Blepharitis Overview and Symptoms
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Questions and Answers

Which symptom is commonly associated with both blepharitis and acne rosacea?

  • Chalazion formation
  • Erythema (correct)
  • Madarosis
  • Foreign body sensation

What is the primary treatment recommended for improving eyelid hygiene?

  • Applying topical antibiotics
  • Cleaning the lids with cotton buds or flannel (correct)
  • Warm compresses
  • Using ocular lubricants

Which abnormality involves the misdirection of eyelashes?

  • Madarosis
  • Trichiasis (correct)
  • Poliosis
  • Entropian

What common complication of blepharitis may lead to excessive tearing?

<p>Epiphora (C)</p> Signup and view all the answers

What is the primary cause of anterior blepharitis?

<p>Bacterial colonisation, mainly staphylococcal (C)</p> Signup and view all the answers

Which of the following is NOT mentioned as a symptom of blepharitis?

<p>Facial flushing (B)</p> Signup and view all the answers

Which of the following symptoms is NOT associated with anterior blepharitis?

<p>Watering (C)</p> Signup and view all the answers

In the treatment of blepharitis, how often should warm compresses typically be applied initially?

<p>Twice a day for 10 minutes (A)</p> Signup and view all the answers

Which of the following conditions could arise due to complications from blepharitis?

<p>Conjunctivitis (B)</p> Signup and view all the answers

Which condition is a major predisposing factor for blepharitis?

<p>Dry eye syndrome (C)</p> Signup and view all the answers

In posterior blepharitis, which gland's dysfunction is a primary characteristic?

<p>Meibomian glands (D)</p> Signup and view all the answers

Which condition is characterized by the loss or absence of eyelashes?

<p>Madarosis (A)</p> Signup and view all the answers

Which of the following is a sign of anterior blepharitis?

<p>Lid margin swelling (C)</p> Signup and view all the answers

What describes the characteristics of seborrheic anterior blepharitis?

<p>Oily/greasy deposits on lid margins (A)</p> Signup and view all the answers

What symptom is primarily associated with posterior blepharitis?

<p>Burning sensation (A)</p> Signup and view all the answers

Which of the following can lead to meibomian gland dysfunction?

<p>Direct bacterial colonisation of eyelids (C)</p> Signup and view all the answers

What is the most common type of basal cell carcinoma (BCC) that presents with small, translucent lesions?

<p>Nodular (B)</p> Signup and view all the answers

Which demographic is most likely to have a higher incidence of basal cell carcinoma?

<p>Light skinned individuals with high UV exposure (B)</p> Signup and view all the answers

Which treatment is typically not used as a management option for basal cell carcinoma?

<p>Chemotherapy (B)</p> Signup and view all the answers

What is a significant sign that may indicate the presence of basal cell carcinoma on the eyelid?

<p>Change in lid contour or direction (D)</p> Signup and view all the answers

Which type of eyelid lesion is characterized by dome-shaped, waxy nodules and is spread through direct contact?

<p>Molluscum contagiosum (B)</p> Signup and view all the answers

Which condition is commonly associated with Squamous Cell Carcinoma?

<p>Xeroderma pigmentosa (B)</p> Signup and view all the answers

Which of the following is a systemic symptom of Graves Disease?

<p>Mood changes (A)</p> Signup and view all the answers

What age range do thyroid eye diseases predominantly affect?

<p>Women in their 4th to 6th decade (C)</p> Signup and view all the answers

What is a common cause of internal hordoleum?

<p>Infection of the meibomian glands (B)</p> Signup and view all the answers

Which treatment is primarily indicated for severe cases of blepharitis with complications?

<p>Topical steroids (C)</p> Signup and view all the answers

What distinguishing feature does an external hordoleum have compared to an internal one?

<p>Location of the swelling (D)</p> Signup and view all the answers

Which of the following is NOT a sign of an internal hordoleum?

