Lids III: Infection and inflammation

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27 Terms

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What is blepharitis?

inflammation of eyelid margins
extremely common
chronic /relapsing
typically bilateral (both eyes)

itis= inflammation

belpharo - lids

<ul><li><p><mark data-color="red" style="background-color: red; color: inherit;">inflammation of eyelid margins</mark></p></li><li><p>extremely <mark data-color="red" style="background-color: red; color: inherit;">common</mark></p></li><li><p><strong>chronic /relapsing</strong></p></li><li><p>typically <mark data-color="red" style="background-color: red; color: inherit;">bilateral (both eyes)</mark></p></li></ul><p></p><p>itis= inflammation</p><p>belpharo - lids</p><p></p>

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what are the predisposing/risk factors for blepahritis?

seborrheic dermatitits (dandruff)

ocular rosacea —> skin condition effecting checks , nose and eyes

long term Contact lens wear

topical eye medication (glaucoma)

demodex - hair mite follicle

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what glands are involved in anterior blepharitis ?

> Zeiss + Moll

anterior blepharitis occurs where eyelash follicles are (base of eyelashes)

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what glands are involved in posterior blepharitis?

> meibomian glands

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what is the aetiology for anterior blepharitis?

> Bacterial - staphylococcal

> Sebhorrheic —> excess lipid - Gland of Zeiss

> demodex - mite

<p>><mark data-color="red" style="background-color: red; color: inherit;"> Bacterial</mark> - staphylococcal</p><p></p><p>> <strong>Sebhorrheic</strong> —> excess lipid - Gland of Zeiss</p><p></p><p>> <strong>demodex - mite</strong></p>

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what is the aetiology for posterior blepharitis?

> Meibomian gland Dysfunction

MGD - thickened secretions which block duct

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How are the symptoms of blepharitis?

similar in all types
very variable
chronic (months-years)
doesn’t always correspond well with signs

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What are the symptoms of blepharitis

ocular discomfort

soreness
burning
itching
grittiness
photophobia
CL intolerance

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what are the signs of anterior blepharitis - bacterial ?

Bacterial - staphylococcal —> most common cause of blepharitis

crusting/collarettes/scales - yellow deposits at base of lashes

talengiectasia (dilated blood vessels)

lash misdirection/loss

<p>Bacterial - staphylococcal —> most common cause of blepharitis</p><p></p><ul><li><p><strong><u>crusting/collarettes/scales</u></strong> - yellow deposits at base of lashes</p></li></ul><p></p><ul><li><p><mark data-color="red" style="background-color: red; color: inherit;">talengiectasia (dilated blood vessels)</mark></p></li></ul><p></p><ul><li><p><strong><mark data-color="red" style="background-color: red; color: inherit;">lash misdirection/loss</mark></strong></p></li></ul><p></p>

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what are the signs of anterior blepharitis - seborrheic ?

seborrheic (gland of Zeiss): associated with seborrheic dermatitis - dandruff

→ disease of sebaceous gland

greasy deposits at base of lashes

associated with dermatitis rosacea

<p>seborrheic (<strong>gland of Zeiss</strong>): associated with seborrheic dermatitis - dandruff</p><p>→ disease of <strong>sebaceous gland</strong></p><p></p><ul><li><p><u>greasy deposits</u> at base of lashes</p></li></ul><p></p><ul><li><p>associated with <strong>dermatitis rosacea</strong></p></li></ul><p></p>

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what are the signs for anterior blepharitis - demodex?

less common, very itchy

demodex:

cylindrical deposits extending up lashes

lash misdirection/loss , general redness

itching

<ul><li><p>less common, <strong><u>very itchy</u></strong></p></li></ul><p></p><p>demodex:</p><ul><li><p><strong>cylindrical deposits</strong> extending up lashes</p></li></ul><p></p><ul><li><p><strong>lash misdirection/loss</strong> , general redness</p></li></ul><p></p><ul><li><p>itching</p></li></ul><p></p>

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what are the signs of posterior blepharitis?

thickened meibomian secretions

microliths - plaques

meibomianitis - passive retention of secretions (chalazion, styes)

foam in tear meniscus

unstable tear film -evaporative tear deficiency
—> meibomian glands secrete oily lipid layer of tear film so reduced

<ul><li><p><strong>thickened</strong> meibomian secretions</p></li></ul><p></p><ul><li><p><strong>microliths</strong> - plaques</p></li></ul><p></p><ul><li><p>meibomianitis - <mark data-color="green" style="background-color: green; color: inherit;">passive retention of secretions</mark> (chalazion, styes)</p></li></ul><p></p><ul><li><p><mark data-color="yellow" style="background-color: yellow; color: inherit;">foam in tear meniscus</mark></p></li></ul><p></p><ul><li><p><strong>unstable tear film</strong> -<u>evaporative tear deficiency</u></p></li><li><p>—> meibomian glands secrete oily lipid layer of tear film so reduced</p></li></ul><p></p>

