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Z A L D I
FAKULTAS KEDOKTERAN
UNIVERSITAS MUHAMMADIYAH SUMATERA UTARAMEDAN
2013
BLEPHARITIS
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Dengan menyebut nama Allah
Yang Maha Pengasih Maha Penyayang.
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I. TUJUAN INSTRUKSIONAL UMUM
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Setelah Proses Belajar Mengajar mahasiswa
mampu menegakkan diagnosa blefaritisdengan melakukan anamnese dan
pemeriksaan sederhana yang akan dipelajari
selama masa perkuliahan dengan baik danbenar .
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II. TUJUAN INSTRUKSIONAL KHUSUS
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Setelah Proses Belajar Mengajar mahasiswa
mampu mengetahui tanda dan gejala , faktorresiko, prinsip pengobatan, komplikasi, dan
mengkonsulkan secara garis besar dengan
baik dan benar kasus-kasus blefaritis sesuaidengan kompetensinya
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II. TUJUAN INSTRUKSIONAL KHUSUS
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Setelah Proses Belajar Mengajar mahasiswa
mampu mengetahui tanda dan gejala , faktorresiko, prinsip pengobatan, komplikasi, dan
mengkonsulkan secara garis besar dengan
baik dan benar kasus-kasus chalazion sesuaidengan kompetensinya
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SEBORRHOEIC BLEPHARITIS
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BLEPHARITIS
It is a subacute or chronic inflammation of thelid margins. It is an extremely common diseasewhich can be divided into following clinical
types: Seborrhoeic or squamous blepharitis,
Staphylococcal or ulcerative blepharitis,
Mixed staphylococcal with seborrhoeic
blepharitis, Posterior blepharitis or meibomitis,
Parasitic blepharitis.
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e orr oe c or squamousblepharitis
Etiology.
It is usually associated with seborrhoea of
scalp (dandruff). Some constitutional and
metabolic factors play a part in its etiology. Init, glands of Zeis secrete abnormal excessive
neutral lipids which are split by
Corynebacterium acne into irritating free fatty
acids
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SYMPTOMS
Deposition of whitish material at the lid margin associated with
mild discomfort,
irritation,
occasional watering and a
history of falling of eyelashes.
Signs. Accumulation of white dandruff-like scales are
seen on the lid margin, among the lashes (Fig. 14.7).
On removing these scales underlying surface is found
to be hyperaemic (no ulcers). The lashes fall out
easily but are usually replaced quickly without distortion. In long-standing cases lid margin is
thickened and the sharp posterior border tends to be
rounded leading to epiphora
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SIGNS
Accumulation of white dandruff-like scales are
seen on the lid margin, among the lashes
On removing these scales underlying surface
is found to be hyperaemic (no ulcers).
The lashes fall out easily but are usually
replaced quickly without distortion.
In long-standing cases lid margin is thickenedand the sharp posterior border tends to be
rounded leading to epiphora
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TREATMENT
Improvement of health and balanced diet.
Associated seborrhoea of the scalpshould be
adequately treated.
Local measures include removal of scales
from the lid margin with the help of lukewarm
solution of 3 percent soda bicarb or baby
shampoo and frequent application ofcombined antibiotic and steroid eye ointment
at the lid margin.
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ULCERATIVE BLEPHARITIS
ETIOLOGY
It is a chronic staphylococcal infection of the
lid margin usually caused by coagulase
positive strains.
The disorder usually starts in childhood and
may continue throughout life. Chronic
conjunctivitis and dacryocystitis may act aspredisposing factors.
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ULCERATIVE BLEPHARITIS
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SYMPTOMS
Chronic irritation,
Itching,
Mild lacrimation,
Gluing of cilia
Photophobia.
The symptoms are characteristically worse in the morning.
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SIGNS
Yellow crusts are seen at the root of cilia which
glue them together.
Small ulcers, which bleed easily, are seen on
removing the crusts.
In between the crusts, the anterior lid margin
may show dilated blood vessels (rosettes).
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COMPLICATIONS
Conjunctivitis,
Madarosis (sparseness or absence of lashes),
Trichiasis, poliosis (greying of lashes),
Tylosis (thickening of lid margin)
Eversion of the punctum leading to epiphora.
Eczema of the skin
Ectropion
Treatment. It should be treated promptly to avoid complication and sequelae. Crusts should be
removed
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TREATMENT
Hot compresses
Antibiotic ointment after removal of crusts
Antibiotic eyedrops
Oral antibioticssuch as erythromycin or
tetracyclines may be useful.
Oral anti-inflammatory
Avoid rubbing of the eyes or fingering of the lids.
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POSTERIOR BLEPHARITIS
( MEIBOMITIS )
1.Chronic meibomitis is a meibomian gland dysfunction,seen more commonly in middle-aged persons withacne rosacea and seborrhoeic dermatitis.
It is characterized by white frothy (foam-like) secretion
on the eyelid margins and canthi (meibomianseborrhoea). On eversion of the eyelids, verticalyellowish streaks shining through the conjunctiva areseen. At the lid margin, openings of the meibomianglands become prominent with thick secretions.
2.Acute meibomitis occurs mostly due to staphylococcalinfection
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TREATMENT
Treatment of meibomitis consists of expression of
the glands by repeated vertical lid massage,
followed by rubbing of antibiotic-steroid ointment
at the lid margin. Antibiotic eyedrops should be instilled 3-4 times.
Systemic tetracyclines for 6-12 weeks remain the
mainstay of treatment of posterior blepharitis.
Erythromycin may be used where tetracyclines
are contraindicated
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PARASITIC BLEPHARITIS
Blepharitis africa refers to a chronic blepharitis
associated with Demodex folliculoruminfection
and Phthiriasis palpebramto that due to crab-
louse, very rarely to the head-louse. In additionto features of chronic blepharitis, it is
characterized by presence of nits at the lid
margin and at roots of eyelashes.
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TREATMENT
Treatment consists of mechanical removal of
the nits with forceps followed by rubbing of
antibiotic ointment on lid margins, and
delousing of the patient, other family members,clothing and bedding
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REFERENCES
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American Academy of Ophthalmology, External
Disease and Cornea, Section 8, 2011-2012
Khurana AK, Comprehensive Ophthalmology, Fourth
Edition , New Delhi, New Age Internasional (p) LimitedPublisher, 2007.
Vaughan & Asbury's : General Ophthalmology
17th Edition , Mc Graw- HillsCompanies , May 2007
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Segala puji bagi Allah, Tuhan semesta alam.