Dr. Prabhat Kiran Devkota MBBS(TU), MD(NAMS) Ophthalmology Oculoplasty

1. Bacterial Infections of Eyelid
& Blepharitis
Dr. PRABHAT DEVKOTA
MBBS (TU), MD (NAMS)
1

2. CONTENT
Anatomy of eyelids
Blepharitis
External Hordeolum
Chalazion/ Internal Hordeolum
Impetigo
Erysipelas
Anthrax
Tuberculosis
Syphilis
Necrotizing fasciitis 2

3. 3

4. 4

5. Glands of Eyelids
5

6. 6

7. Gland of Zeis
• Definition: Modified holocrine
sebaceous glands
• Site: Attached directly & open into
the follicle of cilium
• Number: ~2 for each cilium
• Structure: Cubical cells (multiplying
to form polyhydral cells).
7

8. • Function:
- Secretes Sebum (lipid) → Prevents lashes from dryness
- Sebum has self-sterilizing properties, which affects the
viability of bacteria
- It contains vitamin E, it prevents the aging process and helps
maintain a healthy skin barrier
- Glycerol produced in the pilosebaceous follicle plays a role
in skin hydration
- Dysfunction causes insufficient hair cell function
8

9. Glands of Moll
• Definition: Modified apocrine sweat gland
which have been arrested in development.
• Site: -Arranged obliquely & parallel to the
bulbs of cilia
-The orifices open into the follicles or
directly onto the eyelid margin between the
cilia.
• Number: Lower eyelid > Upper eyelid
• Structure: Secretory portion & Ducts
9

10. • Function:-
-The moll gland has positive immunohistochemical reactions by
producing secretory components i.e. IgA, mucin, and
lysozymes in the glandular cells.
-This suggests that the moll gland is a vital component for
immune defense against pathogenic microorganisms in the
eyelid and ocular surface.
10

11. Tarsal /Μeibomian Gland
• Modified Sebaceous gland with
holocrine secretion
• Embeded within stroma of tarsal
plate arranged vertically
• ~30-40 in upper eyelid and ~20-30
in lower eyelid
• Secretes Meibum which forms
lipid component of Tear Film
11
Heinrich Meibom

12. 12

13. What is Meibum?
• Mixture of lipids of various classes, including wax esters,
cholesteryl esters, (o-acyl)-v-hydroxy fatty acids and their
esters, acylglycerols, diacylated diols, free fatty acids,
cholesterol, and in smaller amounts, other polar and nonpolar
lipids
• Lipid layer -- polar and non polar
• SPHINGOLIPIDS - 30% of polar lipid layer- increases in MGD
13

14. Bacterial Infections of Eyelids
14
• Eyelids may be the primary site of infection, or part of
multisystem infectious disease.
• Many of these diseases may go unsuspected if they are not
indigenous to one’s practice location.
• Immunocompromised patients are susceptible to a number of
opportunistic infections.

15. Inflammation of the Eyelids
15
Site of Inflammation
Skin of Eyelid
Dermatoblepharitis
Lid Margin
Blepharitis
Anterior Posterior
-Staphylococcal -Meibomian Gland Disease
-Seborrhoeic

16. • "blepharitis" derived - Greek word blepharos, which means
"eyelid," and the Greek suffix itis, which is typically used to
denote an inflammation.
• Blepharitis is a chronic ocular inflammation that involves the
eyelid margin primarily and is a common cause of chronic
ocular irritation
16
BLEPHARITIS

17. CLASSIFICATION
17

18. Spectrum of Blepharitis
18
Anterior
Blepharitis
Posterior
Blepharitis
(MGD)
Mixed
most common

19. Staphylococcal Blepharitis
• Chronic infection of base of lashes.
• Causitive organism-
Staphylococcus aureus.
• Age- young patients
• Associated with- styes.
• Secondary-
–Papillary conjunctivitis
–Punctate corneal erosions
–Marginal keratitis
19

