Blepharitis Overview and Symptoms

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Questions and Answers

Which of the following is NOT a common sign of a hordeolum?

A decrease in tear production (correct)

Lid oedema

Epiphora

Lid erythema

What is the primary cause of trichiasis?

Ageing (correct)

Infection

Conjunctivitis

Allergy

Which of the following is a suitable topical antibiotic for recurrent hordeolums?

Doxycycline

Tetracycline

Azithromycin

Chloramphenicol (correct)

What is the difference between an external and an internal hordeolum?

Internal hordeolums are caused by infection of the meibomian glands. Signup and view all the answers

Which of the following conditions is NOT a risk factor for developing a hordeolum?

Glaucoma Signup and view all the answers

What is the recommended treatment for an internal hordeolum that persists after the acute inflammatory phase?

Incision and curettage under local anesthetic Signup and view all the answers

What is a chalazion?

A blockage of the meibomian gland ducts Signup and view all the answers

Which of the following treatments is NOT typically recommended for an external hordeolum?

Oral antibiotics Signup and view all the answers

What is the most common type of eyelid malignancy?

Basal Cell Carcinoma Signup and view all the answers

Which of the following is a characteristic of nodular basal cell carcinoma?

Excavated center Signup and view all the answers

What is the most common presentation of thyroid eye disease?

Proptosis Signup and view all the answers

Which of the following is a characteristic of molluscum contagiosum?

Waxy, dome-shaped nodules Signup and view all the answers

Which of the following is a treatment option for basal cell carcinoma of the eyelid?

Cryotherapy Signup and view all the answers

What is the most likely reason for a patient with molluscum contagiosum to have follicular conjunctivitis?

Viral infection Signup and view all the answers

What is the best way to prevent squamous cell carcinoma of the eyelid?

All of the above Signup and view all the answers

What is a common predisposition for anterior blepharitis?

Dry eye syndrome Signup and view all the answers

Which symptoms are associated with anterior blepharitis?

Soreness Signup and view all the answers

What is posterior blepharitis primarily associated with?

Meibomian gland dysfunction Signup and view all the answers

Which condition can result from chronic posterior blepharitis?

Marginal keratitis Signup and view all the answers

What sign is indicative of anterior blepharitis related to seborrheic condition?

Oily deposits on lid margins Signup and view all the answers

Which of the following symptoms is NOT typically associated with posterior blepharitis?

Mild photophobia Signup and view all the answers

What is a potential cause of posterior blepharitis?

Direct bacterial colonization of eyelids Signup and view all the answers

What characterizes mixed lid margin disease?

Both anterior and posterior lid margins affected Signup and view all the answers

What is the most common type of entropian related to aging?

Involutional entropian Signup and view all the answers

What is a potential consequence of trachoma if left untreated?

Visual loss and blindness Signup and view all the answers

Which of the following is NOT a type of entropian?

Surgical entropian Signup and view all the answers

Which condition is primarily caused by an infection with the bacterium Chlamydia trachomatis?

Trachoma Signup and view all the answers

What is one of the first symptoms of trachoma?

Conjunctivitis Signup and view all the answers

Which management option is specifically helpful for temporary relief of entropian symptoms?

Taping the eyelid Signup and view all the answers

What is a characteristic of cicatrical entropian?

Scarring and contraction of conjunctival tissue Signup and view all the answers

What is the incubation period for trachoma?

5-12 days Signup and view all the answers

Which symptom is commonly associated with blepharitis?

Photophobia Signup and view all the answers

What is one of the proper treatments for blepharitis?

Lid hygiene with cleansing solutions Signup and view all the answers

Which of the following conditions can be a complication of blepharitis?

Chalazion formation Signup and view all the answers

What is trichiasis?

The misdirection of eyelashes Signup and view all the answers

Which treatment can provide symptomatic relief for dry eyes associated with blepharitis?

Ocular lubricants Signup and view all the answers

What results from meibomian gland dysfunction (MGD) and can accompany blepharitis?

Short tear breakup time (TBUT) Signup and view all the answers

Which of the following is NOT a characteristic of acne rosacea?

Madarosis Signup and view all the answers

How often should lid hygiene be performed initially for blepharitis treatment?

Twice daily Signup and view all the answers

What surgical intervention is commonly performed for proper management of entropion?

Removal of part of the lower lid Signup and view all the answers

Which condition is characterized by the outward rotation of the eyelid margin?

Ectropion Signup and view all the answers

Which symptom is NOT typically associated with ectropion?

