Ophthalmology · MU Sofia

32. Inflammatory diseases of the eyelids* (Blepharitis alot)

Covers the main inflammatory disorders of the eyelid margin, taking seborrhoeic blepharitis, ulcerative blepharitis, meibomitis, stye, chalazion, internal hordeolum and molluscum contagiosum in turn. For each it gives the cause, the typical signs and complications, and the treatment, with the stye and chalazion entries also noting how the stages of stye progress. Six illustrations accompany the entries.

Inside: 1 section · 6 labelled pictures · 16 flashcards · 3 min

Topic 32 of 91 in the MU Sofia syllabus for Ophthalmology (Medicine, Year 4). The free AceMed note covers it in 1 section, about 389 words (3 min of reading), with 16 flashcards.

In this note

  1. Inflammatory disorder of eyelids

Inflammatory disorder of eyelids

Inflammation of lid margins, extremely common

a) Seborrhoeic/squamous (dandruff)

  • Zeis glands excess neutral lipids à irritating FFA by Corynebacterium acne , no ulcers
  • Whitish material deposition at margin , treated with removal of scales+ antibiotic & steroid ointment

b) Ulcerative blepharitis

  • By staphylococcal infection ,starts in childhood and may continue throughout life
  • Chronic irritation, itching, glued cilia; worse in morning
  • Yellow crust at root of cilia (glue), small ulcers bleed easily and in between the crusts à dilated blood vessels
  • Lead to: conjunctivitis, absence of lashes, greying of lashes ,thickening of lid margin & epiphora as punctum eversion
  • Removal of crust after softening &hot compress with 3 % solution sodium bicarbonate + antibiotic ointment immediately (twice) + eyedrops 3-4 + no rubbing

c) Meibomitis (posterior blepharitis)

  • Chronic Meibomitis (meibomian gland dysfunction)
  • White frothy secretion of the margins + canthi
  • Yellowish streaks shining through conjunctiva +thick secretions; acute type due to staphylococcal
  • Vertical lid massage + antibiotic steroid ointment+ antibiotic eye drop 6-12 weeks systemic tetracyclines/erythromycin

d) Stye (external hordeolum) (staph aureus if agent )

  • Acute suppurative inflammation of Zeiss or Moll
  • More in children/young,+ too much rubbing+ excessive intake of carbs+alcohol
  • Acute pain +swelling of lid+mil watering photophobia
  • Usually ;multiple possible ,cellulitis stage (localised, red, hard & tender swelling ) abscess stage (pus visible)
  • 2-3 hot compress against cellulitis + removal of pus+ antibiotic drops +anti-inflammatory + pain killers

e) Chalazion

  • =tarsal or meibomian cyst , non-infective granulomatous inflammation of the meibomian gland
  • Aetiology: like stye
  • Retention of secretion causing enlargements and act like an irritant & excite granulomatous inflammation of gland
  • Painless& hard swelling away from lid margin
  • If inverted ,red ,purple or grey area ; multiple frequent
  • Rarely spontaneous resolution thus increase in size and can press on cornea causing astigmatism and blurred vision , eversion of punctum à epiphora Secondary infectionà hordeolum internum Malignant change (elderly), calcification (rarely)
  • Incision (anaesthesia)& removal & diathermy if marginal

f) Internal Hordeolum

  • Staphylococcal infection of meibomian (primary or secondary)
  • Similar to hordeolum externum but pain more intense
  • DD: point of maximum tenderness away from margin + pus on the conjunctiva side when lid flipped à yellowish area
  • Treated like Styes ; but drainage by incision at conjunctiva

G) Molluscum contagiosum

  • Viral infection by poxvirus
  • Multiple lesions ,pale, waxy, with umbilicus in middle and location is over skin near lid margin

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