Blepharitis and MGD

Question 1

What is likely to cause anterior blepharitis?

Answer 1

Bacterial or sebborhoeic infection of follicles or glands of Zeis and Moll

Question 2

What is likely to cause posterior blepharitis?

Answer 2

Meibomian gland inflammation

Question 3

What are the signs of staphylococcal blepharitis?

Answer 3

Hard, brittle scales (collarettes)
Inflammation
Bleeding on removal of scales
Lid margin hyperaemia
Lid margin telangiectasia (dilated blood vessels)

Question 4

What are the signs of sebborhoeic blepharitis?

Answer 4

Soft, greasy scales
Clumped lashes
Shiny lid margin
Lid margin hyperaemia

Question 5

What are some signs of longstanding blepharitis?

Answer 5

Thickened lid margin and notching
Trichiasis (lashes growing wrong way)
Madarosis (loss of lashes)
Poliosis (loss of pigment in lashes)
Blocked meibomian glands
Corneal staining
Foamy tears caused by excess fatty acids

Question 6

What are some symptoms of longstanding blepharitis?

Answer 6

Soreness, redness and irritation
FB sensation
Dryness and itching
Burning and grittiness
Mild photophobia

Question 7

How should you manage mild blepharitis?

Answer 7

Blepharitis products daily
Lid hygiene daily (loosens collarettes, removes crusts, reduces staph levels)
Artificial tears (to treat sxs)
Blephex (deep clean of lids)

Question 8

How should you manage severe blepharitis?

Answer 8

Chloramphenicol
Systemic antibiotic
Topical corticosteroids

Question 9

How can CL wear effect blepharitis?

Answer 9

Cause infection or exacerbate sxs
Infection can cause corneal staining
Corneal staining can cause tear film destabilisation

Question 10

What should you do to manage CL wear with blepharitis?

Answer 10

No CL wear until bleph managed
Fit lenses with increased replacement frequency to reduce infection risk
Advise careful cleaning of reusable lenses (and lids!)
Fit SiHy for better comfort

Question 11

What can cause meibomian gland duct obstruction?

Answer 11

Hyperkeratinisation of epithelium
Keratinised cell debris
Increased viscosity of meibum

Question 13

What are the risk factors for MGD?

Answer 13

Age
Gender
Contact Lenses
Hormonal disturbance
Systemic agents
Some skin conditions

Question 14

What are the signs of MGD?

Answer 14

Gland plugging/capping
No secretion on expression
Cloudy/paste secretion on expression
Tear foaming
Notching of lids
Increased redness of lid margins
Tear film instability
Corneal staining

Question 15

What are the symptoms of MGD?

Answer 15

Dry, itchy, red eyes
CL intolerance/reduced wearing time
Blurred vision

Question 16

How can MGD be managed?

Answer 16

Increase omega 3 in diet (food better than supplements)
Adjust work station so screen is just below eye level (keeps lids less wide)
Lid hygiene
Warm compresses
Artificial tears (treating sxs not managing MGD itself)
Pharmaceutical treatment
Therapeutic expression
Device assisted therapies

Question 17

How can you manage CL wear alongside MGD?

Answer 17

Increase CL replacement
Use a lens cleaner which contains a surfactant to remove deposits
Fit SiHy (increases lipid deposits which reduces dehydration)
Stop wear until managed if necessary
Document MGD baseline so can compare in future