Podcast
Questions and Answers
Which symptom is commonly associated with both blepharitis and acne rosacea?
Which symptom is commonly associated with both blepharitis and acne rosacea?
What is the primary treatment recommended for improving eyelid hygiene?
What is the primary treatment recommended for improving eyelid hygiene?
Which abnormality involves the misdirection of eyelashes?
Which abnormality involves the misdirection of eyelashes?
What common complication of blepharitis may lead to excessive tearing?
What common complication of blepharitis may lead to excessive tearing?
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What is the primary cause of anterior blepharitis?
What is the primary cause of anterior blepharitis?
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Which of the following is NOT mentioned as a symptom of blepharitis?
Which of the following is NOT mentioned as a symptom of blepharitis?
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Which of the following symptoms is NOT associated with anterior blepharitis?
Which of the following symptoms is NOT associated with anterior blepharitis?
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In the treatment of blepharitis, how often should warm compresses typically be applied initially?
In the treatment of blepharitis, how often should warm compresses typically be applied initially?
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Which of the following conditions could arise due to complications from blepharitis?
Which of the following conditions could arise due to complications from blepharitis?
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Which condition is a major predisposing factor for blepharitis?
Which condition is a major predisposing factor for blepharitis?
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In posterior blepharitis, which gland's dysfunction is a primary characteristic?
In posterior blepharitis, which gland's dysfunction is a primary characteristic?
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Which condition is characterized by the loss or absence of eyelashes?
Which condition is characterized by the loss or absence of eyelashes?
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Which of the following is a sign of anterior blepharitis?
Which of the following is a sign of anterior blepharitis?
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What describes the characteristics of seborrheic anterior blepharitis?
What describes the characteristics of seborrheic anterior blepharitis?
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What symptom is primarily associated with posterior blepharitis?
What symptom is primarily associated with posterior blepharitis?
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Which of the following can lead to meibomian gland dysfunction?
Which of the following can lead to meibomian gland dysfunction?
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What is the most common type of basal cell carcinoma (BCC) that presents with small, translucent lesions?
What is the most common type of basal cell carcinoma (BCC) that presents with small, translucent lesions?
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Which demographic is most likely to have a higher incidence of basal cell carcinoma?
Which demographic is most likely to have a higher incidence of basal cell carcinoma?
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Which treatment is typically not used as a management option for basal cell carcinoma?
Which treatment is typically not used as a management option for basal cell carcinoma?
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What is a significant sign that may indicate the presence of basal cell carcinoma on the eyelid?
What is a significant sign that may indicate the presence of basal cell carcinoma on the eyelid?
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Which type of eyelid lesion is characterized by dome-shaped, waxy nodules and is spread through direct contact?
Which type of eyelid lesion is characterized by dome-shaped, waxy nodules and is spread through direct contact?
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Which condition is commonly associated with Squamous Cell Carcinoma?
Which condition is commonly associated with Squamous Cell Carcinoma?
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Which of the following is a systemic symptom of Graves Disease?
Which of the following is a systemic symptom of Graves Disease?
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What age range do thyroid eye diseases predominantly affect?
What age range do thyroid eye diseases predominantly affect?
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What is a common cause of internal hordoleum?
What is a common cause of internal hordoleum?
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Which treatment is primarily indicated for severe cases of blepharitis with complications?
Which treatment is primarily indicated for severe cases of blepharitis with complications?
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What distinguishing feature does an external hordoleum have compared to an internal one?
What distinguishing feature does an external hordoleum have compared to an internal one?
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Which of the following is NOT a sign of an internal hordoleum?
Which of the following is NOT a sign of an internal hordoleum?
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What is a likely course of action for persistent lumps after an acute internal hordoleum episode?
What is a likely course of action for persistent lumps after an acute internal hordoleum episode?
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What most commonly does NOT describe the presentation of an external hordoleum?
What most commonly does NOT describe the presentation of an external hordoleum?
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Which condition increases the likelihood of developing external hordoleum?
Which condition increases the likelihood of developing external hordoleum?
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What is the primary objective of using warm compresses for an external hordoleum?
