Describe Demodex (mites)
- mites that act as a vector for staph. aureus on lashes
- leads to collarette formation
Describe Keratoconjunctivits sicca (dry eye)
- occurs concurrently with lid disease in several patients
- most common is staph blepharitis
Describe acne rosacea (not signs or treatment)
teleangiestia - dilated twisted vessels
- associated with telangiectasia on blood vessels on face, rapid turnover of epithelial cells and pustules on cheek
- rhinophyma becomes apparent (swollen pores on nose enlarge appearance)
- mimic ocular pemphigoid
- strong association with lid margin (MGD, blepharitis, MKC)
- need dermatological reference for oral antibiotic therapy
- relation to small intestinal bacterial overgrowth. (test with lactulose breath test, treat with rifaximin)
Describe signs of ocular rosacea and treatment
Signs: blepharitis, inflammation, tearing, chalazia, hordeola, corneal vascularization, corneal/conjunctival scarring, corneal thinning and perforation
- Tx: oral antibiotic therapy (acne rosacea)
- Tx: metrogel
Describe seborrhea
focus on hairline and sebaceous glands
- general dysfunction of sebaceous glands
- Signs: dermatitis, dandruff, flack, scaly skin
- likely to develop MKC
- severe cases require cotreatment with dermatologist
List some complications of lid margin disease
- Ulceration
- perforation
- corneal pannus and thinning
- cicatrization
- conjunctivatzation/keratinizatio of the cornea
- concertions, calcificed sebaceous material
- contact lens intolerance
Describe the best nutritional management approach for blepharitides
- for seborrhea, reduce Fatty acid consumption
- antioxidants may counteract free fatty acid damage (omega-3 and alpha-linolenic acid)
- nutritional supplements (Theratears nutrition and Hydrate)
Describe the 3-step Hygiene approach for blepharitis with meibomian involvement
1) warm compresses 5 minutes 6/day
2) massages to open glands
3) lid scrubs
Describe forceful expression and alternatives
- exude sebaceous material, cells, pus and bacterial load
- performed in 6 week intervals
Alternatives:
- Lipoflow (plates that warm lids)
- Mastrada paddle (alternate to swabs)
Describe Antibiotic ointments (when to prescribe, different types)
- helps management of staph, mixed blepharitis and ulcerative forms
- Bactracin, Erythromycin
- Thick preparation like Besivance and Azasite
- For ulcers may need prophylactic antibiotic solution (Ocuflox Quixin, Polytrim)
You have a patient that presents with staph or mixed blepharitis with ulcerative forms. What would be the most appropriate topical treatment?
A. Antibiotic Ointment (Bacitracin, Ethrymycin, Besivance or Azasite) along with a Prophylactic(Ocuflox, Quixin and Polytrim)
B. Steroid ointment (Tobradex, Belphamide, FML)
C. Anti-inflammatories (Azasite daily, Restasis)
D. Bland ointment
A. Antibiotic Ointment (Bacitracin, Ethrymycin, Besivance or Azasite) along with a Prophylactic(Ocuflox, Quixin and Polytrim)
Describe steroid ointments
- use for inflammatory, hypersensitive component
- solution for corneal disease
- Tobradex, blephamide, FML
Name two anti-inflammatory treatment methods
- Asazite daily 1x month
- Restasis BID
When is bland ointment used
- Use when demodex is identified
You have a patient that presents with hypersensitive lid disease involving demodex. What two drugs would be the most appropriate topical treatments? (Pick 2)
A. Antibiotic Ointment (Bacitracin, Ethrymycin, Besivance or Azasite) along with a Prophylactic(Ocuflox, Quixin and Polytrim)
B. Steroid ointment (Tobradex, Belphamide, FML)
C. Anti-inflammatories (Azasite daily, Restasis)
D. Bland ointment
B. Steroid ointment (Tobradex, Belphamide, FML)
D. Bland ointment
Describe oral antibiotics (goals, how it improves patients, drugs)
- Goals: Inhibit bacterial proliferation, inhibit lipase to decrease fatty acid
- Patient improves by removing toxic FA, and exotoxin produced from bacteria that causes hypersensitivity
- Drugs: Tetracycline (empty stomach), Doxycycline (Drug of choice for meibomitis), Alodox, Nutridox, Eryhtromycin
A patient presents with meimbomitis. What would be the most appropriate oral antibiotic to prescribe?
A. Tetracycline
B. Doxycycline, Alodox or Nutridox
C. Erythromycin
B. Doxycycline, Alodox or Nutridox
What would be the least appropriate oral antibiotic to prescribe for pregnant women , children under 12 or patients with peptic ulcer disease?
A. Tetracycline
B. Doxycycline, Alodox or Nutridox
C. Erythromycin
A. Tetracycline
What would be the safest oral antibiotic to prescribe for pregnant women or children under 12?
A. Tetracycline
B. Doxycycline, Alodox or Nutridox
C. Erythromycin
C. Erythromycin
