Blepharitis
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Detailed presentation on Blepharitis, types (bacterial blepharitis / posterior blepharitis or meibomitis / parasitic blepharitis), signs & symptoms, complications, treatment. This presentation is a part of series on Eyelid diseases.
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Exposure keratopathy develops when the eyelids do not adequately cover and protect the cornea during blinking. This can be caused by factors like Bell's palsy or exposure proptosis that limit eyelid closure. Without protection, the corneal epithelium dries out and is invaded by infectious organisms, leading to symptoms of irritation, redness, and corneal ulceration or perforation. Treatment focuses on managing the underlying cause through artificial tears, ointments, or contact lenses and may require suturing the eyelids shut to protect the cornea.
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Ectropion
Ectropion
It is an outward turning of the eyelid margin . This more frequently affects the lower eyelid.Upper eyelid ectropion is uncommon.Classified in 5 types
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Involutional ectropion is more common.Congenital ectropion is very rare.
Symptoms Epiphora :- excessive tearing.Excessive dryness.
Foreign body sensation Irritation.Burning.Redness.Chronic conjunctivitis KeratinizationCorneal exposure
Grading
Lid margin is out rolled and depending on out rolling ectropion can be classified as under:
Grade I –only punctum is everted
Grade II –lid margin is everted and palpebral conjunctiva is visible
Grade III –fornix is also visible
Etiological factors
Horizontal lid laxity:-can be demonstrated by pulling the central part of the lid 8 mm or more from the globe, with a failure to snap back to its normal position on release without the patient first blinking.
Medial canthal tendon laxity
demonstrated by pulling the lower lid laterally and observing the position of the inferior punctum If the lid is normal the punctum should not be displaced more than 1–2 mm
Lateral canthal tendon laxity
characterized by a rounded appearance of the lateral canthus and the ability to pull the lower lid medially more than 2 mm.
>Normally, the displacement should only be 0-2 mm.
Treatment
1 medical therapy
2 surgical therapy
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- Immediate irrigation with saline or water for at least 20 minutes is essential to remove the chemical from the eye.
- The Dua classification system is useful for assessing prognosis based on limbal and conjunctival involvement.
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ectropion & entropion
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- Anterior uveitis is inflammation of the iris and anterior part of the ciliary body. Its prevalence has been increasing and it commonly affects people aged 20-50.
- Uveitis can be classified anatomically, clinically, etiologically, and pathologically. The anatomical classification divides uveitis into anterior, intermediate, posterior, and panuveitis based on location of inflammation.
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The watering eye
Lacrimation refers to watering of the eye due to excessive tear production from the lacrimal gland, while epiphora is watering caused by obstruction of the tear drainage system. Differentiating the two is important to provide proper treatment. The document discusses the anatomy and physiology of tear production, drainage, and evaluates causes of watering eye including lacrimation, dry eye, blepharitis, and epiphora due to punctal stenosis or nasolacrimal duct obstruction. Treatment depends on the underlying cause and may include punctal dilation, dacryocystorhinostomy, Jones tube insertion, or endoscopic lacrimal surgery.
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Bullous keratopathy
Bullous keratopathy refers to corneal swelling caused by insufficient pumping of fluid out of the cornea. It results in the formation of fluid-filled blisters beneath the surface of the eye. It can occur secondary to endothelial dysfunction from trauma, inflammation, dystrophies or other conditions that damage the corneal endothelial pump. Symptoms include blurred vision, glare, pain from ruptured blisters, and potentially scarring. Management involves reducing fluid buildup through hypertonic drops or lenses, lowering eye pressure if high, and corneal transplantation if vision is significantly decreased or pain becomes intolerable.
Dry Eye Disease
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BLEPHARITIS - introduction, types, Etiology, pathogenesis, clinical featur...
