BLEPHARITIS

dr.T. KURINCHI, MS
Blepharitis is a subacute or
chronic inflammation
of the lid margins.

It is an extremely common
disease.
 TYPES
Bacterial
blepharitis

Seborrhoeic or
squamous
blepharitis

Mixed staphylococcal
with seborrhoeic
blepharitis

Posterior
blepharitis or
meibomitis
Parasitic
blepharitis
 BACTERIAL BLEPHARITIS
Also known as chronic anterior blepharitis or
staphylococcal blepharitis or ulcerative blepharitis
is a chronic infection of the anterior part of lid
margin.

ETIOLOGY
Causative organisms : staphylococci
streptococci
propionibacterium acnes
 CLINICAL FEATURES

• chronic irritation
• Itching
SYMPTOMS • mild lacrimation
• gluing of cilia
• mild photophobia

• yellow crusts at roof of cilia

• small ulcers
SIGNS • red, thickened lid margin
• mild papillary conjunctivitis
 COMPLICATIONS AND SEQUELAE

• Lash abnormalities like madarosis, trichiasis,

poliosis
• Tylosis, i.e. thickening and scaring of lid margins
• Eversion of punctum leading to epiphora
• Eczema of skin and ectropion
• Marginal keratitis
• Tear film instability
• Secondary inflammatory and mechanical changes.
 TREATMENT

1. Lid hygiene
Warm compresses for 5-10mins
Crust removal and lid margin cleaning
2. Antibiotic eye ointment
Applied at lid margin after removal of crust.
Eye drops 3-4 times a day
Oral antibiotics like erythromycin or doxycycline
3. Topical steroids : fluoromethalon
4. Ocular lubricant ie artificial tear drops.
 SEBORRHOEIC OR SQUAMOUS BLEPHARITIS
Anterior blepharitis with some spill over posteriorly.

ETIOLOGY
Seborrhea of scalp

SYMPTOMS
Whitish material at lid margin
Mild discomfort
Irritation
Falling of eyelashes
 SIGNS

• Accumulation of white dandruff like scales on lid

margin
• Lashes fall out easily
• Lid margin thickned, posterior border rounded
leading to epiphora.
• Signs of bacterial blepharitis in patients with mixed
seborrhoeic and bacterial blepharitis.
 TREATMENT

• Improvement of health and balanced diet

• Treatment of seborrhoea of scalp
• Removal of scales with lukewarm solution of 3%
soda bicarb or baby shampoo.
• Application of combined antibiotic and steroid eye
ointment at lid margin.
• Antibiotics
 POSTERIOR BLEPHARITIS (MEIBOMITIS)

Meibomitis, ie. Inflammation of meibomian glands

occurs in chronic and acute forms.

Chronic meibomitis
Pathogenesis: Bacterial lipases
Symptoms : Chronic irritation
Burning
Itching
Grittiness
 SIGNS

White frothy secretions on lid margin

Opening of gland becomes prominent.
Vertical yellowish streaks shinnig through conjunctiva
Hyperemia of posterior lid margin.

Acute meibomitis
Staphylococcal infection.
Painfull swelling around the gland.
 Treatment of meibomitis

1. Lid hygiene
Warm compresses
Expression of secretions by vertical massage of lid.
2. Topical antibiotics and eye drops used 3-4 times a day.
3. Systemic tetracyclines
Doxycycline 100mg bdfor 1 week then od for 6-12wks
4. Ocular lubricants
5. Topical steroids like fluromethalon.
 PARASITIC BLEPHARITIS

ETIOLOGY
Infestation of lashes by lice.

Phthiriasis palpebrum: infestation by

phthirus pubis (crab louse)
Pediculosis : infestation by pediculus
corporis (head louse)
 CLINICAL FEATURES

chronic
irritation

Mild
lacrimation SYMPTOMS Itching

Burning
 nits (eggs)
lice on
seen on
lashes
base of cilia

lid margins
conjunctival
red and
congestion
inflamed
SIGNS
 TREATMENT
• Mechanical removal of lices and nits with
forceps
• Application of antibiotic ointmentsand yellow
mercuric oxide 1% to the lid margins and
lashes.
• Delousing of the patient , family members,
clothing and bedding is important to prevent
recurrences.
 External Hordeolum (Stye)
• Acute suppurative inflammation of glands
of Zeis or Moll .
 ETIOLOGY
Predisposing Factors :
• Common in children & young adults
• Patients with eye strain – muscle
imbalance / refractive errors
• Habitual rubbing of eyes
• Chronic blepharitis & DM
• Metabolic factors, ↑ intake of
carbohydrates & alcohol.

Causative Organism – Staph. aureus

 CLINICAL FEATURES
Symptoms

• Acute pain

• Swelling of lid

• Mild watering
 Signs
• Stage of cellulitis :
Localised, firm, red, tender swelling
at lid margin with marked oedema.

• Stage of abscess :
Visible pus point on the lid margin
in relation to affected cilia.
 TREATMENT
Hot compresses - 2-3 times a day

Evacuation of pus by pulling out the

infected cilia

Antibiotic eye drops – 3-4 times a

day & eye ointment – Bed time

Systemic anti inflammatory &

analgesis

Systemic antibiotics
 INTERNAL HORDEOLUM
 Suppurative inflammation of the
meibomian gland with blockage of the
duct.
 ETIOLOGY:
• Prediposing Factors:
Similar to hordeolum externum.
• Causative Mechanism:
Occurs as:
 Primary staphylococcal infection of
meibomian gland
 Secondary infection in a chalazion.
 CLINICAL PICTURE
• Symptoms:
• Similar to hordeolum externum,
except pain is more intense, due to
swelling embedded in dense fibrous
tissue.
• Signs:
• Maximum tenderness & swelling away
from the lid margin.
• Pus usually points on the tarsal
conjunctiva.
 TREATMENT
• Similar to externum
• When pus is formed – drained by vertical
incision from tarsal conjunctiva.
 CHALAZION
 Tarsal or meibomian cyst.
 Chronic non - infective granulomatous
inflammation of meibomian gland.
 Commonest of all lid lumps.
 Etiology
• Predisposing Factors:
Similar to hordeolum externaum

• Pathogenesis:
Pent-up
secretions
Retention of (fatty in
secretions ( nature)-
sebum) in irritant &
Proliferation the gland- excite non-
of epithelium enlargemen infective
& infiltration t. lipogranulo
Mild of wall of matous infl
infection ducts – of blocked
of blocked. m.gland
meibomia
n gland
CLINICAL PICTURE

Painless
swelling

Watering Symptoms Mild heaviness

Blurred
vision
 Signs:
• Nodule – Firm to hard & non tender on
palpation.
• Upper lid – More common (contain more
meibomian gland).
• Reddish purple area – Pal.Conjunctiva.
• Projection – Skin side.
• Marginal chalazion – Small reddish grey
nodule on lid margin.
 Clinical course & complications
 Complete spontaneous resolution occur.
 Slow increase in size.
 Fungating mass of granulation tissue
 Secondary infection – formation of
hordeolum internum.
 Calcification
 Malignant change – meibomian gland
carcinoma. (elderly pepole).
Conservative treatment – Hot
fomentation, topical antibiotic eye drops
& oral anti inflammatory drugs.
Intralesional injection of long acting
steroid (triamcinolone).
Diathermy
Oral tetracycline – Prophylaxis (if
ass.acne rosacea).
Incision & Currettage