PANCE Blueprint EENT (7%)

Blepharitis (Lecture)

Patient will present as → a 34-year-old female with crusting, scaling, red-rimming of eyelid and eyelash flaking along with dry eyes. The patient has a history of seborrhea and rosacea.

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Chronic inflammation of the eyelids without mass and without significant pain, caused by dysfunctional meibomian gland or staph infection

  • Associated with with seborrhea and rosacea
  • Crusty eyelids in the AM

Blepharitis: notice the inflamed, flakey eyelid

Slit-lamp examinationDiagnosis is usually by slit-lamp examination

  • Chronic blepharitis that does not respond to treatment may require biopsy to exclude eyelid tumors that can simulate the condition

Treat with warm compresses, irrigation, lid massage, and topical antibiotics for flare ups

  • Daily lid wash with baby shampoo
Question 1
A 37 year old male presents with itching and redness at the base of his eyelids. On examination you find scaley patches and red skin at the naso-labial folds. What is the most likely diagnosis?
A
Ectropion
Hint:
ectropion occurs when the eyelid turns outward exposing the palpebral conjunctiva, conjunctiva will appear red from air exposure and inflammation
B
Orbital cellulitus
Hint:
Patient will present with decreased extraocular movement, pain with movement of the eye and proptosis.
C
Pterygium
Hint:
Patient will present with an elevated, superficial, fleshy, triangular-shaped “growing” fibrovascular mass (most common in inner corner/nasal side of they eye).
D
blepharitis with seborrheic dermatitis
Question 1 Explanation: 
A patient with blepharitis will present with eyelid changes that include crusting, scaling, red-rimming of eyelid and eyelash flaking. It is associated with with seborrhea and rosacea.
Question 2
The underlying pathology causing blepharitis is
A
A dysfunction in the meibomian glands
B
Impaired aqueous outflow through the trabecular meshwork
Hint:
This is the cause of glaucoma
C
Infectious obstruction of the nasolacrimal gland
Hint:
This is the cause of dacrocystitis
D
Inflammation or infection of the outer membrane of the eyeball and the inner eyelid.
Hint:
This is the description of conjunctivitis (pink eye)
Question 2 Explanation: 
Blepharitis is caused by the oil glands at the base of the eyelashes (meibomian glands) becoming clogged, a bacterial infection, allergies, or other conditions.
Question 3
The treatment of choice for blepharitis includes:
A
Antibiotic ointment (eg, bacitracin/polymyxin B, erythromycin, or gentamicin 0.3% qid for 7 to 10 days)
B
Warm compresses over the closed eyelid
C
Tear supplements during the day
D
Gentle cleansing of the eyelid margin 2 times a day with a cotton swab dipped in a dilute solution of baby shampoo (2 to 3 drops in ½ cup of warm water)
E
all of the above
Question 3 Explanation: 
Chronic disease is treated with tear supplements, warm compresses, and occasionally oral antibiotics (eg, a tetracycline) for meibomian gland dysfunction or with eyelid hygiene and tear supplements for seborrheic blepharitis. Gentle cleansing of the eyelid margin 2 times a day with a cotton swab dipped in a dilute solution of baby shampoo (2 to 3 drops in ½ cup of warm water)
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Lid disorders (PEARLS) (Prev Lesson)
(Next Lesson) Chalazion (Lecture)
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