20. SIGNS:
• Lashes - hard scales around lash roots a/w
collarettes, madarosis, poliosis and trichiasis.
• Anterior lid margin - Scaling, Crusting,
erythema, ulceration, notching and
microabscesses.
• Cysts - acute external hordeolum (stye).
• Tear film - dry.
• Conjunctiva - papillae and phlyctens.
• Cornea - punctate erosions and marginal
infiltrates.
• Associated dermatitis - atopic 20

21. Seborrhoeic Blepharitis
• Associated with generalised
seborrhoeic dermatitis.
• Greasy, waxy scales accumulate
along eyelid margins.
• Age- older patient
• Secondary
–Papillary conjunctivitis
–Punctate corneal erosions.
21

22. SIGNS:
• Lashes - soft greasy scales in between
the lash roots and oily lashes stuck
together
• Anterior lid margin – shiny, hyperemic
& greasy.
• Tear film - dry.
• Conjunctiva - unremarkable.
• Cornea - punctate erosions and
peripheral infiltrates.
• Associated dermatitis - seborrhoeic.
22

23. DIAGNOSTIC TESTS
• no specific clinical diagnostic tests for blepharitis.
• Cultures of the eyelid margins may be indicated for patients
who have recurrent anterior blepharitis with severe
inflammation & for patients not responding to therapy.
• Microscopic evaluation of epilated eyelashes may reveal
demodex mites in some cases of chronic
blepharoconjunctivitis
• Confocal microscopy
23

24. TREATMENT
• Warm compresses and ocular hygiene
• Eyelid cleansing
• Lid scrubs/massage
• Antibiotics (topical and/or systemic)
• Topical anti-inflammatory agents (Eg- Corticosteroids,
cyclosporine)
24

25. Lid Hygiene
• Use warm, moist compresses on closed eyelids to clear
superficial debris and soften secretions; for 5-10 minutes, at
least once daily
• Then clean the eyelid margins carefully and thoroughly; using a
cotton bud soaked in dilute baby shampoo or sodium
bicarbonate, or to use a commercial eyelid hygiene kit.
• Incorporate eyelid hygiene in daily routine, and continue long
term to avoid relapse
25

26. Medical Management
1. Antibiotics
Macrolides:- broad spectrum , dual mechanism of action (anti
inflammatory + anti bacterial), good penetration and prolonged
duration of action
• Oral Tetracyclines
• Oral Azithromycin
26

27. 2. Steroids:
• Hosseini et al. - concluded that the combination therapy
(Antibiotic + Steroid) was more effective than Azithromycin
alone
• Steroid use for blepharitis should be limited to short-term use
for acute exacerbations and should be low potency when
possible.
27
DOI https://doi.org/10.2147/OPTH.S52474

28. 3. Cyclosporine
• Perry et al. Randomized patients to treatment with topical
cyclosporine versus placebo and found statistically significant
reductions in eyelid margin erythema, meibomian gland
inclusions, telangiectasia, and corneal staining at 3 months
28
DOI: 10.1097/01.ico.0000176611.88579.0a

29. Posterior Blepharitis
• Affects the posterior lamella.
• Meibomian gland dysfunction and alterations in meibomian
gland secretions.
• More persistent and chronic inflammatory condition.
• Association with Acne rosacea.
29

30. Symptoms:
• Bilateral and symmetrical
• Burning
• Grittiness , crusting
• Mild photophobia
• Redness of the lid margins with
remissions and exacerbations
30

31. SIGNS:
• Lashes - unremarkable.
• Posterior lid margin - notching, oily capping
or occlusion (pouting, recession/plugging) of
meibomian gland orifices, expressed
meibomian secretions may be turbid and
toothpaste-like.
• Cysts - meibomian
• Tear film- dry, foamy and frothy(unstable).
• Conjunctiva - unremarkable.
• Cornea - punctate erosions and infiltrates.
• Associated dermatitis - acne rosacea 31

