Blepharitis & Meibomitis

BLEPHARITIS
It is a subacute or chronic inflammation of the lid
margins. It is an extremely common disease which
can be divided into following clinical types:
Seborrhoeic or squamous blepharitis,
Staphylococcal or ulcerative blepharitis,
Mixed staphylococcal with seborrhoeic blepharitis,
Posterior blepharitis or meibomitis, and
Parasitic blepharitis.
Seborrhoeic or squamous blepharitis
Etiology. It is usually associated with seborrhoea of
scalp (dandruff). Some constitutional and metabolic
factors play a part in its etiology. In it, glands of Zeis
secrete abnormal excessive neutral lipids which are
split by Corynebacterium acne into irritating free fatty
acids.
Symptoms. Patients usually complain of deposition
of whitish material at the lid margin associated with
mild discomfort, irritation, occasional watering and a
history of falling of eyelashes.
Signs. Accumulation of white dandruff-like scales are
seen on the lid margin, among the lashes (Fig. 14.7).
On removing these scales underlying surface is found
to be hyperaemic (no ulcers). The lashes fall out
easily but are usually replaced quickly without
distortion. In long-standing cases lid margin is
thickened and the sharp posterior border tends to be
rounded leading to epiphora.
Treatment. General measures include improvement
of health and balanced diet. Associated seborrhoea
of the scalp should be adequately treated. Local
measures include removal of scales from the lid margin
with the help of lukewarm solution of 3 percent soda
bicarb or baby shampoo and frequent application of
combined antibiotic and steroid eye ointment at the
lid margin.
Ulcerative blepharitis
Etiology. It is a chronic staphylococcal infection of
the lid margin usually caused by coagulase positive
strains. The disorder usually starts in childhood and
may continue throughout life. Chronic conjunctivitis
and dacryocystitis may act as predisposing factors.
Symptoms. These include chronic irritation, itching,
mild lacrimation, gluing of cilia, and photophobia. The
symptoms are characteristically worse in the morning.
Signs (Fig. 14.8). Yellow crusts are seen at the root of
cilia which glue them together. Small ulcers, which
bleed easily, are seen on removing the crusts. In
between the crusts, the anterior lid margin may show
dilated blood vessels (rosettes).
Complications and sequelae. These are seen in longstanding
(non-treated) cases and include chronic
conjunctivitis, madarosis (sparseness or absence of
lashes), trichiasis, poliosis (greying of lashes), tylosis
(thickening of lid margin) and eversion of the punctum
leading to epiphora. Eczema of the skin and ectropion
may develop due to prolonged watering. Recurrent
styes is a very common complication.
Treatment. It should be treated promptly to avoid
complication and sequelae. Crusts should be removed
after softening and hot compresses with solution of
3 percent soda bicarb. Antibiotic ointment should be
applied at the lid margin, immediately after removal of
crusts, at least twice daily. Antibiotic eyedrops should
be instilled 3-4 times in a day. Avoid rubbing of the
eyes or fingering of the lids. Oral antibiotics such as
erythromycin or tetracyclines may be useful. Oral
anti-inflammatory drugs like ibuprofen help in
reducing the inflammation.
Posterior blepharitis (Meibomitis)
1. Chronic meibomitis is a meibomian gland
dysfunction, seen more commonly in middle-aged
persons with acne rosacea and seborrhoeic dermatitis.
It is characterized by white frothy (foam-like) secretion
on the eyelid margins and canthi (meibomian
seborrhoea). On eversion of the eyelids, vertical
yellowish streaks shining through the conjunctiva
are seen. At the lid margin, openings of the meibomian
glands become prominent with thick secretions
(Fig. 14.9).
2. Acute meibomitis occurs mostly due to
staphylococcal infection.
Treatment of meibomitis consists of expression of
the glands by repeated vertical lid massage, followed
by rubbing of antibiotic-steroid ointment at the lid
margin. Antibiotic eyedrops should be instilled 3-4
times. Systemic tetracyclines for 6-12 weeks remain
the mainstay of treatment of posterior blepharitis.
Erythromycin may be used where tetracyclines are
contraindicated.
Parasitic blepharitis
Blepharitis acrica refers to a chronic blepharitis
associated with Demodex folliculorum infection and
Phthiriasis palpebram to that due to crab-louse, very
rarely to the head-louse. In addition to features of
chronic blepharitis, it is characterized by presence of
nits at the lid margin and at roots of eyelashes
(Fig. 14.10).
Treatment consists of mechanical removal of the nits
with forceps followed by rubbing of antibiotic
ointment on lid margins, and delousing of the patient,
other family members, clothing and bedding.