Blepharitis- inflammation of lid margins
CLINICAL TYPES:
ANTERIOR BLEPHARITIS
$ Bacterial ulcerative blepharitis :
▪︎ also called as chronic anterior blepharitis or staphylococcal blepharitis
ETIOLOGY
Coagulase positive Staphylococci (most common)
Rarely : Streptococci, Propionibacterium acnes, Moraxella
PATHOGENESIS
Bacteria are carried to lid margins by rubbing with contaminated fingers → inflammation
CLINICAL FEATURES
Symptoms: (worse in the morning) irritation, itching, lacrimation, gluing of cilia, photophobia
Signs :
▪︎ Yellow crusts at the root of cilia
▪︎ Small ulcers on removing the crusts
▪︎ Red, thickened lid margins
▪︎ Mild papillary conjunctivitis and conjunctival hyperemia
TREATMENT
1.Lid hygiene : warm compresses, crust removal and lid margins cleaning (with cotton buds dipped in dilute baby shampoo), avoid rubbing of eyes
2. Antibiotics :
⊙ Eye ointment - applied at lid margin after crust removal
⊙ Eye drops - 3 to 4 times a day
⊙ Oral antibiotics - Erythromycin or Doxycyclin in unresponsive patients
3. Topical Steroids with low potency : Fluorometholone
4. Ocular lubricants ︎
$ Seborrhoeic blepharitis:
▪︎ primarily anterior blepharitis associated with dandruff
ETIOLOGY AND PATHOGENESIS
Glands of Zeis secrete abnormal excessive neutral lipids
Corynebacterium acne splits lipids into irritating fatty acids causing inflammation
SYMPTOMS
Deposition of soft scales at lid margin, discomfort, irritation, watering (occasionally), history of falling of eyelashes
SIGNS
▪︎ Accumulation of white dandruff like scales on lid margin
▪︎ Hyperemic greasy surface found on removal of scales - no ulcer
▪︎ Lashes fall out easily and replace quickly
▪︎ Thickened lid margin
COMPLICATIONS - similar to bacterial blepharitis
TREATMENT
General measures - improvement of health and balanced diet
Treat dandruff adequately
Local measures - removal of scales with lukewarm solution of 3% sodium bicarbonate or baby shampoo
Antibiotics - in mixed blepharitis
POSTERIORBLEPHARITIS (MEIBOMITIS) :
▪︎ Meibomian gland dysfunction
▪︎ Common in middle aged individuals having seborrheic dermatitis
▪︎ Bacterial lipases (producing free fatty acids) play a role in pathogenesis
SYMPTOMS
Irritation, burning, itching, grittiness, watering
SIGNS
▪︎ White frothy secretions on lid margins, oily tear film
▪︎ Secretions with toothpaste appearance over Meibomian gland orifices when lids are pressed
▪︎ Vertical yellow streaks in conjunctiva
▪︎ Secondary changes in conjunctiva and cornea
TREATMENT
Lid hygiene : warm compresses, milking of secretions by vertical massage of lids
Topical antibiotics : Eye ointment after massage, eye drops (3 to 4 times a day)
Systemic antibiotics : Doxycycline 100 mg b.d. for 1 week followed by 100 mg o.d for 6 to 12 weeks
Ocular lubricants
Topical Steroids : Fluorometholone
Dry eye management ppt
This document discusses dry eye, including its definition, causes, symptoms, and treatment approaches. It begins by defining dry eye as a multifactorial disease that results in discomfort, visual disturbance, and tear film instability. Various etiological factors that can contribute to dry eye are then outlined, including age, gender, medications, environmental conditions, and ocular surface diseases. Treatment is tailored based on the severity of dry eye and may include artificial tears, anti-inflammatory therapies, punctal plugs, and procedures to improve meibomian gland function. Modern technologies like LipiFlow are also mentioned for managing meibomian gland dysfunction.
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acinal.pptx
Dr. Ajai Agrawal's presentation defines primary angle closure glaucoma (PACG) as a type of glaucoma characterized by occludable anterior chamber angles that lead to increased intraocular pressure and optic nerve damage. The presentation covers the epidemiology, risk factors, pathogenesis, classification, diagnosis and management of PACG. Treatment may involve medical management, laser peripheral iridotomy to open the angle, or filtering surgeries in advanced cases. Regular follow up is important as PACG can progress to cause vision loss if not properly treated.
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The document provides information about the sclera, including its structure, thickness, apertures, nerve supply, inflammation conditions like episcleritis and scleritis, and other related topics. The sclera forms the posterior five-sixths of the outer fibrous tunic of the eyeball. It varies in thickness from 1mm posteriorly to 0.3mm at the muscle insertions. It contains three layers and is pierced by blood vessels and nerves. Inflammation of the sclera can cause episcleritis or scleritis, with the latter being a more serious condition sometimes associated with underlying systemic diseases.
SIANG KLINIK \'DRY EYE\', 27 FEBRUARI 2011
Dry eye is a common condition that causes eye discomfort. It occurs when the tear film is unstable or the eyes do not produce enough tears. Symptoms include dryness, irritation, and blurred vision. Diagnosis involves examining the eyes for signs of damage and testing tear production and stability. Treatment focuses on replacing tears through artificial tears, gels, or ointments. For severe cases, punctal plugs may be placed to block tear drainage, and anti-inflammatory therapies are used to reduce symptoms and prevent further damage to the eyes. The goals of treatment are to relieve discomfort and protect the ocular surface.