32. 32

33. Rosacea Blepharitis
• Hypertrophic sebaceous glands in
areas of facial flushing
• Progresses to plaques and
phymatous change at the face
• Rhinophima is the most advanced
stage
• 30-40 year old
33

34. Meibomian Gland Dysfunction
• International workshop on meibomian gland dysfunction
defines MGD as a chronic, diffuse abnormality of meibomian
glands that is commonly characterized by terminal duct
obstruction qualitative or quantitative changes in glandular
secretion
• It may result in alteration of the tear film, symptoms of eye
irritation, clinically apparent inflammation, and ocular surface
disease.
34

35. 35

36. Pathophysiology of Posterior Blepharitis
36
Inflammation
Bacterial
Lipase
Altered
Lipids Hormone
imbalance
Age
Altered Composition
of Meibomian Gland
Secretions
Pro-inflammatory & irritative
effects of altered meibum
Irritation/Inflammation of lid
margin and ocular surface
Destabilization of tear film
Evaporative dry eyes
Ocular Surface Inflammation/Damage

37. 37

38. Increased viscosity of meibum
Hyperkeratinization of
the ductal epithelium
Gland dropout, atrophy,
and decreased secretion
MGD
38

39. MEIBOGRAPHY
• Non invasive technique to visualizes the
structure of meibomian glands and thereby
able to detect abnormalities in gland
morphology
• to detect possible Meibomian Gland
Dysfunction (MGD) and to monitor their
correct functioning.
40

40. • A normal meibomian gland is
approximately linear and 3-4
mm in length, traversing the
posterior eyelid
perpendicularly from the lid
margin to the opposite edge
of the tarsus
41

41. • Alsaab et al. compared an Infrared Autorefractometer
meibography with meibographs obtained by a designated
Meibography machine.
• A commercially available Autorefractometer could capture high-
quality non-contact infrared digital meibographs.
42
DOI: 10.7759/cureus.51503

42. OCULAR SURFACE ANALYZER
• Studies the surface reflection pattern
and dynamics of the lipid layer of the
tear film, thus allowing the
measurement of the tear film stability
and the thickness of the lipid layer.
• The device enlights the lipid layer and
the pattern defined can be compared
with the reference grading scale.
43

43. These parameters are valuable for
distinguishing MGD from the
normal condition;
Ocular Symptom score,
Lid Margin abnormality score,
Meiboscore, and
Tear film breakup time
44

44. TREATMENT
GOAL:
• Improve the meibomian secretions
• Improve tear film stability
45

45. TREATMENT
• Warm compression- applied for several minutes to soften crusts at
the bases of the lashes.
• Lid hygiene:-
- performed to mechanically remove crusts and other debris,
- scrubbing the lid margins with a cotton bud or clean cloth dipped in
a warm dilute solution of baby shampoo or sodium bicarbonate.
• Lid Massage:- to express the meibomian glands secretion.
46

46. WHY WARM COMPRESSES?
Normal Meibum Melting Tempr 19-32°C
MGD- alteration of mebium
Temperature of 40°C needed in severe MGD
47

47. Medical Treatment
1. Antibiotics:
a) Tetracyclines-
Bacteriostatic, anti-inflammatory (main role)
Acts on lipases, free fatty acids (proinflammatory), inhibition of
MMP, action on neutrophils and lymphocytes
48

48. b) Azithromycin
• Topical 1% eye ointment
• Oral azithromycin 1 gm single dose (14 days)
49

49. 2. Anti-inflammatory:
a) Cyclosporine 0.05% (Restasis FDA approved for Dry Eye)
Calcineurin inhibitor
• Improvements in lid margin redness, meibomian gland inclusions,
telangiectasia, and corneal staining as well as in the quality of
meibomian gland secretions.
50

50. b) Lifitegrast-
Xiidra 5% - FDA approved for Dry Eye
• Lymphocyte function-associated antigen (LFA)-1 antagonist that
blocks T-cell binding to intercellular adhesion molecule
(ICAM)
51

