Blepharoconjunctivitis is an inflammation of the edges of the eyelids in combination with a lesion of the palpebral and orbital conjunctiva. The main symptoms of the disease: redness of the eyes, a feeling of “sand” or foreign bodies under the eyelids, photophobia, increased tearfulness. To make a diagnosis, a physical examination, laboratory examination of secretions from the conjunctival cavity, visometry, biomicroscopy, ultrasound of the eye, a fluorescein test are used. Treatment is based on the use of antibiotics, antihistamines, NSAIDs, antiviral drugs, vitamins C, B and A.
Blepharoconjunctivitis is a polyethological disease in which the conjunctiva and the edges of the eyelids are involved in the inflammatory process. The prevalence of the disease in the general structure of ophthalmic pathologies is about 30%. Blepharoconjunctivitis is diagnosed everywhere in people of all ages, but it is most often found in females in the fourth decade of life. Every third patient suffers from dry eye syndrome.” In 25% of cases, pathology develops a second time against the background of infectious diseases. About 17% of patients report a recurrent course.
The development of the disease is caused by the influence of many factors, but it is not always possible to establish the etiology. Blepharoconjunctivitis is an acquired pathology. The detection of the disease in the neonatal period is due to infection of the mucous membrane of the baby’s eyes during childbirth. The main causes of blepharoconjunctivitis are:
- Infectious diseases. Damage to the anterior segment of the eyes can provoke gonorrhea, rubella, herpes, syphilis. Possible hematogenic spread of infectious agents or infection by household contact.
- Allergic reactions. Clinical manifestations of the allergic form are caused by the release of mediators with vasoactive action. In this variant of pathology , immunoglobulin E is synthesized in the blood of patients .
- Defeat by ticks of the genus Demodex. Secondary changes in the eyelids and conjunctiva occur with demodecosis of the skin. The causative agent of the disease lives in the sebaceous glands (Zeiss and Meibomian). Infection with demodecosis can be complicated by the development of secondary chalazion and keratitis.
- Traumatic injuries. Injuries to the organ of vision contribute to infection of the wound surface. In 98% of cases, the wound canal passes through the conjunctiva. Reflex closing of the eyelids at the sight of danger leads to their additional injury.
- Fungal lesions. Symptoms of blepharoconjunctivitis are often detected in patients with candidiasis, aspergillosis or actinomycosis in the anamnesis. In the chronic course of mycosis, concomitant damage to the posterior segment of the eye is often observed.
Mechanism of development
The pathogenesis depends on the etiology of blepharoconjunctivitis. In ophthalmodemodecosis, the toxic-allergic effect of the parasite on the structures of the anterior pole of the eye provokes the injection of conjunctival vessels and increased secretion of mucous secretions. The development of the bacterial form is often preceded by nasopharyngeal pathology, damage to the middle ear or general infectious diseases. The multiplication of microorganisms leads to tissue damage by bacterial toxins. The thin mucous membrane of the conjunctiva is most vulnerable to their effects. Fungal lesion of the anterior parts of the eyeball is often caused by contact infection with mycosis of another localization. The development of symptoms in traumatic injuries is associated with the mechanical introduction of pathogenic flora into the wound canal.
A key role in the pathogenesis of allergic blepharoconjunctivitis is assigned to the increased sensitivity of the body to individual antigens. The trigger for the development of a hypersensitivity reaction is taking medications, inhaling plant pollen, and contact with past allergens. Predisposing factors are metabolic disorders, irritation of the conjunctiva with chemicals, dust or smoke. Children who were exposed to intrauterine infection with herpes viruses, rubella, are more predisposed to the occurrence of the disease in the future. At the same time, it is often possible to diagnose multiple malformations of the visual system (microphthalmos, anophthalmos, coloboma of the iris).
Patients complain of itching and burning in the eye socket, photophobia, a feeling of “sand” or a foreign body under the eyelids. It is characterized by increased tearfulness when looking at a light source. Performing visual work leads to rapid eye fatigue. The redness and swelling of the orbital conjunctiva is visually determined. When the cornea is affected, visual acuity decreases. With the bacterial form, patients note the release of purulent masses with an unpleasant odor from the eye slit. The separated becomes the cause of gluing of eyelashes, their loss. Instability of the tear film leads to visual dysfunction.
