Ophthalmology: Eyelid & Corneal Diseases

Study Notes

Blepharitis: Inflammation of the eyelid margin causing redness, irritation, and itchy eyelids; leads to dandruff-like scales on eyelashes.
Causes: Can be bacterial (e.g., staphylococcal) or dermatologic (e.g., seborrheic dermatitis). Non-contagious, affects all age groups.
Classification:
- Anterior blepharitis: Involves eyelid skin and lash roots.
  - Staphylococcal: Primary bacterial cause.
  - Seborrheic: Related to scalp dandruff.
- Posterior blepharitis: Affects meibomian glands; can cause dry eye syndrome.
- Mixed blepharitis: Combination of both anterior and posterior types.

Cause: Infestation by Demodex folliculorum, common in the elderly.
Symptoms: Little to no inflammation, characterized by waxy, cylindrical cuffs around eyelashes.

Impact: Blocked oil glands lead to poor tear quality, redness, and irritation.
Signs: Irregular lid margins, prominent blood vessels, blocked gland orifices.
Management:
- Lid hygiene with warm compresses.
- Oral tetracyclines or doxycycline for 4-6 weeks to reduce bacterial lipase production.
- Temporary treatments include lubricants.
- Surgery may be needed for definitive treatment.

Definition: Misdirection of eyelashes rubbing against the eye, causing irritation, tearing, and redness.
Causes: Chronic blepharitis, herpes zoster, trachoma, or secondary to trauma.
Treatment:
- Epilation for few lashes or more extensive treatment like electrolysis or surgery for severe cases.

Definition: Abnormal drooping of the upper eyelid.
Classification:
- Congenital: Present at birth.
- Mechanical: Due to lid edema or mass.
- Neurological: Associated with 3rd nerve palsy or Horner’s syndrome.
- Myogenic: From conditions like Myasthenia gravis.
- Aponeurotic: Most common, often age-related.

Bacterial Keratitis: Common, managed with topical fluoroquinolones. Drugs include vancomycin for Gram-positive bacteria, tobramycin for Gram-negatives.
Fungal Keratitis: Less common, more prevalent in humid conditions. Main risk factors are corneal trauma and contact lens wear.
Symptoms: May present with fewer early signs but often has severe pain.
Management:
- Topical treatments include diamidines, biguanides, imidazoles/triazoles; biguanides are effective against cysts and trophozoites.

Treat ophthalmia neonatorum urgently.
Avoid corticosteroid drops for infectious conjunctivitis and keratitis.
Ensure early referral for traumatic eye conditions showing severe pain, vision reduction, or abnormal appearances.