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Anatomy of Lid

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Title: Anatomy of Lid


1
Anatomy of Lid
2
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Blepharitis
4
Blepharitis
  • Blepharitis is chronic inflammation of lid margin
    occurring as true inflammation or as simple
    hyperaemia.
  • (Very common cause of ocular discomfort and
    irritation)

5
Types
  • 1. Anterior
  • a. Squamous
  • b. Ulcerative
  • 2. Posterior
  • a. Meibomian seborrhoea
  • b. Meibomianitis
  • (Conditions overlap with each other)

6
Causes
  • Following chronic Conjunctivitis especially due
    to staphylococci
  • Phthiriasis Palpabrarum due to crab louse
  • (Poor correlation between signs and symptoms,
    uncertain etiology and mechanism)

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Seborrhoeic or Squamous Blepharitis
  • Is a form of anterior blebharitis characterized
    by deposition of white scales among the eye
    lashes. Eye lashes fall and replaced by distorted
    eyelashes.
  • On removal of scales, lid margins appear
    hyperaemic. Ulcers are absent.

8
Seborrhoeic or Squamous Blepharitis
  • Condition is metabolic associated with dandruff
    of the scalp
  • Usually associated with seborrhoeic dermatitis
    involving scalp, nasolabial folds and
    retroauricular areas

9
Squamous Blepharitis
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Symptoms
  • Burning, grittiness , redness of lid margins,
    mild photophobia
  • Symptoms are worse in the morning
  • (Remissions and exacerbations)

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Seborrhoeic or Squamous BlepharitisTreatment
  • Skin and Scalp condition also requires treatment.
  • Lid Hygiene
  • Hot compresses
  • Topical Antibiotics
  • Oral Azithromycin 500 mg daily for 3 days
  • Weak topical steroids (Flourometholone)
  • Tear Substitutes

12
Staphylococcal or Ulcerative Blepharitis
  • Ulcerative blepharitis is infective condition
    commonly due to staphylococcal infection (Cell
    mediated response)
  • Lid margins are covered with infective material
    (yellow crusts or dry brittle scales-Collarettes)
    matting eyelashes.
  • On removal of discharge small ulcers which bleed
    are found along lid margins around bases of the
    eyelashes

13
Symptoms
  • Redness of lid margins, burning, itching,
    watering and photophobia
  • Signs
  • Small ulcers at lid margins on removal of
    discharge, this feature differentiate it from
    conjunctivitis

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Ulcerative Blepharitis
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Treatment
  • Discharge/ crust is removed from lid margins with
    14 dilution baby shampoo or luke warm 3 soda
    bicarbonate lotion. The loose discharge is then
    cleaned cotton
  • Diseased eyelashes are epilated

16
Treatment
  • Appropriate antibiotic drops are used
  • After control of infection, daily cleaning of lid
    margins with blend lotion

17
Treatment
  • Improvement of local hygiene (rubbing of eyes and
    touching of eyes with dirty hand should be
    discouraged)

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Sequelae of Ulcerative Blepharitis
  • Chronic course and associated chronic
    conjunctivitis Marginal Keratitis
  • Madarosis (Scanty eyelashes) due to falling of
    eyelashes
  • Poliosis (Whitening)

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Sequelae of Ulcerative Blepharitis
  • Trichiasis (misdirected eyelashes) due to
    contraction of scar tissue
  • Cicatrization of lid margins causing thickening
    and hypertrophy of tissue and drooping of lids
    (Tylosis)

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Sequelae of Ulcerative Blepharitis
  • Cicatrization of lid margin may drag conjunctiva
    on posterior border of intermarginal strip
    disturbing angle of posterior edge leading to
    epiphora , eversion of puncta
  • Epiphora leads to eczematous condition of skin,
    scarring of skin leads to ectropion . This
    further aggravate epiphora
  • Tear film instability

21
Posterior Blepharitis
  • Posterior blepharitis i.e. inflammation of
    meibomian duct opening at intermarginal strip and
    posterior border may cause tear film instability
    and inferior punctate keratitis

22
Posterior Blepharitis
  • Meibomian gland dysfunction and alterations in
    meibomian gland secretion
  • Bacterial lipases may result in the formation of
    fatty acids which may lead to increase in melting
    point of meibum

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Posterior Blepharitis
  • Caping with Oil globules
  • Plugging
  • Hyperemia
  • Teengiectasis

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Posterior Blepharitis
  • It occurs in two clinical forms
  • Meibomian seborrhoea
  • Meibomianitis

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Meibomian seborrhoea
  • 1. Meibomian seborrhoea characteristic
    appearance of oil droplet at the opening of
    meibomian duct opening at intermarginal strip.
    Tear film is oily and foamy. Frothy discharge
    accumulate on the lid margin. Foam like discharge
    can be expressed from these lesions

26
Meibomianitis
  • 2. Meibomianitis There is inflammation and
    obstruction of meibomian glands. Characterized by
    diffuse thickening of posterior border of lid
    margin which becomes rounded. On lid massage
    toothpaste like thick material can be expressed
    out. Due to duct blockade cyst formation may be
    present

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Complications
  • Chalazion
  • Tear film instability
  • Papillary conjunctivitis and inferior corneal
    erosions

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Treatment
  • Warm compresses
  • Systemic - Doxycycline 100 mgm twice x 1 week
    then once daily for 6 -12 weeks or Tetracycline
    250 mgm 4 times x 1 week then twice for 6 -12
    weeks
  • Associated tear film abnormality is treated with
    artificial tear drops

30
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