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what are the secondary signs of all blepharitis?

chronic red eye - lid margin & conjunctival hyperaemia

punctate epithelial erosion (lower 1/3rd of cornea) →purple dots in image

conjunctival staining - fluorescein etc

marginal keratitis + scarring

neovascularisation —> new blood vessels + pannus (opacification of cornea)

<ul><li><p><mark data-color="red" style="background-color: red; color: inherit;">chronic red eye</mark> - lid margin & <mark data-color="red" style="background-color: red; color: inherit;">conjunctival hyperaemia</mark> </p></li></ul><p></p><ul><li><p><mark data-color="green" style="background-color: green; color: inherit;">punctate epithelial erosion</mark> (lower 1/3rd of cornea) →purple dots in image </p></li></ul><p></p><ul><li><p><mark data-color="green" style="background-color: green; color: inherit;">conjunctival staining</mark> - fluorescein etc</p></li></ul><p></p><ul><li><p>marginal keratitis + scarring </p></li></ul><p></p><ul><li><p><mark data-color="green" style="background-color: green; color: inherit;">neovascularisation</mark> —> new blood vessels + <strong>pannus </strong>(opacification of cornea)</p></li></ul><p></p><p></p>

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what is the optometric management of blepharitis?

All cases: Lid hygiene

needs to be daily + long term
warm compress, lid massage + clean/wipe
lid scrubs/ wipes , or washes/gels

clean flannel + warm water → hold on closed eyelids for 2 mins so warming up secretions (MG)→ so flow better

eyelid margin massage → help blocked glands express + clean away debris

<p>All cases:<u> Lid hygiene</u></p><p></p><ul><li><p>needs to be <strong>daily + long term</strong></p></li><li><p><strong>warm compress</strong>, lid <strong>massage</strong> + clean/wipe</p></li><li><p>lid scrubs/ wipes , or washes/gels</p></li></ul><p></p><p><strong>clean flannel + warm water</strong> → hold on closed eyelids for <strong>2 mins</strong> so warming up secretions (MG)→ so flow better</p><p></p><p>eyelid margin massage → help blocked glands express + clean away debris</p><p></p>

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what other managements are there for blepharitis ?

> ocular lubricants

> drops/ointments

> vitamin supplements

> omega 3/fish oils

BlephEx→ tool

demodex→ tea tree oil (experienced clinician)

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what treatments for refractory cases - resistant to treatment ?

topical antibiotic ± steroid

oral tetracycline (3months/12) e.g Doxycycline

<ul><li><p><strong><u>topical antibiotic ± steroid</u></strong></p></li></ul><p></p><ul><li><p><strong>oral tetracycline</strong> (3months/12) e.g Doxycycline</p></li></ul><p></p>

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what is hordeolum ?

acute bacterial infection (staphylococcal) of an eyelid gland

24-48 hours red swelling

tender eyelid lump

may spontaneously express itself with a purulent material

often associated with blepharitis

image = external hordeolum

<ul><li><p><strong>acute bacterial infection</strong> (staphylococcal) of an eyelid gland</p></li></ul><p></p><ul><li><p><mark data-color="red" style="background-color: red; color: inherit;">24-48 hours red swelling</mark></p></li></ul><p></p><ul><li><p><mark data-color="red" style="background-color: red; color: inherit;">tender eyelid lump</mark> </p></li></ul><p></p><ul><li><p>may spontaneously express itself with a <mark data-color="red" style="background-color: red; color: inherit;">purulent material</mark> </p></li></ul><p></p><ul><li><p>often <strong><u>associated with blepharitis</u></strong></p></li></ul><p></p><p>image = external hordeolum</p>

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what are the two types of hordeolum ?

