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CASE REPORT BY

ASHISH CHAUDHARI

8/27/2015

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Age : 25 yearsSex : FemaleLocation : Chennai

Chief Complaints:BE: c/o itching, irritation, redness and sore eyelids× 18 monthsBE: c/o crusty eyelids with the loss of eyelashes BE: c/o difficulty in opening of eyelids after waking up and worsens in the morning associated with blur visionNo h/o headache

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Previous ocular history: No h/o glasses No h/o surgery No h/o trauma

Family History : Not contributoryGeneral health : NormalRecent investigation : NilCurrent treatment : Over the counter drug – Chloramphenicol eye dropAllergies : Not aware of any

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Visual Acuity TestDistance vision @ 6m U/A Near vision with (Snellen chart) (continuous text chart)U/ARE:6/9,PH:6/6 RE:N6 @ 40 cmLE:6/9 ,PH:6/6 LE:N6 @ 40 cmBE:6/6

EOMBE: SAFE No pain

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PUPILSBE:PERRLA No RAPD

Cover testDistance and Near – Ortho

HIRSCHBERG TESTOrtho

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SLIT LAMP EXAMINATION

Corneal erosion

Yellow crust

Conjunctiva normal

Pupils normal

RE LE

Eyelashes (madarosis, trichiasis)

ACD Normal

Eyelashes( madarosis, trichiasis)

Lens normal Lens normal

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DiagnosisAnterior blepharitisADVICE

- T. Doxycycline 200mg stat, then 100mg for 2 week - Eye drops sodiumacetamide sodium and prednisolone acetate - Eye ointment Erythromycin (0.5%) in the lid margin qid for 2 weeks - T. Vitamin C-twice a day, for 2 weeks - instructed for swab test #Follow up after two weeks

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Follow up• Swab test Causative agent : staphylococcus aureus infection

• DIAGNOSISStaphylococcal blepharitis

• AdviceContinue same medicine for two weeks

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BLEPHARITIS• Chronic inflammation of lid margins• Extremely common disease causes mostly to females and youngersSYMPTOMS• Irritation, itching, sore and red eyelids• Lacrimation• Crusty eyelashes• Gluing of cilia• Mild photophobia• Loss of eyelashes• Blurred vision occurs

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TYPES• Anterior blepharitis -Staphylococcal blepharitis -Seborrhoeic or squamous blepharitis • Posterior Blepharitis -Meibomian seborrhoea -Meibomianitis• Parasitic blepharitis(lash infestation)

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ANTERIOR BLEPHARITISStaphylococcal Blepharitis• Chronic infection in the anterior part of lid margin• Also called Bacterial blepharitis or ulcerative blepharitisCausative Agents• Staphylococcus aureusSigns• Yellow crust• small ulcers, bleeding on removal of crust• hyperaemia• Lash abnormalities

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Crusty lids

Trichiasis

Madarosis

Poliosis

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SEBORRHOIEC BLEPHARITIS• Usually associated with seborrhea of scalp (dandruff)• Cornynebacterium acne splits into the irritating fatty acidsSIGNS• Accumulation of white dandruff in the lid margin among the eyelashes• Thickening of lid margin

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Dandruff

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POSTERIOR BLEPHARITIS• inflammation of the meibomian glands.1. Meibomian seborrhea• Excessive secretion of meibomian gland• Oily and foamy tear film with accumulation of froth in the lid margin

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Frothy (foam like)secretion

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2. Meibomianitis• Inflammation and obstruction of the meibomian gland• Hyperemia , telangiectasia and cystic dilation of the meibomian ducts.• Thick secretions is expressed out on the lids giving toothpaste

appearance.

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Toothpaste appearance

Blocked meibomian gland

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COMPLICATIONS• Lash abnormalities-Madarosis, trichiasis, poliosis• Tylosis• Eczema and ectropion• Recurrent styes• Marginal keratitis• Tear film instability• Secondary changes in conjunctiva and cornea• Red and thickened lid margins with dilated blood vessels (rosettes)• Mild papillary conjunctivitis

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TREATMENT• Avoid rubbing of the eyes • Warm compress for 5-10 minutes• Crust removal and lid cleaning with a diluted baby shampoo or 3% of sodium

bicarbonate• Antibiotic - Eye ointment Erythromycin - Eye drops sodiumacetamide sodium and prednisolone acetate - T. Doxycycline - Minocycline 100 mg • Topical steroids-Fluoromethanolone• Tear drops for instability and dry eye

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THANK YOU