REFERAT

BLEPHARITIS
Preceptor:
dr. Rahmat Syuhada, Sp.M

Arranged by :
Early Yuri Cintia
17360053
Overview
 Blepharitis is the medical term refers to inflammatory disease processes of
the eyelids.

 Patients with blepharitis typically presents with symptomps eye irritation,

itching, erytema of the lids, flaking of the lid margins, and/or changes in the
eyelashes.

 Blepharitis reported its about 5% from all eye disease in the hospital. Most
common in older age group. 86% of all patients with dry eyes syndrom
have concomitant blepharitis.

 Blepharitis can be caused by infection and allergies. Blepharitis is often

associated with systemic disease (rosacea, atopy, and seborrheic
dermatitis), ocular disesase (dry eye syndromes, chalazion, trichiasis,
ectropion, entropion, conjunctivitis and keratitis).
ANATOMY OF PALPEBRA
On the eyelids there are parts:
• Glands:
• Moll Gland
• Zeiss Gland
• Meibom Gland

• Muscles:
• M. Orbicularis oculi (Close the eye)
• M. Levator palpebra (Open the eye)

• Tarsus

• Vascularisation: a. Palpebra

• Inervation
• Occulomotorius Nervus
• Facialis Nervus
BLEPHARITIS

The inflammation of the eyelids

Etiology
 Infection (Bactery,Virus, Fungal)

 Allergy (Chemical fumes, smoke, smog, other irritants)

 Systemic Disease (Rosacea, Seborrhoic Dermatitis)

 Patofisiologi

Immune system
damage or damage
Microbactery caused by the
excessive oil production of
Invation bacterial toxins,
waste residues and
enzymes.
Anatomical Classification
Anterior
Blepharitis:
Eyelid skin, base of
the eyelashes, and
the eyelashes
folicles
Usually caused by bacterial
infection (staphylococcus
blepharitis) or dandruff in
the head and eyebrows
(seborrhoeic blepharitis),
allergies (rare)
Posterior
Blepharitis:
Meibomian glands,
and glands orifices
Caused by oil production
by excessive eyelid glands
(meibom blepharitis) and
other skin disorders such
as Rosacea.
Classification based on causes
 Blepharitis Bacterial
 Blepharitis Virus
 Blepharitis Fungal
 Blepharitis Allergy
Blepharitis Bacterial
 Blepharitis Seborrheic / Squamos
o Elderly men (50 years) Related Seborrheic Dermatitis

o Complaints: dirty eyes, heat and feeling of slipping.

o Signs:
 Appears as oily flakes or scales around the base of the lashes and
mild redness of the eyelids.
 Presence of squamous or crusting at the base of the lashes which
if peeled does not cause skin injury.

o Treatment:
 cleanse the eyelids from dirt.
 Clean with warm sticky cotton.
 Warm compress for 5-10 minutes.
 Topical Antibiotic (Basitracin, Eritromicin, or Gentamicin 12x2
drops a day)
Blepharitis Seborrheic / Squamos
 Ulcerative blepharitis
o Blepharitis with ulcers, cause of staphylococal chronic infection

o The crust that is formed around lashes is dry and hard, there is a
yellowish scab that when raised will look a small ulcer and bleed
around the lashes.

o Ulceration goes further and deeper and damages the hair follicle
resulting in loss (madarosis).

o Treatment::
 Clean Crust
 Warm compress for 5-10.
 Topical Antibiotic (Basitracin, Eritromicin, or Gentamicin 12x2
drops a day)
 Oral Antibiotic (Doksisiklin 1x100 mg for 2-4 weeks, or
Azythromisin 1x500 mg for 5 days)
Ulcerative blepharitis
 Angular Blepharitis
o Staphylococcus and Moraxella Lacunata infection on the edge of the
eyelid, in the corner of the eyelid, or canthus.

o Resulting in disruption of lacrimal punctum function.

o Sign :
 Redness in one corner of the edge of the eyelid,
 Scaly
 cracked skin in the lateral and medial canthus.

o Usually this disorder is recurrent.

o Treatment: sulfa (Chloramfenico, Eritromisin), tetracycline.

