiectasia of anterior lid margin
- scarring AMD hypertrophy if longstanding

Seborrhoeic
- disorder of hands of Zeus or moll, related to acne rosacea & seborrhoeic dermatitis
- shiny anterior lid margin
- hyperaemia of lid margin
- greasy scales
- lashes stick together
- less redness, swelling, Telangiectasia

Question 3

Symptoms of anterior bleph

Answer 3

• Chronic
• Worse in mornings
• Redness, irritation, grittiness, watery discharge
• FB sensation, soreness, photophobia
• Itching

Question 4

Signs of Ant bleph (early)

Answer 4

• Scales - hard & brittle in staphylococcal (collarettes), soft & greasy in serborrhoeic
• Lid hyperaemia, shiny lid
• Lid margin swelling
• Telengectasia (lid margin veins visible)

Question 5

Signs of longstanding anterior bleph

Answer 5

• Foamy tears
• Scarring
• Thickened lid margin
• Corneal staining
• Trichiasis, Madarosis, Poliosis

Question 6

Symptoms of posterior bleph

Answer 6

• Dryness
• Itchiness
• Redness
• CL intolerance
• Blurred vision due to frothing of tear film (not enough lipids change properties of tear film)

Question 7

Signs of Posterior bleph

Answer 7

• Secretions at meibomian gland orifices
• Foam at tear meniscus
• Plugging of orifices (glands look dilatated)
• Conjunctival hyperaemia
• Evaporative tears
• Secondary signs include: punctate epithelial erosion over lower third of cornea; marginal keratitis; scarring; neovascularisation and pannus; mild papillary conjunctivitis

Question 8

Bleph risk factors

Answer 8

• Age
• Hormones
• Gender
• Secondary to some skin conditions
• Diabetes
• Makeup
• Down’s syndrome
• Dirty people/hygiene
• CL wearers

Question 8

Common causes of aqueous deficient dry eye

Answer 8

• Sjogren syndrome (autoimmune)
• Rheumatoid arthritis (inflammatory)
• Lupus (inflammation)
• Sarcoidosis (autoimmune)
• Aging
• Refractive surgery
• Medications- antidepressants, antipsychotics, antihistamines, antihypertensive, anticholinergics, anti-arrhythmic

Question 8

Dry eye sx

Answer 8

• Irritation, FBS, Redness, Gritiness, Burning
• Possibly blurred vision if epithelial disruption or mucous strands
• Sxs worsen with heat, wind or smoke