Transcript Diseases of Lids

Blepharitis is chronic inflammation
of lid margin occurring as true
inflammation or as simple
hyperaemia.
(Very common cause of ocular discomfort and irritation)
1. Anterior
a. Squamous
b. Ulcerative
2. Posterior
a. Meibomian seborrhoea
b. Meibomianitis
(Conditions overlap with each other)
1.
2.
Following chronic Conjunctivitis
especially due to staphylococci
Phthiriasis Palpabrarum due to crab
louse
(Poor correlation between signs and symptoms, uncertain
etiology and mechanism)
 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.
 Condition
is metabolic associated
with dandruff of the scalp
 Usually
associated with seborrhoeic
dermatitis involving scalp,
nasolabial folds and retroauricular
areas
 Burning,
grittiness , redness of lid
margins, mild photophobia
 Symptoms
are worse in the
morning
(Remissions and exacerbations)
Skin and Scalp condition also requires
treatment.
1. Lid Hygiene
2. Hot compresses
3. Topical Antibiotics
4. Oral Azithromycin 500 mg daily for 3 days
5. Weak topical steroids (Flourometholone)
6. Tear Substitutes


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 scalesCollarettes) matting eyelashes.
 On removal of discharge small ulcers which
bleed are found along lid margins around
bases of the eyelashes

 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
 Discharge/
crust is removed from lid
margins with 1:4 dilution baby
shampoo or luke warm 3% soda
bicarbonate lotion. The loose discharge
is then cleaned cotton
 Diseased
eyelashes are epilated
 Appropriate
used
 After
antibiotic drops are
control of infection, daily
cleaning of lid margins with
blend lotion
 Improvement
of local hygiene (rubbing
of eyes and touching of eyes with dirty
hand should be discouraged)
 Chronic
course and associated
chronic conjunctivitis & Marginal
Keratitis
 Madarosis (Scanty eyelashes)
due to falling of eyelashes
 Poliosis (Whitening)
 Trichiasis
(misdirected eyelashes)
due to contraction of scar tissue
 Cicatrization
of lid margins causing
thickening and hypertrophy of
tissue and drooping of lids (Tylosis)



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
 Posterior
blepharitis i.e.
inflammation of meibomian
duct opening at intermarginal
strip and posterior border may
cause tear film instability and
inferior punctate keratitis
 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
 Caping
with Oil globules
 Plugging
 Hyperemia
 Teengiectasis
It occurs in two clinical forms
1. Meibomian
seborrhoea
2. Meibomianitis
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
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
 Chalazion
 Tear
film instability
 Papillary conjunctivitis and
inferior corneal erosions
 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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