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Blepharitis @ Contact lenses
Introduction• Blepharitis is inflammation or infection of the
eyelid margins .
• Blepharitis is one the most common ophthalmological complications as well as one of the most difficult conditions to treat.
BlepharitisBlepharitis is a common eyelid inflammation that
sometimes is associated with a bacterial eye infection, symptoms of dry eyes or certain types of
skin conditions such as acne rosacea.
Blepharitis is one of the most frequently observed conditions among eye care practitioners, yet remains largely misunderstood.
SLIT-LAMP BIOMICROSCOPY
The slit-lamp biomicroscope is animportant diagnostic instrument forthe examination of the anterior eyestructures as well as the contact lens.
Being able to proficiently use the instrument is important. It usecritical in the fitting of contactlenses.
CLASSIFICATION I will discuss blepharitis according to
its predominant anatomic location, as :
anterior posterior
1 .Anterior• Staphylococcal• Seborrhoeic
• Meibomianitis• Meibomian seborrhoea
2 .Posterior
CHRONIC MARGINAL BLEPHARITIS
Staph Blepharitis
Anterior blepharitis
Anterior blepharitis is characterized by inflammation at the base of the eyelashes .
Patients with anterior blepharitis, compared to those with posterior blepharitis, are more likely to be female and younger *
Two variants of anterior blepharitis are identified: staphylococcal and seborrheic.
In staphylococcal anterior blepharitis, colonization of the eyelids by staphylococci leads to formation of fibrinous scales and crust around the eyelashes.
The seborrheic variant is characterized by dandruff-like skin changes around the base of the eyelids, resulting in greasy scales around the eyelashes.
PATHOPHYSIOLOGY The pathophysiology of blepharitis is not completely understood.
A role for lid-colonizing staphylococcal bacteria was first noted in 1946 . Several mechanisms by which staphylococci may alter meibomian gland secretion and cause blepharitis are supported by many studies .
Direct infection of the lids Evoke reaction to staphylococcal exotoxin Provoke allergic response to staphylococcal antigens . It is likely that a combination of these is responsible for the
clinical manifestations of staphylococcal blepharitis.
CLINICAL PRESENTATION symptoms burning , grittiness and mild photophobia with
remission and exacerbation is characteristic .
Symptoms are usually worse in the morning , although in patients with dry eye they may increase during the day .
signsA. Staphylococcal blepharitis
Hard scales and crusing mainly located around the bases of the lashes esp. collorette
chronic conjunctival hyperemia with mild papillary conjunctivitis .
Staphylococcal blepharitis
• Hyperaemia and telangiectasia of anterior lid margin • Scarring and hypertrophy
if longstanding
• Scales around base of lashes ( collarettes)
• Chronic irritation worse in morning
Cont. Signs of Staphylococcal blepharitis
scarring and notching (tylosis) of the lid margintrichiasis (misdirected eyelashes) madarosis (loss of lashes) or poliosis (loss of pigmentation of lashes) in
sever long standing cases
Cont. Signs of Staphylococcal blepharitis
secondary changes include : stye formation marginal keratitis and occasionally
phlyctenulosis (Corneal nodulesthat developed near the limbus and then spread onto the cornea, carrying behind them a leash of vessels)
associated with tear film instability and dry eye .
Cont. Signs of Staphylococcal blepharitis
The diagnosis of blepharitis is clinical, based on the patient's history and physical examination findings. There are no confirmatory diagnostic tests or laboratory investigations.
The history should include questions about symptom duration, smoking, allergens, contact lenses, and use of retinoids which may provoke or exacerbate symptoms. A history of acne, rosacea, or eczema should be evaluated .
DIAGNOSIS
EXAMINATION OF THE TEAR FILMBubbles, also called frothing, can sometimes be seen in the tearfilm, especially along the lid margins. This can indicatemeibomianitis.
The lashes should be examinedfor abnormalities such blepharitis.With blepharitis there will becollarettes found at the base ofthe lashes.
Plugged gland
• Burning• Flaking• Crusting• Tearing• Irritation• Itching• redness • Foreign body sensation
• bulbar and palpebral hyperemia
Treatment for Blepharitis
Anterior Blepharitis• staphylococcal blepharitis more severe loss of eyelasheseyelid cleansing and hygieneantibiotic ointment for eyelids Viruses and other types of
bacteria besides staphylococcus also can cause anterior blepharitis
• Seborrheic blepharitis seborrheic dermatitisRegular cleansing with eyelid
scrubs and gentle, non-detergent shampoos
Without treatment: blepharitis caused by bacteria can cause
long-term effects such as ectropion, thickened lid margins, dilated and visible
capillaries, trichiasis and entropion. In cases of trichiasis and entropion, the
cornea may exhibit significant erosion from eyelashes rubbing against the eye.
Eyelid Hygiene Relieves Blepharitis Symptoms
Blepharitis can be difficult to manage because it is often chronic, meaning that it never warm compress goes away completely. Your eye doctor may recommend one or more of these steps involving good eyelid hygiene and massage:
Apply a such as a washcloth to the outer eyelids. Cleanse the eyelids with a commercial lid scrub or other
recommended product. Gently massage the outer eyelids. A warm compress loosens the crust on your eyelids and eyelashes
before you clean them. The warmth also can loosen any blocked residue in the oil-secreting meibomian glands in your eyelids
Does blepharitis cause Contact lens intolerance?
If you wear soft contact lenses, your eye doctor may prescribe RGP contacts instead or may recommend more frequent replacement of your soft contacts to reduce lens deposits that may be associated with your blepharitis.
Depending on the severity of your symptoms, you may need to discontinue contact lens wear altogether for a while.
According to recent research
People With Blepharitis More Likely to Have Certain
Inflammatory Diseases
Psychological Issues
Cardiovascular Diseases and More
Thank you
