Lid sensitivities Flashcards
Classic description of staph marginal keratitis
Multiple, bilateral, peripheral corneal stromal infiltrates (without overlying epi defects) secondary to chronic blepharitis. Corneal infiltrates most commonly occur at the 2, 4, 8, and 10 positions where the eyelid margins contact the limbus. Corneal thinning, surface neo, and scarring may eventually occur over time
Corneal infiltrates
Sign that the patient’s immune system is attack the staph antigens with Abs, in isolation, it is an immune mediated response and NOT sign of infection
Corneal ulcers
Corneal epi defect with an underlying stromal infiltrate
RCE
Due to poor hemidesmosome attachments between the corneal epi and the underlying basement membrane, most commonly develop in eyes with a history of trauma or with corneal dystrophies (EBMD), patients classically report pain in the AM upon wakening as well as photophobia and a FB sensation. Recall that although 50% of patietns with RCEs have EBMD, only 10% of patients with EBMD will develop RCE
Diff between corneal ulcer and abrasion
Ulcers have stromal infiltrate
Infectious vs sterile ulcer
Corneal ulcers will have epi defects and an underlying infiltrate, patients will present with mod-severe pain, a mild AC reaction, and diffuse conj injection
- infectious ulcers, the size of the epi defect will match the size of the infiltrate
- sterile ulcers, the epi defect will be smaller than the size of the infiltrate
An infiltrate WITHOUT an overlying epi defect is referred to as an infiltrate. Patients typically have less pain compared to a corneal ulcer, despite having multiple lesions. Sectoral (rather than diffuse) conj injection will be present in the area of corneal infiltrate, and the AC will be quiet
What type of HS reaction is staph marginal keratitis
Type III HS
-against antigens produced by staph aureus. Most commonly associated with staph bleph, acne rosacea, and phlyctenule.
H flu causes infiltrated in what population
Kids
Treatment for staph marginal keratitis
Topical abx/steroid (tobradex or zylet) every 4 hours
Also better lid hygiene
anterior bleph
Anterior eyelid margin inflammation with telangiectasia and flakes within the lashes
Treatment for anterior bleph
- eyelid scrubs BID or TID until condition stabilizes, and then QD thereafter
- bacitracin or erythromycin ung qhs x 2-4 weeks
- AzaSite (topical azith) gtts BID x 2 days, then QD x 12 days
- topical ophthalmic abx/steroid (tobradex) if significant redness and/or inflammation is present
Posterior blepharitis
Inflammation of the meibomian glands
Treatment of posterior bleph
- warm compresses with fingertip massage of the eyelids 5-10m QID
- eyelid scrubs BID or TID until the condition stabilsizes then QD
- AzaSite BID x 2 days then QD x 12 days
- oral doxy 100mg BID for appx 4 week, then 100mg QD (or 50mg QD) for 3-6 months, or 40-50mg QD for appx 6-12 months. Oral mino 50mg BID x 2 months is an alternative
- fish oil and omega 3 FAs
Seborrheic blepharitis
Assocaited with seborrheic dermatitis. Assocaited with less eyelid inflammation, more oily, greasy scales, and flaking compared to staph bleph
Treatment of RCCs and corneal abrasions
- Prevent infection and heal the corneal defect
- broad spectrum abx BID to QID
- PFAT up to Q1h during the day
- debridement of loose, fought, or heaped up corneal epithelium to promote proper tissue adhesion during the healing process
- Reduce pain
- cycloplegic agent 1gt in office to reduce pain
- topical NSAID BID x 2-3 days or until the corneal epithelium heals if needed to control pain
- BCL in order to decrease discomfort and trauma to the corneal epi from the eyelid contacting the epi defect with each blink
- Prevent recurrence
- oral doxy 50mg BID and a topical steroid TID x 3-4 weeks
- murro 128 ung qhs x 3 months
Additional
- pressure patching (large)
- surgical management