Eye discomfort from eyelids rubbing Signup and view all the answers

What is the most common cause of involutional ectropion?

Aging Signup and view all the answers

What management technique is recommended to prevent further eyelid laxity?

Taping the lids closed at night Signup and view all the answers

Which is a common symptom associated with pre-septal cellulitis?

Eyelid edema Signup and view all the answers

Which type of ectropion can result from conditions such as Bell's palsy?

Paralytic ectropion Signup and view all the answers

Which treatment is NOT indicated for managing chronic eyelid irritation due to eyelash rubbing?

Increasing eye exposure to light Signup and view all the answers

Study Notes

Blepharitis

Inflammation of eyelid margins, chronic and recurrent
Anterior, Posterior, or Mixed Lid Margin Disease
Anterior Blepharitis
- Associated with bacterial colonization (primarily staphylococcal) or seborrheic dermatitis
- Symptoms: ocular discomfort, soreness, burning, itching, mild photophobia, blurred vision, intolerance to contact lenses
- Signs: aqueous tear deficiency, lid margin hyperaemia, swelling, crusting, loss of lashes, marginal keratitis, mild papillary conjunctivitis, and oily/greasy deposits on lid margins if seborrheic.
Posterior Blepharitis
- Meibomian gland dysfunction (retention of secretions/blockage)
- Symptoms: irritation, burning, foreign body sensation, worse in mornings
- Signs: watering, photophobia, erythema, telangiectasia, foamy meibomian gland secretions
Mixed Lid Margin Disease: both anterior and posterior lid margins affected
Predisposing conditions: dry eye syndrome (50% of staph bleph, 25-20% of seborrheic bleph), acne rosacea

Complications of Blepharitis

Epiphora (excess tearing), dry eyes, conjunctivitis, chalazion formation, trichiasis (misdirected eyelashes), ectropian (eyelid turns outwards), entropian (eyelid turns inwards)
Corneal disease: punctate epithelial erosion, marginal infiltrates, recurrent erosions, marginal ulcers, pannus, keratitis, contact lens intolerance

Treatment

Lid hygiene (cleaning with cotton buds/flannel with baby shampoo or bicarbonate of soda solutions)
Warm compresses (twice daily, 10 minutes)
Topical lubricants for dry eyes
Topical antibiotics (e.g., chloramphenicol) for infections
Oral tetracyclines (if lid hygiene isn't effective, especially in those with acne rosacea)
Topical steroids (severe cases with marginal keratitis complications)

Hordeolum (Stye)

Localized infection/inflammation of eyelid margin
External hordeolum: involves eyelash follicle; points toward skin, less painful
Internal hordeolum: involves meibomian glands; points towards conjunctiva, more painful
Symptoms: tender inflamed swelling
Management: warm compresses, removal of infected eyelash (if appropriate), topical antibiotics (if needed)
Spontaneous resolution possible

Trichiasis

Trichiasis is characterized by misdirected eyelashes that grow toward the globe of the eye, which can lead to discomfort and potentially serious complications.
Causes of trichiasis include a variety of factors such as ageing which can cause structural changes in the eyelid, scarring of the posterior lid lamella often due to previous injuries or surgeries, blepharitis (a common inflammatory condition of the eyelids), epiblepharon (a condition where skin folds cause eyelashes to misdirect), herpes zoster (which can cause scarring and eyelid deformities), trachoma (a bacterial infection that can lead to scarring of the eyelids), and ocular cicatrical pemphigoid (a rare autoimmune condition leading to scarring of the conjunctiva and eyelids).
Signs of trichiasis often include conjunctival injections, indicating inflammation; pain, which can be significant; foreign body sensations experienced by patients due to the irritation from eyelashes; and posterior lamellar scarring that can worsen visual outcomes if not addressed.
Management involves the removal of misdirected eyelashes through procedures like electrolysis or other methods, in addition to addressing any underlying causes to prevent recurrence.

Entropian

Entropian is defined as the inversion or rolling inward of the eyelid, which can lead to the eyelashes constantly irritating the cornea.
There are several types of entropian: involutional entropian, which is age-related; cicatrical entropian caused by scarring of the eyelid due to previous trauma or disease; spasmodic entropian, associated with muscle spasms, and congenital entropian, which is a condition present from birth.
The primary symptoms include severe discomfort when eyelashes rub against the cornea, potentially leading to corneal abrasions and further complications if left untreated.
Management options for entropian include conservative methods such as eye taping to temporarily hold the eyelid in a proper position, eyelid taping as a more controlled intervention, and surgical options which may be necessary for permanent correction.