51. 3. Corticosteroid:- limited studies in MGD
• Short term use in acute conditions
4. Essential Fatty Acid:- anti-inflammatory
• Oral supplementation with omega 3 fatty acids
52

52. • Mechanical Intraductal Probing:
- to restore the integrity of the
gland's central duct by entering the
gland through the ductal orifice.
53

53. Electronic Heating Devices
Eye Mask:
Lipiflow- Thermal Pulsation System:
Provides controlled, outward directional
heat and intermittent pressure to eyelids
to facilitate release of lipid from the
meibomian glands.
54

54. Intence Pulsed Light:
• High intensity, 500-1200 nm
• Thrombosis of abnormal blood vessels, heating and liquefaction
of meibum allowing greater ease of secretion and expression,
• Reduction in epithelial turnover,
• Local photomodulatory effects,
• Activation of fibroblasts, enhancement of collagen synthesis, and
destruction of demodex mites.
55

55. Demodex Infestation
• Most common ectoparasite found on human skin, hair follicle
and sebaceous gland - dwelling mite Demodex
Demodex folliculorum longus :-Anterior Blepharitis (lash
follicles)
Demodex folliculorum brevis:- Posterior Blepharitis (sebaceous
and meibomian glands of the lids)
56

56. • Demodex folliculorum longus directly damages cells at the base
of the hair follicle, causing reactive hyperkeratinization and
resulting in the formation of cylindrical dandruff.
• Demodex folliculorum brevis physically blocks the meibomian
glands, resulting in a granulomatous reaction from tissue
irritation and thus predisposing to MGD and chalazia.
57

57. Signs:-
• May lead to cylindrical dandruff-
like scaling (collarettes) around
the base of eyelashes
• Mites can be demonstrated under
16X slit lamp magnification
58

58. Treatment:-
Tea Tree Oil:-
-A one-month treatment of weekly 50% TTO lid scrubs in the
clinic and 10% lid scrubs daily at home has been shown to
eradicate ocular demodex.
-Home therapy with daily lid massage and 5% TTO ointment has
also been found to significantly decrease mite counts by four
weeks and provide significant relief from itching.
59

59. Secondary Changes:
–Papillary conjunctivitis
–Inferior corneal punctate
epithelial erosions.(PEEs)
–Corneal scarring and
Vascularization
–Stye formation.
–Marginal keratitis and
occasionally bacterial keratitis.
–Phlyctenular eye disease
60

60. Complications:
• Stye
• Chalazion
• Chronic Conjuctivitis
• Corneal Ulceration
61

61. 62

62. Angular Blepharitis
• Causative organism:-
-Moraxella lacunata
-S. aureus
-Rarely herpes simplex
• Clinical features:-
-Red, scaly, macerated and fissured
skin
-Associated papillary conjunctivitis,
moderate mucopurulent discharge
and adherent exudate.
63

63. SIGNS:
• Lashes - unremarkable.
• Lids - erythema, scaling and
fissuring of skin at one or both
canthi.
• Cysts - absent.
• Tear film - unremarkable.
• Conjunctiva - follicular
conjunctivitis.
• Cornea - marginal infiltrates and
phlyctens.
• Associated dermatitis - atopic.
64

64. Treatment:-
Warm compression
Lid massage
Lid scrub
Topical Chloramphenicol,
Bacitracin and Erythromycin
Oral Tetracycline, Doxycycline or Erythromycin
65

65. Not Just Blepharitis!!!
• The possibility of carcinoma should be considered in patients
with chronic blepharitis unresponsive to therapy, especially
when only one eye is involved.
• Biopsy of the eyelid may be indicated to exclude the possibility
of carcinoma in cases of marked asymmetry, resistance to
therapy, or unifocal recurrent chalazia that do not respond well
to therapy.
66

66. • If there are any signs of cicatrizing disease, clinicians should be
suspicious about the possibility of ocular mucous membrane
pemphigoid (OMMP) and the proper workup should be
initiated, including immunofluorescence studies of the biopsy
specimen
• Discoid lupus erythematosus(DLE) are rare causes
67

