Blepharitis For info :- gvijayendra96@gmail.com

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