Healthcare and Medicine Reference
In-Depth Information
Most cases of discoid lupus affecting the eyelids present as blepharitis, with
small infi ltrated discoid plaques, edema, infi ltration and infl ammation of
the margin (Feldman et al. 1995, Gloor et al. 1997) ( Fig. 4 ).
Early sebaceous glands carcinoma present only subtle signs of
malignancy and may be confused with less aggressive lesions. Meibomian
gland carcinoma infiltrates the dermis and results in eyelid margin
thickening. Sclerosing basal cell carcinoma (BAC) also infi ltrates the dermis
and may be mistaken for localized chronic blepharitis (Kanski 2007).
Determining the clinical margins of the tumor is very diffi cult.
Management of blepharitis varies greatly among health care providers.
Patients' comprehension of the chronic nature of the condition is essential.
Basic treatment for blepharitis includes a long-term commitment to
eyelid hygiene. Topical lubricants, antibiotics, corticosteroids and
immunomodulators may be necessary in selected cases.
Lid Hygiene
Properly instructing the patient on the correct methods of lid hygiene is
the fi rst step of the treatment. Frequently they develop their own processes
and quickly abandon it as ineffective.
The application of warm compresses for a few minutes promotes
melting of the altered lipids, evacuation and cleansing of the gland ducts.
After the compresses the patient should apply pressure at the tarsus,
moving from the medial to the lateral canthus, releasing gland obstruction
and secretion. The margin is washed using mild shampoo (baby shampoo)
diluted in water or commercial formulations. A cotton swab dipped in the
solution is used to rub the base of the eyelashes, removing the crusts and
toxic products.
Artifi cial Lubricants
Dry eye is a concomitant disease in many blepharitis patients. Increasing
tear volume reduces hyperosmolarity and friction between the tarsal
conjunctiva and the cornea. Lubricants also rinse toxins and debris and
dilute infl ammatory molecules. Preserved artifi cial tears may be used up
to 6 times a day without toxicity.
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