Chronic Blepharitis

Question 1

Definition

Answer 1

Inflammation of the eyelid

Question 2

Classification and its Aetiology

Answer 2

1. Anterior
   - involving anterior lid margin ‘eyelash’
   - can be due to:
   i. Staph infection
   ii. Saborrheic (excess sebum secretion)
2. Posterior
   - involving posterior lid margin ‘meibomian gland’
   - postulated due to Staph infection.

Question 3

Pathology

Answer 3

1. Inflammation of the eyelid
2. Can cause tear instability when involving meibomian glands (Dry eyes syndrome)
3. Cx:
   - conjunctivitis
   - keratitis
   - chalazion

Question 4

Symptoms

Answer 4

Types anterior/posterior cant be distinguished clinically.

1. Swelling of the eyelid
   - relapsing remitting
   - usually in the morning
2. Dry eyes syndrome
3. Conjunctivitis/Keratitis sx
   - red eye
   - pain, photophobia

Question 5

Signs

Answer 5

1. Crusting, swelling of the eyelid margin
2. Abnormality in the eyelash (anterior)
   - tylosis (scarring, notching)
   - madarosis (loss of eyelash)
   - trichiasis (ingrowth/introverted eyelash)
   - Sticky, greasy lashes
3. Meibomian
   - cupping/plugging of gland orifices
   - pressure results in expulsion of meibomian fluid

Question 6

Associated clinical features

Answer 6

1. Atopic conjunctivitis- Staph related
2. Saborrheic dermatitis - Saborrheic related
3. Acne rosacae/vulgaris - Posterior blepharitis

Question 7

Treatment

Answer 7

1. Lid hygiene
   - soften the crust
   - cleaning
2. Antibiotic
   - topical
   - tetracyclin (especially in posterior blepharitis)
   ‘against staph-lipase production’
3. Artificial tears
   - for dry eyes