<p>Painless bump in the lid (D)</p> Signup and view all the answers

What is a likely course of action for persistent lumps after an acute internal hordoleum episode?

<p>Incision and curettage under local anaesthetic (C)</p> Signup and view all the answers

What most commonly does NOT describe the presentation of an external hordoleum?

<p>Pointing towards the conjunctiva (A)</p> Signup and view all the answers

Which condition increases the likelihood of developing external hordoleum?

<p>Seborrheic dermatitis (D)</p> Signup and view all the answers

What is the primary objective of using warm compresses for an external hordoleum?

<p>To promote spontaneous resolution (D)</p> Signup and view all the answers

What is the primary cause of involutional ectropion?

<p>Aging and disinsertion of lower lid retractors (C)</p> Signup and view all the answers

Which symptom is related to ectropion?

<p>Corneal exposure (A)</p> Signup and view all the answers

What is a common sign of entropion?

<p>Corneal epithelial disturbance (D)</p> Signup and view all the answers

Which management approach is NOT typically used for entropion?

<p>Shortening the lower lid (A)</p> Signup and view all the answers

What is a common cause of the inversion of the eyelid known as entropian?

<p>Aging-related changes in eyelid structure (A)</p> Signup and view all the answers

What is the incubation period for trachoma caused by Chlamydia Trachomatis?

<p>5-12 days (B)</p> Signup and view all the answers

What condition can be a cause of paralytic ectropion?

<p>Bell’s palsy (D)</p> Signup and view all the answers

Which management option is NOT appropriate for treating entropian?

<p>Prescribing antiviral medication (D)</p> Signup and view all the answers

Which management strategy helps reduce eye irritation in ectropion patients?

<p>Advise against constant wiping (C)</p> Signup and view all the answers

What complication can arise from trichiasis resulting from entropian?

<p>Punctate epitheliopathy (C)</p> Signup and view all the answers

Which is a less common cause of cicatrical ectropion?

<p>Tumors affecting the eyelid (A)</p> Signup and view all the answers

What symptom is typically NOT associated with pre-septal cellulitis?

<p>Corneal exposure (D)</p> Signup and view all the answers

Which factor primarily differentiates cicatricial entropian from involutional entropian?

<p>Caused by conjunctival scarring (B)</p> Signup and view all the answers

What is NOT a recognized type of entropian?

<p>Recurrent (D)</p> Signup and view all the answers

Which condition is most associated with a risk of visual loss due to eyelash inversion?

<p>Trachoma (A)</p> Signup and view all the answers

What is a common symptom associated with epiblepharon?

<p>Foreign body sensation (D)</p> Signup and view all the answers

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Flashcards

Blepharitis

Inflammation of the eyelid margins, often chronic and recurrent, affecting the anterior, posterior, or both margins.

Anterior Blepharitis

A type of blepharitis where the inflammation is on the front of the eyelid margin.

Cause of Anterior Blepharitis

Anterior Blepharitis is commonly caused by a build-up of bacteria, particularly staphylococcus.

Posterior Blepharitis

A type of blepharitis where the inflammation is on the back of the eyelid margin, affecting the meibomian glands.

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Cause of Posterior Blepharitis

Posterior Blepharitis is caused by a dysfunction of the meibomian glands, which secrete oil to lubricate the eye.

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Symptoms of Blepharitis

Discomfort, soreness, burning, itching, mild photophobia, blurred vision, and contact lens intolerance are some common symptoms of blepharitis.

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Signs of Blepharitis

Lid margin hyperemia, swelling, crusting, loss of lashes, inferior punctate epithelial erosion, marginal keratitis, and mild papillary conjunctivitis are some signs of blepharitis.

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Predisposing Conditions for Blepharitis

Dry eye syndrome, acne rosacea, and seborrheic dermatitis can all contribute to blepharitis.

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Foreign body sensation

A common symptom of blepharitis, it refers to the sensation that a foreign object is present in the eye.

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Erythema

Reddening of the skin, often seen in blepharitis and rosacea.

