Download Ophthalmic Blepharitis- : A Short Note

Vinod Singh et al., Guru Drone Journal of Pharmacy and Research, 2013;1(1):1-6
Ophthalmic Blepharitis- : A Short Note
Vinod Singh1*, Rizwan Ahmad2, Mamta Farswan Singh3
1
Gurukul Kangri University, Haridwar, Uttarakhand. (India)
2
Oman Medical College, Sohar, (Oman)
3
SBS PG Institute of Biomedical Sciences & Research, Dehradun, Uttrankhand.(India)
Received: 10.10.2013
Accepted:20.11.2013
Abstract:
Blepharitis is a non-specific term to describe an array of inflammatory conditions involving the
eyelid margin, and it is often overlooked. This may be attributed to its complex and
multifactorial nature, the lack of an uncomplicated and formal definition. In Blepharitis, there
is formation of scars, scales or greasy stakes at hair follicles of eyelids. Blepharitis affects the
lid margins, the lash follicles, or the openings of the meibomian glands, can occur as either an
acute or a chronic condition. It can affect vision by disrupting the surface of the cornea and the
bulbar conjunctiva and may influence tear film composition. Despite of the high extreme of
this disease, it has been poorly understood clinical entity and considered as a challenge for
pharmaceutical scientists.
Keywords: blepharitis, eye crusts, inflammation, eye redness.
Introduction
The eye is a unique window into health. It’s the only
place in the body where, without surgery, we can look
in and see veins, arteries, and a optic nerve. The eyes’
transparency explains why common eye diseases such
as glaucoma, cataracts, and macular degeneration can
be detected early with regular eye exams.
Unfortunately, people get busy and delay not only eye
exams but regular physicals. That’s why eye doctors
sometimes discover other issues, like diabetes or high
blood pressure, People like caregivers, who worry
about others around them while neglecting care for
themselves.
Blepharitis is a chronic inflammation of the eyelid
margins. It begins early in the childhood and frequently
continues throughout life. Blepharitis is a descriptive
term that refers to a group of disorders that produces
inflammation of the lid margin and associated adnexal
structures. It usually involves the eyelids and eyelashes.
It can also include the glands that lubricate the lid, and
the white area of the eye.
Blepharitis affects the lid margins, the lash follicles, or
the openings of the meibomian glands, can occur as
either an acute or a chronic condition. It can affect
vision by disrupting the surface of the cornea and the
bulbar conjunctiva and may influence tear film
composition.
Blepharitis is a complicated, chronic condition that may
be difficult to treat and can have an early onset with
periods of remission and exacerbation. Even with an
accurate diagnosis, the absence of a consensus on
treatment may impact the progression, severity, and
prognosis of the disease. Management of blepharitis can
vary; however, treatment generally is comprised of both
a pharmacological and a non pharmacological
component.
Despite of the high extreme of this disease, it has been
poorly understood clinical entity and considered as a
challenge for pharmaceutical scientists. It has been well
established that microorganisms play a significant role
in the pathogenesis of blepharitis.1-7
Corresponding author: Dr. Vinod Singh, Department of Pharmaceutical Sciences, Gurukul Kangri University,
Haridwar, Uttarakhand. (India), Mobile: +91-9412070199, E-mail: [email protected]
1
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Figure 1. Comparision depicting blepharitis and
normal eye condition
Figure 2. Scalp/ Crusts formation at eyelids
A feeling that something is in the eye. This can
cause itching, burning, redness, and swelling of the
lid. May also have tearing and be sensitive to
bright light.
- Irritation in eye was observed if flakes from the lid
fall into the eye.
- Eyelashes may fall out, Formation of ulcers may
take place. (Figure 4)
Frequent signs and symptoms
-
On the eyelid, small sores may grow. Crusts may
form on the edges of the eyelid (Figure 1 and 2).
- On the eyelid edges, redness and greasy flakes was
observed (Figure 3)
- During sleep, discharge from the lid can be
observed. Lids may be stuck together in the
morning.
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Figure 3. Greasy Flakes on the eye lid
Causes
Figure 4. Presence of ulcers in blepharitis
Risk of blepharitis increases with some factors
Seborrheic blepharitis is caused by a skin condition
called seborrhea. It is similar to dandruff.
- Bacterial infection of the eyelash follicles and the
glands that lubricate the eye. The infection cannot
be spread from one person to another.
