definition of blepharitis
group of disorders characterised by inflammation of the eyelids and associated adnexal structures including skin, lashes, and meibomian glands
usually bilateral
chronic with exacerbations
signs and sx of blepharitis
burning sensation
itching
foreign body sensation
crusting of eyelids
dry eye
lid erythema, telangiectasia
collarettes around lashes - seen on slit lamp
capped meibomian glands
conjunctaive hyperaemia
unstable tear film with rapid tear break up time
capped meibomian glands - seen in blepharitis
ix for blepharitis
clinical dx if doubt:
- lid biopsy in atypical cases to rule out malignancy (unilateral lid changes, significant lid architecture alteration, lash changes or loss, recurrent chalazion, and cases not responsive to treatment)
- lid margin culture - if severe inflammation and/or not responding to rx
- microscopic evalulation of epilated eyelashes - demodex mites
mx of blepharitis
no visual impairment:
1. eyelid hygeine - warm compress, eye lid massage, baby shampoo
2. consider: topical ab, topical steroids, omega-3 acids, artificial tears
with visual impairment
1. eyelid hygeine
2. oral abx - doxycycline for 1 mo
refractory
1. oral abx
2. eyelid hygiene
complications of blepharitis
Corneal changes:
* punctate epithelial erosions (fluorescein staining typically in inferior third of cornea),
* vascularisation,
* scarring,
* marginal ulcers,
* phlyctenular keratitis (limbal nodules),
* perforation.
lash and lid margin changes
* depigmentation of lashes,
* trichiasis (turning in of lashes),
* madarosis (loss of lashes),
* eyelid thickening and ulceration,
* ectropion or entropion.
px of belpharitis
most recover well
chronic
some lose vision due to corneal change
aetiology of blepharitis
bacteria staph epidermidis is the most common
