2. INTRODUCTION
• Blepharitis is inflammation or infection of
the eyelid margins .
• Blepharitis is one the most common
ophthalmological complications as well as
one of the most difficult conditions to treat.
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3. BLEPHARITIS
Blepharitis is a common eyelid inflammation
that sometimes is associated with a bacterial
eye infection, symptoms of dry eyes or certain
types of skin conditions such as acne rosacea.
Blepharitis is one of the most frequently observed
conditions among eye care practitioners, yet
remains largely misunderstood.
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4. SLIT-LAMP BIOMICROSCOPY
The slit-lamp biomicroscope is an
important diagnostic instrument for
the examination of the anterior eye
structures as well as the contact lens.
Being able to proficiently use the
instrument is important. It use
critical in the fitting of contact
lenses.
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8. ANTERIOR BLEPHARITIS
Anterior blepharitis is characterized by
inflammation at the base of the eyelashes .
Patients with anterior blepharitis, compared
to those with posterior blepharitis, are more
likely to be female and younger *
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9. Two variants of anterior blepharitis are
identified: staphylococcal and seborrheic.
In staphylococcal anterior blepharitis,
colonization of the eyelids by staphylococci leads
to formation of fibrinous scales and crust around
the eyelashes.
The seborrheic variant is characterized by
dandruff-like skin changes around the base of the
eyelids, resulting in greasy scales around the
eyelashes.
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10. PATHOPHYSIOLOGY
The pathophysiology of blepharitis is not completely
understood. A role for lid-colonizing staphylococcal
bacteria was first noted in 1946 . Several mechanisms by
which staphylococci may alter meibomian gland
secretion and cause blepharitis are supported by many
studies .
Direct infection of the lids
Evoke reaction to staphylococcal exotoxin
Provoke allergic response to staphylococcal antigens .
It is likely that a combination of these is responsible for
the clinical manifestations of staphylococcal blepharitis.
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11. CLINICAL PRESENTATION
symptoms
burning , grittiness and mild photophobia
with remission and exacerbation is
characteristic .
Symptoms are usually worse in the morning
, although in patients with dry eye they may
increase during the day .
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12. SIGNS
A. Staphylococcal blepharitis
Hard scales and crusing mainly located around
the bases of the lashes esp. collorette
chronic conjunctival hyperemia with mild
papillary conjunctivitis .
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13. STAPHYLOCOCCAL
BLEPHARITIS
Hyperaemia and telangiectasia of •
anterior lid margin
Scarring and hypertrophy if •
longstanding
Scales around base of lashes •
(collarettes)
Chronic irritation worse in morning•
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14. Cont. Signs of Staphylococcal
blepharitis
Scarring
Notching (tylosis) of the lid margin
Trichiasis (misdirected eyelashes)
Madarosis (loss of lashes) or
Poliosis (loss of pigmentation of
lashes) in sever long standing cases
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15. Cont. Signs of Staphylococcal
blepharitis
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16. secondary changes include :
stye formation
marginal keratitis and occasionally
phlyctenulosis (Corneal nodules that developed
near the limbus and then spread onto the cornea,
carrying behind them a leash of vessels)
associated with tear film instability and dry eye
.
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17. The diagnosis of blepharitis is clinical, based on
the patient's history and physical examination
findings. There are no confirmatory diagnostic
tests or laboratory investigations.
The history should include questions about
symptom duration, smoking, allergens, contact
lenses, and use of retinoids which may provoke
or exacerbate symptoms. A history of acne,
rosacea, or eczema should be evaluated .
DIAGNOSIS
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19. EXAMINATION OF THE TEAR FILM
Bubbles, also called frothing, can sometimes be seen in the tear
film, especially along the lid margins. This can indicate
meibomianitis.
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21. The lashes should be examined for abnormalities
such blepharitis. With blepharitis there will be
collarettes found at the base of the lashes.
Plugged
gland
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23. TREATMENT FOR BLEPHARITIS
Anterior Blepharitis
• staphylococcal blepharitis
more severe
loss of eyelashes
eyelid cleansing and hygiene
antibiotic ointment for eyelids
Viruses and other types of
bacteria besides
staphylococcus also can cause
anterior blepharitis
• Seborrheic blepharitis
seborrheic dermatitis
Regular cleansing with
eyelid
scrubs and gentle, non-
detergent shampoos
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24. Without treatment :
blepharitis caused by bacteria can cause
long-term effects such as ectropion,
thickened lid margins, dilated and visible
capillaries, trichiasis and entropion.
In cases of trichiasis and entropion, the
cornea may exhibit significant erosion
from eyelashes rubbing against the eye.
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25. Eyelid Hygiene Relieves Blepharitis
Symptoms
Blepharitis can be difficult to manage because it is
often chronic, meaning that it never warm compress
goes away completely. Your eye doctor may
recommend one or more of these steps involving
good eyelid hygiene and massage:
Apply a such as a washcloth to the outer eyelids.
Cleanse the eyelids with a commercial lid scrub or
other
recommended product.
Gently massage the outer eyelids.
A warm compress loosens the crust on your eyelids
and eyelashes before you clean them. The warmth
also can loosen any blocked residue in the oil-
secreting meibomian glands in your eyelids
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