- Plugged glands on the eyelid may increase chances
of blepharitis.
- Allergies or lice in the eyelashes may cause
blepharitis.
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Skin Infection or Dermatitis of the scalp and other
body parts.
Exposure to allergens.
Exposure to environmental irritants, such as smoke
or smog.
Dirty hands for most of the day may increases the
chances of blepharitis.
Advanced or older age.
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Vinod Singh et al., Guru Drone Journal of Pharmacy and Research, 2013;1(1):1-6
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blepharitis. Patients complains of burning sensation of
eyes just after waking up called chronic conjunctivitis
meibomiana. In some cases, meibomian froth, which
arises from agitation of the oily secretion by blinking is
present on the lid margins.
Acne rosacea.
Over years, several classification schemes for
categorizing different types of blepharitis have been
proposed. In 1946, Thygenson divided blepharitis into
three etiologic types based on distinct clinical
characteristics: Staphycoccal, seborreic, diplobacillary
blepharitis8. McCulley et al introduced a more elaborate
classification scheme based on the characteristics of
eyelid, lashes, hair follicles, meibomian orifices, debris
on the lid margin and corneal changes. In the McCulley
classification, Blepharitis is subdivided into six groups:
Staphylococcal blepharitis, Sborrheic alone, Seborrheic
with staphylococcal , Seborrheic with Meibomian
seborrhea, seborrheic with secondary meibomitis, and
primary meibomitis9.
Wilhelmus has described a clinically approach for
evaluating blepharitis based on an anatomic delineation
of lid margin according to the gray line. The gray line (
muscle of riolan) divides the lid into an anterior lamella
( skin and muscle) and a posterior lamella ( tarsus and
conjunctiva). The eyelash follicles and associated
glands of Zeiss are part of anterior lamella and
meibomian glands are part of posterior lamella.
Wilhelmus divided into two general categories:
Anterior lid margin and posterior lid margin10.
3. Seborrheic/Staphylococcal Blepharitis
Also referred to as ulcerative or mixed blepharitis, it is
the least common form of blepharitis and is
characterized by secondry keratoconjunctivitis,
papillary and follicular hypertrophy, conjunctival
injection, and mixed crusting. Ulcerative blepharitis is
caused by the acute and chronic suppurative
inflammation of the follicles of the lashes and the
associated glands of Zeis and Moll. Caustive organism
is usually staphylococcus aureus but some strains of
S.epidermidis is also present. In the ulcerative
blepharitis , symptoms are generally inflamed and red
eyelid margins, multiple lesions surrounded by yellow
pus that crusts and is removed with difficulty, Loss of
lashes and necrotizing inflammation cause distortion of
the eyelid margins, leading to epiphora and chronic
conjunctivitis.
4. Meibomian Seborrheic Blepharitis 16
Description and classification
In Meibomian Seborrheic blepharitis increased
meibomian and seborrheic secretions without acute
inflammation was observed. Altered meibomian
secretions may lead to bulbar injection.
1. Staphylococcal Blepharitis 11,12,13,14
Usually caused by staphylococcus aureus or
staphylococcus epidermidis organisms, it produces a
moderately acute inflammation of relatively short
duration; more prevalent in warmer climates and often
occurs in middle aged females. Related hordeolum and
chalazion may also occur.
5. Seborrheic
Meibomianitis
Blepharitis
with
Secondary
Sporadic episodes of inflammation and meibomianitis ,
result in clogged meibomian glands and anterior
seborrhea, producing an unstable preocular tear film
(POTF).
2. Seborrheic Blepharitis 15
Part of a dermatologic condition that includes the scalp,
face, and eyebrows; also called squamous blepharitis.
Clinical signs include greasy, scaly lashes.
Inflammation is usually minimal. Seborrheic dermatitis
commonly affects the scalp, the brows, lid margin
causing seborrheic blepharitis. Blephiritis is
characterized by edema, hyperemia and dry flakes or
oily secreations that accumulate on the eye lashes and
lid margin.
6. Meibomian Keratoconjunctivitis
Seborrhea is associated with staphylococcal lid
infections. The Major symptoms of seborrheic
blephiritis include irritation, itching , severe burning of
eyes, heavy or tired feeling of eyelids, Red eyelid
margins, Foreign body sensation. Meibomian gland
inflammation may be imposed on seborrheic
In this case, both the staphylococcal and the moraxella
forms of angular blepharitis are located on the lid at the
outer canthus.
