Dry Eyes and BlepharitisDry Eyes and BlepharitisDry Eyes and BlepharitisDry Eyes and Blepharitis
Mitch Menage
Consultant Eye Surgeon
Leeds Teaching Hospitals Trust
Mitch Menage
Consultant Eye Surgeon
Leeds Teaching Hospitals Trust
GP Meeting Sep 2006GP Meeting Sep 2006
Dry Eyes and BlepharitisDry Eyes and Blepharitis
Common chronic conditions in often
unhappy patients
‘Heartsink’
Common chronic conditions in often
unhappy patients
‘Heartsink’
BlepharitisBlepharitis
Chronic inflammation of the lid margins Common Remitting Range of ages Bilateral Often misdiagnosed as conjunctivitis
Chronic inflammation of the lid margins Common Remitting Range of ages Bilateral Often misdiagnosed as conjunctivitis
BlepharitisBlepharitisBlepharitisBlepharitis Lid anatomy Types Associated conditions Symptoms Signs Treatment
Lid anatomy Types Associated conditions Symptoms Signs Treatment
Lid anatomyLid anatomyMeibomian/tarsal glands
Glands of Zeiss and Moll
Lid anatomyLid anatomy
Blepharitis-TypesBlepharitis-Types
Anterior –staphylococcal/dandruff
Yellow flakes on lid margin
Posterior sebborhoeic Inflamed red oily lid edges
Anterior –staphylococcal/dandruff
Yellow flakes on lid margin
Posterior sebborhoeic Inflamed red oily lid edges
BlepharitisBlepharitis
Staphylococcal BlepharitisStaphylococcal Blepharitis
More common young patients Chronic infection of base of lashes Staph. Aureus Associated with styes Secondary
Papillary conjunctivitis Punctate corneal erosions Marginal keratitis
More common young patients Chronic infection of base of lashes Staph. Aureus Associated with styes Secondary
Papillary conjunctivitis Punctate corneal erosions Marginal keratitis
Seborrhoeic BlepharitisSeborrhoeic Blepharitis
More common older patients Excessive lipid secretion meibomian glands
Meibomitis/MGD
Lid commensals break down to free fatty acids Shiny waxy lids with greasy lashes Secondary
Papillary conjunctivitis Punctate corneal erosions
More common older patients Excessive lipid secretion meibomian glands
Meibomitis/MGD
Lid commensals break down to free fatty acids Shiny waxy lids with greasy lashes Secondary
Papillary conjunctivitis Punctate corneal erosions
Acne RosaceaAcne Rosacea Strongly associated with seborrhoeic blepharitis Mild forms not diagnosed
Strongly associated with seborrhoeic blepharitis Mild forms not diagnosed
Blepharitis-SymptomsBlepharitis-SymptomsBlepharitis-SymptomsBlepharitis-Symptoms
Sore burning itching irritation of lids Grittiness and watering Mild stickiness particularly on waking Red lid margins Dry eyes
Sore burning itching irritation of lids Grittiness and watering Mild stickiness particularly on waking Red lid margins Dry eyes
SignsSignsSignsSigns
Red lid margins Greasy material along margin of lids Clogging of meibomian gland openings Mild conjunctival injection Punctate corneal staining Acne Rosacea Styes/chalazions
Red lid margins Greasy material along margin of lids Clogging of meibomian gland openings Mild conjunctival injection Punctate corneal staining Acne Rosacea Styes/chalazions
ChalazionChalazion
TreatmentTreatmentTreatmentTreatment
Patient education! Lid hygiene Hot compresses
Warm flannel 10 mins Eyebag
Lubricants Antibiotic gel/ointments Oral antibiotic
Intermittent steroid ointment
Patient education! Lid hygiene Hot compresses
Warm flannel 10 mins Eyebag
Lubricants Antibiotic gel/ointments Oral antibiotic
Intermittent steroid ointment
Dry EyesDry EyesDry EyesDry Eyes
Lacrimal apparatus Tear Film Causes/Associated Conditions Symptoms Signs Treatment
Lacrimal apparatus Tear Film Causes/Associated Conditions Symptoms Signs Treatment
Lacrimal anatomyLacrimal anatomyLacrimal anatomyLacrimal anatomy
Causes of Dry EyeCauses of Dry Eye‘Keratoconjuctivitis Sicca’‘Keratoconjuctivitis Sicca’
Causes of Dry EyeCauses of Dry Eye‘Keratoconjuctivitis Sicca’‘Keratoconjuctivitis Sicca’
Lacrimal gland aging
Strongly associated with blepharitis
Inflammatory conditions
