anatomy of lid

Blepharitis is chronic inflammation of lid margin

occurring as true inflammation or as simple hyperaemia.

(Very common cause of ocular discomfort and irritation)

1. Anteriora. Squamous b. Ulcerative

2. Posterior a. Meibomian seborrhoea b. Meibomianitis

(Conditions overlap with each other)

1. Following chronic Conjunctivitis especially due to staphylococci

2. Phthiriasis Palpabrarum due to crab louse

(Poor correlation between signs and symptoms, uncertain etiology and mechanism)

Is a form of anterior blebharitis characterized by deposition of white scales among the eye lashes. Eye lashes fall and replaced by distorted eyelashes.

On removal of scales, lid margins appear hyperaemic. Ulcers are absent.

Condition is metabolic associated with dandruff of the scalp

Usually associated with seborrhoeic dermatitis involving scalp, nasolabial folds and retroauricular areas

Burning, grittiness , redness of lid margins, mild photophobia

Symptoms are worse in the morning (Remissions and exacerbations)

Skin and Scalp condition also requires treatment.

1.Lid Hygiene2.Hot compresses3.Topical Antibiotics4.Oral Azithromycin 500 mg daily for 3 days

5.Weak topical steroids (Flourometholone)6.Tear Substitutes

Ulcerative blepharitis is infective condition commonly due to staphylococcal infection (Cell mediated response)

Lid margins are covered with infective material (yellow crusts or dry brittle scales-Collarettes) matting eyelashes.

On removal of discharge small ulcers which bleed are found along lid margins around bases of the eyelashes

Redness of lid margins, burning, itching, watering and photophobia

Signs: ◦Small ulcers at lid margins on removal of discharge, this feature differentiate it from conjunctivitis

Discharge/ crust is removed from lid margins with 1:4 dilution baby shampoo or luke warm 3% soda bicarbonate lotion. The loose discharge is then cleaned cotton

Diseased eyelashes are epilated

Appropriate antibiotic drops are used

After control of infection, daily cleaning of lid margins with blend lotion

Improvement of local hygiene (rubbing of eyes and touching of eyes with dirty hand should be discouraged)

Chronic course and associated chronic conjunctivitis & Marginal Keratitis

Madarosis (Scanty eyelashes) due to falling of eyelashes

Poliosis (Whitening)

Trichiasis (misdirected eyelashes) due to contraction of scar tissue

Cicatrization of lid margins causing thickening and hypertrophy of tissue and drooping of lids (Tylosis)

Cicatrization of lid margin may drag conjunctiva on posterior border of intermarginal strip disturbing angle of posterior edge leading to epiphora , eversion of puncta

Epiphora leads to eczematous condition of skin, scarring of skin leads to ectropion . This further aggravate epiphora

Tear film instability

Posterior blepharitis i.e. inflammation of meibomian duct opening at intermarginal strip and posterior border may cause tear film instability and inferior punctate keratitis

Meibomian gland dysfunction and alterations in meibomian gland secretion

Bacterial lipases may result in the formation of fatty acids which may lead to increase in melting point of meibum

Caping with Oil globulesPluggingHyperemiaTeengiectasis

It occurs in two clinical forms

1.Meibomian seborrhoea

2.Meibomianitis

1. Meibomian seborrhoea – characteristic appearance of oil droplet at the opening of meibomian duct opening at intermarginal strip. Tear film is oily and foamy. Frothy discharge accumulate on the lid margin. Foam like discharge can be expressed from these lesions

2. Meibomianitis – There is inflammation and obstruction of meibomian glands. Characterized by diffuse thickening of posterior border of lid margin which becomes rounded. On lid massage toothpaste like thick material can be expressed out. Due to duct blockade cyst formation may be present

Chalazion Tear film instabilityPapillary conjunctivitis and inferior corneal erosions

Warm compresses Systemic - Doxycycline 100 mgm twice x 1 week then once daily for 6 -12 weeks or Tetracycline 250 mgm 4 times x 1 week then twice for 6 -12 weeks

Associated tear film abnormality is treated with artificial tear drops

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