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Ocular System

Blepharitis

Subacute chronic inflammation of lid margins.

Subacute chronic inflammation of lid margins.


Etiology

Bacterial blepharitis:

Chronic infection of anterior part of lid margin.
  • Primary: Coagulase positive Staphylococci 
  • Others: Streptococci, Propionibacterium acnes, Moraxella

Seborrheic/squamous blepharitis

Anterior blepharitis with some spill over posteriorly.

Mixed staphylococcal with seborrhoeic blepharitis

Posterior blepharitis (meibomitis)

Inflammation of the Meibomian glands
  • Chronic Meibomitis
  • Acute Meibomitis

Parasitic blepharitis:

Lice infestation
  • Demodex folliculorum: Demodex blepharitis or blepharitis acarica
  • Crab louse: Phthiriasis palpebrarum

Predisposing factors:

  • Chronic conjunctivitis
  • Dacryocystitis

Presentation

Symptoms:

  • Chronic irritation, itching , mild lacrimation, glueing of cilia, mild photophobia
  • Worse in the morning
  • Remission and exacerbations common

Signs

  • Yellow crusts
  • Small ulcers
  • Red, thickened lid margins
  • Mild papillary conjunctivitis

Complications:

  • Lash abnormalities
    • Madarosis
    • Trichiasis
    • Poliosis
  • Tylosis
  • Eversion of punctum
  • Exzema of skin and entropion
  • Recurrent styes
  • Marginal keratitis
  • Tear film instability & Dry Eye
  • Secondary inflammatory and mechanical changes in the conjunctival and cornea

Management

  1. Lid Hygiene
    • Warm compress
    • Crust removal and lid margin cleaning
    • Avoid rubbing of the eyes
  2. Antibiotics
    • Eye ointment
    • Antibiotic eye drops
    • Oral antibiotics: Erythromycin or Doxycycline
  3. Topical Steroids (weak)
    • Fluorometholone
      • For patients with papillary conjunctivitis, marginal keratitis, phlyctenulosis
  4. Ocular lubricants
    • Artificial tear drops
      • For associated tear film instability and dry eye

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