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Thread: Blepharitis (Diagnosis and treatment)

  1. #1

    Default Blepharitis (Diagnosis and treatment)

    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:

    Blepharitis (Diagnosis treatment) blepharitis.jpg



    Blepharitis (Diagnosis treatment) blepharitis_l.jpg
    Debris and protein build-up at the base of eyelashes are called "collarettes" in blepharitis.

    Blepharitis (Diagnosis treatment) meibomian_gland_pluggs_l.jpg
    Meibomian glands are clogged with oil in blepharitis.
    Blepharitis (Diagnosis treatment) blepharitis_49120_lg.jpg
    This is the classic appearance of blepharitis involving the outer angle of the eyelid, called angular blepharitis.



    Blepharitis (Diagnosis treatment) blepharitis_45368_lg.jpg
    The crusty, grainy, or scaly appearance at the base of the eyelashes is the most common finding in blepharitis.

    Blepharitis (Diagnosis treatment) 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 .












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    Thanks for the great material.

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