BLEPHARITIS - introduction, types, Etiology, pathogenesis, clinical features, management

Blepharitis- inflammation of lid margins
CLINICAL TYPES:
ANTERIOR BLEPHARITIS
$ Bacterial ulcerative blepharitis :
▪︎ also called as chronic anterior blepharitis or staphylococcal blepharitis
ETIOLOGY
Coagulase positive Staphylococci (most common)
Rarely : Streptococci, Propionibacterium acnes, Moraxella
PATHOGENESIS
Bacteria are carried to lid margins by rubbing with contaminated fingers → inflammation

CLINICAL FEATURES
Symptoms: (worse in the morning) irritation, itching, lacrimation, gluing of cilia, photophobia
Signs :
▪︎ Yellow crusts at the root of cilia
▪︎ Small ulcers on removing the crusts
▪︎ Red, thickened lid margins
▪︎ Mild papillary conjunctivitis and conjunctival hyperemia

TREATMENT
1.Lid hygiene : warm compresses, crust removal and lid margins cleaning (with cotton buds dipped in dilute baby shampoo), avoid rubbing of eyes
2. Antibiotics :
⊙ Eye ointment - applied at lid margin after crust removal
⊙ Eye drops - 3 to 4 times a day
⊙ Oral antibiotics - Erythromycin or Doxycyclin in unresponsive patients
3. Topical Steroids with low potency : Fluorometholone
4. Ocular lubricants ︎

$ Seborrhoeic blepharitis:

▪︎ primarily anterior blepharitis associated with dandruff
ETIOLOGY AND PATHOGENESIS
Glands of Zeis secrete abnormal excessive neutral lipids

Corynebacterium acne splits lipids into irritating fatty acids causing inflammation

SYMPTOMS
Deposition of soft scales at lid margin, discomfort, irritation, watering (occasionally), history of falling of eyelashes
SIGNS
▪︎ Accumulation of white dandruff like scales on lid margin
▪︎ Hyperemic greasy surface found on removal of scales - no ulcer
▪︎ Lashes fall out easily and replace quickly
▪︎ Thickened lid margin

COMPLICATIONS - similar to bacterial blepharitis
TREATMENT
General measures - improvement of health and balanced diet
Treat dandruff adequately
Local measures - removal of scales with lukewarm solution of 3% sodium bicarbonate or baby shampoo
Antibiotics - in mixed blepharitis

POSTERIORBLEPHARITIS (MEIBOMITIS) :

▪︎ Meibomian gland dysfunction
▪︎ Common in middle aged individuals having seborrheic dermatitis
▪︎ Bacterial lipases (producing free fatty acids) play a role in pathogenesis

SYMPTOMS
Irritation, burning, itching, grittiness, watering
SIGNS
▪︎ White frothy secretions on lid margins, oily tear film
▪︎ Secretions with toothpaste appearance over Meibomian gland orifices when lids are pressed
▪︎ Vertical yellow streaks in conjunctiva
▪︎ Secondary changes in conjunctiva and cornea
TREATMENT
Lid hygiene : warm compresses, milking of secretions by vertical massage of lids
Topical antibiotics : Eye ointment after massage, eye drops (3 to 4 times a day)
Systemic antibiotics : Doxycycline 100 mg b.d. for 1 week followed by 100 mg o.d for 6 to 12 weeks
Ocular lubricants
Topical Steroids : Fluorometholone

1. BLEPHARITIS Angelin A (Roll no:11)

2. OVERVIEW : Blepharitis is the inflammation of lid margins Clinical types : ANTERIOR BLEPHARITIS : ▪︎ Bacterial ulcerative blepharitis ▪︎ Seborrhoeic or squamous blepharitis ▪︎ Mixed (bacterial + seborrheic) blepharitis 2. POSTERIOR BLEPHARITIS or Meibomitis - acute and chronic 3. PARASITIC BLEPHARITIS

3. STRUCTURE OF EYELID

4. ANTERIOR BLEPHARITIS

5. Bacterial ulcerative blepharitis ▪︎ also called as chronic anterior blepharitis or staphylococcal blepharitis ETIOLOGY Coagulase positive Staphylococci (most common) Rarely : Streptococci , Propionibacterium acnes , Moraxella PATHOGENESIS Bacteria are carried to lid margins by rubbing with contaminated fingers → inflammation