What is the primary objective of using warm compresses for an external hordoleum?
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What is the primary cause of involutional ectropion?
What is the primary cause of involutional ectropion?
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Which symptom is related to ectropion?
Which symptom is related to ectropion?
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What is a common sign of entropion?
What is a common sign of entropion?
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Which management approach is NOT typically used for entropion?
Which management approach is NOT typically used for entropion?
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What is a common cause of the inversion of the eyelid known as entropian?
What is a common cause of the inversion of the eyelid known as entropian?
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What is the incubation period for trachoma caused by Chlamydia Trachomatis?
What is the incubation period for trachoma caused by Chlamydia Trachomatis?
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What condition can be a cause of paralytic ectropion?
What condition can be a cause of paralytic ectropion?
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Which management option is NOT appropriate for treating entropian?
Which management option is NOT appropriate for treating entropian?
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Which management strategy helps reduce eye irritation in ectropion patients?
Which management strategy helps reduce eye irritation in ectropion patients?
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What complication can arise from trichiasis resulting from entropian?
What complication can arise from trichiasis resulting from entropian?
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Which is a less common cause of cicatrical ectropion?
Which is a less common cause of cicatrical ectropion?
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What symptom is typically NOT associated with pre-septal cellulitis?
What symptom is typically NOT associated with pre-septal cellulitis?
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Which factor primarily differentiates cicatricial entropian from involutional entropian?
Which factor primarily differentiates cicatricial entropian from involutional entropian?
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What is NOT a recognized type of entropian?
What is NOT a recognized type of entropian?
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Which condition is most associated with a risk of visual loss due to eyelash inversion?
Which condition is most associated with a risk of visual loss due to eyelash inversion?
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What is a common symptom associated with epiblepharon?
What is a common symptom associated with epiblepharon?
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Study Notes
Blepharitis
- Inflammation of eyelid margins, chronic and recurrent
- Anterior, Posterior, or Mixed
-
Anterior Blepharitis associated with bacterial (staphylococcal) and seborrheic colonization (disorder of ciliary glands)
- Symptoms include ocular discomfort, soreness, burning, itching, mild photophobia, blurred vision, and contact lens intolerance
- Signs include aqueous tear deficiency, lid margin hyperemia, swelling, crusting, loss of lashes, inferior punctate epithelial erosion, marginal keratitis, and mild papillary conjunctivitis
- Oily/greasy deposits on the lid margins, conjunctiva and lid margin hyperemia, and seborrheic dermatitis involving oily, flaking skin found on scalp/eyebrows are seborrheic symptoms
-
Posterior Blepharitis associated with Meibomian gland dysfunction, retention of secretions, and blockage of meibomian glands
- Direct bacterial colonization, immune mediated damage, and bacterial toxins/waste products/enzymes may cause damage
- Symptoms include irritation, burning, and foreign body sensation, worse in the morning
- Signs include watering, photophobia, erythema, telangiectasia, foamy gland secretions, short TBUT, marginal keratitis with small white cell precipitates, and acneiform spots especially around the nose. Facial flushing, erythema, and rhinophyma (enlarged thickening of nasal soft tissues) and eyelash abnormalities (madorosis, poliosis, trichiasis) are also signs
Complications of Blepharitis
- Epiphora (watery eyes)
- Conjunctivitis
- Chalazion formation
- Trichiasis
- Ectropian
- Entropian
- Corneal disease: punctate epithelial erosions, marginal infiltrates, recurrent erosions, marginal ulcers, pannus, keratitis, contact lens intolerance
Treatment
- Lid Hygiene: cleaning lids with cotton buds/flannel to remove crusts, use baby shampoo/bicarbonate of soda solutions. Avoid cosmetics
- Warm Compress: 2x daily, 10 mins, to relieve dry eyes, trichiasis, and entropian
- Ocular Lubricants: symptomatic relief
- Topical Antibiotics: chloramphenicol for marked lid infection (2x daily after deposit removal)
- Oral Tetracyclines: if lid hygiene doesn't work, especially if acne rosacea is a factor
- Topical Steroids: reserved for severe or complicated cases with marginal keratitis
Internal/External Hordeolum (Stye)
- Localized infection/inflammation of eyelid margin
- External Hordeolum involves eyelash follicle/associated glands(Moll and Zeiss), tender, inflamed lid swelling which often points outward
- Internal Hordeolum involves meibomian glands, tender, inflamed swelling within the tarsal plate (more painful), points inward toward conjunctiva
- Staphylococcus Aureus is implicated in many cases, along with staphylococcal blepharitis, diabetes, seborrhea
- Management: mostly spontaneous resolution, warm compress, removal of infected eyelash, topical antibiotics (e.g., chloramphenicol) for recurrent lesions, referral if necessary (fever, tender preauricular lymph nodes, pre-septal cellulitis)
Trichiasis
- Misdirection of eyelashes towards the globe (different from pseudotrichiasis)
- Causes could be attributed to aging, scarring of posterior lid lamella, blepharitis, epiblepharon, herpes zoster, trachoma, ocular cicatrical pemphigoid, Stevens Johnson syndrome, or other conditions
- Management can involve removal of offending eyelashes (epilation often repeated 4-6 weeks), treating underlying condition, or temporarily taping the eyelids.