With the viral origin of the disease, the conjunctival discharge has a mucous or watery consistency. Patients note pronounced pain in the eyes. An increase in regional lymph nodes is characteristic. A feature of allergic blepharoconjunctivitis is a bilateral lesion of the eyes, combined with pronounced blepharospasm. There is a release of mucosal secretions of viscous consistency, concomitant damage to the skin. The lymph nodes are not enlarged. The use of contact lenses provokes an increase in clinical manifestations, increased irritability of the eyes.
A prolonged course of blepharoconjunctivitis can lead to the development of a secondary ectropion, less often entropion of the eyelid. Patients with a history of this pathology are more at risk of joining infectious and bacterial complications (keratitis, chorioretinitis). The spread of pathological agents into the nasolacrimal canal provokes dacryocystitis. Most patients have symptoms of xerophthalmia. The formation of scarring defects on the skin of the eyelids not only disrupts the process of closing the orbital slit, but is also a cosmetic defect. The most threatening consequence of the severe course of blepharoconjunctivitis is the phlegmon of the orbit. In rare cases, thrombosis of the sigmoid sinus occurs.
The diagnosis is based on the results of specific research methods, analyses of secretions from the orbital fissure and physical examination. During a visual examination, an ophthalmologist reveals hyperemia and swelling of the conjunctiva, redness of the edges of the eyelids. From the anamnesis, it usually turns out that patients associate the appearance of the first symptoms with allergic or infectious pathologies. The plan of instrumental diagnostics includes:
- Visometry. With a mild course of the pathological process, there is no visual dysfunction. Progressive decrease in visual acuity occurs when the cornea is affected.
- Biomicroscopy of the eye. Swelling and injection of conjunctival vessels are visualized. The eyelids are hyperemic, edematous, with a cluster of pathological compartments along the peripheral edge. With concomitant corneal lesion, its ulceration and clouding are determined.
- Ultrasound of the eyes. Ultrasound examination allows you to measure the parameters of the eyeball, to identify signs of damage to the posterior segment of the eye with opacity of optical media.
- Fluorescein instillation test. During the test, it is possible to detect a violation of the integrity of the epithelial layer of the cornea. When studying the structure of the tear film, multiple ruptures are visualized.
Laboratory tests are necessary to determine the etiology. With bacterial genesis, neutrophils predominate in the contents of eye secretions. In patients with the viral form of the disease, mononuclear cells are detected during cytological examination. The allergic origin of blepharoconjunctivitis is indicated by the detection of eosinophils during microscopic examination. The cultural diagnostic method makes it possible to detect the growth of pathogen cultures in the sowing of contents from the conjunctival cavity. Additionally, the consultation of an infectious disease specialist and an allergist is indicated.
Therapeutic tactics are determined by the etiology and nature of the course of the disease. The purpose of treatment is the elimination of the pathogen and the relief of the inflammatory process. The application of an aseptic dressing is contraindicated due to an increase in the likelihood of secondary keratitis. Mechanical removal of the discharge from the conjunctival cavity is carried out by washing the eyes with antiseptic solutions. Drug therapy includes:
- Antibiotics. Antibacterial therapy is carried out in a short course (3-7 days). Instillations of antimicrobial agents are carried out every 2-4 hours. As the signs of inflammation subside, the frequency of application of drops decreases to 3-6 times a day.
- Nonsteroidal anti-inflammatory drugs. Local (instillation) or systemic administration of NSAIDs is indicated. Diclofenac sodium drops are used for the non-infectious nature of the disease. With insufficient effectiveness or severe pathology, glucocorticosteroids are used.
- Antihistamines. The appointment of funds from the group of H1-histamine blockers is advisable for allergic form. Patients are recommended to use eye drops of olopatadine hydrochloride or sodium cromoglycate.
- Antiviral agents. An indication for the use of eye drops is viral blepharoconjunctivitis. The duration of the course of treatment is 12-14 days. In acute cases, it is recommended to instill the drug 6-10 times a day.
- Vitamin therapy. Regardless of the form of pathology, oral intake of vitamins B, A and C is indicated for all patients. When involved in the pathological process of the cornea, corneal regeneration stimulators (methyluracyl ointment, solcoseryl) are additionally prescribed.
Prognosis and prevention
The prognosis for life and working capacity in blepharoconjunctivitis is favorable. The outcome of pathology with timely diagnosis and treatment is complete recovery. Specific preventive measures have not been developed, non-specific ones are aimed at preventing secondary damage to the anterior part of the eyes with a history of infectious and allergic diseases. Patients with a recurrent course of the disease should increase the overall reactivity and resistance of the body with the help of natural (correction of diet, hardening) or medications (immunomodulators).