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Telangiectasia

Dilated blood vessels, commonly seen in blepharitis and rosacea.

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Meibomian Gland Dysfunction (MGD)

A condition affecting the eyelid margin, characterized by inflammation of the meibomian glands which produce oily secretions.

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Tear Break-Up Time (TBUT)

A sign of dry eye, it refers to the time it takes for tears to break up after blinking.

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Blepharitis with Acne Rosacea

A type of blepharitis often characterized by facial flushing, acneiform spots around the nose, telangiectasia, and rhinophyma.

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Entropian

A serious complication associated with blepharitis, it refers to the turning inward of the eyelid causing lashes to rub against the cornea.

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Hordeolum (Stye)

A localized infection or inflammation of the eyelid margin that can involve either external or internal structures.

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External Hordeolum

Involves the eyelash follicle and associated glands, presenting as a tender inflamed swelling on the exterior of the eyelid margin.

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Internal Hordeolum

Involves the meibomian glands, presenting as a tender inflamed swelling within the tarsal plate, often more painful than an external hordeolum.

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Chalazion

A painless bump in the eyelid caused by a blockage of the meibomian gland ducts, often forming after resolution of an internal hordeolum, but can occur spontaneously.

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Trichiasis

A misdirection of eyelashes towards the globe, often caused by aging, congenital conditions, or scarring of the eyelid.

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Pseudotrichiasis

A condition where the eyelashes are turned inwards secondary to entropion, causing irritation and damage to the cornea.

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Conjunctivitis

Inflammation of the conjunctiva, often a secondary symptom of other conditions like blepharitis or trichiasis.

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Cicatrical Entropion

Entropion caused by scar tissue pulling the eyelid inward.

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Involutional Entropion

Entropion caused by aging, most common type.

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Trachoma

Condition caused by an infection with the bacterium Chlamydia Trachomatis.

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Trachoma Complications

Trachoma causes scarring on the inner eyelid, potentially leading to entropion.

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What is Entropion?

A condition where the lower eyelid rolls inwards, causing eyelashes to rub against the cornea and conjunctiva.

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What is the main cause of Entropion?

Caused by improper development of the lower lid retractor aponeurosis insertion, leading to eyelid instability and entropion.

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What are the symptoms of Entropion?

Redness, irritation, eye discomfort and pain caused by eyelashes rubbing against the cornea and conjunctiva.

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What is Ectropion?

Outward rotation of the eyelid margin, common in older people.

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What are the main causes of Ectropion?

Aging, scarring, or nerve paralysis.

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What are the signs of Ectropion?

Conjunctival hyperaemia, corneal exposure, tearing, globe apposition, keratinisation of the palpebral conjunctiva, visual loss, and mucous discharge.

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What is Pre-Septal Cellulitis?

An acute inflammation of the eyelid and periorbital soft tissues.

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What are the symptoms of Pre-Septal Cellulitis?

Acute eyelid erythema and eyelid oedema.

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Basal Cell Carcinoma (BCC)

A common type of skin cancer that affects the eyelid, often in older individuals with fair skin and significant sun exposure.

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Squamous Cell Carcinoma (SCC)

A more aggressive type of skin cancer than BCC, less common but potentially more dangerous.

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Cyst of Moll

A benign lesion in the eyelid, often filled with clear fluid and occurring on the eyelid margin.

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Molluscum Contagiosum

A benign skin lesion that is contagious and can spread through direct contact.

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Graves' Disease

Most common thyroid eye disease, often occurs in women in their 40s-50s, associated with hyperthyroidism (overactive thyroid).

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Morpheic BCC

A type of BCC that presents as a firm, pale, waxy yellow plaque with indistinct borders.

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Ulcerative BCC

A type of BCC that presents as a nodular lesion with a reddish hue and an excavated center.

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Nodular BCC

A type of BCC that presents as a small translucent nodule with poorly defined borders.

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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.

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