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Bacterial Bleph

Ocular Pathology

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.
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
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
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
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
Poliosis white lashes; results from a deeper infection within the cilia follicle
Madarosis Missing lashes
Angular Blepharitis Moraxells lacunata or Staph species
Trichiasis misdirected lashes
Clinical signs of bacterial conjunctivitis (conj and corneal findings) papillary conjunctivitis, effects of Staph exotoxins, long term sequellae of chronic lid inflammation
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
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
Demographics of Bacterial Blepharitis all ages; bilateral (unilateral may occur); women are more frequently affected
Significant Hx for Bacterial Blepharitis Dry eye and tear deficiencies; ocular rosacea, seborrheic blepharitis, eczema, impetigo, other infectious skin diseases
Topical Treatment of Bacterial Blepharitis lid scrubs (decrease bioload and stimulate flow of meibomian glands); topical antibiotics; topical antibiotic/steroid; unresponsive patients
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
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
Unresponsive Bacterial Bleph Patients may be carriers and require culturing of the nasopharynx, ear canal and skin, as well as systemic therapy
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;
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
Created by: 5221114