Module 1 blepharitis, hordeolum, chalazion

Question 1

blepharitis

Answer 1

inflammation of the eyelid margins
- infectious or inflammatory
- 2 basic categories anatomically: anterior and posterior
- usually assoc. with staph

Question 2

anterior blepharitis

Answer 2

involves the anterior lid margin surrounding the eyelashes. Can extend to posterior lid margin, conjunctiva, and cornea
- usually assoc. with staph infection or seborrhea

Question 3

posterior blepharitis

Answer 3

involves the posterior lid margin and is characterized by meibomian gland dysfunction
- sometimes assoc. with rosacea

Question 4

meibomian glands

Answer 4

enlarged sebaceous glands aligned inn a row posterior to the eyelashes
- produce a clear lipid secretion that makes up the outer layer of the tear film

Question 5

blepharitis may result in

Answer 5

disruption of the ocular surface
dry eye syndrome
development of hordeola or chalazia

Question 6

hordeolum

Answer 6

acute infection and inflammation of one of the oil glands in the eye lid, surrounds eyelash follicle
- can become a chalazion without tx
- self-limiting spontaneously improve in 1-2 weeks with warm, moist compresses and light massage
- more common in children and adolescents
- INTERNAL: points to skin or conjunctiva
- EXTERNAL: points to lid margin

Question 7

chalazion

Answer 7

chronic, sterile, nontender lipogranulomatous inflammatory lesion of the meibomian gland
- more common in adults
- non-infectious

Question 8

anterior staphylococcal blepharitis patho

Answer 8

caused by abnormal cell-mediated response to staph
- more common in younger patients

Question 9

anterior seborrheic blepharitis patho

Answer 9

assoc. with generalized seborrhea that may involve
- scalp
- nasolabial folds
- skin behind ears
- sternum

Question 10

posterior blepharitis patho

Answer 10

meibomian gland dysfunction
- bacterial lipases may -> formation of free fatty acies, inc. melting point of the meibum and preventing its expression from the glands -> S. aureus growth and development of hordeolum
- more common in older patients

Question 11

blepharitis s/s

Answer 11

scaling of eyelid margins
ocular tear film instability and dry eye
burning
foreign body sensation
tearing
photophobia
itching
crusting
redness
discharge
swollen erythematous lids
worse in the morning

Question 12

hordeolum s/s

Answer 12

gradually enlarging localized nodules
painful
erythema and edema
sensation of grit or foreign body in eye

Question 13

chalazion s/s

Answer 13

gradually enlarging localized nodule
painless
“lump” along eyelid

Question 14

staphylococcal blepharitis physical exam

Answer 14

lid margin erythema with fine ulceration at the base of lashes and collarettes of fibrin along the lash
- lashes may be absent, broken, or misdirected

Question 15

seborrheic blepharitis physical exam

Answer 15

greasy scales along the lid margin and lashes with excess oily meibomian secretion and foamy tears
- diffuse seborrhea: dandruff, scaling of brows, behind ears, base of nose

Question 16

demodex blepharitis

Answer 16

caused by eyelash mite
- cylindrical debris encasing the base of eyelash follicles

Question 17

posterior blepharitis physical exam

Answer 17

hyperemia and telangiectasis of the lid margin
oily and frothy tear film
pressure on the lid margin -> expression of thick inspissated secretions
- Rosacea commonly assoc:
– inspect for erythema with telangiectasis over cheeks and nose, pustular skin eruption, sebaceous gland hypertrophy, rhinophyma

Question 18

All blepharitis can cause

Answer 18

conjunctival injection
corneal infiltrates
excess tearing
lid crusting
discharge
inflammation of the lid margin

Question 19

non-pharm management

Answer 19

• lid hygiene
• warm compresses for 5-10 minutes
• lid scrub kits or warm water with diluted baby shampoo on a cotton tip applicator at lid margin

Question 20

pharmacological management

Answer 20

antibiotic ointment
artificial tears
- tx needs to be maintained for months to years due to chronicity
Demodex: tea tree oil

Question 21

complications

Answer 21

• hordolum may progress to preseptal cellulitis or abscess
• large lesions can induce corneal astigmatism and mechanical ptosis may restrict the superior visual field
• chronic blepharitis may result in scarring and loss of eye lashes