Ectropian

Ectropian is characterized by the outward rotation of the eyelid away from the eye, leading to exposure of the conjunctiva and other ocular structures.
Common symptoms experienced by individuals with ectropian include dryness of the eye, irritation especially when exposed to wind and environmental elements, and corneal exposure which may lead to further complications such as keratitis.
Signs that might be observed during an examination include conjunctival hyperemia, indicating increased blood flow to the conjunctival tissue; corneal exposure, resulting in potential damage to the cornea; and tearing due to reflex responses to irritation.
The management of ectropian typically involves taping the eyelid to provide temporary relief, surgical interventions to properly reposition the eyelid, and the use of ocular lubricants to address dryness and protect the cornea.

Pre-septal Cellulitis

Pre-septal cellulitis refers to an infection involving the eyelid and periorbital tissues, primarily affecting the soft tissues in front of the orbital septum.
This condition is particularly common among children younger than 5 years of age, highlighting the need for vigilant monitoring and early intervention.
Symptoms typically include acute eyelid erythema (redness), eyelid edema (swelling), and pain, which can markedly decrease quality of life and function.
Common causes of pre-septal cellulitis include the spread of infections from adjacent sinuses, trauma that may introduce bacteria, or surgical interventions that can predispose to infection.
Management strategies include systemic antibiotics for general treatment, intravenous (IV) antibiotics in more severe cases that do not respond to oral medications, and CT scans of the orbit and sinuses for cases that do not show improvement to examine for possible complications such as abscess formation.

Orbital Cellulitis

Orbital cellulitis is a severe condition characterized by the infection of the tissues located behind the orbital septum, posing a risk for serious complications.
The symptoms may mirror those of pre-septal cellulitis but often present with more rapid progression, which can lead to increased risk of vision loss and other ocular complications.
Primary causes of orbital cellulitis often include the extension of infection from adjacent sinus structures, emphasizing the importance of addressing sinus infections effectively.
Management of orbital cellulitis necessitates aggressive treatment approaches, including the initiation of IV antibiotics to effectively combat the infection, and potential surgical intervention may be required to drain abscesses and alleviate any orbital pressure.

Tumors

Basal cell carcinoma represents the most common form of eyelid cancer, known for its slow-growing nature and local invasion. It typically presents as a non-healing ulcer characterized by a pearly border, which originates from the basal layer of the epidermis. This type of cancer is more prevalent among individuals with lighter skin tones, underscoring the impact of ultraviolet (UV) exposure in its pathogenesis.
Squamous cell carcinoma, while less common than basal cell carcinoma, is identified as the second most prevalent eyelid cancer. This type of cancer is noted for its aggressive behavior, and it is often associated with significant sun exposure, increasing the risk for outdoor workers and individuals with a history of excessive tanning or sunburns. Importantly, squamous cell carcinoma has the potential to metastasize, making early detection and treatment critical.

Benign Eyelid Lesions

Benign eyelid lesions include a range of conditions such as cysts of Moll and cysts of Zeiss, as well as molluscum contagiosum, which are viral-induced lesions that can appear on the eyelids.
These lesions characteristically present as cyst-like bulges around the eyelid margin, which can be more aesthetically concerning than medical concerns for the patients.
Management of benign eyelid lesions typically involves surgical removal, often performed for cosmetic reasons as these lesions can be unsightly and lead to self-esteem issues for affected individuals.

Thyroid Eye Disease

Thyroid eye disease, also known as Graves' ophthalmopathy, presents with signs including proptosis (forward displacement of the eye), lid retraction, lid lag (when the upper lid fails to follow the eye movement), irritation of the eyes, and significant corneal dryness.
This condition is primarily caused by autoimmune responses, particularly in connection with Graves' disease, which leads to inflammation and swelling of the eye muscles and fatty tissue around the eyes.
Symptoms can range from minor eyelid problems to significant visual loss, particularly if the optic nerve experiences compression due to swelling or expansion of ocular structures.
The management of thyroid eye disease focuses on treating the underlying autoimmune problem and controlling symptoms. Urgent referral to an ophthalmologist is essential if optic nerve involvement is suspected, as timely intervention can protect vision.

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Description

This quiz provides an overview of blepharitis, focusing on its classification into anterior, posterior, and mixed lid margin disease. Participants will learn about the associated symptoms and signs of each type, as well as predisposing conditions. Test your knowledge about this common ocular condition and its implications.