BLEPHARITIS

Fadhlina Muharmi Hrp

0708112239

How is blepharitis diagnosed?

Patient history to determine any symptoms the patient is experiencing and the presence of any general health problems that may be contributing to the eye problem.

External examination of the eye, including lid structure, skin texture and eyelash appearance.

Evaluation of the lid margins, base of the eyelashes and meibomian gland openings using bright

light and magnification. Evaluation of the quantity and quality of

tears for any abnormalities.

Symptoms

red and swollen eyelids itching & burning of the eyelid margins conjunctival irritation with lacrimation sensitivity to light (photophobia) blurred vision foreign body sensation crusting on eyelashes Loss of eyelashes may occur

A differentiation among the various types of blepharitis can

often be made based on the appearance of the eyelid margins :

Staphyloccal blepharitis patients frequently exhibit mild sticking together of the lids, thickened lid margins, and missing and misdirected eyelashes.

Seborrheic blepharitis appears as greasy flakes or scales around the base of eyelashes and a mild redness of the eyelids.

Ulcerative blepharitis is characterized by matted, hard crusts around the eyelashes that when removed, leave small sores that ooze and bleed. There may also be a loss of eyelashes, distortion of the front edges of the eyelids and chronic tearing. In severe cases, the cornea, the transparent front covering of the eyeball, may also become inflamed.

Meibomian blepharitis is evident by blockage of the oil glands in the eyelids, poor quality of tears, and redness of the lining of the eyelids.

Acute ulcerative blepharitis is usually caused by bacterial infection of the eyelid margin at the origins of the eyelash follicles and the meibomian glands. Eyelid margins become edematous and erythematous, and eyelashes become crusted with dried serous fluid.

Chronic blepharitis is caused by noninfectious inflammation associated with seborrheic dermatitis, or with meibomian gland dysfunction such as occurs in patients with rosacea, like the individual in this image.

The crusty, grainy, or scaly appearance at the base of the eyelashes is the most common finding in blepharitis.

This is the classic appearance of blepharitis involving the outer angle of the eyelid, called angular blepharitis.

Chronic blepharitis can lead to misdirected eyelashes, misshapen eyelashes, and loss of eyelashes (trichiasis).

Differential Diagnoses

Basal Cell Carcinoma, Eyelid

Cellulitis, Preseptal Chalazion Conjunctivitis, Bacterial Conjunctivitis, Viral Contact Lens

Complications Dermatitis, Contact Dry Eye Syndrome

Hordeolum Keratitis, Bacterial Keratoconjunctivitis, Atopic Keratoconjunctivitis,

Epidemic Keratoconjunctivitis, Sicca Keratoconjunctivitis,

Superior Limbic Ocular Rosacea Trichiasis

Background Etiology Signs & Symptoms

Basal Cell Carcinoma, Eyelid

the most common epithelial tumor, its molecular-genetic pathogenesis is unclear, lower eyelid (48.9-72.1%), medial canthus (25-30%), upper eyelid (15%), lateral canthus (5%).

Solar radiation exposure

Nonhealing ulcer,painless nodule, shiny & waxy, indurated, firm & immobile, pearly, rolled border, fine (small) telangiectatic vessels on the surface.

Cellulitis, Preseptal

A common infection of the eyelid & periorbital soft tissues characterized by acute eyelid erythema &edema. This bacterial infection usually results from local spread of adjacent upper respiratory tract infection, external ocular infection, or following trauma to the eyelids

Staphylococcus aureus, Staphylococcus epidermidis, Streptococcus species

Pain,conjunctivitis,epiphora,blurred vision,periorbital erythema & edema (sometimes so severe that patients cannot voluntarily open the eye).

Chalazion

Background Etiology Signs & Symptoms

Conjunctivitis, Bacterial

a microbial infection involving the mucous membrane of the surface of the eye

Alterations in the host defense or in the species of bacteria (normal flora such as streptococci, staphylococci, & Corynebacterium strains) by external contamination, by spread from adjacent sites, or via a blood-borne pathway.

Conjunctival injection,purulent discharge,eyelid edema,inflammation of the conjunctiva (papillary pattern)

Conjunctivitis, Viral

Characterized commonly by an acute follicular conjunctival reaction and preauricular adenopathy, lasting for approximately 2-4 weeks

Adenovirus,HSV, VZV,picornavirus (enterovirus 70, Coxsackie A24), poxvirus (molluscum contagiosum, vaccinia),HIV

Preauricular adenopathy, epiphora,hyperemia, chemosis,subconjunctival hemorrhage,follicular conjunctival reaction, cicatricial conjunctival reaction,edematous eyelid, pronounced hemorrhage beneath the bulbar conjunctiva, a serous or mucopurulent discharge, vesicles on the eyelid or face, small papular lesions that erupt along the lid margin or at the limbus

Background Etiology Signs & Symptoms

Contact Lens Complications

All eyes are altered by contact lens wear

A rigid contact lens can dislocate from the cornea and settle into the upper fornix

fibrous tissue in the lid, mechanical ptosis, lid retraction, severe GPC

Dermatitis, Contact

any inflammatory reaction of the skin that results from direct contact with an offending agent

