Acute or chronic inflammation of the eyelid margins, most commonly caused by dysfunctional meibomian gland or staph infection
Further divided into anterior and posterior blepharitis
Itchy/sore, tearing, blurry vision
Crusting at lid margins, eye flaking, red-rimming of eyelid
Warm compresses, irrigation, massage
Topical antibiotics (ex. erythromycin, bacitracin) if infection suspected
Most patients can be discharged. Recommend ophthalmology follow-up for refractory cases.
Although typically caused by bacteria, blepharitis can sometimes be caused by viral pathogens such as herpes or VZV. These cases may require antivirals (acyclovir, valacyclovir)
Some cases of bleparitis may be chronic due to meibonmian gland dysfunction. There may be a role for oral antibiotics in these cases (ex. azithromycin or doxycycline) as this helps alter the composition of skin bacteria and meibominan gland secretion.
Foreign material that becomes embedded on or in the corneal epithelium.
Commonly caused by grinding or hammering metal w/o eye protection.
Eye pain, tearing, foreign body sensation, blurred/decreased vision (rare)
(+) Seidel sign; suggests corneal perforation
Slit lamp or X-ray
Topical anesthetic, irrigation/cotton-swab
Deep foreign bodies and rust rings may require removal by ophthalmologist
Most patients can be discharged if the foreign body has been successfully removed and there was no penetration into the globe. Ophthalmology follow-up in 24 hours is required if a large defect or rust ring is left over.
Admit any patient with retained foreign bodies. Consult ophthalmology.
Be especially careful with high impact metal projectiles (power tools, metal-on-metal impacts, weapons, etc.). These carry a greater risk of ocular involvement.
Ultrasound may be useful for identifying intraocular foreign bodies, but should not be used for open globe injuries.