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Anterior Segment Disease > 3: Eyelids- Blepharitis > Flashcards

3: Eyelids- Blepharitis Flashcards

1
Q

anterior blepharitis

A

chronic inflammation of the eyelid margin anterior to the mucocutaneous junction

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2
Q

anterior blepharitis etiology

A
  • staphylococcal: inflammatory reaction to a colony of bacteria on the eyelid margin (biofilm); biofilm migrates into the lash follicle –> low grade inflammation
  • seborrheic: excessive sebum released by sebaceous glands
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3
Q

anterior blepharitis demographics

A

more common in adults

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4
Q

anterior blepharitis laterality

A

bilateral

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5
Q

anterior blepharitis symptoms

A
  • crusty debris along the eyelid margins
  • eyelid margin redness (may extend beyond the margin)
  • ocular irritation (e.g., burning, FBS)
  • tearing
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6
Q

anterior blepharitis signs

A
  • scurf within the eyelashes and on the skin surrounding the lashes
  • if seborrheic, greasy appearance to the eyelid margin (as well as the scalp, nasolabial folds, behind the ears)
  • eyelid margin erythema and edema
  • madarosis (mechanical, not malignant)
  • tear film debris
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7
Q

anterior blepharitis management

A
  • lid hygiene: warm cloth and baby shampoo to soften crusty debris
  • topical lubrication
  • eyelid cleanser
  • hypochlorous acid eyelid spray (neutralizes bacteria, toxins, and inflammatory mediators)
  • for moderate to severe cases, antibiotic or antibiotic/steroid ung
  • BlephEx with eyelid cleanser in office; Rx antibiotic/steroid ung following the treatment
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8
Q

demodicosis, aka demodex

A

specific type of anterior blepharitis due to Demodex infection

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9
Q

demodicosis (demodex) etiology

A

overpopulation of demodex folliculorum or demodex brevis (obligatory human ectoparasite that resides in or near the pilosebaceous units)

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10
Q

demodicosis (demodex) demographics

A

more common in the elderly

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11
Q

demodicosis (demodex) laterality

A

bilateral

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12
Q

demodicosis (demodex) symptoms

A
  • eyelid margin itching, especially in the morning (mites are more active in the dark)
  • crusty debris along the eyelid margins
  • eyelid margin redness (may extend beyond the margin)
  • ocular irritation (e.g., burning, FBS)
  • tearing
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13
Q

demodicosis (demodex) signs

A
  • cylindrical dandruff (clear tubular cuff that is attached to the eyelid margin and encircles the eyelash base)
  • mite attached to lash base (epilate lash and view under microscope for definitive diagnosis; mites are semi-transparent and 0.1-0.4 mm in length)
  • eyelid margin erythema and edema
  • madarosis (mechanical, not malignant)
  • tear film debris
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14
Q

demodicosis (demodex) management

A
  • eyelid cleanser with tea tree oil bid x1 month (as maintenance, 2x/week)
  • BlephEx with eyelid cleanser and tea tree oil in office; Rx antibiotic/steroid ung following tx; repeat in 2 weeks (1st application kills adults, 2nd kills eggs)
  • recommend discarding old makeup and discontinuing wear x1 month
  • recommend spouse/partner evaluation for infestation
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15
Q

demodicosis (demodex) clinical pearls:

  • _____ is the most active ingredient to kill demodex mites
  • caution against using _____
A

4-terpineol (found in tea tree oil);

100% tea tree oil

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16
Q

posterior blepharitis, meibomitis

A

chronic inflammation of the eyelid margin posterior to the mucocutaneous junction (i.e., meibomian glands)

17
Q

posterior blepharitis, meibomitis etiology

A
  • inflammatory reaction to a colony of bacteria on the eyelid margin (biofilm); biofilm migrates into the MG and causes low-grade inflammation; as the biofilm thickens, bacteria release exotoxins –> more inflammation –> causes thickening and stasis of meibum
  • may be associated with acne rosacea
18
Q

posterior blepharitis, meibomitis demographics

A

more common in adults

19
Q

posterior blepharitis, meibomitis laterality

A

bilateral

20
Q

posterior blepharitis, meibomitis symptoms

A
  • eyelid margin redness (may extend beyond the margin)
  • ocular irritation (e.g., burning, FBS, mild pain)
  • tearing
21
Q

posterior blepharitis, meibomitis signs

A
  • eyelid margin erythema and edema
  • meibomian gland inspissation (capping)
  • turbid, viscous, or toothpaste-like meibum upon expression of the MG (apply pressure to the MG to evaluate the expression of meibum)
  • telangiectasia
  • MG atrophy (can evaluate using transillumination or meibography; may give the lid margin a scalloped appearance)
  • decreased TBUT
  • tear film debris
22
Q

posterior blepharitis, meibomitis management

A
  • eyelid cleanser
  • hypochlorous acid eyelid spray (neutralizes bacteria, toxins, and inflammatory mediators)
  • warm compresses to liquefy meibum
  • topical lubrication with lipid supplements
  • omega 3 fatty acid supplement (fish oil); improves meibum production
  • oral doxycycline if blepharitis is refractory to eyelid hygiene and warm compress
  • for moderate to severe cases, antibiotic or antibiotic/steroid ung
  • BlephEx with eyelid cleanser in office; Rx antibiotic/steroid ung following Tx
  • meibomian gland expression in office
  • meibomian gland probing in office
  • LipiFlow in office
  • intense pulsed light (IPL) therapy in office
23
Q

posterior blepharitis, meibomitis clinical pearls:

  • primary cause of ____
  • frequently occurs in conjunction with _____
A

evaporative dry eye (85% of dry eye cases have MGD as its primary cause or at least contributory);
anterior blepharitis

24
Q

angular blepharitis

A

infection of the epidermis at the temporal canthus

25
Q

angular blepharitis etiology

A
  • most commonly staphylococcus aureus or moraxella lacunata

- less commonly herpes simplex

26
Q

angular blepharitis demographics

A

more common in adults

27
Q

angular blepharitis laterality

A

unilateral

28
Q

angular blepharitis symptoms

A
  • redness at the temporal canthus
  • crusting or white discharge at the temporal canthus
  • itching of the skin at the temporal canthus
29
Q

angular blepharitis signs

A
  • erythema at the temporal canthus
  • crusting or whitish frothy discharge at the temporal canthus (moraxella produces stickier, frothier presentation)
  • fissured skin at the temporal canthus
30
Q

angular blepharitis management

A
  • eyelid cleanser
  • hypochlorous acid eyelid spray (neutralizes bacteria, toxins, and inflammatory mediators)
  • antibiotic or antibiotic/steroid ung

Anterior Segment Disease (22 decks)

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