Blepharitis and MGD Flashcards
What is likely to cause anterior blepharitis?
Bacterial or sebborhoeic infection of follicles or glands of Zeis and Moll
What is likely to cause posterior blepharitis?
Meibomian gland inflammation
What are the signs of staphylococcal blepharitis?
Hard, brittle scales (collarettes)
Inflammation
Bleeding on removal of scales
Lid margin hyperaemia
Lid margin telangiectasia (dilated blood vessels)
What are the signs of sebborhoeic blepharitis?
Soft, greasy scales
Clumped lashes
Shiny lid margin
Lid margin hyperaemia
What are some signs of longstanding blepharitis?
Thickened lid margin and notching
Trichiasis (lashes growing wrong way)
Madarosis (loss of lashes)
Poliosis (loss of pigment in lashes)
Blocked meibomian glands
Corneal staining
Foamy tears caused by excess fatty acids
What are some symptoms of longstanding blepharitis?
Soreness, redness and irritation
FB sensation
Dryness and itching
Burning and grittiness
Mild photophobia
How should you manage mild blepharitis?
Blepharitis products daily
Lid hygiene daily (loosens collarettes, removes crusts, reduces staph levels)
Artificial tears (to treat sxs)
Blephex (deep clean of lids)
How should you manage severe blepharitis?
Chloramphenicol
Systemic antibiotic
Topical corticosteroids
How can CL wear effect blepharitis?
Cause infection or exacerbate sxs
Infection can cause corneal staining
Corneal staining can cause tear film destabilisation
What should you do to manage CL wear with blepharitis?
No CL wear until bleph managed
Fit lenses with increased replacement frequency to reduce infection risk
Advise careful cleaning of reusable lenses (and lids!)
Fit SiHy for better comfort
What can cause meibomian gland duct obstruction?
Hyperkeratinisation of epithelium
Keratinised cell debris
Increased viscosity of meibum
What are the risk factors for MGD?
Age
Gender
Contact Lenses
Hormonal disturbance
Systemic agents
Some skin conditions
What are the signs of MGD?
Gland plugging/capping
No secretion on expression
Cloudy/paste secretion on expression
Tear foaming
Notching of lids
Increased redness of lid margins
Tear film instability
Corneal staining
What are the symptoms of MGD?
Dry, itchy, red eyes
CL intolerance/reduced wearing time
Blurred vision
How can MGD be managed?
Increase omega 3 in diet (food better than supplements)
Adjust work station so screen is just below eye level (keeps lids less wide)
Lid hygiene
Warm compresses
Artificial tears (treating sxs not managing MGD itself)
Pharmaceutical treatment
Therapeutic expression
Device assisted therapies
