Blepharitis: Difference between revisions
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==Background== | ==Background== | ||
*Inflammation of eyelids | |||
*Acute (ulcerative or nonulcerative) | |||
**Usually bacterial (typically [[staph]]), less often viral ([[VZV]], [[herpes]]) | |||
*Chronic (meibomian gland dysfunction, seborrheic blepharitis) | |||
==Clinical Features== | ==Clinical Features== | ||
*Sore/itchy | *Sore/itchy | ||
*Inflammation of lid margin with ocular irritation, matted lashes | *Inflammation of lid margin with ocular irritation, matted lashes | ||
*Blurry vision | *[[blurred vision|Blurry vision]] | ||
*Tearing | *Tearing | ||
*Crusting at the lid margins | *Crusting at the lid margins | ||
*Distinguish anterior from posterior blepharitis using slit lamp | *Distinguish anterior from posterior blepharitis using slit lamp | ||
**Posterior - swelling and | **Posterior - swelling and plugging of meibomian gland openings | ||
**Anterior - on external exam, material such as greasy flakes (seborrheic) or hard crust (staph) surrounds eyelashes | **Anterior - on external exam, material such as greasy flakes (seborrheic) or hard crust (staph) surrounds eyelashes | ||
Revision as of 16:01, 5 October 2019
Background
- Inflammation of eyelids
- Acute (ulcerative or nonulcerative)
- Chronic (meibomian gland dysfunction, seborrheic blepharitis)
Clinical Features
- Sore/itchy
- Inflammation of lid margin with ocular irritation, matted lashes
- Blurry vision
- Tearing
- Crusting at the lid margins
- Distinguish anterior from posterior blepharitis using slit lamp
- Posterior - swelling and plugging of meibomian gland openings
- Anterior - on external exam, material such as greasy flakes (seborrheic) or hard crust (staph) surrounds eyelashes
Differential Diagnosis
Periorbital swelling
Proptosis
- Normal IOP
- Orbital cellulitis
- Orbital pseudotumor
- Orbital tumor
- Increased IOP
- Retrobulbar abscess
- Retrobulbar emphysema
- Retrobulbar hemorrhage
- Ocular compartment syndrome
- Orbital tumor
No proptosis
- Periorbital cellulitis/erysipelas
- Dacryocystitis (lacrimal duct)
- Dacryocele/Dacryocystocele
- Dacryostenosis
- Dacryoadenitis (lacrimal gland)
- Allergic reaction
- Nephrotic Syndrome (pediatrics)
Lid Complications
- Blepharitis (crusts)
- Chalazion (meibomian gland)
- Stye (hordeolum) (eyelash folicle)
Other
- Subperiosteal abscess
- Orbital abscess
- Cavernous sinus thrombosis
- Conjunctivitis
- Contact dermatitis
- Herpes zoster
- Herpes simplex
- Sarcoidosis
- Granulomatosis with polyangiitis
Evaluation
- Clinical diagnosis
Management
- Lid hygiene most important for both anterior and posterior blepharitis
- Avoid eye-makeup
- Warm compresses 15min 4x/day
- Scrub with mild shampoo BID
- Consider topical erythromycin or bacitracin directly onto lid margin
- No conclusive evidence for oral antibiotics or topical steroids
Disposition
- Outpatient optho - chronic condition without definitive cure