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Mahmood J Showail
Mahmood J Showail
Mahmood J Showail
2. Posterior
Meibomianitis•
Meibomian seborrhoea•
Anterior blepharitis is characterized by
inflammation at the base of the eyelashes .
Patients with anterior blepharitis, compared
to those with posterior blepharitis, are more
likely to be female and younger *
4. Tear substitutes
Required for associted tear film instability and
dryness
Posterior blepharitis, the more common
condition, is characterized by inflammation
of the inner portion of the eyelid, at the
level of the meibomian glands . It is often
described as meibomian gland dysfunction.
MG are modified sebaceous glands located within
the tarsal plates . These holocrine glands are
responsible for secretion of the oily layer of the
tear film.
This oily layer prevents tear evaporation and
reduces the surface tension of the tear layer,
thereby facilitating the spread of tears over the
ocular surface . It is critical for normal ocular
surface lubrication.
symptoms :
Similar to anterior blepharitis
Signs :
* Excessive and abnormal meibomian gland
secretion which may manifest as capping of
meibomian gland orifices with oil globule .
pouting, recession or pulgging of the
meibomian gland orifices with hyperemia and
telangictasis of the posterior lid margin
Toothpaste-like plaques
from meibomian glands
the tear film is oily and
foamy and froth may
accumelate on the lid
margin or inner canthi .
1.Lid hygine
As in anterior blepharitis with emphasis on
messaging the lid to express acumilated
meibum, the messaging is toward the lid
margin edge to “milk” meibum .
2. Systemic tetracycline
Are the mainstay of treatment .
It is used mainly to block staphylococcal lipase
production .
It is particularly idicated in patients with recurrent
phlyctenulosis and margina keratitis .
Lactating women
6-12 wks
Minocycline : 100mg daily for 6-12 wks
used in children “
3. Topical glucocorticoids
There may be a role for topical glucocorticoid
use in the short term treatment of acute
blepharitis exacerbations. Patients should
generally be evaluated by an ophthalmologist
prior to its initiation “ to adjust benefit VS
S/E “
4. Topical cyclosporine
(1) Rubin, M, Rao, SN. Efficacy of topical cyclosporin 0.05% in the treatment of
posterior blepharitis. J Ocul Pharmacol Ther 2006; 22:47.
(2) Perry, HD, Doshi-Carnevale, S, Donnenfeld, ED, et al. Efficacy of commercially
available topical cyclosporine A 0.05% in the treatment of meibomian gland
dysfunction. Cornea 2006; 25:171.
Several topical medications are under
evaluation as treatment for blepharitis.
Topical metronidazole is a potential
substitute for the use of systemic antibiotics,
especially in cases of blepharitis related to
rosacea *
Cohen, EJ. Cornea and external disease in the new millennium. Arch
Ophthalmol 2000; 118:979.
Topical tacrolimus ointment has been
used to treat severe refractory blepharitis
with good results (1)
Picture
demonstrating
thinning of eyelids
secondary to
corticosteroid use.
Note sleeves and
scurf
Sebacous gland carcinoma
— Blepharitis is nearly always bilateral.
A malignant tumor of the lid skin
(ie, sebaceous cell carcinoma) should be
suspected in a patient with persistent
unilateral eyelid inflammation