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Questions and Answers
What is the mainstay treatment for blepharitis?
Which of the following symptoms is NOT commonly associated with blepharitis?
During the physical examination of blepharitis, what does a white sebaceous discharge from the meibomian gland indicate?
Which underlying conditions can lead to a severe case of blepharitis?
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Which of the following is a differential diagnosis for blepharitis?
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What is the typical appearance of the eyelid margins in a patient with blepharitis?
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What may be observed when using a magnifying glass or woods lamp on a blepharitis patient?
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What is a possible complication of untreated severe blepharitis?
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What is the primary cause of both hordeolum and chalazion?
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How does a hordeolum typically present?
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Which treatment is considered the mainstay for both hordeolum and chalazion?
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Which physical exam finding is characteristic of a chalazion?
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When should a patient be referred to an ophthalmologist?
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What is a common treatment application for a hordeolum infection?
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Which of the following conditions needs to be differentiated from persistent eyelid inflammation?
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What patient education should be emphasized for managing recurrent blepharitis?
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Study Notes
Blepharitis
- Inflammation of the eyelids and margins, affecting either the anterior (eyelash follicles) or posterior (obstruction of meibomian glands) eyelid.
- Common symptoms include eye itching, burning, tearing, redness, and a foreign body sensation.
- Symptoms can be unilateral or bilateral, and worsen in the morning.
- During physical exam, the lid margins will appear edematous and erythematous.
- May reveal scaling, erythema, crusting, and scale fragments along lid margins using a magnifying glass or woods lamp.
- Gentle pressure on the eyelid may reveal white sebaceous discharge from the meibomian gland, indicating a gland problem.
- Staphylococcal blepharitis may present with pustules at the base of the hair follicles, which can crust or bleed.
- Severe blepharitis may be associated with rosacea.
- Diagnostics include evaluating visual acuity bilaterally with and without corrective lenses. Eyelid and conjunctival cultures are not typically needed.
- Differentials include squamous cell, basal cell, and sebaceous cell carcinoma, hordeolum, conjunctivitis, herpes simplex infection, orbital cellulitis, dacryocystitis, and foreign body.
- Treatment includes warm compresses and gentle eyelid scrubbing at the base of the lashes.
- For staphylococcal blepharitis, bacitracin or erythromycin 0.5% ointment can be used 1-3 times/day for 7-10 days. If infection persists, refer to an ophthalmologist.
- For posterior blepharitis, compresses and massage to the Meibomian gland are recommended. If resistant, topical fluoroquinolone or bacitracin, oral doxycycline, or referral to an ophthalmologist may be necessary.
- Severe blepharitis may require oral doxycycline 100mg 2x/day, or tetracycline 250mg 4x/day for several weeks, followed by tapering, or referral to an ophthalmologist.
- Patient education includes: washing hands often, avoiding irritants, using hypoallergenic soap and makeup, being careful with contact lenses, and long-term eyelid hygiene to prevent recurrent blepharitis.
Hordeolum and Chalazion
- Both conditions are caused by ductal obstruction of the meibomian gland, often secondary to staphylococcal infection.
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Hordeolum (Stye): an acute, erythematous eyelid lump caused by inflammation or infection of the eyelid margin.
- Presents as a tender, erythematous lump localized to the eyelid affecting hair follicles of eyelashes or meibomian glands.
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Chalazion: granulomatous inflammation due to glandular blockage (meibomian gland).
- Presents as a nontender lump or painless swelling of the eyelid.
- Initially may be tender and erythematous, but develops slowly and has a high recurrence rate.
- During physical exam, evaluate visual acuity (typically unaffected).
- Hordeolum: Erythema, localized tenderness with palpation, drainage from the lesion, and pustule.
- Chalazion: Inversion of the eyelid reveals a red, elevated, painless mass.
- Pain with eye movement and eyelid edema or erythema should raise concern for orbital cellulitis, requiring urgent referral.
- Diagnostics usually include appearance, cultures are not indicated for uncomplicated or first-time occurrences. Refer to an ophthalmologist if persistent.
- Differentials include squamous cell, basal cell, and sebaceous cell carcinoma, blepharitis, conjunctivitis, herpes simplex infection, orbital cellulitis, dacryocystitis, and foreign body.
- Treatment for both includes warm compresses and gentle eyelid scrubbing followed by gentle massage.
- For Hordeolum infection/inflammation, erythromycin ointment or sulfacetamide ointment 4x/day, or ciprofloxacin ointment 3x/day to the eyelid margin can be used.
- For Hordeolum that is resistant/recurrent, oral antibiotics like doxycycline or tetracycline may be prescribed, or referral to an ophthalmologist.
- For Chalazion that is resistant to treatment, surgical incision and drainage, or injection of corticosteroids may be considered.
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Description
Test your knowledge about blepharitis, a common eyelid inflammation that affects the anterior and posterior margins. This quiz covers symptoms, diagnostics, and related conditions such as rosacea. Assess your understanding of this condition and its clinical presentation.