Ectropion
Ectropion
It is an outward turning of the eyelid margin . This more frequently affects the lower eyelid.Upper eyelid ectropion is uncommon.Classified in 5 types
1)Congenital 2) Involutional 3) Paralytic 4) Cicatricial 5) Mechanical
Involutional ectropion is more common.Congenital ectropion is very rare.
Symptoms Epiphora :- excessive tearing.Excessive dryness.
Foreign body sensation Irritation.Burning.Redness.Chronic conjunctivitis KeratinizationCorneal exposure
Grading
Lid margin is out rolled and depending on out rolling ectropion can be classified as under:
Grade I –only punctum is everted
Grade II –lid margin is everted and palpebral conjunctiva is visible
Grade III –fornix is also visible
Etiological factors
Horizontal lid laxity:-can be demonstrated by pulling the central part of the lid 8 mm or more from the globe, with a failure to snap back to its normal position on release without the patient first blinking.
Medial canthal tendon laxity
demonstrated by pulling the lower lid laterally and observing the position of the inferior punctum If the lid is normal the punctum should not be displaced more than 1–2 mm
Lateral canthal tendon laxity
characterized by a rounded appearance of the lateral canthus and the ability to pull the lower lid medially more than 2 mm.
>Normally, the displacement should only be 0-2 mm.
Treatment
1 medical therapy
2 surgical therapy
Corneal edema
The document discusses corneal hydration and edema. It begins by explaining that the cornea's water content is normally around 78% to maintain transparency. Corneal edema occurs when water content increases above this level. Factors that influence corneal hydration are then described, including stromal swelling pressure, intraocular pressure, and the sodium-potassium pump in the endothelium. Causes of corneal edema are outlined as either primary, such as endothelial dystrophies, or secondary due to trauma, glaucoma, contact lenses or metabolic disorders. Symptoms, evaluation and management of corneal edema are also summarized.
Chemical injury to eye
This document provides information on chemical eye burns, including:
- Alkali burns are more dangerous than acid burns as alkalis penetrate rapidly into the eye.
- Immediate irrigation with saline or water for at least 20 minutes is essential to remove the chemical from the eye.
- The Dua classification system is useful for assessing prognosis based on limbal and conjunctival involvement.
- Medical management focuses on removing the chemical, promoting healing, controlling inflammation and infection, and managing intraocular pressure.
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The document summarizes techniques for evaluating the tear film, which has three layers: an outer lipid layer, intermediate aqueous layer, and inner mucous layer. Non-invasive techniques discussed include tear break-up time tests, lipid layer evaluation using interferometry, and inferior tear meniscus height measurements. Invasive techniques involve Schirmer's tests to evaluate tear secretion, fluorescein and rose bengal staining of the ocular surface, and conjunctival impression cytology to examine goblet cell density. The document provides details on procedures and normal results for each evaluation method.
ectropion & entropion
This document describes different types of ectropion and entropion conditions. It discusses involutional, cicatricial, paralytic, congenital, and mechanical causes. Treatment options are provided depending on the severity and include procedures like conjunctivoplasty, wedge resection, tarsorrhaphy, and skin grafts. Assessment of horizontal lid laxity and canthal tendon positioning helps determine the best surgical approach.
Anterior uveitis
Dr. TP Chhangte discusses anterior uveitis, including its definition, epidemiology, classification, pathology, clinical features, complications, and differential diagnosis. Some key points:
- Anterior uveitis is inflammation of the iris and anterior part of the ciliary body. Its prevalence has been increasing and it commonly affects people aged 20-50.
- Uveitis can be classified anatomically, clinically, etiologically, and pathologically. The anatomical classification divides uveitis into anterior, intermediate, posterior, and panuveitis based on location of inflammation.
- Clinical features of anterior uveitis include eye pain, redness, photophobia, and decreased vision. On examination
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Dry eye is a disease characterized by unstable tear film and ocular surface inflammation. It results in eye discomfort, visual disturbance, and potential ocular surface damage. Dry eye is caused by factors that interrupt normal tear production or function like lacrimal gland damage, meibomian gland dysfunction, or neurological issues. Diagnosis involves evaluating symptoms, ocular surface staining, and tear film breakup time. Management includes artificial tears, punctal plugs, cyclosporine drops, and procedures like LipiFlow that target meibomian glands.
