Anatomy of Lid

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Anatomy of Lid
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Blepharitis
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Blepharitis

• Blepharitis is chronic inflammation of lid margin
  occurring as true inflammation or as simple
  hyperaemia.
• (Very common cause of ocular discomfort and
  irritation)

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Types

• 1. Anterior
• a. Squamous
• b. Ulcerative
• 2. Posterior
• a. Meibomian seborrhoea
• b. Meibomianitis
• (Conditions overlap with each other)

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Causes

• Following chronic Conjunctivitis especially due
  to staphylococci
• Phthiriasis Palpabrarum due to crab louse
• (Poor correlation between signs and symptoms,
  uncertain etiology and mechanism)

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Seborrhoeic or Squamous Blepharitis

• Is a form of anterior blebharitis characterized
  by deposition of white scales among the eye
  lashes. Eye lashes fall and replaced by distorted
  eyelashes.
• On removal of scales, lid margins appear
  hyperaemic. Ulcers are absent.

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Seborrhoeic or Squamous Blepharitis

• Condition is metabolic associated with dandruff
  of the scalp
• Usually associated with seborrhoeic dermatitis
  involving scalp, nasolabial folds and
  retroauricular areas

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Squamous Blepharitis
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Symptoms

• Burning, grittiness , redness of lid margins,
  mild photophobia
• Symptoms are worse in the morning
• (Remissions and exacerbations)

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Seborrhoeic or Squamous BlepharitisTreatment

• Skin and Scalp condition also requires treatment.
• Lid Hygiene
• Hot compresses
• Topical Antibiotics
• Oral Azithromycin 500 mg daily for 3 days
• Weak topical steroids (Flourometholone)
• Tear Substitutes

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Staphylococcal or Ulcerative Blepharitis

• Ulcerative blepharitis is infective condition
  commonly due to staphylococcal infection (Cell
  mediated response)
• Lid margins are covered with infective material
  (yellow crusts or dry brittle scales-Collarettes)
  matting eyelashes.
• On removal of discharge small ulcers which bleed
  are found along lid margins around bases of the
  eyelashes

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Symptoms

• Redness of lid margins, burning, itching,
  watering and photophobia
• Signs
• Small ulcers at lid margins on removal of
  discharge, this feature differentiate it from
  conjunctivitis

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Ulcerative Blepharitis
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Treatment

• Discharge/ crust is removed from lid margins with
  14 dilution baby shampoo or luke warm 3 soda
  bicarbonate lotion. The loose discharge is then
  cleaned cotton
• Diseased eyelashes are epilated

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Treatment

• Appropriate antibiotic drops are used
• After control of infection, daily cleaning of lid
  margins with blend lotion

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Treatment

• Improvement of local hygiene (rubbing of eyes and
  touching of eyes with dirty hand should be
  discouraged)

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Sequelae of Ulcerative Blepharitis

• Chronic course and associated chronic
  conjunctivitis Marginal Keratitis
• Madarosis (Scanty eyelashes) due to falling of
  eyelashes
• Poliosis (Whitening)

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Sequelae of Ulcerative Blepharitis

• Trichiasis (misdirected eyelashes) due to
  contraction of scar tissue
• Cicatrization of lid margins causing thickening
  and hypertrophy of tissue and drooping of lids
  (Tylosis)

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Sequelae of Ulcerative Blepharitis

• Cicatrization of lid margin may drag conjunctiva
  on posterior border of intermarginal strip
  disturbing angle of posterior edge leading to
  epiphora , eversion of puncta
• Epiphora leads to eczematous condition of skin,
  scarring of skin leads to ectropion . This
  further aggravate epiphora
• Tear film instability

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Posterior Blepharitis

• Posterior blepharitis i.e. inflammation of
  meibomian duct opening at intermarginal strip and
  posterior border may cause tear film instability
  and inferior punctate keratitis

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Posterior Blepharitis

• Meibomian gland dysfunction and alterations in
  meibomian gland secretion
• Bacterial lipases may result in the formation of
  fatty acids which may lead to increase in melting
  point of meibum

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Posterior Blepharitis

• Caping with Oil globules
• Plugging
• Hyperemia
• Teengiectasis

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Posterior Blepharitis

• It occurs in two clinical forms
• Meibomian seborrhoea
• Meibomianitis

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Meibomian seborrhoea

• 1. Meibomian seborrhoea characteristic
  appearance of oil droplet at the opening of
  meibomian duct opening at intermarginal strip.
  Tear film is oily and foamy. Frothy discharge
  accumulate on the lid margin. Foam like discharge
  can be expressed from these lesions

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Meibomianitis

• 2. Meibomianitis There is inflammation and
  obstruction of meibomian glands. Characterized by
  diffuse thickening of posterior border of lid
  margin which becomes rounded. On lid massage
  toothpaste like thick material can be expressed
  out. Due to duct blockade cyst formation may be
  present

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Complications

• Chalazion
• Tear film instability
• Papillary conjunctivitis and inferior corneal
  erosions

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Treatment

• Warm compresses
• Systemic - Doxycycline 100 mgm twice x 1 week
  then once daily for 6 -12 weeks or Tetracycline
  250 mgm 4 times x 1 week then twice for 6 -12
  weeks
• Associated tear film abnormality is treated with
  artificial tear drops

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• Thanks