Internal Medicine

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

246 Blastomyces Dermatitidis Blepharitis

complications and prognosis

Complications

■Relapse in immunosuppressed

■Disseminated disease, especially to bone/joint, rarely to CNS

Prognosis

■Good for normal hosts with acute disease

■Much poorer for end-stage AIDS (mortality upward of 20%)

Blepharitis.........................................

AYMAN NASERI, MD

history & physical

History

■Symptoms of bilateral, chronic ocular burning, itching, and/or irri-

tation

■More common in older adults

■Frequently no associated illnesses or exposures

■Seen in younger patients with rosacea or atopy

■Commonly, no Hx of other ocular disease

Signs & Symptoms

■Screening ophthalmic exam often normal (ie, vision, pupils, eye

movements, visual fields, etc.)

■Classic eyelid margin findings: debris on lashes, thickened eyelid

margin with telangiectasias

■Unilateral symptoms or conjunctivitis very uncommon

tests

■Clinical diagnosis

■No diagnostic lab test

■Need baseline ophthalmic exam

■Slit-lamp examination very helpful

■Eyelid margin cultures useful in some patients

differential diagnosis

■Unlikely blepharitis if unilateral or markedly asymmetric disease

■Malignancy