External hordeolum (stye)

—> lash follicle + associated with gland of Zeiss or Moll - bass of eyelash

internal hordeolum - further in lid (image)

—> meibomian gland - tarsal plate

treat as per blepharitis

<ul><li><p>External hordeolum (stye)</p></li></ul><p>—> lash follicle + associated with gland of<strong> Zeiss or Moll</strong> - bass of eyelash</p><p></p><ul><li><p>internal hordeolum - further in lid (image)</p></li></ul><p>—><strong> meibomian gland</strong> - tarsal plate</p><p>treat as per blepharitis</p><p></p>

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what is the aetiology of a chalazion?

common, chronic lid lump

Blockage of meibomian gland duct

inflammatory response —> stagnate secretions + inflammatory cells

spontaneous or follow hordeolum

typically less acute + occur over a period of weeks

<ul><li><p><strong>common, chronic lid lump</strong></p></li></ul><p></p><ul><li><p><u><mark data-color="#fbfc97" style="background-color: rgb(251, 252, 151); color: inherit;">Blockage of meibomian gland duct</mark></u></p></li></ul><p></p><ul><li><p>inflammatory response —> stagnate secretions + inflammatory cells</p></li></ul><p></p><ul><li><p>spontaneous or <strong>follow hordeolum</strong></p></li></ul><p></p><ul><li><p>typically <strong>less acute</strong> + occur over a <strong>period of weeks</strong></p></li></ul><p></p>

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what are the symptoms of a chalazion?

usually painless lid lump

single or multiple, may be recurrent

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what are the signs of a chalazion?

well-defined , 2-8mm subcutaneous nodule in tarsal plate

may be associated with blepharitis and astigmatism

<ul><li><p>well-defined ,<strong> 2-8mm subcutaneous nodule in tarsal plate</strong></p></li></ul><p></p><ul><li><p>may be associated with <strong>blepharitis and astigmatism</strong></p></li></ul><p></p>

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what is the management for a chalazion?

tend to resolve on their own

lid hygiene as per bleph - warm compress, massage + clean lids

resolution may take several weeks

occasionally may be surgically removed → if persistent and hasn’t resolved for 6 months

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what is herpes simplex virus ?

> swollen lids + conjunctivitis

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what is herpes zoster virus (shingles)

Varicella (chicken pox vius)

herpesvirus-3

pain/neuralgia (tingling pain) - one sided

vesicular rash

lesion tip on nose (hutchingsons sign)- higher risk of ocular complications

oral acyclovir within 72 hours of vesicles starting ,reduces eye disorders from 50% to 20-30% + reduces pain

<ul><li><p>Varicella (<strong>chicken pox vius)</strong></p></li></ul><p></p><ul><li><p>herpesvirus-3</p></li></ul><p></p><ul><li><p>pain/neuralgia (<strong>tingling </strong>pain) - one sided</p></li></ul><p></p><ul><li><p><mark data-color="purple" style="background-color: purple; color: inherit;">vesicular rash</mark></p></li></ul><p></p><ul><li><p><mark data-color="purple" style="background-color: purple; color: inherit;">lesion tip on nose</mark> (hutchingsons sign)- higher risk of ocular complications</p></li></ul><p></p><ul><li><p><mark data-color="purple" style="background-color: purple; color: inherit;">oral acyclovir within 72 hours</mark> of vesicles starting ,reduces eye disorders from 50% to 20-30% + reduces pain</p></li></ul><p></p>

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what is molluscum contagiosum?

poxvirus

mildly contagious (skin to skin)

umbilicated skin nodule → 2-3mm

viral toxins may cause follicular conjunctivitis

curette lesions → local or general anaesthetic

—> moluscumi scraped out

<ul><li><p><strong>poxvirus</strong></p></li></ul><p></p><ul><li><p>mildly <strong>contagious</strong> (skin to skin)</p></li></ul><p></p><ul><li><p><mark data-color="green" style="background-color: green; color: inherit;">umbilicate</mark>d skin nodule → 2-3mm</p></li></ul><p></p><ul><li><p>viral toxins may cause follicular conjunctivitis</p></li></ul><p></p><ul><li><p><mark data-color="green" style="background-color: green; color: inherit;">curette</mark> lesions → local or general anaesthetic</p></li></ul><p>—> moluscumi scraped out </p><p></p>

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what is Tinea faciei ?

fungal infection - Rare

<ul><li><p>fungal infection - Rare </p></li></ul><p></p>

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what is impetigo?

Staph infection

rash

occasionally blisters on skin

common in children younger than 14yrs of age

—> can lead to orbital cellulitis

<ul><li><p>Staph infection</p></li></ul><p></p><ul><li><p><mark data-color="blue" style="background-color: blue; color: inherit;">rash</mark></p></li></ul><p></p><ul><li><p>occasionally <strong>blisters on skin</strong></p></li></ul><p></p><ul><li><p>common in <mark data-color="blue" style="background-color: blue; color: inherit;">children </mark><strong><mark data-color="blue" style="background-color: blue; color: inherit;">younge</mark>r than <mark data-color="blue" style="background-color: blue; color: inherit;">14yrs</mark></strong> of age</p></li></ul><p></p><p>—> can lead to <strong><mark data-color="blue" style="background-color: blue; color: inherit;">orbital cellulitis</mark></strong></p><p></p>