Ocular Pathology
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| Pathophysiology of Bacterial Blepharitis | Colonization and infection of the lid margin, lid glands or cilia follicle by bacterial pathogens; the liberation of potent bacterial exotoxins may result in inflammation and potential morphological changes to the lid, cilia, conj and cornea.
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| Etiology of Bacterial Blepharitis | Most commonly S. aureus, S. epidermidis and Moraxella sp.; other causes of infectious bleph should be ruled out (Herpes simplex and Candida); commonly assoc. tear deficiencies are present
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| Clinical symptoms of bacterial blepharitis | chronic itching, burning, fb sensation, lash crusting with occasional flare-ups; typically worse in the morning; often complaints of dry eye
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| Clinical Signs of Bacterial Blepharaitis (lid and lash findings) | thickened lid margins, collarette, fine flakes or keratinized epithelium surrounding the base of the lashes, poliosis, madarosis, trichiasis, telangectasias, ulcerated lid margins, hordeola, chalazia, preseptal cerllulitis
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| Collarettes | infection of the base of the cilia leads to deposition of fibrin which eventually hardens and separates from the lids as a disc upon growth of the cilia
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| Poliosis | white lashes; results from a deeper infection within the cilia follicle
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| Madarosis | Missing lashes
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| Angular Blepharitis | Moraxells lacunata or Staph species
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| Trichiasis | misdirected lashes
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| Clinical signs of bacterial conjunctivitis (conj and corneal findings) | papillary conjunctivitis, effects of Staph exotoxins, long term sequellae of chronic lid inflammation
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| Effects of Staph exotoxins | Toxic conjunctivitis, development of inflammatory infiltrates of the cornea (found usually at 11, 2, 4 and 8 o'clock adjacent to the limbus; may necrose resulting in a sterile ulcer), fine punctate keratitis (inferiorly), phlyctenules
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| Phlyctenules | Raised lesions consisting of lymphocytes; may be found in cornea or conj.; most frequently seen in limbal area; may ulcerate with neutrophils appearing and necrosis occurs
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| Demographics of Bacterial Blepharitis | all ages; bilateral (unilateral may occur); women are more frequently affected
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| Significant Hx for Bacterial Blepharitis | Dry eye and tear deficiencies; ocular rosacea, seborrheic blepharitis, eczema, impetigo, other infectious skin diseases
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| Topical Treatment of Bacterial Blepharitis | lid scrubs (decrease bioload and stimulate flow of meibomian glands); topical antibiotics; topical antibiotic/steroid; unresponsive patients
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| Topical Antibiotics for Bacterial Blepharitis | Azithromycin 1%, 1 gtt bid x2 days, 1 gtt qd x28 days; topical bacitracin or erythromycin ointment to lids and lashes hs x3-4 weeks, then tapered to a maintenance dose; alternation of antibiotics may reduce the tendency of developing resistant organisms
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| Topical Antibiotic/steroids for Bacterial Blepharitis | gtts may be helpful for bulbar conj and corneal involvement; Maxitrol drops (neomycin/polymyxin B/dexamethasone) 1 gtt qip x7-10 d; Zylet (tobramycin/letoprednol etabonate 0.5%) 1 gtt qid x7-10 d; Tobradex (tobramycin/dexamethasone) 1 gtt qid x 7-10 d
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| Unresponsive Bacterial Bleph Patients | may be carriers and require culturing of the nasopharynx, ear canal and skin, as well as systemic therapy
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| Systemic Tx of Bacterial Blepharitis | Tetracycline (not in pregnant women or kids <8) or Erythromycin: 250 mg qid po x2-4 mo; Doxycyclineor Minocycline 100 mg bid po x1 mo, then tapered and used for several mo;
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| Systemic Tx of Bacterial Blepharitis with Penicillinase-resistant antibiotic | Cloxacillin: dose >20kg - 250 mg q6h po x10 d, dose <20kg - 50mg/kg/day in equally divided doses q6h po x10 d
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