4. BACTERIAL BLEPHARITIS
It is also called chronic anterior blepharitis
It is a common cause of ocular discomfort and irritation
The disorder usually starts in childhood and may continue throughout life.
7. CLINICAL FEATURES
SYMPTOMS
Chronic irritation
Itching
Mild lacrimation
Gluing of cilia
Mild photophobia
These symptoms are characteristicaly worse in the morning
Remissions and exacerbations in the symptoms are quite common
8. SIGNS
Yellow crusts are seen at the root of the cilia which glue them together
Small ulcers , which bleed easily, are seen on removal of the crusts
Red thickened lid margins are seen with dilated blood vessels.
Mild papillary conjunctivitis and conjunctival hyperemia are common
associations.
9. COMPLICATIONS AND SEQUEALE
Lash abnormalities – trichiasis madarosis poliosis
Tylosis
Eversion of punctum leading to epiphora
Eczema of skin and ectropion
Recurrent stye are common complication
Marginal keratitis may be seen
Tear film instablility and dry eye may result
10. TREATMENT
Lid hygiene
Crusts should be removed after softening and hot compresses with solution of
3 percent soda bicarbonate.
Avoid rubbing of the eyes or fingering of the lids.
Antibiotics should be used as follows-
Antibiotic ointment should be applied at the lid margin, immediately after
removal of crusts, at least twice daily.
Antibiotic eyedrops should be instilled 3-4 times in a day.
Oral antibiotics such as erythromycin or tetracyclines may be useful.
Oral anti-inflammatory drugs like ibuprofen help in reducing the inflammation.
Weak topical steroids such as fluoromethalon may be required in patients with
paplillary conjunctivitis and marginal keratitis.
11. SEBORRHEIC BLEPHARITIS
It is primary anterior blepharitis with some posterior spill over
Etiology.
It is usually associated with seborrhoea of scalp (dandruff).
Some constitutional and metabolic factors play a part in its etiology.
In it, glands of Zeis secrete abnormal excessive neutral lipids which are
split by Corynebacterium acne into irritating free fatty acids.
12. SYMPTOMS
Patients usually complain of deposition of whitish material at the lid margin
associated with mild discomfort, irritation, occasional watering and a
history of falling of eyelashes.
13. SIGNS
Accumulation of white dandruff-like scales are seen on the lid margin,
among the lashes .
On removing these scales underlying surface is found to be hyperaemic
(no ulcers).
The lashes fall out easily but are usually replaced quickly without
distortion.
In long-standing cases lid margin is thickened and the sharp posterior
border tends to be rounded leading to epiphora
14.
15. TREATMENT
General measures include improvement of health and balanced diet.
Associated seborrhoea of the scalp should be adequately treated.
Local measures include removal of scales from the lid margin with the help
of lukewarm solution of 3 percent soda bicarbonate or baby shampoo and
frequent application of combined antibiotic and steroid eye ointment at the
lid margin.
Complications are similar to bacterial blepharitis
16. PARASITIC BLEPHARITIS
Phthiriasis palpebram to that due to crab-louse, very rarely to the head-
louse. In addition to features of chronic blepharitis, it is characterized by
presence of nits at the lid margin and at roots of eyelashes
Peduculosis refers to infestation by pediculus humanus corporis (head
louse). If heavily infested, the lice may spread to involved lashes
Etiology
17. CLINICAL FEATURES
Symptoms such as chronic irritation, itching , burning and mild
lacrimation.
Signs
1. Lid margins are red and inflamed.
2. Lice anchoring lashes with their claws may be seen on slit lamp
examination.
3. Nits may be seen as opalescent pearls adherent to the base of the cilia.
4. Conjunctival congestion may be seen in long standing cases.
18.
19. Treatment
Treatment consists of mechanical removal of the nits with forceps followed
by rubbing of antibiotic ointment on lid margins, and delousing of the
patient, other family members, clothing and bedding.
20. POSTERIOR BLEPHARITIS/
MEIBOMITIS
Chronic meibomitis is a meibomian gland dysfunction, seen more
commonly in middle-aged persons with acne rosacea and seborrhoeic
dermatitis.
1. It is characterized by white frothy (foam-like) secretion on the eyelid
margins and canthi (meibomian seborrhoea).
2. On eversion of the eyelids, vertical yellowish streaks shining through
the conjunctiva are seen.
3. At the lid margin, openings of the meibomian glands become
prominent with thick secretions.
Acute meibomitis occurs mostly due to staphylococcal infection.
21.
22. TREATMENT
Treatment of meibomitis consists of expression of the glands by repeated
vertical lid massage, followed by rubbing of antibiotic-steroid ointment at
the lid margin.
Antibiotic eyedrops should be instilled 3-4 times.
Systemic tetracyclines for 6-12 weeks remain the mainstay of treatment of
posterior blepharitis.
Erythromycin may be used where tetracyclines are contraindicated.
