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Blepharitis (Lecture)

Patient will present as → a 37-year-old male with crusting, scaling, red-rimming of the eyelid, and eyelash flaking along with dry eyes. The patient has a history of seborrheic dermatitis and rosacea.

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

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

Blepharitis: notice the inflamed, flakey eyelid

Blepharitis is a clinical diagnosis based on characteristic findings of redness and irritation of the eyelid margin associated with crusting or flakes on the lashes or lid margins

  • Slit-lamp examination allows for a more detailed examination; however, is generally not necessary to make the diagnosis.
  • Chronic blepharitis that does not respond to treatment may require a 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
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 1 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)
Question 2
Which of the following best describes the pathophysiological mechanism of anterior blepharitis?
A
Autoimmune destruction of meibomian glands
Hint:
Autoimmune destruction of meibomian glands is more indicative of conditions like meibomian gland dysfunction, not anterior blepharitis.
B
Infection of the eyelid margin by Staphylococcus species
C
Allergic reaction to environmental antigens
Hint:
Allergic reactions can cause eyelid inflammation but are not the primary mechanism of blepharitis.
D
Blockage of the lacrimal drainage system
Hint:
Blockage of the lacrimal drainage system leads to conditions like dacryocystitis, not blepharitis.
E
Degenerative changes in the tarsal plate
Hint:
Degenerative changes in the tarsal plate are not associated with blepharitis.
Question 2 Explanation: 
Anterior blepharitis is commonly caused by infection of the eyelid margin, particularly by Staphylococcus species. This leads to inflammation, redness, and irritation of the eyelid margins.
Question 3
A 35-year-old patient presents with red, irritated eyelids and flaky debris at the base of the eyelashes. Which diagnostic feature is most indicative of blepharitis?
A
Eyelid erythema and scaling at the lash base
B
Painless, firm nodule on the eyelid
Hint:
A painless, firm nodule on the eyelid is more indicative of a chalazion.
C
Outward turning of the eyelid margin
Hint:
Outward turning of the eyelid margin describes ectropion, not blepharitis.
D
Inward turning of the eyelid margin
Hint:
Inward turning of the eyelid margin is characteristic of entropion, not blepharitis.
E
Acute, localized swelling of the eyelid
Hint:
Acute, localized swelling of the eyelid is suggestive of a hordeolum (stye), not blepharitis.
Question 3 Explanation: 
Eyelid erythema and scaling at the lash base are characteristic findings in blepharitis, often accompanied by irritation and a sensation of burning or grittiness
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References: Merck Manual · UpToDate

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