Blepharitis, chalazion, stye

This slide contains information regarding blepharitis, chalazion and stye. This can be helpful for proficiency level and bachelor level nursing students.

1. Disorders of Eye Review anatomy and physiology

2. Blepharitis

3. Definition It is a common eye condition characterized by chronic inflammation of the eyelid generally the part where eyelashes grow. It is an inflammation which occurs when tiny oil glands located near the base of the eyelashes malfunction.

4. Etiology Commonest causes are dirt, staphylococcal infection and allergy. Infection with coagulase positive staphylococcus.

5. Predisposing factors Seborrheic dermatitis-dandruff of the scalp and eyebrow

6. Predisposing factors contd. Malfunction of oil gland Rosacea-a skin condition characterized by facial redness

7. Contd. Allergies-allergic reaction to eye medication, contact lens solution, eye make up Eyelash mites or lice Certain medications-acne medicine ISOTRETINOIN can lead to increase in bacteria in eyelids and can affect the tear production.

8. Types Clinically two types of blepharitis a)Squamous/ Sebborheic blepharitis : More common than ulcerative form. It is not essentially an infective condition. Metabolic causes, hygienic factors, eye strain and sebborhoea of the scalp usually leads to the development of this condition. In this case, there is accumulation of white scales like dandruff on the lid margin. On removing this scales, the lid margins appears hyperemic but there is no ulceration.

9. Contd. b)Ulcerative/Infective blepharitis: This condition is due to infection of lid margin with coagulase positive staphylococcus. There is suppurative inflammation of ciliary follicles along with gland of zeis and moll. Yellow crusts are deposited at the roots of eyelash. On removing the crusts, small ulcers appear around the base of the eyelashes which bleed freely .

10. Pathophysiology

11. Sign and symptoms Red Swollen eye lids

12. Contd. Flaking of skin around eyes

13. Contd. Crusted eyelashes upon awakening/ Eyelid sticking Gritty, burning sensation in the eye

14. Contd. Frequent blinking of eyes

15. Contd. Sensitivity to light (Photophobia)

16. Sign and symptoms Loss of eyelashes Misdirected eyelashes inward

17. Diagnosis History and physical examination(eye examination) Slit lamp examination Culture and sensitivity: Collect the sample of oil or crust on the eyelid for bacteria , fungi or allergic reaction.

18. Contd. Slit lamp examination

19. Medical Management Warm compression: apply warm wet compresses to the lids for about 2 minutes.

20. Contd. Maintain hygiene: Hygiene maintenance by cleaning the scalp, eyebrows and lid margins daily with medicated shampoo (baby shampoo) to control sebborheic dermatitis.

21. Contd. Mechanical removal of debris

22. Contd. Antibiotics like Gentamycin or Chloromycetin ointment 3 times a day for 5days Topical anti-inflammatory agents: hydrocortisone 1% ointment usually on bedtime for 7 days.

23. Preventive measures Teach the client to, avoid cosmetics. separate towel for face and hair and use it individually. avoid using the eye frequently with uncleaned hands.

24. Nursing management Emphasize the importance of keeping the scalp, eyebrows and eyelid margins clean. Instruct the patient to remove eyelid crusts with wash cloth or wet cotton. Crusts are easier to remove when warm moist compresses are applied for10 to 15 minutes. Hand washing before and after the care of the eyelids Tell the patient to avoid rubbing or touching the eyes Tell the patient to trim the nails. Avoid cosmetics which may cause irritation.

25. Chalazion /Meibomian cyst/ Tarsal Cyst

26. Chalazion

27. Definition It is a cyst in the eyelid that is caused by inflammation of blocked meibomian gland, usually on the upper eyelid. It is a painless inflammation of the meibomian gland characterized by localized swelling.

28. Risk Factors History of chalazion Unclean hands Person with blepharitis, stye , rosacea

29. Pathophysiology

30. Sign and Symptoms Painless, hard lump on eyelid Mild heaviness in the lid Mild irritation Sensitivity to light Eyelid tenderness

31. Diagnosis History and physical examination Test for vision

32. Management Warm compression: for 10 to 20 minutes at least four times a day which may soften the hardened oil blocking the duct and promote drainage and healing . Topical antibiotic eye drops or ointment: like Chloramphenicol or Fusidic acid 3 times a day for 5 days. If such therapy fails, Incision and curettage under local anesthesia Pressure eye patch Teaching on proper lid hygiene.

33. Stye / Hordeolum

34. Definition It is an infection of the sebaceous glands of zeis or glands of moll at the base of the eyelashes. It is a suppurative inflammation of the follicles of eyelashes along the edge of the eyelid margin.

35. Etiology Staphylococcal bacteria

36. Predisposing factors AGE: can occur at any age but most common in young adults MEATBOLIC FACTORS : diabetes,debility

37. Sign and symptoms Acute pain on the lid margin Localized , red ,swollen area Edema in the affected lid Burning in the eye Itching on the eyeball

38. Contd. Irritation on the eye Tearing Discomfort during blinking Foreign body sensation

39. Diagnosis History and physical examination Culture and sensitivity: Take sample of the purulent material from abscess

40. Medical Management Warm compression Antibiotics If conservative treatment fails, incision and curettage

41. Nursing management Advise the patient to use clean cloth for warm compression and dispose it separately to prevent from spreading. Avoid squeezing the stye which spreads the infection along the eyelid margin . Advise the patient with recurrent or persistent stye to see the doctor.