67. External Hordeolum / Stye
• Acute suppurative inflammation of
lash follicle and its associated gland
of Zeis or Moll.
• Causative agent:- Staph. aureus
• Age Group:- children & young adults
• Predisposing Factors:- habitual eye
rubbing, fingering of nose, chronic
blepharitis, diabetes, chronic debility 68

68. 69
Clinical Features:
Symptoms:-
Pain
Swelling
Redness of eyelids
Watering, Discomfort
Signs:-
An elevated, superficial, erythematous, painful, warm papule.
Tender swelling in lid margin pointing anteriorly through the
skin, usually with a lash at its apex.

69. Histologically - Polymorphonuclear
leukocytes, necrotic cellular debris,
edema, and vascular congestion
Treatment:-
- Hot compression
- Epilation of the associated lash.
- Topical (Eyedrop & ointment)
Antibiotics – erythromycin or
bacitracin.
- Systemic (Oral) Antibiotics & Anti-
inflammatory/ Analgesics.
70

70. Chalazion and Internal Hordeolum
• Chalazion is a chronic, non-
suppurative, lipogranulomatous
inflammatory lesion caused by
retained secretions from meibomian
gland(sometimes Zies) into the
stroma.
• Usually associated with Blepharitis,
Acne Rosacea
71

71. 72
Clinical features:-
Painless gradually enlarging nodule
Lid heaviness
Blurred vision, Astigmatism (large chalazion)
Watering due to eversion of lower punctum
Nodules away from eyelid margin,
(Upper eyelid > Lower eyelid)
Reddish purple area on palpebral conjuntiva
on lid eversion
Polypoid Granuloma may occur as it rupture
through the tarsal conjunctiva

72. Clinical Course & Complication:
Spontaneous Resolution
Often slowly increases in size and
becomes very large.
May burst on the conjunctival side,
forming a fungating mass of granulation
tissue
Secondary infection leading to formation
of hordeolum internum.
Calcification (rare)
Malignant Change (rare)
73

73. 74
Internal Hordeolum:-
• Suppurative inflammation of the
Meibomian gland associated with
blockage of the duct.
Etiology:
•Primary staph. infection of
meibomian gland
•Secondary infection in a chalazion

74. 75
Clinical Features:-
• Acute pain, swelling of lids, watering and photophobia
• Signs: localized firm tender swelling of lid with edema.
• Point of maximum tenderness and swelling away from lid margin
and that pus usually points on the tarsal conjuntiva seen as yellow
area on everting eyelid.

75. 76
Treatment:-
1. Conservative Management:
- hot fomentation,
- topical antibiotics,
- oral anti-inflammatory drugs.
2. Steroid injection:
- into or around the lesion.
- Preferred in marginal lesions or lesions close to lacrimal
puncta.
- 0.2-2ml of 5mg/ml triamcinolone diacetate aqueous
suspension diluted with lidocaine (or equivalent) to a
concentration of 5mg/ml with 27 or30 gauge needle.

76. 77
3. Surgery:- Incision & Curettage

77. 78

78. 79
4. Prophylaxis-
•Treatment of Blepharitis: daily lid hygiene
•Systemic tetracycline in case of recurrent chalazia
particularly if associated with acne rosacea.

79. Impetigo
• Contagious, superficial pyogenic
infection of the skin
• Causative Organism:-
Streptococcus pyogens
or, Staphylococcus aureus
• Age Group:- Children
80

80. 81
• Highly contagious
• Acute glomerulonephritis - 2–5% of group A hemolytic
streptococcal skin infections
Clinical Features:-
• Small, 1–2 mm, erythematous macules
develop into vesicles and bullae
• Hematogenous spread - scalded skin syndrome with
widespread exfoliation at distant sites.

