L4: Eyelid disease

Question 1

What is blepharitis?

Answer 1

Chronic inflammation of eyelids, more anterior than meibomian gland dysfunction

Question 2

What causes blepharitis?

Answer 2

S. aureus

Demodex –> mite that lives in follicles of the glands

Seborrhoeic dermatitis (dandruff)

Eczema

Question 3

What are the symptoms of blepharitis?

Answer 3

THICKENED LID MARGIN
IRRITATED LIDS
CRUSTING OF EYELASHES

Redness with mild foreign body sensation

Question 4

What is meibomian gland dysfunction?

Answer 4

Meibomian glands along lid margins are blocked

Question 5

What causes meibomian gland dysfunction

Answer 5

Inflammation

Increased bacterial load

Question 6

Pathophysiology of meibomian gland dysfunction

Answer 6

Cannot produce lipid component of tear film

• Increased evaporation
• Poor quality tear
• -> Dry eye
• -> Localised infections ie. stye

Question 7

How to treat a stye?

Answer 7

Warm compress –> flannel or wheat bag
- Opens up glands to increase lipid layer production

Topical antibiotics in first few days

• Fusidic acid
• Chloramphenicol

Oral antibiotics if no improvement otherwise

Question 8

How to manage blepharitis & meibomian gland dysfunction?

Answer 8

1. Clean lids of crusts
   - Warm compress
   - Lid wipes
   - Eyelid cleansers
2. Massage with fingers –> stimulate glands
3. Artificial tears
   - Support associated dry eye
   - Caution preservative

4. Treat cause
Topical antibiotics
-- Fusidic acid
-- Chloramphenicol
Systemic antibiotics
-- Doxycycline
-- Azithromycin
Topical steroids
-- FML
Topical immunosuppressant
-- Cyclosporin
IPL --> closes up blood vessels in lid margin to decrease inflammatory mediators

Question 9

What is dry eye?

Answer 9

Meibomian gland dysfunction = lipid layer not formed so tears evaporate faster = poor quality tear

Lacrimal gland dysfunction = no nutrients for tear film = poor quantity tear

Question 10

What are some causes of dry eye?

Answer 10

AQUEOUS-DEFICIENT

• Sjogren’s syndrome –> autoimmune dry eye & dry mouth
• Reflex tearing –> to overcome dry eye

EVAPORATIVE

• Cannot close eyes
• Low blink rate
• Drug action eg. anticholinergics
• Vitamin A deficiency
• Contact lens wearer
• Allergy

Question 11

How to manage dry eye poor QUANTITY tears?

Answer 11

Need to add more tears

1. Artificial tears
2. Punctual plugs
3. Anti-inflammatory drops (no tears, less flushing out of toxins = increased inflammation)
4. Dietary supplements eg. omega 3

Question 12

How to manage dry eye poor QUALITY tears?

Answer 12

Improve the tear film

1. Warm compresses
2. Lid massage
3. Lid cleansers, lid wipes
4. Steroids, doxycycline

Question 13

Types of artificial tears

Answer 13

Carmellose –> Refresh

Hypromellose –> Poly-Tears

Wool Fat –> Poly-Visc

Carbomer –> GenTeal

Question 14

What is allergic conjunctivitis?

Answer 14

Mild IgE hypersensitivity

Caused by allergens: commonly foreign body, seasonal allergies, contact lens wearer

Question 15

What are symptoms of allergic conjunctivitis?

Answer 15

ITCHY
Red/pink conjunctiva
Watery or rope-y discharge
Other hayfever symptoms

Question 16

How to manage allergic conjunctivitis?

Answer 16

Avoid allergen
1. Change contact lens solution

2. Artificial tears to flush out allergen, then short course of topical antihistamine (sting upon administration)
3. Mast cell stabiliser for seasonal allergies –> takes up to 1 week to have effect, needs to be used regularly. Can be used with systemic antihistamines
4. Antihistamine/mast cell stabiliser combination (Patanol, Zaditen), steroid (FML)
5. Ocular decongestants (eg. naphazoline) –> quick relief of redness, rebound effect so only 3 days