Blepharitis is inflammation of the eyelid margin that can be caused by bacteria, seborrhea, or parasites. Common symptoms include chronic irritation, itching, mild lacrimation, and worsening of symptoms in the morning. Signs include yellow crusts, small ulcers, hyperemia, and lash abnormalities. Treatment involves warm compresses, lid cleaning, antibiotics, and topical steroids. There are multiple types of blepharitis that can affect the anterior or posterior lid margin.

2. • DEFINITION:-
Blepharitis is a subacute (or) chronic inflammation of the lid
margins
Antomy of lid margin:-
- It is about 2mm broad & is divided into 2 parts by the
punctum(Medial & lateral)
Lacrimal portion(medial) :- It is devoid of lashes & glands
Ciliary portion ( lateral) :- It consists of rounded antr.boder Sharp
post.border & an intermarginal strip (b/w the two borders)
• The grey line divides the intermarginal strip into
a)Anterior strip bearing 2-3 rows of lashes
b)Posterior strip on which openings of meibomian glands are
arranged in a row
• Importance – the splitting of eyelids when required in operations is
done at the level of grey line

4. • TYPES OF BLEPHARITIS :-
A.Bacterial blepharitis
B.Seborrhoeic or Squamous blepharitis
C.Mixed staphylococcal with seborrhoeic blepharitis
D.Posterior blepharitis or Meibomitis
E.Parasitic blepharitis

5. • Also known as
-Chronic antr.blepharitis
-Staphylococcal blepharitis
-Ulcerative blepharitis
• It is a chronic infection of the anterior part of lid
margin
• It is a common cause for occular & discomfort and
irritation
• It is usually starts in childhood & may continue
throught out the life

6. • ETIOLOGY :-
 Causative organisms –
- (M/C) cogulase +ve staphylococci
- Rarely streptococci , propionibacterium acnes &
moraxella may be involved
PREDISPOSING FACTORS :-
Rarely includes chronic conjuctivitis and dacrocystitis

7. • CLINICAL FEATURES:-
Symptoms :- Chronic irritation
Itching
Mild lacrimation
Gluing of cilia
Mild photophobia
Symptoms are worse in the morning
Remissions and exacerbations in symptoms are quite
common

8. • SIGNS :-
- Yellow crusts
- Small ulcers on removing crusts
- Hyperemia
• Mild papillary conjuctivitis and conjuctiva hyperemia
are common assosciations

9. Lash abnormalitiesTrichiasis poliosis
Madarosis
COMPLICATIONS :-

10. - Tylosis
- Epiphora
- Eczema of skin & ectropion
- Recurrent styes
- Marginal keratitis
- Tear film instabillity → dry eye

11. • Treatment :-
a) Lid hyegine(twice daily) - includes
- Warm compress
- Crust removal (3% sodium bicarbonate)
- Avoid rubbing of eyes
b) Antibioics
- Eye ointment
- Eye drops
- Oral antibiotics (erythromycin,doxicycline)
c) Topical steroids (Fluoromethalone)
d) Occular lubricants

12. • It is primarily anterior blepharitis with some spill over posteriorly
• ETIOLOGY:-
- Assosciated with seborrhoea of scalp(dandruff)
- Glands of zeis secrete abnormal excessive neutral lipids
• Symptoms:-
- whitish material at the lid margins
- Mild discomfort
- Irritation
- occasional watering
- Falling of eyelashes
Corynebacterium acne
Neutral lipis Irritating free fatty acids
Seborrhoea of scalp

13. • Signs:-
- Accumulation of white dandruff like scales among lashes
- Underlying surface hyperaemic with out ulcers
- Lashes fall out easily
- Lid margin is thickened
• Complications:-
similar to bacterial blepharitis
• Treatment :-
- General improvement of health & diet
- Seborrhoea of scalp should treated
- Removal of scales with luke warm sol.
(3% NaHco /baby samphoo)
- Antibiotics (erythromycin/doxicycline)
3
Madarosis & Lid oedema

14. • It is inflammation of Meibomian glands
• Two forms as Chronic & acute
• Chronic type :-
- Due to meibommian gland dysfunction
- Common in middle aged people
- Due to action of bacterial lipases
• Clinical features :-
a) Symptoms :- Chronic irritation
Burning
Mild lacrimation
Symptoms are more worse in morning

15. • Signs :-
a) Lid margins – shows foam like secretions
b) Meibommian glands
-openings are prominent with secretions expressed by pressure
on lids with toothpaste appearance
-Orifice shows capping with oil globules,plugging
c)Vertical yellowish streaks shining through conjuctiva
d) Hyperemia and telangectisia of post. Lid margin
e) Secondary changes
- papillary conjuctivitis
- inferior corneal punctate epithelial erosions
Capping of meibimian gland
orifice by oil globules
Thickened posterior lid margin

16. • Acute Meibomitis :-
- It is due to staphylococcal infection
Characteristic features:-
- Painful swelling around the involved gland
- Pressure results in expression of pus → serosanguinous
discharge
• Treatment :-
- Lid hygiene(warm compress , massage)
- Topical antibiotics (immediately after massage)
- Systemic tetracyclines (doxycycline-blocks lipase production)
- Ocular lubricants
- Topical steroids (fluoromethalon-for papillary conjuctivitis)

17. • It is associated infestation of lashes by lice
• Common in people living in poor hygienic conditions
• Clinicalfeatures:-
Infestation with lice causes chronic blepharitis & chronic follicular comjuctivitis
• Symptoms :-
- Chronic irritation
- Itching
- Burning
-Mild lacrimation
PHTHIRIASIS PALPEBRUM PEDICULOSIS
Due to infestation by phthiriasis pubis(crab
louse)
Due to infestation by pediculus humanus
corporis / capitis
Common in adults & mainly acquired as
sexually transmitted disease
Infested lice spreads to involve lashes

18. • Signs:-
a)Lid margin – red & inflammed
b)Slit lamp examination – Lice anchoring lashes with claws
c)Nits – seen as opalescent pearls adherent to base of cilia
d)Conjuctiva congestion on land standing cases
• Treatment :-
- Mechanical removal of lashes with forceps
- Application of antibiotic ointment & yellow mercuric oxide
1% to lid margins and lashes
- Delousing of patient