Trachoma
- Bacterial infection (Chlamydia trachomatis) causing conjunctivitis and scarring in the tarsal plate, leading to entropian and trichiasis
- Causes eye ulcers, further scarring, and visual loss/blindness in severe cases
Entropian
- Inversion of eyelid, lid margin turned inward toward globe
- Typically associated with aging, scarring, or trauma
- Can be involutional, cicatrical, spastic, or congenital
Ectropian
- Outward rotation of eyelid margin
- Typically seen in individuals over 50 yrs of age; can be bilateral in some cases
- Causes include aging, decrease or weakness of pre-septal/pre-tarsal orbicularis muscle.
- Management involves taping the lower lid, use of ocular lubricants, and sometimes surgery to strengthen canthal tendons or inferior retractors, and to remedy the eyelid's outward rotation.
Pre-septal Cellulitis
- Common infection of eyelid and periorbital soft tissue
- Typically affects children under 5, often due to upper respiratory infections
- Caused by bacteria such as Staphylococcus aureus, Staphylococcus epidermidis, Streptococcus, and Anaerobes
- Characterized by acute eyelid erythema and oedema affecting one or both eyes, with symptoms such as blurred vision, pain, redness, or a swollen eyelid.
Bacterial Orbital Cellulitis
- Infection of deeper tissues, usually from spread of infection from adjacent sinuses
- Bacteria involved: Haemophilus influenzae, Staphylococcus aureus, Streptococcus pneumoniae, Beta Haemolytic Streptococci
- Symptoms include pain, eye movement discomfort, proptosis (forward movement of the eye), and restricted eye movement. Optic nerve compression is a severe possible complication.
Tumours (Basal cell carcinoma and Squamous cell carcinoma)
- Basal Cell Carcinoma (BCC): account for 80-90% of cancerous eyelid lesions, slow-growing, destructive, locally invasive
- Squamous Cell Carcinoma (SCC): rare, but more aggressive, 2nd most common eyelid tumour
- Signs and symptoms of both vary, but typically involve a change in eyelid contour, potential redirection/loss of eyelashes, or secondary infection.
- Management, though, may involve surgical removal, skin grafting, cryotherapy, or radiation therapy, depending on the tumour's size and location.
Benign eyelid lesions
- Cysts (of Moll or Zeiss)
- Molluscum contagiosum
Thyroid Eye Disease
- Most common in women in their 40-60s
- Graves' disease related
- Systemic manifestations include tremor, mood changes, weight loss, and tachycardia.
- Ocular symptoms may include proptosis, lid retraction, lid lag, irritation due to dry eyes.
- Important complication is optic nerve compression which can lead to visual loss in some cases
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Description
This quiz explores the inflammation of eyelid margins known as blepharitis, including its anterior and posterior forms. Participants will learn about the symptoms, signs, and causes associated with both types, as well as related conditions like seborrheic dermatitis. Test your knowledge on this common ocular condition and enhance your understanding of its management.
