Blepharitis

BLEPHARITIS, blepharitis (from Greek blepha-rop-eyelid), inflammation of the eyelid margin. Usually, b. squamosa and b. ulcerosa are distinguished, squamous and ulcerative B. In the first of them, the skin of the eyelid is hyperemic throughout its length, but only slightly thickened; at the root of the eyelashes and between them on the skin there are small scales of epidermis resembling dandruff or yellowish thin fatty crusts. Upon removal of such scales and crusts, no erosions are found on the skin beneath them, only hyperemia of the skin. Part of the eyelashes easily falls out during this operation, but soon grows back again, since their follicles are not affected. - In ulcerative B., the eyelid margin is also covered with crusts of dried secretions in places (or throughout its length), but upon removal of the latter, not only hyperemia of the skin, but also an ulcerative process are found. In severe cases, the entire eyelid margin is covered with small ulcers and small abscesses from the suppuration of hair follicles and sebaceous glands. Ulcers leave scars, and the eyelashes finally die. Subjective phenomena in mild cases of B. may be insignificant, but most often there are complaints of itching, forcing one to scratch the eyes, increased sensitivity of the eyes to any irritations, and rapid fatigue of the eyes during work, especially in the evenings. From the standpoint of dermatology, B. with scales should be considered as seborrhoea squamosa, B. with fatty crusts (instead of scales) - as sebor. oleosa, and ulcerative B. - as eczema with suppuration of hair follicles. True folliculitis of the eyelid margin is occasionally encountered. Pathoanatomically, in most cases of ulcerative B., there are follicular and perifollicular inflammations of the hair follicles. Bacteriologically, in squamous B., non-virulent Staphylococcus albus is found more often, while in ulcerative B. - sometimes the same Staph. albus, but more often Staph. aureus of varying virulence. The course of B. is generally chronic (months, years), with frequent recurrences after temporary improvements. With prolonged existence, B., especially ulcerative B., may be accompanied by other changes in the tissues of the eyelid margins. These include: 1) hypertrophy and persistent thickening of the eyelid margins, their tylosis; 2) improper growth of eyelashes due to scarring of ulcers and friction of eyelashes on the cornea - trichiasis; 3) complete loss of eyelashes - madarosis; 4) chronic catarrh of the conjunctiva; and 5) eversion of the lower eyelid, usually starting with eversion of the lacrimal puncta due to scarring of ulcers; the resulting epiphora macerates the skin of the eyelids, making it eczematous; the eyelid itself becomes inflexible and heavy and increasingly lags behind the eye and turns outward. - Causes of B. may be of general and local character. To the former belong: constitution of the patient (scrofula, anemia, tuberculosis), in connection with which in some families B. is almost hereditary; intoxications from the intestine; external harmful conditions - dust, smoke, heat, etc. Local causes include: chronic diseases of the conjunctiva and lacrimal passages; incomplete closure of the eyelids of cicatricial and paralytic origin. Refractive errors that cause strong eye fatigue during studies, hyperemia of the eyes, in connection with temporary blurring of vision and rubbing of the eyes, should also be taken into account, especially in people of intellectual labor, as causes, if not causing B., then supporting it. - B. can also be caused by the presence of lice - pediculi and their eggs (nits) on the eyelashes. - Treatment and prophylaxis of B. should be general and local. Improvement of hygienic conditions, regimen, and nutrition of the patient should be carried out as fully as possible. Diseases of the lacrimal passages and conjunctiva must be treated first. In local treatment of the eyelid margins, cleansing of the eyelids and removal of scales and crusts from them should be in the foreground. To soften the latter, ointments in which fats play the main role are used. The latter soften scales and crusts, facilitate their removal, prevent blockage of the excretory ducts of the glands, soften the skin of the eyelids, and protect it from maceration by tears. Such ointments include boric, white mercurial (1-2%), ichthammol (2-5%), neocercar (3-5%), airolo (3%), bismuth, zinc, etc.; stronger irritants are yellow mercurial, salicylic (1-2%), and resorcinol (1-2%). In B. in scrofulous patients, rubbing of fish oil is recommended. Ointments must act on the skin itself, and therefore removal of scales and crusts should be performed as often and carefully as possible, especially before repeated rubbing of ointments. Their removal is performed by carefully wiping the eyelid margins with a rag or a piece of cotton moistened in disinfecting solutions (boric, sublimate, or mercuric cyanide solutions - 1:5,000), alcohol, or hydrogen peroxide. Pediculi and nits on the eyelashes are killed by rubbing with yellow mercurial ointment. In the treatment of ulcerative B., after removal of crusts and affected eyelashes and cleansing of the ulcers, the latter are slightly cauterized with a stick of silver nitrate or repeatedly with 2-5% solutions of silver nitrate (after the scab from the previous cauterization falls off); after the ulcers heal, the above treatment. In tylosis, removal of eyelashes and persistent massage with white mercurial precipitate ointment are indicated. In recent years, many authors have obtained good results in the treatment of B. with Bezredka filtrates (compresses, drops, ointments), although even with this method of treatment, as long-term observations show, recurrences of the disease are often possible. Sometimes good results are also given by ionization (with zinc), X-ray therapy, and ultraviolet rays.