6. Bacterial ulcerative blepharitis - contd. CLINICAL FEATURES Symptoms: (worse in the morning ) irritation, itching, lacrimation, gluing of cilia , photophobia Signs : ▪︎ Yellow crusts at the root of cilia ▪︎ Small ulcers on removing the crusts ▪︎ Red, thickened lid margins ▪︎ Mild papillary conjunctivitis and conjunctival hyperemia

7. → Yellow crusts at the root of cilia Red thickened lid margins ←

8. Bacterial ulcerative blepharitis- contd. Complications ▪︎ Lash abnormalities : madarosis, trichiasis ▪︎ Tylosis ▪︎ Eversion of punctum → epiphora → eczema of skin and ectropion ▪︎ Recurrent styes, marginal keratitis ▪︎ Tear film instability and dry eye ▪︎ Secondary inflammation in conjunctiva and cornea

9. → Madarosis Trichiasis ←

10. → Ectropion Marginal keratitis ←

11. Bacterial ulcerative blepharitis - contd. TREATMENT 1.Lid hygiene : warm compresses , crust removal and lid margins cleaning (with cotton buds dipped in dilute baby shampoo), avoid rubbing of eyes 2. Antibiotics : ⊙ Eye ointment - applied at lid margin after crust removal ⊙ Eye drops - 3 to 4 times a day ⊙ Oral antibiotics - Erythromycin or Doxycyclin in unresponsive patients 3. Topical Steroids with low potency : Fluorometholone 4. Ocular lubricants ︎

12. Seborrhoeic or squamous blepharitis ▪︎ primarily anterior blepharitis associated with dandruff ETIOLOGY AND PATHOGENESIS Glands of Zeis secrete abnormal excessive neutral lipids Corynebacterium acne splits lipids into irritating fatty acids causing inflammation

13. Seborrhoeic blepharitis - contd. SYMPTOMS Deposition of soft scales at lid margin, discomfort, irritation, watering (occasionally), history of falling of eyelashes SIGNS ▪︎ Accumulation of white dandruff like scales on lid margin ▪︎ Hyperemic greasy surface found on removal of scales - no ulcer ▪︎ Lashes fall out easily and replace quickly ▪︎ Thickened lid margin

14. Dandruff like.scales

15. Seborrhoeic blepharitis - contd. COMPLICATIONS - similar to bacterial blepharitis TREATMENT General measures - improvement of health and balanced diet Treat dandruff adequately Local measures - removal of scales with lukewarm solution of 3% sodium bicarbonate or baby shampoo Antibiotics - in mixed blepharitis

16. POSTERIOR BLEPHARITIS (MEIBOMITIS)

17. Acute meibomitis ETIOLOGY Staphylococcus SYMPTOM Painful swelling around involved Meibomian gland SIGN Pressure on the swelling → expression of pus bead and serosanguinous discharge

18. Chronic meibomitis ▪︎ Meibomian gland dysfunction ▪︎ Common in middle aged individuals having seborrheic dermatitis ▪︎ Bacterial lipases (producing free fatty acids) play a role in pathogenesis

19. Chronic meibomitis - contd. SYMPTOMS Irritation, burning, itching, grittiness, watering SIGNS ▪︎ White frothy secretions on lid margins, oily tear film ▪︎ Secretions with toothpaste appearance over Meibomian gland orifices when lids are pressed ▪︎ Vertical yellow streaks in conjunctiva ▪︎ Secondary changes in conjunctiva and cornea

20. Treatment of posterior blepharitis Lid hygiene : warm compresses , milking of secretions by vertical massage of lids Topical antibiotics : Eye ointment after massage, eye drops (3 to 4 times a day) Systemic antibiotics : Doxycycline 100 mg b.d. for 1 week followed by 100 mg o.d for 6 to 12 weeks Ocular lubricants Topical Steroids : Fluorometholone

21. PARASITIC BLEPHARITIS

22. Parasitic blepharitis ▪︎ Infestation of lashes by lice ▪︎ Common in poor hygienic conditions ▪︎ Includes : ⊙ Phthiriasis palpebrarum by crab louse ⊙ Pediculosis by head louse ⊙ Demodex blepharitis ▪︎ causes chronic blepharitis and chronic follicular conjunctivitis

23. Parasitic blepharitis - contd CLINICAL FEATURES SYMPTOMS irritation, itching, burning, lacrimation SIGNS ▪︎ Red and inflamed lid margins ▪︎ Slit lamp: Lice on lashes and nits at the base of cilia ▪ Conjunctival congestion

24. Parasitic blepharitis - contd. TREATMENT Mechanical removal of lice and nits with forceps Antibiotic ointment and 1% yellow mercuric oxide Delousing patient, family members and clothes