Eyelid margin biomicroscopy demonstrated regression of meibomitis
signs as well as disappearance of chemosis of bulbar conjunctiva and fornix conjunctiva inferior.
Diagnosis was based on the presence of anterior blepharitis, meibomitis and/or meibomian gland dysfunction (MGD), recurrent chalazion, eyelid telangiectasia, punctate epitheliopathy, corneal infiltrates or neovascularization, particularly in the peripheral cornea.
(7) Considering the anti-inflammatory effect of cyclosporine A and its efficacy in the treatment of meibomitis, we also prescribed 0.05% topical cyclosporine four times daily as an adjunct therapy.
Scoring system of the patients' ocular signs Scoring 0 1 Eyelid telangiectasia None Mild Meibomitis Minimal, Clear Cloudy Conjunctival hyperemia None Mild Corneal neovascularization None 1 clock hour, in the peripheral cornea Scoring 2 3 Eyelid telangiectasia Moderate Severe Meibomitis Granular Pasty Conjunctival hyperemia Moderate Severe Corneal neovascularization 1-3 clock >3 clock hours, hours and/or affecting the mid- peripheral cornea Scoring 4 Eyelid telangiectasia Extremely Severe Meibomitis Not expressible Conjunctival hyperemia Extremely Severe Corneal neovascularization >3 clock hours, affecting the central cornea Table 3.
Clinical findings were found involving most of the area of the upper eye lid surface, not only the lid margins, contrary to other lid pathologies such as meibomitis
or posterior blepharitis (ocular rosacea).
Exclusion criteria included pump failure, ocular surface disease, dry eye syndrome, trichiasis, distichiasis, and eyelid margin diseases like blepharitis or meibomitis
. Patients with a history of radioactive iodine therapy, chemotherapy or radiotherapy, and patients who had previous trauma to the lacrimal region or who had granulomatous or inflammatory diseases like sarcoidosis were also excluded from the study.
In 18% there was associated Meibomitis. 17% cases presented with history of prior use of steroid.
In present study most common risk factor was trauma in 45% cases followed by Meibomitis in 18% cases.
Inflammation of the meibomian glands (meibomitis
) may result in inspissated secretions, which are difficult to express and thus lead to obstruction of the glands.
For meibomitis (posterior blepharitis), hot compresses or commercial units like the 'Eye Bag' help to soften the inspissated oils within the meibomian glands.
(8) DRY EYE SEVERITY LEVELS 1 * Education and Environmental/ Dietary modifications * Elimination of offending systemic medications * Artificial tear substitutes, gels/ ointments * Eye lid therapy 2 If Level 1 treatments are inadequate, add: * Anti-inflammatories * Tetracyclines (for meibomitis, acne rosacea) * Punctal plugs * Secretogogues * Moisture chamber spectacles 3 If Level 2 treatments are inadequate, add: * Autologous Serum * Contact lenses * Permanent punctal occlusion 4 * If Level 3 treatments are inadequate, add: * Systemic anti-inflammatory agents * Surgery (lid surgery, tarsorrhaphy; mucus membrane, salivary gland, amniotic membrane transplantation)
During their week-long stay in the Mulanje District they dealt which a variety of rare tropical conditions such as snake poison in the eye, HIV-related fundii, meibomitis
, trachoma and a dendritic ulcer.