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May 31, 2006
Staphylococcal Blepharitis Treatment
by SirGan
 Blepharitisrefers to chronic inflammation of the eyelids. Blepharitis is one of the most common disorders of the eye and is often the underlying reason for eye discomfort, redness and tearing. Other eye symptoms of blepharitis include: burning, itching, light sensitivity, and an irritating, sandy, gritty sensation that is worse upon awakening.There are 4 forms of blepharitis:
All three forms of blepharitis are chronic in nature. Several studies have shown that patients with staphylococcal blepharitis are relatively young with a short history of ocular symptoms, while patients with seborrheic blepharitis and MGD blepharitis are generally older and have a longer history of ocular symptoms. There are also several other possible causes such as: Herpes simplex dermatitis,
Varicella-zoster dermatitis, Molluscum Contagiosum and Allergic or contact dermatitis.
Pathophysiology of the conditionThe pathophysiology of blepharitis is well understood! It involves simple bacterial colonization of the eyelids. Bacteria that is most commonly found in the culture is Staphylococcus aureus! Of course- this results in direct microbial invasion of tissues, immune system–mediated damage, or damage caused by the production of bacterial toxins, waste products, and enzymes. It is also important to know that colonization of the lid margin is increased in the presence of seborrheic dermatitis or Meibomian gland dysfunction.
Signs and symptomsGenerally there is a persistent and unsightly redness and scaliness of the skin on and around the eyelid margins.
Other problems may include:
What's also characteristic? The eyelids may appear greasy and crusted with scales that cling to the lashes. This debris can cause the eyelids to stick together at night. Patient shouldn’t be concerned if it have to pry eyes open in the morning because of these sticky secretions. Sometimes patients may notice only the presence of dried tear secretions in the morning that feel like small grains of sand.
Diagnosis of blepharitis
Doctor usually is be able to diagnose blepharitis after carefully examining patient’s eyes and eyelids. Sometimes he of she may use a special magnifying instrument during the examination.
In the cases when he or she suspects in bacterial etiology, sample of the skin deposits may be collected to see if any bacteria are present. Bacterial culture will confirm the diagnosis if staphylococcal blepharitis!
This test have showed very good and effective because it usually shows additional features, including loss of lashes , whitening of the lashes, scarring and misdirection of lashes, crusting, margin ulcers, telangiectasias, and several other irregularities!
Histological picture of blepharitisSeborrheic dermatitis has characteristic histological structure characterized by spongiosis, mild perivascular lymphohistiocytic mononuclear infiltrates in the superficial dermis. It is important to point out that the Staphylococcal blepharitis is a chronic non0granulomatous inflammation, usually with neutrophils.
Complications if left untreatedMost common complications of blepharitis are:
Other possible complications associated with blepharitis include:
Treatment of blepharitisUnfortunately, blepharitis is one chronic disease for which there is no cure, and what's most important- it requires long-term treatment to keep it under control. Treatment consists of 2 phases:
Blepharitis rarely disappears completely. Even with successful treatment, relapses are common. While over-the-counter treatments for blepharitis are available, it is advisable to seek professional help the first time you experience the condition.
Warm CompressesWarm compresses have shown very good and effective in treatment of all kinds of blepharitis and eye infections as well. What really happen? These compresses heat the debris and crust on the lid margin to the melting point of their individual components so that they are easily removed with the lid scrubs. Warm compresses may be combined with eyelid massage. This is especially important in patients who have Meibomian gland dysfunction (MGD). Therefore after every 1 minute of warm compresses, massaging the eyelid as follows will be useful.
Lid ScrubsLid scrubbing is one very effective treatment method and there are several ways of performing lid scrubbing. These is only one rule –the scrubbing should only be directed at the base of the eyelashes on the eyelid margin. And another thing - soaps should not have excessive perfume or lotion content. Soap should be applied with fingertips on the eyelid margin and eyelash bases for up to 1 minute. This is followed by a facial rinse. The soap solution can alternatively be diluted in a container and scrubbing performed using a washcloth wrapped around a finger.
Antibiotic treatmentThe use of an ointment on the eyelid margin immediately after lid scrubbing may help to increase patient comfort. Two antibiotics are being used: Erythromycin eye ointment or Tobradex (steroid) eye ointment. Of course, what's also good- these antibiotics help to further reduce the bacterial load on the eyelids. Oral tetracyclines for about 3 months can be used in recalcitrant Meibomian Gland Dysfunction cases. Oral antibiotics may be prescribed in the presence of a lid abscess or associated rosacea.
Anti-Inflammatory treatmentCastor oil has been used traditionally for many years now as an anti-inflammatory remedy for treatment of blepharitis. Why is this oil so effective!? The main ingredient in this oil is ricinoleic acid. Patients must know one thing: eyelid inflammation may increase initially after starting treatment but with repeated use over a week, the blepharitis inflammation will be reduced.
Antioxidant treatmentWhat types of food are rich in antioxidants? The answer is- fruits, especially grapes! Eating more grapes may help blepharitis patients. The formation of oxidants like nitric oxide in the involved eyelid margin have been speculated to play a role in blepharitis. The substance, known as resveratrol is an anti-oxidant that is very effective against these nitrite types of oxidants. Grapes are particularly good sources of resveratrol. Resveratrol is found in the skin (not flesh) of grapes. Oral N-acetylcysteine treatment for blepharitis needs further evaluation. N-acetylcysteine is a supplement and therefore is available over the counter or in health food stores without prescription.
Surgical CareSurgical care for blepharitis is needed only for complications such as:
Self-careIt is recommended that patient should deliberately clean eyelid at the base of the eyelashes. To best accomplish this, he or she should gently pull the eyelid away from eye to avoid accidental injury to the cornea from the washcloth. Treatment should be continued until signs and symptoms disappear. Although you may be able to decrease the frequency of eyelid soaking and washing, every patient should maintain an eyelid care routine to keep the condition under control.
PrognosisOver all, the prognosis for patients with blepharitis is good to excellent. For most, it remains more of a symptomatic affliction than a true threat to their health and function. It is true that patients experience a considerable amount of discomfort and misery that can greatly reduce their well-being and ability to carry out the daily activities but recognition of the disease symptoms and with appropriate management should helps them to approach the disease in a successful manner.
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