Blepharitis - Essay Example

Blepharitis Definition Inflammation of the eyelids is known a blepharitis. This condition leads to irritated and itchy red eyelids and also dandruff-like scales on the eyelashes (American Optometric Association, 2008). Anatomically, blepharitis can be divided into two types: 1. Anterior blepharitis: The inflammation is mainly seen around the eyelashes and follicles. It is commonly caused due to dandruff of the scalp and eyebrows or due to infections of certain bacteria like staphylococcus (American Optometric Association, 2008). 2. Posterior blepharitis. The inflammation is mainly seen in the meibomiam glands due to irregular oil production. Posterior blepharitis is common in many conditions like scalp dandruff and acne rosacea (American Optometric Association, 2008). Etiology Blepharitis involving the skin and lashes is most likely to be staphylococcal and /or seborrheic. Meibomiam gland blepharitis is either obstructive, seborrheic or mixed (Jackson, 2008). Certain diseases may cause blepharitis. These include herpes simplex dermatitis, rosacea, molluscum contagiosum, varicella-zoster dermatitis, contact dermatitis, seborrheic dermatitis, Sjogren syndrome and staphylococcal dermatitis. Chronic exposure to smoke, chemical fumes, smog and other irritants may lead to chronic blepharitis (Lowery, 2006). Pathophysiology The pathophysiology of blepharitis is quite complex and is multifactorial. Abnormal lid-margin secretions, infections and infestations of the lid margins and dysfunction of the precorneal tear film contribute to the development of blepharitis (Jackson, 2008) Differential diagnosis Symptoms and signs of blepharitis mimic those of many other conditions like preseptal cellulitis, chalazion, viral conjunctivitis, bacterial conjunctivitis, contact lens complications, dry eye syndrome, trichiasis, ocular rosacea, sicca keratoconjunctivitis, bacterial keratitis, atopic keratoconjuctivitis and hordeolum (International Council of Ophthalmology, 2009). Diagnosis Since there are many conditions which can cause red eye and irritation, diagnosis of blepharitis can be made only by comprehensive ophthalmic examination involving evaluation of the eyelids and also the front of the surface of the eyeball. History should include ocular symptoms and signs and their duration, time of the day when the symptoms are worse, general health problems which can contribute to this condition, conditions which aggravate the symptoms, current medications, previous history of ocular diseases and their management and exposure to scalp and eye infections. Examination of the eye must include visual acuity and examination of the skin of the eyelids and the eyelids. Also, a slit lamp biomicroscopy examination of the anterior and posterior eyelid margins, tear film, eyelashes, tarsal and bulbar conjunctivae and the cornea must be done. Intraocular pressure must also be measured. Diagnosis is mainly based on examination. Further investigations may be needed in difficult cases. Culture of the pus from the eyelashes must be done in recurrent blepharitis or in cases not responding to routine treatment. In marked asymmetry of the eyelid, carcinoma may be suspected and biopsy is indicated. Biopsy is also indicated in recurrent chalazia (International Council of Ophthalmology, 2009). Treatment Initial treatment of blepharitis includes warm compresses and hygiene of the eyelid. Heat fomentation to eyelid glands enhances evacuation of secretory passages of the glands. In staphylococcus blepharitis, topical antibiotic like erythromycin must be prescribed and directed to apply once or more times preferably at bed time on the eyelids for atleast a week. Recent reports suggest the efficacy of azithromycin over erthromycin in the treatment of chronic mixed anterior blepharitis (John and Shah, 2008) and posterior blepharitis (Luchs, 2008). In posterior blepharitis and in cases where initial treatment is not responsive, oral tetracyclines are indicated. For inflammation of the eyelids and ocular surface, topical corticosteroids are helpful (International Council of Ophthalmology, 2009). Rarely tear film dysfunctions can arise which may prompt the use of artificial tear solutions and tear ointments. For those with seborrheic dermatitis antidandruff shampoo may help. Temporary discontinuation of contact lens and eye make-up is essential for effective treatment. Follow-up is necessary to look for resolution of inflammation. Evaluation during follow-up includes interval history, assessment of visual acuity, external examination and also slit-lamp biomicroscopy. Patients on corticosteroids must be evaluated for response, intraocular pressures and compliance (International Council of Ophthalmology, 2009). Role of ophthalmic nurse Ophthalmologic nurses have an important role in the management of blepharitis. Since nurses have a closer relationship to patients, counseling by them is more effective. Counseling in blepharitis cases must include educating the patients about hygiene of the eye, how fomentation must be done and how to recognize recurrence and chronicity and report to the ophthalmologist. The nurses must teach the patients how to apply fomentation. Patients must be directed to soak clean cloth pieces or gauze or even cotton in warm water for compression. The fomentation must be applied on the closed eyes. Even dry fomentation is useful. Patients must be advised to repeat fomentation many times a day. The eyelid margins must be washed mechanically many times a day to remove crust material adherent to the eyelashes. Washing of the eyes must be done after washing the hands properly. Warm water with a small amount of non-irritating shampoo can be used for cleaning. A clean cloth (different one for each eye) must be used to rub the cleansing solution back and forth across the eyelashes on the eyelids. Patients must also be educated that symptoms can only be frequently improved and treatment with fomentation and eyelid hygiene must be continued long term to prevent recurrence (International Council of Ophthalmology, 2009). Prognosis The overall prognosis for blepharitis is good to excellent. This condition is more a symptomatic affliction than a true threat to health. References American Optometric Association. (2008). Blepharitis. Retrieved on 13th Feb, 2009 from http://www.aoa.org/Blepharitis.xml International Council of Ophthalmology. (2009). International Clinical Guidelines: Blepharitis (Initial and Follow-up Evaluation). Retrieved on 13th Feb, 2009 from http://www.icoph.org/guide/guideble.html Jackson, B.W. (2008). Blepharitis: current strategies for diagnosis and management. Can J Ophthalmol 43(2), 170- 179. John, T. and Shah, A.A. (2008). Use of azithromycin ophthalmic solution in the treatment of chronic mixed anterior blepharitis. Ann Ophthalmol (Skokie) 40(2), 68-74. Lowery, R.S. (2006). Blepharitis, Adult. Emedicine from WebMD. Retrieved on 13th Feb, 2009 from http://emedicine.medscape.com/article/1211763-overview Luchs, J. (2008). Efficacy of topical azithromycin ophthalmic solution 1% in the treatment of posterior blepharitis. Adv Ther. 25(9), 858-70. Read More