Blepharitis is a chronic inflammation of the eyelid margins with various types including bacterial, seborrheic, and meibomitis, each having distinct symptoms and treatments. Symptoms may include irritation, itching, and the presence of crusts, while treatments range from hygiene practices to antibiotics and steroid eye drops. Complications can include madarosis, styes, and dry eyes if not properly managed.

1. BLEPHARITIS
DR. ANSHUMALEE PATEL

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