Internal Medicine

0521779407-B01 CUNY1086/Karliner 0 521 77940 7 June 4, 2007 20:52

Blepharitis 247

➣Sebaceous cell carcinoma

➣Squamous cell carcinoma

■Dry eyes/keratitis sicca

■Atopic disease

■Roscaea

■Allergic conjunctivitis

■Medication toxicity

■Herpes simplex infection (usually unilateral)

management

What to Do First

■Document baseline ophthalmic exam (ie, vision, pupils, eye move-

ments, visual fields, etc.)

■Assess for signs and symptoms of rosacea, atopy, medication toxicity

■If symptoms are unilateral or acute, refer to ophthalmologist

General Measures

■Warm compresses to both eyes BID

■Gentle cleansing of eyelid margin with mild soap (e.g. baby shampoo)

specific therapy

■After failure of general measures, consider referral to ophthalmolo-

gist

■Ophthalmologist may consider empiric topical antibiotic therapy

■Eyelid cultures with organism susceptibility and directed therapy

sometimes necessary

■Management of concomitant atopy or rosacea

■Topical antibiotic/steroid combination may be used by ophthalmol-

ogist but patients must be followed for complications including glau-

coma and cataract

follow-up

■Four to six weeks after initial therapy (see general measures)

■Refer to ophthalmologist if no improvement in 2–3 months after

therapy

complications and prognosis

■Misdiagnosis may delay appropriate therapy

■Toxicity may result from topical medications

■Cataract and glaucoma from antibiotic/steroid preparations