Transcript
BLEPHARITIS dr.T.
KURINCHI, MS
Blepharitis is a subacute or chronic inflammation of the lid margins.
It is an extremely common disease.
TYPESBacterial blepharitis
Seborrhoeic or
squamous blepharitis
Mixed staphylococcal with
seborrhoeic
blepharitis
Posterior blepharitis or meibomitis
Parasitic
blepharitis
BACTERIAL BLEPHARITIS Also known as chronic anterior blepharitis or
staphylococcal blepharitis or ulcerative blepharitis is a chronic infection of the anterior part of lid margin.
ETIOLOGY Causative organisms : staphylococci streptococci propionibacterium acnes
CLINICAL FEATURES
SYMPTOMS
•chronic irritation•Itching•mild lacrimation•gluing of cilia•mild photophobia
SIGNS •yellow crusts at roof of cilia•small ulcers •red, thickened lid margin •mild papillary conjunctivitis
COMPLICATIONS AND SEQUELAE
• Lash abnormalities like madarosis, trichiasis, poliosis
• Tylosis, i.e. thickening and scaring of lid margins• Eversion of punctum leading to epiphora• Eczema of skin and ectropion• Marginal keratitis• Tear film instability• Secondary inflammatory and mechanical changes.
TREATMENT
1. Lid hygiene Warm compresses for 5-10mins Crust removal and lid margin cleaning2. Antibiotic eye ointment Applied at lid margin after removal of crust. Eye drops 3-4 times a day Oral antibiotics like erythromycin or doxycycline3. Topical steroids : fluoromethalon4. Ocular lubricant ie artificial tear drops.
SEBORRHOEIC OR SQUAMOUS BLEPHARITIS
Anterior blepharitis with some spill over posteriorly.
ETIOLOGY Seborrhea of scalp
SYMPTOMS Whitish material at lid margin Mild discomfort Irritation Falling of eyelashes
SIGNS
• Accumulation of white dandruff like scales on lid margin
• Lashes fall out easily• Lid margin thickned, posterior border rounded
leading to epiphora.• Signs of bacterial blepharitis in patients with mixed
seborrhoeic and bacterial blepharitis.
TREATMENT
• Improvement of health and balanced diet• Treatment of seborrhoea of scalp • Removal of scales with lukewarm solution of 3%
soda bicarb or baby shampoo.• Application of combined antibiotic and steroid eye
ointment at lid margin.• Antibiotics
POSTERIOR BLEPHARITIS (MEIBOMITIS)
Meibomitis, ie. Inflammation of meibomian glands occurs in chronic and acute forms.
Chronic meibomitis Pathogenesis: Bacterial lipases Symptoms : Chronic irritation Burning Itching Grittiness
SIGNS
White frothy secretions on lid margin Opening of gland becomes prominent. Vertical yellowish streaks shinnig through conjunctiva Hyperemia of posterior lid margin.
Acute meibomitis Staphylococcal infection. Painfull swelling around the gland.
Treatment of meibomitis
1. Lid hygiene Warm compresses Expression of secretions by vertical massage of lid.2. Topical antibiotics and eye drops used 3-4 times a day.3. Systemic tetracyclines Doxycycline 100mg bdfor 1 week then od for 6-
12wks4. Ocular lubricants5. Topical steroids like fluromethalon.
PARASITIC BLEPHARITIS
ETIOLOGY Infestation of lashes by lice. Phthiriasis palpebrum: infestation by
phthirus pubis (crab louse) Pediculosis : infestation by pediculus
corporis (head louse)
CLINICAL FEATURES
SYMPTOMS
chronic irritation
Itching
Burning
Mild lacrimatio
n
SIGNS
lid margins red and inflamed
lice on lashes nits (eggs) seen on base of cilia
conjunctival congestion
TREATMENT• Mechanical removal of lices and nits with
forceps• Application of antibiotic ointmentsand yellow
mercuric oxide 1% to the lid margins and lashes.
• Delousing of the patient , family members, clothing and bedding is important to prevent recurrences.
INFLAMMATORY DISORDERS OF EYE
LIDS
External Hordeolum (Stye)
• Acute suppurative inflammation of glands of Zeis or Moll .
ETIOLOGYPredisposing Factors :• Common in children & young
adults• Patients with eye strain –
muscle imbalance / refractive errors
• Habitual rubbing of eyes • Chronic blepharitis & DM• Metabolic factors, ↑ intake of
carbohydrates & alcohol.
Causative Organism – Staph. aureus
CLINICAL FEATURES Symptoms
• Acute pain
• Swelling of lid
• Mild watering
Signs• Stage of cellulitis : Localised, firm, red, tender
swelling at lid margin with marked oedema.
• Stage of abscess : Visible pus point on the
lid margin in relation to affected cilia.
TREATMENTHot compresses - 2-3 times a day
Evacuation of pus by pulling out the infected cilia
Antibiotic eye drops – 3-4 times a day & eye ointment – Bed time
Systemic anti inflammatory & analgesis
Systemic antibiotics
INTERNAL HORDEOLUM Suppurative inflammation of
themeibomian gland with blockage
of theduct.
ETIOLOGY:• Prediposing Factors: Similar to hordeolum
externum.• Causative Mechanism: Occurs as:
Primary staphylococcal infection of meibomian gland
Secondary infection in a chalazion.
CLINICAL PICTURE• Symptoms:• Similar to hordeolum
externum, except pain is more intense, due to swelling embedded in dense fibrous tissue.
• Signs:• Maximum tenderness &
swelling away from the lid margin.
• Pus usually points on the tarsal conjunctiva.
TREATMENT• Similar to externum• When pus is formed – drained
by vertical incision from tarsal conjunctiva.
CHALAZION Tarsal or meibomian cyst. Chronic non - infective
granulomatous inflammation of meibomian gland.
Commonest of all lid lumps.
Etiology• Predisposing Factors: Similar to hordeolum
externaum
• Pathogenesis:
Mild infection of meibomian gland
Proliferation of epithelium & infiltration of wall of ducts – blocked.
Retention of secretions ( sebum) in the gland-enlargement.
Pent-up secretions (fatty in nature)-irritant & excite non-infective lipogranulomatous infl of blocked m.gland
CLINICAL PICTUREPainless swelling
Mild heaviness
Blurred vision
Watering
Symptoms
Signs:• Nodule – Firm to hard & non
tender on palpation.• Upper lid – More common
(contain more meibomian gland).
• Reddish purple area – Pal.Conjunctiva.
• Projection – Skin side.• Marginal chalazion – Small
reddish grey nodule on lid margin.
Clinical course & complications
Complete spontaneous resolution occur.
Slow increase in size. Fungating mass of granulation
tissue Secondary infection –
formation of hordeolum internum.
Calcification Malignant change – meibomian
gland carcinoma. (elderly pepole).
Conservative treatment – Hotfomentation, topical antibiotic eye drops& oral anti inflammatory drugs.Intralesional injection of long actingsteroid (triamcinolone).Diathermy Oral tetracycline – Prophylaxis (ifass.acne rosacea).
Incision & Currettage
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