PDA

View Full Version : Blepharitis (Diagnosis and treatment)



Medical Videos
03-29-2008, 07:25 PM
Diagnosis:


Complaints:


Burning
Watering
Foreign body sensation
Crusting and mattering of the lashes and medial canthus
Red lids
Red eyes
Photophobia
Pain
Decreased vision
It has chronic course with exacerbations and eruptions of symptomatic disease.
It can be associated with symptoms of scalp itching , flaking and oily skin in Seborrhiec dermatitis.
In Rosacea it can be associated with a red and sowlen nose (rhinophyma), facial flushing,broken and distended vessels in the face , pustules , oily skin , eye irritation.


Examination:
External examination :
for associated symptoms
Gross examination :
eyelids shows erythema and crusting of the lashes and lid margins
Slit lamp examination :
Lashes:
loss of lashes (madarosis)
whitening of the lashes (poliosis)
scarring and misdirection of lashes (trichiasis)
crusting of the lashes
Mebomian orifices:
crusting
plugging and "pouting"
conjunctiva:
papillary injection.
Corneal findings :
punctate epithelial erosions
marginal infiltrates
marginal ulcers
pannus
and phlyctenule formation
Others:
eyelid margin ulcers
telangiectasias, and lid irregularity (tylosis).


Treatment:
3main lines:
1-Repeated soaked warm compresses .
2-Eyelid margin is washed(a few drops of baby shampoo be mixed in one bottle cap full of warm water )
3-Antibiotic ointment .
-E-Mycin(Erythromycin ointment 0.5%)
Apply a small amount (0.5-inch ribbon) topically to the outer lid 3-4 times qd
-Blephamid: (Sulfacetamide sodium and prednisolone acetate ) for short periods
Ointment: 0.5-inch ribbon topically to affected lid(s) 3-4 times qd and once or twice at night; discontinuation should be gradual
Drops: May be instilled 1 gtt 3-4 times qd; gradual discontinuation is necessary
Specific clinical situations :
-Refractory cases of blepharitis often respond to oral antibiotic use.
Sumycin(Tetracycline):
1-2 g PO divided bid to qid, depending on severity, for 1-2 mo.
not given in:impaired renal function,pregnancy,impaired renal function,teething,antiacids.
-Asoociated conjunctivitis and keratitis :
antibiotic-corticosteroid drops(Tobradex).
Atlas of blepharitis:


http://e-learning.studmed.unibe.ch/augenheilkunde/systematik/lid/images/blepharitis.jpg




http://www.ueseyecare.com/images/photos/blepharitis_l.jpg
Debris and protein build-up at the base of eyelashes are called "collarettes" in blepharitis.


http://www.ueseyecare.com/images/photos/meibomian_gland_pluggs_l.jpg
Meibomian glands are clogged with oil in blepharitis.
http://www.visualdxhealth.com/images/dx/webAdult/blepharitis_49120_lg.jpg
This is the classic appearance of blepharitis involving the outer angle of the eyelid, called angular blepharitis.




http://www.visualdxhealth.com/images/dx/webAdult/blepharitis_45368_lg.jpg
The crusty, grainy, or scaly appearance at the base of the eyelashes is the most common finding in blepharitis.


http://www.visualdxhealth.com/images/dx/webAdult/blepharitis_52998_lg.jpg
Chronic blepharitis can lead to misdirected eyelashes, misshapen eyelashes, and loss of eyelashes (trichiasis).


I hope you add more photos and information that help in diagnosis and treatment of blepharitis .

WalkerGoss60
01-16-2012, 07:30 PM
Thanks for the great material.