Midterm 2- Meibomianitis Skin

Question 1

Meibomian Gland Dysfunction

Answer 1

• Not considered an infectious entity
• Altered meibomian gland metabolism
• • secretions become thickened and block the gland opening
• • stagnant material becomes growth medium for bacteria
• • bacteria produce lipase and the released fatty acids trigger inflammation

Question 2

Often associated with (acne) rosacea

Etiology

Answer 2

Chronic inflammatory disorder involving skin and eye

Sebaceous glands

Question 3

Often associated with (acne) rosacea

Epidemiology

Answer 3

• “Celtic”, northern ancestry (genetic component)
• Adults 30-60 years of age
• > 30% have ocular problems

Question 4

Rosacea

Answer 4

Redness (erythema) in the “facial flush area”

Papules and pustules in the “flush areas”

Question 5

Pustule

Answer 5

w/ Rosacea

• A typical ‘pimple’
• Red and inflamed with a white head
• Sometimes brownish core can be seen as a cap on the pus head
• Pustules follow papules after white blood cells invade
• White cap on a pustule is pus, sebaceous matter and cellular debris

Question 6

rosacea Telangiectasias -

Answer 6

visible (dilated) small blood vessels on nose or cheeks

Question 7

rosacea Rhinophyma

Answer 7

red, bullous nose (sebaceous gland hypertrophy)

Question 8

hyerplasia and hypertrophy

Answer 8

Hyperplasia- increase in number of something

Hypertrophy- increase in size of something

Question 9

rosacea tx

Answer 9

• Doxycycline 100 mg bid x 4-6 weeks

- Topical metrodiazole gel 0.75% bid x 5-8 weeks

Question 10

Treatment of Facial Rosacea

Answer 10

Dietary restrictions that trigger reaction
well-known rosacea tripwires:
hot spices, alcohol, heated beverages
lesser-known rosacea tripwires:
chocolate, tomatoes, citrus fruits
No significant effect:
dairy products (milk, cheese) 

Environmental restrictions that may trigger reaction
Sun exposure, strong winds, strenuous exercise, change in humidity/weather 
Emotional factors (stress, fear, anxiety, embarrassment) 
Heliobacter pylori (bacteria linked with stomach ulcers) 
Vasodilators

Question 11

Ocular Manifestations of Rosacea

Answer 11

Meibomian gland dysfunction
Blepharitis
Hordeolum
Chalazion
Inflammation and infection of the lids
Poor tear film
Conjunctival injection 
PEE (SPK)
Corneal vascularization
Corneal thinning

Question 12

rosacea manifestations

Answer 12

Papules and pustules
Telangiectasias
Staph blepharitis
Madarosis
Meibomian gland dysfunction
Conjunctivitis

Question 13

Ocular Rosacea definition

Answer 13

Infection and inflammation of the lids

Question 14

Keratitis

Answer 14

Corneal vascularization and thinning

Question 15

Ocular Rosacea tx

Answer 15

Meibomian gland dysfunction
Warm compresses, lid scrubs, gland expression

Blepharitis
Same as staphylococcal blepharitis

Keratitis
Artificial tears/ointments
Steroids if severe inflammation

Question 16

Ocular Rosacea follow up

Answer 16

Without corneal involvement - weeks

With corneal involvement - days

Question 17

ocular rosacea pt education

Answer 17

Lid hygiene
Dietary restrictions (triggers)
Environmental triggers

Question 18

Meibomian Gland Dysfunction

Answer 18

Plugged meibomian glands
Meibomian ‘caps’

-Significant pouting of meibomian glands
-Inflammation of lid surrounding glands
-Serrated lid margin
Tarsal conjunctival streaking
-Conjunctival injection

Question 19

Meibomian Gland Dysfunction diagnosis

Answer 19

Diagnosis usually made clinically

Forced expression of the meibomian glands
“Toothpaste” test - thickened secretions are forced out of some glands
Many glands will yield no visible secretion

Thickened secretions in the tears

Question 20

Meibomian Gland Dysfunction tx

Answer 20

Warm compresses
Softens any material on the meibomian gland orifices
Softens thickened secretions in glands

In-office and at-home meibomian gland expression (digital massage)
Pressure on the lids from the part of the tarsus away from lid margin towards lid margin (opening)
Open the ducts of the glands and express the thickened secretions

Question 21

Meibomian Gland Dysfunction tx

If disease severe or not responding to therapy

Answer 21

Consider doxycycline 100 mg bid for 6 to 10 weeks
Taper to lowest dose or, if possible, discontinue
Works by inhibiting lipase production

don’t use on pregnant women

Question 22

meibomian gland management

Answer 22

Manage dry eye
Evaluate overlap with staphylococcal blepharitis
Treat both conditions
Evaluate overlap with seborrheic blepharitis
Treat both conditions
Evaluate if rosacea present
Consider dermatologic consult

Question 23

Meibomian Gland Dysfunction follow up

pt education

Answer 23

1 week
Then 3-4 weeks later

Chronic condition
No cure, management only

Question 24

LipiFlow Thermal Pulsation System (TearScience)

Answer 24

Meibomian expression in-office treatment device
Invented by Donald Korb, O.D.
Applies heat to tarsal side, pressure to skin side
Can adjust heat/pressure; 12 minute sessions
FDA-approved 7/11/11

Question 25

Intense Pulsed Light Therapy (IPL)

Answer 25

- Non-laser, high intensity light - Hand piece contacts skin - Intensity, duration and wavelengths vary based on skin type/treatment goals - Thermal heating of meibum, superficial telangiectasia - Potential benefit for ocular rosacea and dry eye related to meibomian gland dysfunction (MGD) - Increases lipid layer and noninvasive TBUT

Question 26

Impetigo

Answer 26

-Skin infection with Staphylococcus aureus or Streptococcus pyogenes -Most common Children under age 6 Sometimes very elderly Exposed to poor hygienic conditions -Contagious

Question 27

impetigo signs

Answer 27

- Rash with crusts (‘honey crusts’) | - Face, distal extremities

Question 28

Impetigo tx

Answer 28

``` Oral antibiotic Culture and susceptibility testing Cephalosporin Macrolide Dicloxacillin ``` Wash involved areas Topical antibiotic after washing Bacitracin Mupirocin

Question 29

Erysipelas

Answer 29

-Skin infection involving the dermis Superficial dermal lymphatics swell up local redness, heat, swelling, and highly characteristic raised, indurated border - Most common in young and elderly - Legs and face most frequently affected sites - Caused by Streptococcus pyogenes

Question 30

Erysipelas symptoms

Answer 30

``` Fever, chills Malaise Painful edematous patches on skin If on face, can continue into lids Sharply demarcated areas of swelling and redness ```

Question 31

Erysipelas tx

Answer 31

- PCP and/or dermatologic consult | - Antibiotic: Penicillin G (injected) or penicillin V (PO)