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Eye Disease > Lid Margin Disease > Flashcards

Lid Margin Disease Flashcards

1
Q

What is another term for lid margin disease?

A

Marginal Blepharitis

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2
Q

Where are the meibomian glands located on the lid margin?

A

In front of the mucocutaneous junctions (this is the point at which keratinized stratified squamous epithelial cells of the eyelid skin to cuboidal epithelial cells of the palpebral conjunctiva)

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3
Q

What does the grey line represent ?

A

The location of Riolans muscle and divides the lid anterior and posterior lamellae

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4
Q

What is the function of meibomian glands?

A

They are glands that secrete the meibomian responsible for the formation of the tear film’s outer layer and located in the tasrsal plates

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5
Q

Are there more meibomian glands in the upper or lower lid?

A

More numerous and longer in the upperlid

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6
Q

What is the function of the lipid layer of the tears?

A

Reduce tear evapouration by contributes to tear stability

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7
Q

Can you cure lid margin disease?

A

NO- once you have it, theres no going back

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8
Q

What is endophalmitis?

A

Post-operative infection following ophthalmic surgery and is an intraocular infection which is sight threatening

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9
Q

What are three classifications that lid margin disease can be classified into?

A
  • Anterior lid margin disease (anterior lid + eye lashes)
  • Posterior lid margin disease (posterior to the grey line including MGD)
  • Mixed anterior and posterior lid margins disease
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10
Q

What are the two aetiologies of lid margin disease

A

Inflammatory or result of an infection

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11
Q

What are the inflammatory causes of lid margin disease? (there are four)

A
  • Seborrheic
  • MGD
  • Allergic
  • Associated with dermatosis
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12
Q

What are the infectious causes of lid margin disease? (there are four +name the organism associated)

A
  • Bacteria (Staphylococcus Aureus)
  • Viral (Herpes simplex)
  • Fungal
  • Parasitic (Demodex folliculorum)
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13
Q

Name two cutaneous (affects the skin) associations of lid margin disease

A

Acne Rosacae - inflammatory condition of the glands of skin and face
Seborreic dermatitis- inflammatory skin condition of sebacous gland + you see scaly red leisons on the face

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14
Q

What are some symptoms of lid margin disease?

A
  • Discomfort
  • Itching
  • Burning
  • Irritation
  • Dryness
  • Tearing
  • Vision fluctuation
  • Puffiness
  • Contact lens intolerance
    *you can not diagnose lid margin disease from just symptoms alone
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15
Q

What must you let your px know if you are fitting them with contact lenses and they have lid margin disease?

A

They will have reduced wear time of contact lens use such as 6 hours; manage expectations

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16
Q

What are signs of anterior lid margin diseasee?

A
  • Debris within eye lashes and scaling,
  • misdirection of eyelashes (trichiasis) ,
  • hypereamia
17
Q

What organisms can cause anterior lid margin disease?

A
  • Over growth of gram positive bacteria (esp Staphylococcus)
  • Mite infestation (Demodex folliculorum - these are mites that naturally live on your eye lashes)
18
Q

What are collarettes?

A

Pathognomonic sign of Demodex blepharitis which is characterised by scaling at the base of the eye lash/ cylindrical dandruff

19
Q

What causes the hyperemia on the lid margin?

A

Production of toxins from bacteria - the progression of toxins on to the tear film could cause keratitis

20
Q

What is commonly associated with posterior lid margin disease?

A

MGD

21
Q

What type of dry eye disease is commonly associated with posterior lid margin disease and why does this happen?

A

Evaporative dry eye because are the meibomian glands have blocked with solidified meibum therefore this is not secreted on the ocular surface and the integrity of the lipid layer is lost

22
Q

What are two classifications of MGD?

A
  • Low delivery (can be due to hyposecretory or obstruction- more common)
  • high delivery (hypersecretory)
23
Q

In simple terms what is the definition mgd?

A

Chronic abnormality of the meibomian glands which causes duct obstruction which may result in the alteration of the tear film, eye symptoms and ocular surface disease

24
Q

Why is it important to identify mgd at an early stage?

A

It is less likely to progress and treatment is more likely to have a successful outcome

25
Q

What are signs of mgd?

A
  • Plugging of ducts
  • Foaming of tears
  • Notching of posterior lid margin; this indicates meibomian gland drop out
  • Increased lid margin vascularity
26
Q

What is telangiectasia?

A

Increased lid margin vascularity

27
Q

How do you clinically assess lid margin disease?

A
  • Dry eye investigation (tear meniscus height, tbut, schrimer test, staining with NaFl)
  • Observation of lid margins
  • Expression quantification (graded)
28
Q

How is meibomian gland excretion graded (quality & expressivity)?

A
  • Quality: 8 glands assessed of the central third of the lid & EACH gland graded 0-3
    (0= clear, 3= thick like tooth paste)
  • Expressivity: 5 glands graded 1-3
    graded 1 =3-4 glands expressive
    grade 2= 1-2 glands expressive
    grade 3 = no glands expressive
29
Q

How is lid margins disease managed?

A
  • LID HYGIENE (like blephoclean, or boiled water with baby shampoo + cotton buds)
  • Warm compresses (eye masks, warm fannel + eyelid massage)
  • Pharmacotheraphy (ocular lubricants, liposmal spray, topical antibiotics, systemic tetracyclines + omega-3 fatty acids)
30
Q

Why would topical antibiotics be used to treat lid margin disease?

A

Reduces the bacterial load on lid margins

31
Q

Why would systemic tetracyclines be used to treat lid margin disease?

A

Treats rosacea and mgd by suppressing bacterial lipases that alter meibomian secretions

32
Q

What is a characteristic of demodex blepharitis?

A

Cylinderical dandruff (collarettes)

33
Q

What causes demodex blepharitis?

A

Demodex mites- some people hypersensitive or have an overload of these mites

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