OPT 221 Eyelids: Blepharitis

What is anterior blepharitis?

chronic inflammation of the eyelid margin anterior to the mucocutaneous junction

What is the etiology of anterior blepharitis?

-staphylococcal: inflammatory reaction to a biofilm

-seborrheic: excessive sebum released by sebaceous glands

Who is most affected by anterior blepharitis?

more common in adults

-bilateral

What are symptoms of anterior blepharitis?

-crusty debris along the eyelid margins

-eyelid margin redness

-ocular irritation

-tearing

What are signs of anterior blepharitis?

-scurf within eyelashes and on skin of surrounding areas

-seborrheic: greasy appearance to eyelid margin

-eyelid margin erythema and edema

-madarosis (mechanical)

-tear film debris

How is anterior blepharitis managed?

-Lid hygiene: Warm cloth and baby shampoo to soften crusty debris

-Topical lubrication

-Eyelid cleanser (e.g., Ocusoft, Cliradex) qday-bid

-Hypochlorous acid eyelid spray (e.g., Avenova) (Neutralizes bacteria, toxins, and inflammatory mediators)

-For moderate to severe cases, antibiotic or antibiotic/steroid ung

-BlephEx with eyelid cleanser in office (Rx antibiotic/steroid ung following the treatment Ex: Maxitrol ung bid x 2-4 weeks)

What is Demodicosis (Demodex)?

specific type of anterior blepharitis due to demodex infestation

What is the etiology of demodicosis?

overpopulation of demodex folliculorum or demodex brevis

Who is most affected by demodicosis?

more common in elderly (bilateral usually)

What are symptoms of demodicosis?

-Eyelid margin itching, especially in the morning (mites are more active in the dark)

-Crusty debris along the eyelid margins

-Eyelid margin redness May extend beyond the margin

-Ocular irritation (e.g., burning, FBS)

-Tearing

What are signs of demodicosis?

-hallmark is cylindrical dandruff

-mite attached to lash base

-eyelid margin erythema and edema

-madarosis

-tear film debris

How is demodicosis managed?

-eyelid cleanser with tea tree oil (maintenance= clean with cleanser 2x/week)

-blephEx with eyelid cleanser + tea tree oil in office (Rx antibiotic/steroid ung following treatment and then repeat in two weeks; 1st kills adults 2nd kills eggs)

-discard old makeup and discontinue wear x 1 month

-recommend spouse/partner/family evaluation

What is the most active ingredient against demodex?

4-terpineol (found in tea tree oil)

What is posterior blepharitis?

chronic inflammation of the eyelid margin posterior to the mucocutaneous junction (like MGD)

What is the etiology of posterior blepharitis?

inflammatory reaction to a colony of bacteria on the eyelid margin (biofilm) causing thickening and stasis of the meibum

Who is most affected by posterior blepharitis?

more common in adults (usually bilateral)

What are symptoms of posterior blepharitis?

-Eyelid margin redness

-Ocular irritation

-Tearing

What are signs of posterior blepharitis?

-eyelid margin erythema and edema

-meibomian gland inspissation (capping)

-turbid, viscous, or toothpaste like meibum upon expression

-telangiectasia

-MG atrophy

-decreased tear break up time

-tear film debris

How is posterior blepharitis managed?

-eyelid cleanser

-hypochlorus acid eyelid spray

-warm compress to liquify meibum

-topical lubrication with lipid supplements

-omega 3 fatty acids

-oral doxycycline

-antibiotic or steroid ung

-BlephEx with eyelid cleanser

-meibomian gland probing in office

-lipiflow in office

-IPL in office (warm compress to liquefy meibum secretions)

What is the primary cause of 85% of dry eye cases?

meibomian gland dysfunction

What is angular blepharitis?

infection of the epidermis at the temporal canthus

What is the etiology of angular blepharitis?

most commonly staphylococcus aureus or moraxella lacunata

-less commonly herpes simplex infection

What demographics are more affected by angular blepharitis?

more common in adults (usually unilateral)

What are symptoms of angular blepharitis?

-Redness at the temporal canthus

-Crusting or white discharge at the temporal canthus

-Itching of the skin at the temporal canthus

What are signs of angular blepharitis?

-Erythema at the temporal canthus

-Crusting or whitish frothy discharge at the temporal canthus

-Fissured skin at the temporal canthus

How is angular blepharitis managed?

-eyelid cleanser qday-bid

-hypochlorus acid eyelid spray

-antibiotic or antibiotic steroid ung (erythromycin ung bid x 2 weeks or maxitrol ung bid x 2 weeks)