17. MGD & Blepharitis I Flashcards
What is blepharitis?
Family of inflammatory disease processes of the eyelids (which includes skin, lashes, and meibomian glands).
What happens in severe eye lid disease?
Significant corneal changes such as ..., ..., ..., and .... Over-colonisation of eyelid is thought to trigger ... and ... reactions of the ocular surface.
What happens in severe eye lid disease?
Significant corneal changes such as neovascularisation, scarring, ulceration, and perforation. Over-colonisation of eyelid is thought to trigger hypersensitivity and inflammatory reactions of the ocular surface.
What structures dictate the differentiation between anterior and posterior blepharitis in the upper and lower lids?
Upper lid - aponeurosis of orbital septum blending with levator palpbrae superioris
Lower lid - aponeurosis of orbital septum blending with the tarsal plate
What do anterior and posterior blepharitis affect?
Anterior: lash follicles and glands of Moll (sweat glands) and Zeis (sebaceous glands)
Posterior: meibomian glands
What are the types of anterior blepharitis?
(3 types)
Staphylococcal (bug-based)
Seborrheic (fungal/yeast based, idiopathic)
Both
What is posterior blepharitis also called, and what does it involve?
MGD
Meibomian gland orifices, meibomian glands, tarsal plate, and blepharo-conjunctival junction.
What are the symptoms of anterior blepharitis?
They are frequently ... as the patient just ....
.........-
...and... .........
What are the symptoms of anterior blepharitis?
They are frequently benign as the patient just tolerates it.
ocular surface burningforeign body sensationcrusting/deposits on lid margins-
erythemaanditchy lid margins watery eyesphotophobiacontact lens intolerance
What are the characteristics of staphylococcal anterior blepharitis?
- It’s usually
...,..., and...with intermittent.... - Caused by
...of the eyelid - Damage caused by
...which cause... - May have
...reactions to... - Bacterial
...destroy lipid molecules and release highly irritating...that disrupt the... -
...is increased in the presence of...and...
What are the characteristics of staphylococcal anterior blepharitis?
- It’s usually
bilateral,symmetrical, andchronicwith intermittentexacerbations. - Caused by
bacterial infectionof the eyelid - Damage caused by
bacterial exotoxinswhich causelow grade inflammation - May have
delayed hypersensitivityreactions tobacterial antigens - Bacterial
coenzymesdestroy lipid molecules and release highly irritatingfree fatty acidsthat disrupt thetear film integrity -
Bacterial colonisationis increased in the presence ofseborrheic dermatitisandMGD
What are the non-chronic inflammation-related signs of staphylococcal anterior blepharitis (least severe to most)?
-
...-... -
...-... ...-
...of bulbar conjunctiva - increased
...of lid margins ...-
...-...of lashes -
...- destruction of...results in this, patient might do this to relieve symptoms
What are the non-chronic inflammation-related signs of staphylococcal anterior blepharitis (least severe to most)?
-
lid erythema-lid redness -
telangiectasia-small dilated BV near skin surface deposits at lash bases-
hyperaemiaof bulbar conjunctiva - increased
thicknessof lid margins trichiasis-
poliosis-depigmentationof lashes -
madarosis- destruction ofhair follicleresults in this, patient might do this to relieve symptoms
What is staphylococcal marginal keratitis?
- hypersensitivity to
... - this is
...separated from...by...-...mm - no
...but may have...
What is staphylococcal marginal keratitis?
- hypersensitivity to
staph exotoxins - this is
subepithelial marginal infiltratesseparated fromlimbusby1-2mm - no
epithelial ulcerationbut may haveconfluent SPK
What are the non-chronic inflammation-related signs of staphylococcal anterior blepharitis (least severe to most)?
- poor quality
... -
...over lower 3rd of cornea .........-
...of lash base ......
What are the non-chronic inflammation-related signs of staphylococcal anterior blepharitis (least severe to most)?
- poor quality
tear film -
punctate epithelial erosionsover lower 3rd of cornea staphylococcal marginal keratitisexternal hordeoluminternal hordeolum-
ulcerationof lash base recurrent bacterial conjunctivitisbacterial keratitis
What are the signs of seborrheic anterior blepharitis?
- less
...and...than staph blepharitis - rare
... - rare
... - uncommon
... - rare
... - no association with
...
What are the signs of seborrheic anterior blepharitis?
- less
inflammationandtelangiectasiathan staph blepharitis - rare
eyelash loss - rare
trichiasis - uncommon
inferior punctate epithelial erosions - rare
chalazia - no association with
hordeola
What are the characteristics of seborrheic anterior blepharitis?
-
...from Glands of Zeis result in...across anterior lid margins and lashes which... - Intermittent episodes
- Symptoms:
...and... -
...-...% have... - Often associated with
... -
...% patients with this had...
What are the characteristics of seborrheic anterior blepharitis?
-
excess production of sebumfrom Glands of Zeis result ingreasy depositsacross anterior lid margins and lashes whichblock gland orifices - Intermittent episodes
- Symptoms:
burninganditching -
15-25% haverosacea - Often associated with
seborrheic skin conditions -
95% patients with this hadseborrheic dermatitis
What are the differential diagnoses for anterior blepharitis?
(6 conditions)
Posterior blepharitis
Basal cell carcinoma
Squamous cell carcinoma
Sebaceous cell carcinoma
Dry eye disease
Eyelid tumour
How do we assess anterior blepharitis?
(3 techniques)
History
Slit lamp examination
Skin conditions?
