BLEPHARITIS ppt.pptx

BASICS OF BLEPHARITIS,
ANT POSTERIOR.

1. BLEPHARITIS By Dr. Sandhya

2. Definition- Blepharitis is an inflammatory condition of the eyelid margin, is a common cause of ocular discomfort and irritation in all age and ethnic groups.

3. Types- (Anatomical location) Anterior blepharitis - Bacterial S eborrehic Parasitic Posterior blepharitis . M ixed

4. Anterior blepharitis Bacterial Seborrehic Parasitic

5. Bacterial blepharitis Reason for chronic anterior blepharitis Etiology - Coagulase positive staph Streptococci Propionibacterium acne moraxella

6. Clinical features signs symptoms Yellow cilia are seen at the root of the cilia which glue them together Chronic pain Small ulcers, bleeds on removal of crusts Itching Red thickened lid margins with dialted blood vessels lacrimation Mild papillary conjunctivitis and conjunctival hyperemia are common associations Glue cilia symptoms worse in the morning Remissions and exacerabations in the symptoms are quite common

7. S eborrheic blepharitis It is the primary anterior blepharitis with some posterior spil over. Etiology - Associated with seborrhoea of scalp (dandruff). Gland of zeis - secrete abnormal excessive neutral lipids which are are spilt by corynebacterium acne into irritating free fatty acids.

8. symptoms signs Deposition of whitish material at the lid margin Dandruff like scales are seen on the lid margin, OILY GREASY CRUST , Irritation, Upon removing these scales under lying surface found to be hyperemic (no ulcers) falling of eye lashes falling of eye lashes

9. Parasitic blepharitis Etiology Phthiriasis palpebram (mite/ ectoparasite )

10. symptoms Signs Chronic irritation Lid margins are red and inflammed itching Lice anchoring lashes can be seen on slit lamp examination burning Mild lacrimation

11. Posterior blepharitis / Meibomitis Acute meibomitis - CA is staph Chronic meibomitis is a meibomian gland dysfunction, seen more commonly in middle aged persons with acne roasacea and seborrhoic dermatitis.

12. Symptoms signs Frothy (foam like) secretion on eye lid margin On eversion of the eyelids, vertical yellowish streaks shinning through the conjunctiva are seen. Openings of meibomian glands become prominent with thick secretions

13. Conditions associated with chronic blepharitis Lash abnormality- triachiasis , madarosis , poliosis Epiphora - Eczema of skin and ectropion Recurrent styes / chalazion Tear film instability and dry eye. Acne vulgaris Atopic keratoconjunctivitis Bacterial keratitis

14. DIAGNOSIS In all forms of blepharitis , examination of the tear film may show instability and rapid evaporation. T ear break-up time (TBUT )- T he time interval between a complete blink and the first appearance of a dry spot in the pre-corneal tear film after fluorescein instillation..<10 sec(ABN). Schirmer’s test. RECENT ADVANCES- Meibography -The silhouette of the meibomian gland structure is captured LIPIVIEW- This instrument measures the lipid layer thickness between blinks and gives a quantitative assessment.

15. Meibography

16. LIPIVIEW- REAL TIME MEIBOGRAPHY

17. TREATMENT (COMMON)

18. T reatment Bacterial seborrheic parasitic Posterior blepharitis Lid hygiene Manual removal of crusts after softening and hot compress . Avoid rubbing of eyes Improvement of health and balanced diet Mechanical removal of parasite with the help of forceps. Expression of glands by repeated Vertical lid massage AB ointment/DROPS- tid / Qid Oral antibiotics- erythromycin Scalp dandruff should be treated adequately Delousing of patient and other family members, clothing and bedding Antibiotic eye drops- tid / qid Oral NSAIDS- to reduce inflammation. Removal of scales from lid margins with the help of baby shampoo. Antibiotic ointment over eye lids. Systemic tetracyclines (DOXYCYCLINES)- 6-12 weeks mainstay. MACROLIDES( AZITHRO Week topical steroids- FML/LOTEPREDNOL Combined antibiotic and steroid eye ointment at the lid margin 50%TEA TREE OIL EYELID SCRUBS Restasis . LIPIFLOW

19. LIPIFLOW

20. References https:// eyewiki.aao.org/Blepharitis https://eyewiki.aao.org/Diagnostic_Testing_for_Dry_Eye