81. • Bullae rapidly progress and
rupture.
• Form a thin, varnish-like crust in
cases of staphylococcal (bullous)
impetigo.
• Thick honey-colored crust in
cases of Streptococcus or mixed
infections of streptococci and
staphylococci.
82

82. Diagnosis:-
- Characteristic clinical appearance
- Specimens - obtained for culture and sensitivity
Treatment:-
Gentle washing of the affected area.
Topical Mupirocin 3 times - 7 days.
Topical Bacitracin or Erythromycin.
Oral antibiotics.
Healthy children with community-acquired MRSA infections -
Clindamycin or Trimethoprim Sulfamethoxazole
83

83. Erysipelas (St Anthony’s fire)
• Uncommon acute, potentially severe,
dermal and superficial lymphatic
infection.
• Causative agent:-
Streptococcus pyogens
• Predisposing factors:-
- Diabetes
- Obesity
- Alcohol abuse
84

84. • Clinical features:-
- Inflamed erythematous plaque.
- Well-defined raised border
distinguishes erysipelas from other
forms of cellulitis.
• Complications:- metastatic
infection (rare).
• Treatment:- Oral Antibiotics.
• Recurrence common.
85

85. Anthrax:
• Infections in humans - contact with
contaminated animal.
• Causative organism- Bacillus anthraci, a gram-
positive spore-forming bacteria.
• Cutaneous anthrax - 95% of all cases.
• Cutaneous anthrax - most prevalent in wool
sorters, livestock workers, and tanners.
result of inoculation of spores through injured
skin.
86

86. Clinical Features:-
• Inflammatory pruritic papule after a 1–10day
incubation period.
• Papule vesicle pustule necrotic ulcer
black eschar .
• Progressive lid edema –
–sloughing of the skin of the eyelid
–cicatricial ectropion with corneal exposure
–necessitating secondary reconstruction.
87

87. Diagnosis:-
• Readily diagnosed from the skin lesions.
• Clinical suspicion for anthrax
– blood cultures obtained in addition to the tissue.
88

88. Treatment:-
• Drug of choice for cutaneous anthrax
- oral Penicillin V
• For extensive lesions:-
 aqueous procaine Penicillin G x 5–7 days.
Tetracycline, Erythromycin, and Sulfadiazine.
Cicatricial eyelid deformities - full-thickness skin grafts.
89

89. Tuberculosis
• Caused by Mycobacterium tuberculosis
• Most commonly secondary in nature.
• Have been reported following
blepharoplasty.
90

90. 91
Clinical Features:-
Early on, lesions isolated to the eyelids can
often be mistaken for preseptal cellulitis.
Discrete subcutaneous nodules develop over
time with abscess formation
May drain spontaneously through cutaneous
sinus tracts.
Clinical suspicion based on:-
 appearance of the lesion,
 positive Mantoux reaction,
 failure to respond to antibiotics.

91. 92
• Diagnosis:-
Presumptive diagnosis- based on the findings of acid-fast bacilli
on tissue or exudates specimens.
Definitive diagnosis- positive culture results.
• Polymerase chain reaction amplification.
• Treatment:-
2 months of Isoniazid, Rifampicin, and Pyrazinamide,
followed by a 4-month course of Isoniazid and Rifampicin.

92. Syphilis
• Contagious venereal disease.
• Causative organism-
Treponema pallidum; bacterial
spirochete.
93

93. Clinical Features:
•Primary Syphilis:-
-After an average incubation period of 21
days
-Chancre begins as a single, painless,
small, firm, red papule or a crusted
superficial erosion.
-Regional Lymphadenopathy.
94

94. • Secondary syphilis:-
maculopapular, papulosquamous,
pustular, follicular, or nodular
lesion following an average 8-
week incubation period.
• Tertiary syphilis:-
- Typical granulomatous lesion
(gumma)
- Diffuse gummatous
ulcerations - untreated late
congenital syphilis
- Tarsitis or lid abscess
95

95. • Definitive diagnosis:-
- Darkfield examinations
- Direct fluorescent antibody
tests of exudates and tissue
97

