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blepharitis

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blepharitis / dry eyes

blepharitis

  • blepharitis is inflammation of the eyelids which is the main cause of dry eyes accounting for over 80% of cases
  • anterior blepharitis involves the skin, eyelashes and lash follicles
  • posterior blepharitis involves meibomian glands and orifices, tarsal plate, and blepharo-conjunctival junction
  • it may be due to auto-immune conditions, but mostly it appears to be due to colonisation with bacteria which is more likely when there is dermatologic conditions such as dermatitis
  • chronic inflammation may result in:
    • trichiasis
    • notching entropion
    • ectropion
    • keratitis with secondary corneal scarring, astigmatism, impaired vision, and if severe, can result in corneal perforation

aetiology

    • involves meibomian glands in 90% of ocular cases, and if untreated, may result in chalazia, keratitis, episcleritis or anterior uveitis
    • most common in 40-80yr olds but can arise in younger patients
    • 10% of population develop rosacea and of these, 60% develop ocular rosacea
  • seborrhoeic dermatitis - especially in those over 50yrs
  • dry eye syndromes such as:
  • chalazion
  • trichiasis
  • ectropion
  • entropion
  • conjunctivitis
  • keratitis

Rx

  • as blepharitis is a chronic condition, treatment needs to be long term and continued even when there is improvement
  • patients with dry eyes may benefit from use of artificial tears
  • graded Rx starting with:
    • eyelid hygiene
      • twice daily warm compresses placed over closed eyes for 5-10 minutes (esp. if posterior)
      • eyelid cleansing and massage after their evening warm compress - massage with no-tears baby shampoo or eyelid wipes
    • consider 2 week bd trial of topical antibiotics if anterior symptoms, either:
      • erythromycin ointment
      • azithromycin solution
    • consider oral antibiotics if posterior symptoms or ocular rosacea
      • oral azithromycin 1 g each week for 3 weeks every 3-4 months
    • consider omega 3 acids
      • two 1g tablets tds appears to improve symptoms
    • consider topical tea tree oil scrubs
    • severe cases may need topical steroids / cyclosporine as per ophthalmologist opinion
blepharitis.txt · Last modified: 2017/07/07 17:55 (external edit)