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