Approach To Microbial Keratitis - 1
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clinical video on https://www.youtube.com/watch?v=oMFfZmOUSt4
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CLINICAL TYPES:
ANTERIOR BLEPHARITIS
$ Bacterial ulcerative blepharitis :
▪︎ also called as chronic anterior blepharitis or staphylococcal blepharitis
ETIOLOGY
Coagulase positive Staphylococci (most common)
Rarely : Streptococci, Propionibacterium acnes, Moraxella
PATHOGENESIS
Bacteria are carried to lid margins by rubbing with contaminated fingers → inflammation
CLINICAL FEATURES
Symptoms: (worse in the morning) irritation, itching, lacrimation, gluing of cilia, photophobia
Signs :
▪︎ Yellow crusts at the root of cilia
▪︎ Small ulcers on removing the crusts
▪︎ Red, thickened lid margins
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TREATMENT
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2. Antibiotics :
⊙ Eye ointment - applied at lid margin after crust removal
⊙ Eye drops - 3 to 4 times a day
⊙ Oral antibiotics - Erythromycin or Doxycyclin in unresponsive patients
3. Topical Steroids with low potency : Fluorometholone
4. Ocular lubricants ︎
$ Seborrhoeic blepharitis:
▪︎ primarily anterior blepharitis associated with dandruff
ETIOLOGY AND PATHOGENESIS
Glands of Zeis secrete abnormal excessive neutral lipids
Corynebacterium acne splits lipids into irritating fatty acids causing inflammation
SYMPTOMS
Deposition of soft scales at lid margin, discomfort, irritation, watering (occasionally), history of falling of eyelashes
SIGNS
▪︎ Accumulation of white dandruff like scales on lid margin
▪︎ Hyperemic greasy surface found on removal of scales - no ulcer
▪︎ Lashes fall out easily and replace quickly
▪︎ Thickened lid margin
COMPLICATIONS - similar to bacterial blepharitis
TREATMENT
General measures - improvement of health and balanced diet
Treat dandruff adequately
Local measures - removal of scales with lukewarm solution of 3% sodium bicarbonate or baby shampoo
Antibiotics - in mixed blepharitis
POSTERIORBLEPHARITIS (MEIBOMITIS) :
▪︎ Meibomian gland dysfunction
▪︎ Common in middle aged individuals having seborrheic dermatitis
▪︎ Bacterial lipases (producing free fatty acids) play a role in pathogenesis
SYMPTOMS
Irritation, burning, itching, grittiness, watering
SIGNS
▪︎ White frothy secretions on lid margins, oily tear film
▪︎ Secretions with toothpaste appearance over Meibomian gland orifices when lids are pressed
▪︎ Vertical yellow streaks in conjunctiva
▪︎ Secondary changes in conjunctiva and cornea
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Lid hygiene : warm compresses, milking of secretions by vertical massage of lids
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Topical Steroids : Fluorometholone
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Blepharitis
- 2. DEFINITION Subactue / Chronic inflammation of lid margins
- 3. TYPES ● Bacterial blepharitis ● Seborrheic / Squamous blepharitis ● Mixed staph + seborrheic blepharitis ● Post blepharitis / Meibomitis ● Parasitic blepharitis
- 4. BACTERIAL BLEPHARITIS ● DEFINITION ● ETIOLOGY ● SYMPTOMS ● SIGNS ● COMPLICATIONS ● TREATMENT
- 5. DEFINITION ● Chronic anterior blepharitis ● Usually starts in childhood, may continue throughout life
- 6. ETIOLOGY ● Coagulase positive staph ● Strep ● Propionibacterium acnes ● Moraxella ● Predisposing factors: ○ Chronic conjunctivitis ○ Dacryocystitis
- 7. SYMPTOMS ● Chronic irritation ● Itching ● Mild lacrimation ● Gluing of cilia ● Mild photophobia ● Worse in morning
- 8. SIGNS ● Yellow crusts at the root of cilia ● On removal of crusts - Small ulcers that bleed easily ● Red, thickened lid margins ● Mild papillary conjunctivitis ● Conjunctival hyperemia
