1. In The Name of God
A . Doostdar Razi
Member of TUMS
asgar_doostdar@yahoo.com

2. Blepharitis @ Contact lenses

3. Introduction
• Blepharitis is inflammation or infection of the
eyelid margins .
• Blepharitis is one the most common
ophthalmological complications as well as one
of the most difficult conditions to treat.

4. Blepharitis
Blepharitis is a common eyelid inflammation
that sometimes is associated with a bacterial
or certaindry eyeseye infection, symptoms of
.rosaceaacnetypes of skin conditions such as
Blepharitis is one of the most frequently observed
conditions among eye care practitioners, yet
remains largely misunderstood.

5. SLIT-LAMP BIOMICROSCOPY
The slit-lamp biomicroscope is an
important diagnostic instrument for
the examination of the anterior eye
structures as well as the contact lens.
Being able to proficiently use the
instrument is important. It use
critical in the fitting of contact
lenses.

7. CLASSIFICATION
I will discuss blepharitis according to
its predominant anatomic location,
as :
 anterior
 posterior

8. 1. Anterior
• Staphylococcal
• Seborrhoeic
• Meibomianitis
• Meibomian seborrhoea
2. Posterior Staph
Blepharitis

9. Anterior blepharitis
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 *

10. Two variants of anterior blepharitis are
identified: staphylococcal and seborrheic.
In staphylococcal anterior blepharitis,
colonization of the eyelids by staphylococci leads
to formation of fibrinous scales and crust around
the eyelashes.
The seborrheic variant is characterized by
dandruff-like skin changes around the base of
the eyelids, resulting in greasy scales around the
eyelashes.

11. PATHOPHYSIOLOGY
The pathophysiology of blepharitis is not completely
understood. A role for lid-colonizing staphylococcal
bacteria was first noted in 1946 . Several mechanisms by
which staphylococci may alter meibomian gland secretion
and cause blepharitis are supported by many studies .
Direct infection of the lids
Evoke reaction to staphylococcal exotoxin
Provoke allergic response to staphylococcal antigens .

It is likely that a combination of these is responsible for the
clinical manifestations of staphylococcal blepharitis.

12. CLINICAL PRESENTATION
symptoms
 burning , grittiness and mild photophobia with
remission and exacerbation is characteristic .
 Symptoms are usually worse in the morning ,
although in patients with dry eye they may
increase during the day .

13. signs
A. Staphylococcal blepharitis
 Hard scales and crusing mainly located around
the bases of the lashes esp. collorette
 chronic conjunctival hyperemia with mild
papillary conjunctivitis .

14. Staphylococcal blepharitis
•Hyperaemia and telangiectasia of
anterior lid margin
•Scarring and hypertrophy if
longstanding
•Scales around base of lashes
(collarettes)
•Chronic irritation worse in morning

15. Cont. Signs of Staphylococcal
blepharitis
scarring and
 notching (tylosis) of the lid margin
trichiasis (misdirected eyelashes)
 madarosis (loss of lashes) or
 poliosis (loss of pigmentation of lashes) in
sever long standing cases

16. Cont. Signs of Staphylococcal
blepharitis

17. secondary changes include :
 stye formation
 marginal keratitis and occasionally
phlyctenulosis (Corneal nodulesthat developed
near the limbus and then spread onto the
cornea, carrying behind them a leash of vessels)
 associated with tear film instability and dry eye
.
Cont. Signs of Staphylococcal blepharitis

18.  The diagnosis of blepharitis is clinical, based on
the patient's history and physical examination
findings. There are no confirmatory diagnostic
tests or laboratory investigations.
The history should include questions about
symptom duration, smoking, allergens, contact
lenses, and use of retinoids which may provoke
or exacerbate symptoms. A history of acne,
rosacea, or eczema should be evaluated .
DIAGNOSIS

20. EXAMINATION OF THE TEAR FILM
Bubbles, also called frothing, can sometimes be seen in the tear
film, especially along the lid margins. This can indicate
meibomianitis.

22. The lashes should be examined
for abnormalities such blepharitis.
With blepharitis there will be
collarettes found at the base of
the lashes.
Plugged gland

23. • Burning
• Flaking
• Crusting
• Tearing
• Irritation
• Itching
• redness
• Foreign body sensation
• bulbar and palpebral
hyperemia

24. Treatment for Blepharitis
Anterior Blepharitis
• staphylococcal blepharitis
more severe
loss of eyelashes
eyelid cleansing and hygiene
antibiotic ointment for eyelids
Viruses and other types of
bacteria besides
staphylococcus also can cause
anterior blepharitis
• Seborrheic blepharitis
seborrheic dermatitis
Regular cleansing with eyelid
scrubs and gentle, non-
detergent shampoos

25. Without treatment :
blepharitis caused by bacteria can cause
,ectropionterm effects such as-long
thickened lid margins, dilated and visible
.entropionandtrichiasiscapillaries,
In cases of trichiasis and entropion, the
erosionmay exhibit significantcornea
from eyelashes rubbing against the eye.

26. Eyelid Hygiene Relieves Blepharitis
Symptoms
 Blepharitis can be difficult to manage because it is often chronic,
meaning that it never warm compress goes away completely.
Your eye doctor may recommend one or more of these steps
involving good eyelid hygiene and massage:
 Apply a such as a washcloth to the outer eyelids.
 Cleanse the eyelids with a commercial lid scrub or other
recommended product.
 Gently massage the outer eyelids.
 A warm compress loosens the crust on your eyelids and eyelashes
before you clean them. The warmth also can loosen any blocked
residue in the oil-secreting meibomian glands in your eyelids

27. Does blepharitis cause Contact lens
intolerance?
 If you wear soft contact lenses, your eye doctor may
prescribe RGP contacts instead or may recommend more
frequent replacement of your soft contacts to reduce lens
deposits that may be associated with your blepharitis.
 Depending on the severity of your symptoms, you may need to
discontinue contact lens wear altogether for a while.

28. According to recent research
People With Blepharitis More Likely to Have Certain
 Inflammatory Diseases
 Psychological Issues
 Cardiovascular Diseases and More

29. Thank you