Angular Blepharitis
 Meibomianitis
o Disorders of the meibomian gland which results in local inflammatory
signs in the gland.

o Associated with rosacea

o Sign:
 Blockage of the oil glands on the eyelids,
 low quality of tears,
 redness of the eyelid membrane.
 The estuary of the meibom gland appears prominently with thick
whitish secretions

o Treatment:
 warm compresses,
 suppression and removal of pus over and over
 Topical Antibiotic (Basitracin, Eritromicin, or Gentamicin 12x2 drops
a day)
 Oral Antibiotic (Tetrasiklin 1x1000 mg for 6-12 weeks)
Meibomianitis
BLEPHARITIS VIRUS
 Herpes zoster
o Eldery

o If the ophthalmic branch ganglion is affected, it will show symptoms of

herpes zoster on the eyes and upper eyelids.

o Symptoms of pain in the affected area and body feel fever

o On the eyelids visible vesicles and infiltrates on the cornea when the
eye is exposed.

o Does not exceed the median line of the head

o Treatments: Simptomatic. Superficial steroids to reduce the symptoms

of inflammation and analgesics to reduce pain.
Herpes zoster ophtalmica
(HZO)
 Herpes simpleks
o Small vesicles surrounded by erythema can be accompanied by the
same circumstances on the lips

o Inflammation of the edges of the eyelids lightly with wet yellow

crusts on the edges of the lashes, which results in both the eyelids
sticking.

o Treatments:
 There is no specific treatment for this disease. If there is a
secondary infection, Oral Antibiotic or topical antibiotics can be
given.
 Corticosteroids are contraindicated because they can cause
herpes to spread to the cornea.
 Asiclovir can be given especially in early infections
Herpes simpleks
BLEPHARITIS FUNGAL
(RARE)
 Superficial Infection
Usually treated with griseofulvin especially effective for
epidermomycosis, given 0.5-1 grams a day in a single dose or divided
equally 1-2 weeks. Candida with topical nystatin is 100,000 units per
gram.

 Deep fungal infection

Treatment using systemic drugs. Actinomyces and Nocardia are
effective using sulfonamides, penicillin or broad-spectrum antibiotics.
Other species can be used Amphotericin B starting with 0.05-0.1mg /
kgBB iv 6-8 hours later 5% dextrose is dissolved in water.
Blepharitis Allergy
 Contact Dermatitis
o Cause: The material that is in contact with the eyelids

o Treatment: Cleaning the eyelids from the causative, washing with a

physiological saline solution, ointment steroids

 Blepharitis Urticaria
o Cause: from the entry of drugs or food in susceptible patients

o Treatments: topical or systemic steroids, antihistamin

Diagnosa
 Anamnesa

 external eye examination, including eyelid structure, skin

texture and appearance of eyelashes.

 Evaluate the margins of the eyelids, base of eyelashes

and meibom gland openings using bright light and
enlargement.

 Evaluation of the quantity and quality of tears

Complications
 Dry eye syndrome
o the most frequently

o a condition where the patient's eyes can not produce enough tears,
or the tears evaporate too quickly.

o Symptoms: pain, or dryness, around the eyes, and there are those
who stand in the eyes with blurred vision.

o Treatment: eye drops containing liquids that are made to replace

tears.
 Conjunctivitis
o occurs when there are bacteria in the eyelid.
o This condition causes bad effects on vision.
o In many cases conjunctivitis will disappear after two or three weeks
without treatment.
o Treatment: Antibiotic eye drops

 Corneal ulceration:
o continuous irritation of inflamed or misplaced eyelashes can cause
scratches (ulcers) in the cornea
Prognosis
 Good hygiene (regular cleaning of the eye area) can control the
signs and symptoms of blepharitis and prevent complications.

 Good eyelid treatment is usually sufficient for treatment. Must be

comfortable enough to avoid recurrence, because blepharitis is
often a chronic condition.

 If blepharitis is associated with underlying causes such as

Seborrhric Dermatitis or rosacea, treating these conditions can
reduce blepharitis.

 In patients who have multiple blepharitis episodes, this condition

rarely heals completely. Even with successful treatment, recurrence
can occur.