Blepharoconjunctivitis

Question 1

Blepharoconjunctivitis (Secondary Bacterial Conjunctivitis)

Answer 1

treat chronic Staph lid disease long-term management and control microbial resistance / “oddball” bacteria fluroquinolones chloramphenicol detailed documentation oral antibiotics true Primary Bacterial Conjunctivitis in non-ped/Senior Pts implies acquired immune dysfunction / deficiency

Question 2

Blepharoconjuncitivitis Symptoms

Answer 2

burn, itchy, red watery, tearing lids “matted shut in AM” scratchy, FB sens swollen

Question 3

Blepharoconjunctivitis Signs

Answer 3

red and edematous eyelids interpalpebral injection, NaFl staining of SPK near lid margins palpebral conjunctival papillae? chemosis? some degree of mucopurulent material (yellow / green?) typically without preauricular adenopathy (PAN)

Question 4

Blepharconjuncitivitis Physiology

Answer 4

• bacteriostatic lysozymes and immunoglobulins in the tear film, the shearing force of the blink, the immune system in general, and non-pathogenic bacteria that compete against external organisms that try to enter • invading bacteria and the exotoxins are foreign antigens; causes inflammation • in a normal healthy person, the eye will fight to return to homeostasis and the bacteria will eventually be eradicated • an extra heavy load of external organisms from lid infections can be too difficult to fight off, causing a conjunctival infection and setting the eye up for potential corneal infiltration (see Marginal Corneal Infiltrates below) and infection (see Bacterial Keratitis below)

Question 5

Treatments: Blepharoconjunctivitis caused by Staphylococci

Answer 5

a. colonized on lid margins, conjunctiva, and possibly in meibomian glands b. complete eradication is impossible c. goal is to control amount of Staph. to reduce infection and inflammation but to maintain its position in anterior segment’s normal flora d. clinically focus on lid disease to treat blepharoconjunctivitis

Question 6

Treatment to control colonization in Blepharoconjunctivitis

Answer 6

b. soaks / scrubs remove scales that protect staphylococci c. express excess microbes from meibomian glands

Question 7

Treatment for microbial resistance in Blepharoconjuncitivitis

Answer 7

a. can occur b. culture and sensitivity testing can be helpful c. avoid over-used medications on a long-term basis (particularly sulfacetamide), with widespread resistance and little effect d. continued blepharoconjunctivitis or true primary bacterial conjunctivitis may be due to oddball, unusual microbes

Question 8

Regimen of treatment for Blepharoconjunctivitis

Answer 8

a. initial therapy must be aggressive i. lid hygiene daily ii. topical abx (Polysporin and erythromycin) alternating ointments, eg AzaSite q 1-2/ weeks (off-label) iii. daily regimen for several weeks

Question 9

AzaSite and Doxycycline

Answer 9

50-100 mg, PO, qD for 3 weeks or more -avoid Doxy with children 8-12 -avoid with pregnant or lactating females

Question 10

When are we cautious about using Dicloxacillin?

Answer 10

patients allergic to cephalosporins (cross sensitvity if possible)

Question 11

If patient is not allergic to penicillin, what could we use to treat resistant staph infection?

Answer 11

Dicloxacillin -ok for children -NOT RECOMMENDED for newborns

Question 12

If patient is allergic to penicillin, what should we use?

Answer 12

erythromycin ethylsuccinate (EES) -ok for children and pregnant

Question 13

When is EES contraindicated?

Answer 13

patients with impaired hepatic function and pregnant

Question 14

What do we presume if there are: no signs of chronic blepharitis healthy non geriatric/non pediatric patient acute or chronic conjunctivitis

Answer 14

oddball true bacterial conjunctivitis

Question 15

If caused by oddball true bacterial conjunctivitis, what type of testing and treatment do we use?

Answer 15

culture and sensitvity testing strong antibiotic drop: besifloxacin (Besivance) susp gentamicin, trimethoprim, vancomycin: MRSA moxifloxacin (Vigamox) sol gatifloxacin (Zymar) sol

Question 16

What great antibiotic is unfortunately too “dangerous” legally to prescribe?

Answer 16

chloramphenicol considered DANGEROUS due to a few cases of a SERIOUS idiosyncratic side effect: a few premature infants have died from aplastic enemia with topical use

Question 17

What information does a specialist need if your treatment is unsuccessful?

Answer 17

detailed documentation of your Tx and the lack of resolution of the patient’s symptoms and signs • may need PO abx Tx due to ineffective topical abx (resistant microbes)