Bacterial bleph

Lid findings

• Thickened lid margins w/ telangectasias
• Collarette- hallmark sign of bact. bleph
• Flakes of keratinized epithelium at the base of lashes
• Poliosis
• Madrosis
• Trichiasis
• ulcerated lid margins - herpes simplex/ pseudomembrane
  
• hordeola
• chalazia
• preseptal cellulitis
  

Hordeola

• infection of glands on the lids
• pain: differeniate a horedola from a chalazion
• Internal: infection of meibomian glands
• external (stye): infection of glands of zeiss or moll
• come on very quick, tender, sore, self express

Bact. bleph

Collarette

Hallmark of bact. bleph

- infection of the base of cila leads to deposition of  fibrin which eventually hardens and separates from the lids as a disc upon growth of the cilia.

- collarette piecered by a cilia

differ. dx: greyish sleeve with demodex infestation

Collarette (Staph)

Scurf (Seborrhea)

Sleeve (Demodex)

Non-bacterial Lash Signs

Demodex organism- people over the age of 40-45

Scurf

• Sterile, granulotomous inflammation of meibomian gland > not an infection
• Tx: Triamcinalone (kenalog 10 or 20)
• inject .1-.2 ml w/ small 26g needle

• Localize the bump
• palipate the lid until they feel pain
• Orbital cellulitis: sick people, froze globe, fatal condition.

Bact bleph.

Corneal and conjunctival findings

• Papillary conjunctivitis w/ occasional exacerbation
• effects of staph exotoxins
• long term of chronic lid inflammation (not an infection- treat with antibiotic steriod anyway)
  

-toxic conjunctivitis

- development of inflammatory infiltrates of the cornea

subepithelial infiltrates adjacent to the limbus: most prominently inferiorly (11, 2, 4, 8 o' clock) : infiltrate may necrose resulting in a sterile ulcer.

no staining because its subepitheilial

-fine punctate keratopathy

-inferior portion of the cornea

-phlyctenules

-raised lesions consisting of lymphocytes (most frequently found in the limbal area but can be see on the cornea or conjunctiva)

- may ulcerate with neutrophils

- cause: staph or TB

chronic or recurrent corneal involvement: visually significant vascularization and scarring may occur

Demographics: all ages

Usually Bilateral

Women mostly affected

Bacterial Bleph

Significant Hx

Dry eyes and tear deficiencies - contributing factors

Other conditions found: Ocular rosacea, seborrheic blepharitis, eczema, impetigo, other infectious skin disease.

*mangament

Topical

-Lid hygiene

-Antibiotics

-Antibiotics/Steriod

Systemic

Bacterial Bleph

TXT: Topical

- Lid Hygiene

-Lid scrub preparation- dilute baby shampoo

- Decrease the bioload on the lids

- stimulate the flow of the meibomian glands

Bacterial Bleph

TXT: Topical

Antibiotics

-Azithromycin 1% (Azasite) gtts

*1gtt bid x 2 days; then 1 gtt  qd x 28 d

- Topical bacitracin or erythromycin oinment

*hs x 3-4 wks; taper

Alternation of antibiotics- reduce resistance.