eyelid anomalies

anterior blepharitis (marginal blepharitis)

chronic/recurrent inflammation of anterior eyelid margin involving eyelashes, lash follicles, and associated periocular skin

staphylococcal blepharitis

• primarily associated w/ colonization by S.aureus

• considered the infectious/microbial-associated form

seborrheic blepharitis

primarily associated w/ seborrheic dermatitis & sebaceus gland dysnfunction

seborrheic dermatitis

common, non-contagious inflammatory skin condition that causes greasy. scale patches & stubborn dandruff

ulceration

loss of surface tissue of eyelid margin

notching

permanent indentation/defect in contour of eyelid margin

treatment/management of staphylococcal blepharitis

• lid hygiene (warm compress, eyelid wipes, mechanical lid exfoliation, education regarding eye rubbing avoidance & makeup replacement)

• topical antibiotic therapy (most common is erythromycin ophthalmic ointments)

erythromycin ophthalmic ointment

• macrolide

• bacteriostatic antibiotic which blocks protein synthesis by binding to 50S ribosomal subunit

pathogenesis seborrheic blepharitis

believed to be a combination of altered sebum composition, increased involvement of malassezia, activation of innate immune pathways & inflammatory cytokines secondary to sebum alterations & microbial products

Malassezia

lipophilic yeast which produces the enzymes necessary to hydrolyze sebum triglycerides thereby releasing fatty acids

treatment/management of seborrheic blepharitis

• lid hygiene

• topical antibiotic therapy (erythromycin ophthalmic ointment)

• referral to dermatology for treatment of seborrheic dermatitis

angular blepharitis

localized form of anterior blepharitis involving canthal skin & eyelid margins (prevalence in lateral canthus vs medial)

pathogenesis of anterior blepharitis

believed to be a combination of initial disruption of the canthal environment, increased incidence of microbial colonization, resultant response to associated bacterial products include enhanced cell-mediated immunity & inflammatory response

treatment/management of angular blepharitis

• lid & periocular hygiene

• control excessive moisture (helps reduce microbial growth w/in canthus)

• topical antibiotic therapy (erythromycin ophthalmic ointment)

demodex blepharitis

chronic, recurrent inflammatory disorder of the eyelid margin associated w/ infestation of demodex mites

pathogenesis of demodex blepharitis

overpopulation of demodex mites

d.folliculorum

reside in eyelash follicles

d.brevis

reside in meibomian & sebaceous glands

treatment/management of demodex blepharitis

• lid hygiene (mechanical lid exfoliation)

• topical formulations (lotilaner ophthalmic solution 0.25% <XDEMVY>)

lotilaner ophthalmic solution 0.25%

selectively targets & inhibits the GABA-gated chloride channels in demodex mites resulting in spastic paralysis & death

phthiriasis palpebrarum (pediculosis)

infestation of eyelashes w/ lice

etiology of phthiriasis palpebrarum

most commonly involves phthirus pubis; transmitted either sexually or secondary to extremely close contact w/ infected individual

treatment/management of phthiriasis palpebrarum

• mechanical removal

• topical formulations (ophthalmic petrolatum jelly & erythromycin ophthalmic ointment)

• education on potentially contaminated items & regarding transmission

meibomian gland dysfunction (MGD)

• posterior blepharitis, meibomianitis

• chronic, diffuse abnormality of meibomian glands characterized by terminal duct obstruction & alterations to glandular secretion

pathogenesis of MGD

described as self-perpetuating inflammatory cycle beginning w/ abnormal meibum production & composition

treatment/management of MGD

• lid warming & hygiene

• lubrication

• topical formulations (MIEBO)

• manual meibomian gland expression

• thermal pulsation

• IPL

MIEBO

• has ability of forming monolayer at air-liquid interface of tear film

• only drop that is FDA approved for evaporative dry eye