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Introduction to Eyelid

I. Chronic Blepharitis

It is an inflammation of the lid margin

The two main types of chronic blepharitis are:

  1. Anterior
    1. Staphylococcal
    2. Seborrhoeic
  2. Posterior
  1. Staphylococcal (Anterior Blepharitis)
    It is caused by chronic infection of the base of the lashes which results in formation of tiny intrafollicular abscesses. This leads to secondary dermal and epidermal ulceration.
    1. Clinical Features
      1. Burning                            
      2. Foreign body sensation
      3. Mild photophobia              
      4. Lid crusting.

        On Examination: Hard brittle scales which leave behind bleeding ulcers when removed.
    2. Complications: 
      1. Trichiasis
      2. Madarosis
      3. Poliosis.
      4. Scarred, notched and hypertrophic anterior lid margin
      5. External and internal hordeolum.
      6. Recurrent attacks of acute bacterial conjunctivitis
      7. Secondary changes due to hypersensitivity to staphylococcal exotoxins are:
      • Mild papillary conjunctivitis               
      • Toxic punctate epitheliopathy ­
      • Marginal keratitis                     
      • Phlyctenulosis.
      • Tear film instability
  2. Seborrhoeic Anterior Blepharitis

It is a disorder of glands of Zeis and Moll* and is frequently associated with seborrhoeic dermatitis.

a. Two main forms are:

  1. The oily type: Scaly eruptions are greasy.
  2. The dry type: It is due to pityriasis capitis or dandruff

CF: Similar to staphylococcal blepharitis but less severe.


O/E: Soft scales, which do not leave a small ulcer when removed. Complications are less frequent compared to staphylococcal blepharitis.

  1. Posterior Blepharitis
    It is caused by dysfunction of the Meibomian glands.
    1. Three main types are
      • Meibomian seborrhea                       
      • Primary meibomitis
      • Meibomitis with secondary blepharitis.
    2. Treatment
      • Lid hygiene.
      • Antibiotic ointment.
      • Weak topical steroids for secondary changes in conjunctivitis.
      • Artificial tears.

Extra Edge: Systemic Medicine Only For Posterior Blepharitis

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