Rheumatoid arthritis
Sarcoidosis
Sjogrens Syndrome
Lacrimal gland aging
Strongly associated with blepharitis
Inflammatory conditions
Rheumatoid arthritis
Sarcoidosis
Sjogrens Syndrome
Sjogrens SyndromeSjogrens Syndrome Very severe dry eyes Middle-aged women KCS/Xerostomia and vasculitic disease
Rheumatoid Arthritis SLE Scleroderma Polyarteritis
Blood tests ANA 70% SSA(RO) 70% SSB (LA) 40% RhF 60%
Very severe dry eyes Middle-aged women KCS/Xerostomia and vasculitic disease
Rheumatoid Arthritis SLE Scleroderma Polyarteritis
Blood tests ANA 70% SSA(RO) 70% SSB (LA) 40% RhF 60%
SymptomsSymptoms
Feel dry (Can be watery!) No relation to emotional tearing
Gritty burning eyes Worsening through day peak in evening Worsened by reading, TV, computer Worsened by air conditioning, central heating, dry
arid conditions
Feel dry (Can be watery!) No relation to emotional tearing
Gritty burning eyes Worsening through day peak in evening Worsened by reading, TV, computer Worsened by air conditioning, central heating, dry
arid conditions
SignsSigns
Often none! Poor tear film on SL with rapid break-up time Punctate staining of cornea inferiorly Filament strands of mucus on cornea Schirmers test
Often none! Poor tear film on SL with rapid break-up time Punctate staining of cornea inferiorly Filament strands of mucus on cornea Schirmers test
SignsSignsRapid tear break-up time
SignsSignsRose Bengal staining
SignsSignsMucus Filaments
Schirmers TestSchirmers Test
Treatment - LifestyleTreatment - LifestyleTreatment - LifestyleTreatment - Lifestyle
Avoid dry situations Car Air conditioners Irritants cigarette smoke etc.
Drugs BP, antidepressant, antihistamine etc Increase humidity
Plants, wet towels, radiator trays etc.
Humidity chambers Wraparound glasses Swim goggles
Avoid dry situations Car Air conditioners Irritants cigarette smoke etc.
Drugs BP, antidepressant, antihistamine etc Increase humidity
Plants, wet towels, radiator trays etc.
Humidity chambers Wraparound glasses Swim goggles
Treatment-LubricantsTreatment-LubricantsTreatment-LubricantsTreatment-Lubricants
Liquid drops Frequent application
Gels More blurring
Ointments Usually only at night Nocturnal lagophthalmos
Preservative free?
Liquid drops Frequent application
Gels More blurring
Ointments Usually only at night Nocturnal lagophthalmos
Preservative free?
Liquid LubricantsLiquid Lubricants
Gel LubricantsGel Lubricants
OintmentsOintments
New TreatmentsNew Treatments
TreatmentTreatment
Anti-inflammatory Steroid Cyclosporin –Restasis
Antimucolytic acetylcysteine –Ilube
Oral pilocarpine-Salagen Usually only in Sjogrens Side effects/limited efficacy
Anti-inflammatory Steroid Cyclosporin –Restasis
Antimucolytic acetylcysteine –Ilube
Oral pilocarpine-Salagen Usually only in Sjogrens Side effects/limited efficacy
TreatmentTreatment
Punctal occlusion Cautery Plastic Plugs Smartplugs
Punctal occlusion Cautery Plastic Plugs Smartplugs
Punctal CauteryPunctal Cautery
Simple procedure under L/A Often preceded by temporary trial occlusion Cautery inserted into punctum/canaliculus Sometimes not successful Permanent and difficult to reverse More common to use temporary plugs first
Simple procedure under L/A Often preceded by temporary trial occlusion Cautery inserted into punctum/canaliculus Sometimes not successful Permanent and difficult to reverse More common to use temporary plugs first
Punctal PlugsPunctal PlugsPunctal PlugsPunctal Plugs
SmartplugsSmartplugs
Dry Eyes and BlepharitisDry Eyes and BlepharitisDry Eyes and BlepharitisDry Eyes and Blepharitis
Very common in older patients Chronic remitting problem Not usually serious but constant nuisance Patient Education
Lifestyle Regular hygiene/instillation of drops/gels Realistic expectations of treatment!
Very common in older patients Chronic remitting problem Not usually serious but constant nuisance Patient Education
Lifestyle Regular hygiene/instillation of drops/gels Realistic expectations of treatment!
