Game 17
Solve
in
1
A patient presents with lid oedema, watery eyes, has crusty eyes and debris. The eyelids look scaly.
You notice that the scale feature is not only lines the eyelid margins, but also the lateral canthus.
The typical features of an inflammation are present:
- Red eyes,
- Watery eyes
- Pain
- Photophobia
But the patient seems to describe it as a hot burning sensation, with great irritation.
Solve
in
2
Your patient's eyelid margin is fairly shiny even in your dark consultation room, and it looks oily.
Phew, at least the meibomian glands should be working if there's oil.
​
You scrape the lateral canthus and do a simple test using the following:
- Crystal violet
- Iodine
- Alcohol
- Safranin
The result is a blue mix, with some clumping resembling that of caviar, or grapes.
Last
chance
You stain the cornea using fluorescin, but apart from the stain being present in tiny dots around the cornea, there doesn't seem to be any large lesions or ulcers.
​
You ask the patient about the burning.
"yeah it started a day or two ago, and I just wanted to get it check out. It is bearable but I don't like burning eyelids you get me?"
The
answer
Anterior Blepharitis
- Due to the gram positive bacteria Staphylococcus Aureus
- Will stain a purple violet under crystal-violet-iodine-alcohol-safranin staining test
- Will clump like grapes due to staphylocoagulase
- If there is excessive buildup, it will go to the lateral canthus, causing angular blepharitis
- If seborrhoeic, will have scaly and oily skin and some debris.
- Can be treated with warm compresses, and topical antibiotics and steroids.
- The burning is ok according to the patient, and he has come relatively quick to see you, so it is still in the early phase. Burning and eyelid sticking gets worse over time
- Due to early phase, you probably wouldn't expect anything too severe on cornea, such as phlyctenulosis or marginal keratitis.