Blepharitis

Question 1

Anterior and posterior

Answer 1

Anterior
• chronic inflammation of lid margins caused by staphylococcus

Posterior
• MGD (meibomian gland dysfunction)
• posterior lid margin disease, affecting meibomian glands and secretions

Question 2

Differential diagnosis

Answer 2

• allergy

• carcinoma

• herpes (simplex or zoster)

• dacrocystitis

Question 3

Signs (anterior)

Answer 3

• hyperaemia, swelling, and crusting of lid margin.

• scales at base of lashes

• reduction in number of lashes, and misdirection

• recurrent styes

• in chronic cases ulcers can form along lid margin

Question 4

Signs (posterior)

Answer 4

• obstruction of meibomian orifices

• thick, cloudy meibomian secretions

• foam in lower tear film

• hyperaemia of lid margin

Question 5

Symptoms

Answer 5

• tired, itchy, sore eyes

• greasing of CL due to sebaceous secretion

• CL intolerance

• general dry eye symptoms

• none in mild cases

Question 6

associations

Answer 6

• strong relationship between demodex infection and blepharitis, 50%

• more prevalent in older patients

• patients with dermatitis

• poor immune system / diet / hygiene

• dandruff / psoriasis sufferers

Question 7

Management & treatment

Answer 7

• routine referral to CLO / optom / GP

• artificial tears

• cease CL wear

Question 8

Anterior treatment

Answer 8

• lid scrubs / hygiene

• topical steroids to reduce inflammation (GP/IP)

• chloramphenicol

• avoid cosmetics especially at lid margins

Question 9

Posterior treatment

Answer 9

• lid massage and bathing

• oral tetracycline/ other topic drops (GP/IP)