Lecture on Blepharitis , Stye & Chalazion For 4th Year MBBS Undergraduate Students By Prof. Dr. Hussain Ahmad Khaqan

1. Blepharitis, Stye & Chalazion
Prof. Dr. Hussain Ahmad Khaqan
 MD
 FRCS(Glasgow)
 FCPS(Ophth.)
 FCPS(Vitreo Retina)
 MHPE (KMU)
 CICO(UK)
 CMT(UOL)
 Fellowship in Medical Retina (LMU, Munich)
 Fellowship in Vitreo Retinal Surgery (LMU, Munich)
 Consultant Ophthalmologist & Retinal Surgeon
Professor of Ophthalmology
Lahore General Hospital, Lahore
Ameer Ud Din Medical College, Lahore
Post Graduate Medical Institute, Lahore
Shaukat Khanum Memorial Cancer Hospital & Research Centre ,Lahore

2. BLEPHARITIS

3. DEFINITION
• Blepharitis is a general term describing inflammation
of the eyelids, whereas marginal blepharitis is
inflammation of the eyelid margin.

4. TYPES
• Anterior blepharitis: involves inflammation of the lid
margin anterior to the gray line and concentrated
around the eyelashes and hair follicles. It may be
accompanied by squamous debris, scurfs, and
collarettes around the lashes
• Posterior blepharitis: involves inflammation
posterior to the gray line, which may have various
causes, including meibomian gland dysfunction
(MGD) and conjunctivitis.

5. SYMPTOMS
• Chronic burning
• Irritation
• Foreign body sensation

6. SIGNS
• Lashes stuck together by soft scales
• Collarettes
• Telangiectatic vessels over lid margin

7. WORK UP
• Culture samples taken from the eyelid margins
• Microscopic examination of meibomian gland
secretions
• Transillumination method
• Vivo laser scanning
Figure: Transillumination of the lid with
normal meibomian gland structure.

8. TREATMENT Continue..
• Lid hygiene, the mainstay of treatment for blepharitis
• Warm compresses – (Treatment with warm
compresses involves the placement of a warm
washcloth on closed lids daily for 5–10 minutes.)
• Lid scrubs - (Cleansing with lid scrubs is usually done
once or twice daily initially)
• Avoidance of excessive eye makeup
• Lid massage

9. TREATMENT
• The BlephEx device – (a less invasive method of
microexfoliation of the lid margins, utilizes a rapidly
rotating microsponge to remove lid debris and
microbial biofilm from the lid margins.
• Ocular lubricants: tear film instability is common.
• Antibiotics: topical antibiotics may be required for
acute exacerbations.
• External hordeola and preseptal cellulitis also require
oral antibiotics.

10. STYE

11. STYE
• Anterior lamella:
External hordeolum (Stye)
• Posterior lamella:
Internal hordeolum

12. Anterior lamella:
External hordeolum (Stye)

13. DEFINITION
• This is an acute abscess within a lash follicle and its
associated glands of Zeis and Moll. It is usually
staphylococcal in origin.

14. CLINICAL FEATURES
• Tender lump
• Inflammation

15. TREATMENT
• Warm compresses; if associated with preseptal
cellulitis, add in oral antibiotics flucloxacillin 250–
500mg 4×/day for 1week.

16. Posterior lamella:
Internal hordeolum

17. DEFINITION
• This is an acute abscess within an meibomian gland.
It is usually staphylococcal in origin.

18. CLINICAL FEATURES
• Tender lump
• Inflammation

19. TREATMENT
• Acute—warm compresses; acute with preseptal
cellulitis—add in oral antibiotics.
• Chronic (or large acute lesion)—also perform incision
and curettage.

20. CHALAZION

21. DEFINITION
• Area of focal, chronic lip granulomatous
inflammation within the eyelid secondary to the
obstruction of a meibomian gland or gland of Zeis.

22. SYMPTOMS
• Acute or chronic eyelid lump/ swelling

23. SIGN
• Visible, palpable nodule in the eyelid

24. TREATMENT
• Topical: antibiotic–steroid combination such as
neomycin/polymyxin B/dexamethasone q.i.d. for 1 to
2 weeks.
• Systemic therapy with doxycycline 100 mg.
• Hot compresses can be effective in encouraging
drainage
• Surgery: incision and curettage

25. INCISION AND CURETTAGE