Blepharitis

Blepharitis: Infection of the Eyelids
By Dr. Ed Mapes
Stonebridge Animal Hospital
McKinney,Tx

dogs eyeBlepharitis, or infection of the eyelids, can arise secondary to several common disorders; but the resulting infection can be challenging to control whatever the cause.

Skin and follicles of the eyelashes make up the outer layer of the lids. A middle layer contains glands that produce an oily substance that lubricates the eyes (Meibomian glands). Each gland connects to a duct that delivers the lubricant through openings at the lid margins. An inner portion of each lid consists of the conjunctival membrane, which allows contact of the lid with the cornea.

Any inflammatory condition that affects the eyelids can result in blepharitis. Possibilities include allergy, mechanical damage or injury, reaction to local pollutants or irritants such as household cleaning agents or smoke, infestation by mites that produce mange, or a lack of adequate tear film.

An inwardly-positioned eyelid (entropion) or lids that curl outward (ectropion) will interrupt tear film and can cause direct irritation of the eye and surrounding membranes. The Meibomian glands may be exposed to bacteria and become infected. These infections, known as “sties” are also seen in humans.

With so many possible factors to consider, it becomes necessary to fully assess each case to determine which of the above factors are involved. Treatment then must alleviate all causative factors in addition to combatting the actual infection.

Patients with blepharitis usually squint their eyes or blink frequently. They often scratch at the area or rub their faces on the floor. This can worsen the inflammation and cause secondary skin abrasions.

There is usually a discharge from affected eyes that can range from quite watery to thick and yellow or greenish in color. You may see small lumps on the eyelids that ooze an oily or pus-like exudate.

Blepharitis can become severe quickly, and initiating effective therapy right away is important. The infection can be caused by many different bacteria that are controlled by various antibiotics. Early culturing of the organism(s) and testing to determine which antibiotics should effectively kill those microbes is a prudent first step; simply guessing at what antibiotic will be effective can waste time while the condition worsens.

Topical antibiotics are always part of the treatment plan, and patients often resist having eye drops administered because these lesions are usually painful. Medication to control pain is usually important to provide relief to the patient and make treatment easier.

Along with correction of any predisposing factors, the most effective antibiotics are chosen according to the culture and sensitivity testing. I usually prescribe topical drops and oral antibiotics to attack bacteria in a multi-modal fashion. Application of hot packs to the eyes provides soothing relief and breaks down the discharges. Improvement in the condition is usually noted within days of onset of effective therapy. I recheck these patients several times to monitor closely until the condition is fully controlled.

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