96. Treatment:-
• Parenteral Penicillin
- Treatment of choice for all stages of acquired syphilis.
• Primary, secondary, and early latent syphilis
- Benzathine Penicillin G: 2.4 million units intramuscularly in
a single dose.
• Late latent and benign tertiary syphilis
- Benzathine Penicillin G: 7.2 million units in three divided
doses of 2.4 million units intramuscularly administered
weekly for three successive weeks
99

97. • Neurosyphilis
- 3–4 millions units of aqueous Penicillin administered
intravenously every 4 h over 10–14 days.
• Allergic to penicillin
- Tetracycline or Doxycycline.
100

98. Necrotizing Fasciitis
• Rare, fatal soft tissue infection - affects the
trunk and extremities.
• Two microbiologic subtypes:
- Type I - Anaerobes and
facultative anaerobes
- Type II - Group A B-hemolytic
Streptococcus with or without S. aureus
coinfection.
101

99. Predisposing factors:-
– Diabetes Mellitus
– Alchoholism
– Immunosuppression
Associated with:-
–Acute Dacryocystitis
–Following endoscopic sinus surgery
–Blepharoplasty
–Minor trauma
102

100. Clinical features:-
• Identical to preseptal cellulitis in the
initial stages.
• Presence of violaceous or grayish
discoloration of the overlying skin.
• Subsequent development of cutaneous
bullae.
• Pyrexia and other features of systemic
infection.
103

101. • Infection spreads along fascial planes.
• Subcutaneous involvement - more
extensive than apparent by the
cutaneous margins of the infection.
• Preseptal necrotizing fascitis - spread
into the posterior orbit via the fascial
envelopes of the rectus muscles
104

102. Diagnosis:-
• Clinically Tenderness - beyond the
margins of the clinically apparent
infection.
• Blood cultures
• Tissue cultures
• CT scan with contrast
- demonstrate enhancement and
thickening of the adjacent fascial
planes.
105

103. Treatment:-
• Often require intensive care with cardiac monitor.
• Collaboration of an intensivist, infectious disease specialist,
and a surgeon.
• Intravenous Penicillin G with appropriate anaerobic coverage.
• Surgical debridement.
106

104. Phthiriasis Palpebrarum
• Caused by- Crab louse/ Phthirus
pubis
• Symptoms:-
–Chronic irritation
–Itching of the lids, but the lice are
often an incidental discovery.
–Conjunctivitis - uncommon..
107

105. • Signs:-
-Lice visible anchored to lashes - lice
have six legs
-Ova and their empty shells- appear as
oval, brownish, opalescent pearls
adherent to the base of the cilia .
108

106. • Treatment:-
–Mechanical removal of the lice and
their attached lashes with fine
forceps.
–Topical yellow mercuric oxide 1% or
petroleum jelly applied to the lashes
and lids twice a day for 10 days.
–Delousing of the patient, family
members, clothing and bedding.
109

107. Tick Infestation of Eyelid
• Ticks - attach themselves to the eyelid
• Should be removed at the earliest
opportunity in order to minimize the
risk of contacting a tick-borne
zoonosis
• Insect repellent - pyrethrin or a
pyrethroid should be sprayed on the
tick twice at intervals of a minute.
• Alternatively a scabies cream
containing permethrin.
110

108. • Tick should be detached as close to
its skin attachment as possible in
order to remove its head and
mouthparts.
• In areas endemic for Lyme disease-
routine antibiotic prophylaxis with
Doxycycline
111

109. Bibliography
• Kanski Clinical ophthalmology, 9th edition
• Yanoff and Duker Ophthalmology, 6th Edition
• Albert and Jackobiec, Volume 4
• AAO Oculofacial Plastic & Orbital Surgery, 2022-2023
• DOI: https://doi.org/10.2147/OPTH.S52474
• DOI: 10.1097/01.ico.0000176611.88579.0a
• DOI: 10.7759/cureus.51503
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110. THANK YOU!!!
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