Eyelid conditions

Question 1

Briefly compare pathophysiology of a stye, chalazion, and blepharitis

Answer 1

Stye: acute infection of 1 or more eyelid glands
Chalazion: Inflammation of the lid due to obstructed meibomian glands
Blepharitis: Inflammation of the lid margins associated with infection, dermatological conditions, or meibomian gland dysfunction

Question 2

What is an external vs. internal stye?

Answer 2

External: infection of glands of Zeis or Moll, smaller more superficial infection
Internal: infection of Meibomian glands, larger area of swelling

Question 3

What non-pharmacologic therapy can we use to treat a stye?

Answer 3

Warm compress for 10-15 minutes 3-4 times a day.
External styes: should drain spontaneously within 48 hours
Internal styes: should drain spontaneously within 1-2 weeks

Question 4

What pharmacologic treatment can we use to treat styes?

Answer 4

Self-medication with antibacterials not recommended since most styes will drain spontaneously

Question 5

How does a chalazion present?

Answer 5

Painless, localized swelling, common in people with blepharitis, acne, or seborrheic dermatitis

Question 6

What non-pharmacologic therapy can we use to treat a chalazion?

Answer 6

Warm compresses

Warm water, eyelid wipes, or diluted baby shampoo can be used to remove excess discharge

Question 7

What pharmacologic therapy can be used to treat a chalazion?

Answer 7

Self-medication with nonprescription ophthalmic antibacterials is not recommended, since it’s not an infection

Question 8

Describe the pathophysiology of blepharitis and presentation

Answer 8

Affects the eyelids bilaterally
Can be caused by Demodex mite infection, or phthirus pubic (crab lice), staphylococcal infection, seborrheic, or Meibomian gland dysfunction

Question 9

What is anterior blepharitis?

Answer 9

Anterior: either infection or inflammation
Anterior: classified as staphylococcal or seborrheic, but common for patients to present with both. Staphylococcal blepharitis: inflammation and redness, lid margins are scaly and crusty. Seborrheic blepharitis: lids are oily and greasy

Question 10

What is posterior blepharitis?

Answer 10

Posterior: inflammation
Posterior: meibomian gland dysfunction that can lead to inflammation of the posterior eyelid. Can present as either meibomian seborrhea or meibomianitis
Meibomian seborrhea: excessive glandular secretions, not much inflammation
Meibomianitis: Inflammation and obstruction of meibomian glands

Question 11

What non-pharmacologic therapies can be used to treat blepharitis?

Answer 11

Artificial tears to alleviate symptoms
Avoiding cocamidolpropyl betaine– a surfactant in many products.
Warm compress, gentle cleansing of the lid margin

Question 12

What antibiotics can be used to treat blepharitis?

Answer 12

Anterior blepharitis: ophthalmic anti-staphylococcal antibiotics and erythromycin
Posterior blepharitis: tetracyclines, erythromycin, azithromycin

Question 13

What ophthalmic anti-inflammatory agents can be used to treat blepharitis?

Answer 13

Ophthalmic corticosteroids or corticosteroid/antibacterial combinations
Dexamethasone
Loteprednol
Fluorometholone ophthalmic drops

Question 14

What are other agents that can be used to treat blepharitis?

Answer 14

Immunomodulatory agents
Calcineurin inhibitors
Oral ivermectin for demodex infection

Question 15

What natural health products can be used to treat blepharitis?

Answer 15

Omega-3 fatty acids

Tea tree oil cleansers/shampoos