It is severe lid margin inflammation, which occurs in
persons in their fifties, is more common in colder
climates, is frequently associated with acne rosacea,
and is part of a generalized sebaceous gland
dysfunction which clogs the meibomian openings.
7. Angular Blepharitis17
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Preventive measures18,19,20
1. Disappearing eyebrows
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Use warm-water soaks to reduce discomfort and
speed healing. Apply soaks for 20 minutes, then
rest at least 1 hour. Repeat as often as needed.
Wash the eyelid edge and eyelashes twice a day.
Use a baby shampoo diluted with some water, or a
commercial eyelid cleanser.
Use a washcloth wrapped around the index finger
or cotton swabs. Don't rub too hard, as it can lead
to irritation. Rinse with warm water and then dry
the area. Avoid use of eye make-up until
symptoms improves. When used, be sure to
remove it each night at bedtime.
Wash hands often, and dry them with clean
towels.
Keep face, eyelids, and scalp clean.
Avoid places that have lots of dust or other
irritating substances.
Get treatment for any skin disorders.
Control scalp problems with antidandruff
shampoos.
When the outer third of the brow (the part closest to the
ears) starts to disappear on its own, this is a common
sign of thyroid disease — either hyperthyroidism
(overactive thyroid gland) or hypothyroidism
(underactive thyroid gland). The thyroid is a small but
critical gland that helps regulate metabolism, and
thyroid hormones are among those critical to hair
production.
Brows tend to thin with age naturally. But with thyroid
disease, the brow-hair loss isn’t evenly distributed; it’s
a selective dropout on the ends. Brows are so
prominent , it’s often noticed here first. Early graying is
a related sign of a thyroid problem. Women are more
often affected than men, and hyperthyroidism
especially strikes women in their 20s and 30s.
2. A stye
A small, raised, often reddish bump along the inner or
outer eyelid margin is just an unsightly but innocuous
stye (also called a “chalazion”). But if the spot doesn’t
clear up in three months, or seems to keep recurring in
the same location, it can also be a rare cancer
(sebaceous gland carcinoma).
Evaluation 21,22
Ocular Examination
External examination of the eye, including lid structure,
skin texture, and eyelash appearance has to be
observed. Comparison of the eyes helps determine the
severity of the inflammation
Biomicroscopic examination of the lid margins, the
base of the lashes, and the meibomian gland orifices
and their contents are also helpful. Examination of the
tear film for lipid layer abnormalities, palpebral and
bulbar conjunctiva is to be taken into consideration.
Actual styes are plugged-up oil glands at the eyelash
follicle. Fairly common, they tend to clear up within a
month. A cancerous cyst that mimics a stye, on the
other hand, doesn’t go away.
3. Bumpy yellowish patches on the eyelid
Xanthelasma palpebra, the medical name for these tiny
yellow bumps, are usually a warning for high
cholesterol contents. They’re also called “cholesterol
bumps” — they’re basically fatty deposits. These are
quite small bumps.
Available Treatment Options
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Lid hygiene (e.g., warm, moist compresses,
commercial lid scrub)
Scalp and eyebrow hygiene (selenium
antidandruff shampoo)
Tear supplements to alleviate symptoms and
reestablish ocular surface integrity
Antibiotic eyedrops or ointment (e.g.,
erythromycin, bacitracin, polymyxin-bacitracin,
gentamicin, tobramycin) to control infection
Massage/expression of meibomian glands
Topical antibiotic/steroid ointment or oral
tetracycline/doxycycline for meibomianitis
4. Burning eyes, blurry vision while using a
computer
While using computer, eyestrain is partly caused by the
lack of contrast on a computer screen (compared with
ink on paper) and the extra work involved in focusing
on pixels of light. What’s more, by midlife the eyes lose
some of their ability to produce lubricating tears.
Irritation sets in, adding to blurriness and discomfort.
Does the problem worsen in the afternoon (when the
eyes tend to become drier)? Is it worse when you’re
reading fine print (more eyestrain)?
General visible symptoms not to be overlooked
23, 24
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Sometimes the problem is made worse by a fan
positioned so it blows right in the face. If it is possible,
Reduce glare by closing window shades, use
antireflective coating for your glasses.