- 9. COMPLICATIONS ● Madarosis ● Trichiasis ● Poliosis ● Tylosis ● Eversion of punctum > Epiphora ● Eczema of skin
- 10. COMPLICATIONS ● Ectropion ● Recurrent stye - External hordeolum ● Marginal keratitis ● Tear film instability > Dry eye ● Secondary inflammation & mechanical changes in conjunctiva and cornea
- 11. TREATMENT - LID HYGIENE Done twice daily ● Warm compresses for 5-10 minutes ● Crust removal & cleaning of lid margin
- 12. TREATMENT - ANTIBIOTICS ● Topical: Apply ointment after removal of crusts. Eye drops 3-4 times a day ● Oral: Erythro / Doxy
- 13. TREATMENT - TOPICAL STEROIDS ● Fluoromethalon ● In pt with papillary conjunctivitis / marginal keratitis / phlyctenulosis
- 14. TREATMENT - TEAR DROPS ● Improve tear film stability ● Prevent dry eye
- 15. SEBORRHOEIC BLEPHARITIS ● DEFINITION ● ETIOLOGY ● SYMPTOMS ● SIGNS ● COMPLICATIONS ● TREATMENT
- 16. DEFINITION ● Primarily anterior with some spillover posteriorly
- 17. ETIOLOGY Glands of Zeis → Excessive, abnormal Neutral lipids → Split by Corynebacterium acne into FFA A/w seborrhoea of scalp
- 18. SYMPTOMS ● Soft white scales at lid margin ● Discomfort ● Watering ● Irritation ● Falling of eyelashes
- 19. SIGNS ● White scales on the lid margin along the lashes ● Removal of scales - Hyperemic & Greasy surface ● Lashes fall out easily ● Thickened lid margin ● Rounded posterior border → Epiphora
- 20. COMPLICATIONS Similar to bacterial blepharitis, less frequent
- 21. TREATMENT ● Lukewarm soln of 3% soda bicarb for scale removal & cleaning of lid margin ● Antibiotic & Steroid eye drops ● Oral antibiotics are used if mixed with bacterial blepharitis
- 22. POSTERIOR BLEPHARITIS ● DEFINITION ● ETIOLOGY ● SYMPTOMS ● SIGNS ● COMPLICATIONS ● TREATMENT
- 23. DEFINITION ● Inflammation of Meibomian glands ● Chronic / Acute
- 24. CHRONIC MEIBOMITIS ● Common ● Middle aged persons ● A/w rosacea / acne / seborrhoeic dermatitis
- 25. SYMPTOMS - CHRONIC ● Discomfort ● Grittiness ● Irritation ● Itching ● Remissions & Exacerbations
- 26. SIGNS - CHRONIC ● White frothy secretions at lid margins & canthi ● Opening of meibomian glands clogged with thick secretions > May show pouting, recession ● On pressure - secretions can be expressed ● Vertical yellowish streaks seen through conjunctiva - Meibomian ducts ● Hyperemia & telangiectasia of post lid margin ● Oily & foamy tear film
- 27. ACUTE MEIBOMITIS Painful swelling of Meibomian gland with serosanguinous discharge
- 28. TREATMENT - LID HYGIENE Done twice daily ● Warm compresses for 5-10 minutes ● Vertical massage of lids & expression of secretions
- 29. TREATMENT - ANTIBIOTICS ● Topical: Apply ointment after removal of crusts. Eye drops 3-4 times a day ● Oral: Doxy 100 mg, BD, 1 week + Doxy 100 mg, OD, 6-12 weeks OR Erythromycin
- 30. TREATMENT - TOPICAL STEROIDS ● Fluoromethalon ● In pt with papillary conjunctivitis / marginal keratitis / phlyctenulosis
- 31. TREATMENT - TEAR DROPS ● Improve tear film stability ● Prevent dry eye
- 32. PARASITIC BLEPHARITIS ● ETIOLOGY ● SYMPTOMS ● SIGNS ● COMPLICATIONS ● TREATMENT
- 33. ETIOLOGY Lice infestation - poor hygiene ● Phthiriasis palpebrum - infestation by phthirus pubis (crab louse), an STI ● Pediculosis - infestation by pediculus humanus corporis or capitis (head louse)
- 34. SYMPTOMS ● Discomfort ● Burning ● Watering ● Irritation ● Itching
- 35. SIGNS ● Red, inflamed lid margins ● Lice visible clawing on to lashes on SLE ● Nits at the base of cilia ● Conjunctival congestion & follicles in long- standing cases
- 36. TREATMENT ● Removal of lice & nits with forceps ● Apply antibiotic ointment to lid margin ● Apply Yellow Mercuric Oxide 1% to lid margin & lashes ● Delousing of pt, pt belongings (bed, clothes), family members
- 37. THANK YOU