Allergic contact dermatitis ,Irritant contact dermatitis,Photodermatitis,Contact urticaria (immunologic, nonimmunologic)

Acute = bright red edematous skin, clear fluid-filled vesicles or bullae appear. Subacute = less edema,dry scales.Chronic = scaling, skin fissuring,lichenification,minimal edema, excoriations

Dry Eye Syndrome

a multifactorial disease of the tears & the ocular surface that results in symptoms of discomfort, visual disturbance, tear film instability with potential damage to the ocular surface. Dry eye is accompanied by increased osmolarity of the tear film and inflammation of the ocular surface.1

Deficient aqueous production, Evaporative

Bulbar conjunctival vascular dilation,decreased tear meniscus,Irregular corneal surface,Decreased tear break-up time,Punctate epithelial keratopathy,Corneal filaments,Increased debris in the tear film,Conjunctival pleating,Superficial punctuate keratitis,Mucous discharge,Corneal ulcers in severe cases

Background Etiology Signs & Symptoms

Hordeolum an acute focal infection (usually staphylococcal) involving either the glands of Zeis (external hordeola, or styes) or, less frequently, the meibomian glands (internal hordeola).

S aureus infection, Patients with chronic blepharitis, meibomian gland dysfunction, & ocular rosacea are at greater risk, immunoglobulin M (IgM) deficiency, elevated serum lipid levels may increase the risk of blockage to oil glands of the eyelids

a tender erythematous subcutaneous nodule near the eyelid margin (unilateral or bilateral, single or multiple), signs of meibomitis, blepharitis, or ocular rosacea.

Keratitis, Bacterial

a sight-threatening process, rapid progression; corneal destruction may be complete in 24-48 hours

Ulceration of the epithelium; corneal infiltrate; dense, suppurative stromal inflammation with indistinct edges; stromal tissue loss; & surrounding stromal edema, Increased anterior chamber reaction with or without hypopyon, Folds in the Descemet membrane,Upper eyelid edema,Posterior synechiae, Conjunctival hyperemia, Adherent mucopurulent exudate, Endothelial inflammatory plaque

Background

Etiology Signs & Symptoms

Keratoconjunctivitis, Atopic

a relatively uncommon but potentially blinding ocular condition

hypersensitivity in patients with familial histories of allergic disease

Periorbita - Dennie-Morgan folds,Hertoghe sign, Lids (thickening and tylosis, crusting, edema, fissures, ptosis,staphylococcal blepharitis), Conjunctiva (small- or medium-sized papillae, hyperemia, edema, excessive mucin), Cornea (punctate epitheliopathy and keratitis, persistent epithelial defects, shield-shaped ulcers, anterior stromal scarring, and micropannus), Lens (posterior or anterior subcapsular shield-shaped cataracts),Fundus (degenerative vitreous changes and retinal detachment)

Keratoconjunctivitis, Epidemic

Background Etiology Signs & Symptoms

Keratoconjunctivitis, Sicca

This condition is characterized by inadequate tear film protection of the cornea because of either inadequate tear production or abnormal tear film constitution, which results in excessively fast evaporation or premature destruction of the tear film.

those affecting the aqueous tear layer, those affecting the lipid tear layer, those affecting the mucin tear layer.

Decreased tear meniscus,Increased debris in the tear film,Conjunctival pleating,Superficial punctate keratopathy (with positive fluorescein, lissamine green and/or rose bengal staining),Conjunctival hyperemia,Mucous plaques and discharge,Xerostomia, Corneal filaments,Corneal epithelial defects or ulceration in more severe cases

Keratoconjunctivitis, Superior Limbic

characterized as an inflammation of the superior bulbar conjunctiva with predominant involvement of the superior limbus, an adjacent epithelial keratitis, and a papillary hypertrophy of the upper tarsal conjunctiva.

The cause of SLK is unknown, but inflammatory changes from mechanical soft tissue microtrauma are the final common pathway.

Marked inflammation of the upper lid tarsal conjunctiva, adjacent inflammation of the upper bulbar conjunctiva, punctate rose bengal staining of the cornea at the upper limbus,filaments on the upper cornea or along the superior limbus.

Background Etiology Signs and Symptoms

Ocular Rosacea

a dermatologic condition that affects the midfacial region (nose, cheeks, forehead, chin, and glabella) are most commonly affected. Ocular manifestations are essentially confined to the eyelids and ocular surface.

Flushing triggers, UV sunlight, Migraines, Demodex, H pylori

Facial findings [Telangiectasias, Papules and pustules,Rhinophyma]Ocular findingsEyelid telangiectasias, Blepharitis,Meibomian gland dysfunction, Thick viscous plugging of meibomian gland orifices,Hordeola/chalazia,diffuse hyperemia,marginal corneal infiltrates, Corneal neovascularization, Corneal thinning, ulceration, and perforation, Secondary bacterial keratitis,Episcleritis

Trichiasis the misdirection of eyelashes toward the globe. The misdirected lashes may be diffuse across the entire lid or in a small segmental distribution.

Infectious, Autoimmune, Inflammatory, Trauma

Conjunctivitis, Bacterial

Conjunctivitis, Viral

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