Flat-panel LCD display screens (like those on laptops)
cause less eyestrain than older models. Keep reference
material close to the same height as your monitor,
giving your eyes a break from having to refocus so
much.
liver can’t process. Skin can also turn yellowish when a
person consumes too much beta carotene — found in
carrots — but in those cases the whites of the eyes
remain white.
9. Brown spot on the eyelid
Most malignant eyelid tumors are basal cell carcinoma.
When such a tumor appears as a brown spot, then — as
with any other form of skin cancer — it’s more likely to
be malignant melanoma.
5. Increasing gunk in the eye
Elderly, fair-skinned people are at highest risk. Look
especially at the lower eyelid. The bump may look
pearly, with tiny blood vessels. If the bump is in the
eyelash area, some eyelashes may be missing.
Blepharitis — inflammation of the eyelids, especially at
the edges — can have several causes. Two of them,
surprisingly, are conditions better associated with other
body parts: scalp dandruff and acne rosacea (which
causes flushed red skin, usually in the faces of fairskinned women at midlife).
The eyes may also feel irritated, as if piece of glass is
present in eye. They may burn, tear, or feel dry. The
crusty debris tends to gather in the lashes or the inner
corners of the eyes, or even on the lids.
10. Eyes that seem to bulge
The Cause of protruding eyes is hyperthyroidism
(overactivity of the thyroid gland), known as Graves’
disease. Some people inherit a tendency toward eyes
that bulge, so if the appearance seems to run in a family
so maybe it is not hyperthyroidism. The person may
not blink often and may seem to be staring at you.
Because the condition develops slowly, it’s sometimes
first noticed in photos or by the occasional visitor rather
than by someone who lives with the person every day.
6. A small blind spot in your vision
An ocular migraine / ophthalmic migraine/ optical
migraine/ migraine aura produces this disturbed vision,
with or without an accompanying headache. Changes in
blood flow to the brain are thought to be the cause.
The visual distortion starts in the center of the field of
vision. It might appear as a bright dots , or a line that
can seem to move and disrupt your ability to see
properly, as if you were looking through a pocked or
cracked window. It’s painless and causes no lasting
damage. Patients seem to have different triggers
(ranging from chocolate, caffeine, and alcohol to stress)
for headache possibly severe enough to cause nausea.
11. Sudden double vision, dim vision, or loss of
vision
These are the visual warning signs of stroke. The other
signs of stroke include sudden numbness or weakness
of the arm or leg or face, typically on just one side of
the body; trouble walking because of dizziness or loss
of balance or coordination; slurred speech; or bad
headache.
7. Itchy and Red eyes
In a large stroke caused by a blood clot or bleeding in
the brain, these symptoms happen all at once. In a
smaller stroke caused by narrowed arteries, they can
occur across a longer period of minutes or hours.
Many things can irritate eyes, but itchiness
accompanied by sneezing, coughing, sinus congestion,
and a runny nose, usually screams “I’m allergic!” When
the eyes are involved, the trigger is usually airborne,
like pollen, dust, or animal dander. An eye allergy can
also be caused by certain cosmetics or ointments.
12. Dry eyes sensitive to light
Sjogren’s syndrome is an immune system disorder. It
impairs the glands in the eyes and mouth that keep them
moist.
Sjogren’s usually affects women over age 40 with
autoimmune disorders such as rheumatoid arthritis or
lupus. Usually the eyes and mouth are affected together.
The person may also have vaginal dryness, dry sinuses,
and dry skin. Because of a lack of saliva, it can be
difficult to chew and swallow.
8. Yellowish eye
Generally observed in patients suffering jaundice:
Newborns with immature liver function and adults with
problems of the liver, gallbladder, or bile ducts,
including hepatitis and cirrhosis. The yellow in the
white part of the eye (the sclera) is caused by a buildup
of bilirubin, the by-product of old red blood cells the
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13. Sudden difficulty closing one eye, inability
to control tears in it
9.
Bell’s palsy is an impairment of the nerve that controls
facial muscles (the seventh cranial nerve), causing
temporary paralysis in half the face. It sometimes
follows a viral infection (such as shingles) or a bacterial
infection (such as Lyme disease). Diabetics and
pregnant women are also at higher risk.
Half of the entire face, not just the eye, is affected.
Effects vary from person to person, but the overall
effect is for the face to appear droopy and be weak. The
eyelid may droop and be difficult or impossible to
close, and there will be either excessive tearing or an
inability to produce tears.
10.
11.
12.
13.
14.
15.
16.
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