Meibomitis is an inflammation of the meibomian glands, manifested by hyperemia, edema, soreness in the affected area and the presence of purulent infiltrate. This pathology is accompanied by the release of a “foamy” secretion, dense yellow or grayish masses, followed by the formation of dry crusts. Diagnosis is based on the results of biomicroscopy, microscopic and cultural examination of the secretion, PCR, scraping analysis. With the bacterial genesis of meibomitis, the appointment of fluoroquinolones of the 3rd generation is recommended, with the defeat of a tick of the genus Demodex – antiparasitic agents. Surgical opening of the infiltrate and the use of hardware methods of treatment are possible.
Meibomitis or internal barley is a polyetiological disease, the development of which is based on purulent inflammation of the meibomian glands. In 41.6% of patients, the causative agent is S. epidermidermitis. In 65.9% of cases, meibomitis caused by a tick of the genus Demodex is combined with the addition of bacterial microflora. Pathology is widespread everywhere. It is most often found in female representatives, which is associated with the use of someone else’s or low-quality cosmetics. In pediatric ophthalmology, it is observed against the background of a decrease in immunity or with hormonal imbalance in puberty. Meibomitis is prone to frequent recurrence and exacerbation in the elderly.
The causative agent of meibomitis in most cases is pathogenic microflora. S. epidermidermitis, S. aigeis, Propionibacterium acnes, Corynebacterium xerosis synthesize lipases that break down lipids of the mucous and liquid parts of the lacrimal fluid with prolonged bacterial carrier. Violation of the composition of the conjunctival secretion refers to the main triggers of meibomitis. The presence of pathogenic bacteria on the conjunctiva leads to the development of the inflammatory process, promotes the growth of other microorganisms and increases the tendency to severe course of the disease. Less often, this pathology is provoked by fungi, viruses or mites of the genus Demodex. With prolonged parasitization of the tick in the ducts of the meibomian glands, the qualitative composition of their secretions changes, followed by insufficiency of the lipid layer of the tear film.
As a rule, infection with meibomitis occurs when rubbing the eyelids with contaminated hands, prolonged stay in a dirty, dusty room. Contributes to the development of this pathology by reducing the resistance of the body against the background of hypothermia or acute infectious diseases in the anamnesis. The cause of the development of meibomitis may be non-compliance with the rules of personal hygiene, the use of other people’s cosmetics. Wearing contact lenses longer than their expiration date, prolonged eye irritation with smog or smoke are also triggers of this disease.
The etiological relationship between the development of meibomitis and hormonal imbalance (more often in the puberty period), diabetes mellitus, diseases of the gastrointestinal tract and hepatobiliary system has been proven. The risk group includes people with acne, rosacea, seborrheic dermatitis, keratoconjunctivitis in the anamnesis, because these pathologies are accompanied by hypersecretion and dysfunction of the meibomian glands, which subsequently leads to meibomitis.
From a clinical point of view, acute and chronic meibomitis are distinguished. The pathological process can be localized both on the upper and lower eyelid. Less often there is a combined lesion of both eyelids. In acute meibomitis is manifested by hyperemia, edema, severe pain syndrome in the affected area, a feeling of a foreign body in the eye. The inflammatory infiltrate is located on the inside of the eyelid, so puffiness is visible from the outside. With spontaneous opening of the infiltrate, patients complain about the release of purulent masses. A small retracted scar forms at the site of the breakthrough. The severe course of the inflammatory process in meibomitis is accompanied by an increase in body temperature to 38-39 degrees C. At the same time, the development of an abscess of the eyelid and purulent melting of cartilage tissues is possible.
Chronic meibomitis occurs when there is no opening of the infiltrate in the acute course of the disease. When chronicling the process, the affected eyelid looks thickened, somewhat hyperemic. Distinctive symptoms are itching and burning. When the eyelid is turned out, a yellow seal is visualized. Chronic meibomitis is often complicated by secondary conjunctivitis due to prolonged irritation of the conjunctiva with the secret of the meibomian glands. A thick grayish secret is secreted from the ducts, which leads to the formation of dry crusts at the outer openings. On the side of the lesion, cervical, submandibular, chin groups of lymph nodes may increase. A decrease in visual acuity in meibomitis is possible against the background of secondary conjunctivitis.
With meibomitis of the lower eyelid, patients complain of “foamy” discharge, the appearance of which is caused by a change in the qualitative composition of the secretions of the glands. The area of eyelash growth is often covered with crusts of yellow or grayish color. The degree of dysfunction of the meibomian glands in meibomitis is determined depending on the severity of stagnation. The result of 0 points indicates the absence of stagnation, 1 point – the third part of the glands is blocked, 2 points – 50% of all ducts are affected, 3 points – all ducts are blocked, 4 points – stagnation of the glands, expansion of the mouths of the excretory ducts, hyperemia and inflammation of the surrounding tissues.
The diagnosis of meibomitis is established on the basis of anamnestic data, the results of external examination, biomicroscopy, microscopic and cultural examination of pathological secretions, polymerase chain reaction (PCR), examination of eyelashes for the detection of the Demodex tick. All patients with meibomitis are required to undergo standard diagnostics, including visiometry, tonometry and ophthalmoscopy. This pathology can be indicated by such anamnestic data as occupational hazards (working in a dusty room, prolonged contact with smoke, smog), the use of other people’s decorative cosmetics, recent visits to beauty salons, relapses of meibomitis.
An external examination of the eyes of a patient with meibomitis reveals a yellow or grayish seal on the inner surface of the eyelid, the presence of dry crusts near the mouths of the excretory ducts, in the corners of the eyelids and at the base of the eyelashes, hyperemia and swelling of the surrounding tissues. The method of biomicroscopy determines the expansion of the mouths of the excretory ducts of the meibomian glands, their thickening and yellowish tint. Microscopic and cultural examination is carried out in order to isolate the pathogen, followed by inoculation to determine sensitivity to antibiotics. PCR for meibomitis allows you to identify the DNA of the pathogen in a short time and is a more informative test. To detect the Demodex tick that provokes meibomitis, scraping from the affected area is carried out in the laboratory with further microscopic examination of the material and counting of tick individuals in case of its detection.
The results of the primary diagnosis (ophthalmoscopy and tonometry) for meibomitis are usually normal. With the development of secondary complications, there may be a slight decrease in visual acuity detected during visiometry.
Conservative therapy of meibomitis consists in the appointment of etiotropic drugs, taking into account the data of the antibioticogram or the results of microscopic and cultural studies. With the bacterial genesis of the disease, pathogens are most sensitive to fluoroquinolones of the 3rd generation. For the treatment of meibomitis provoked by demodecosis, the appointment of antiparasitic agents is recommended. Often, with demodectic lesions, bacterial flora joins, so it is advisable to combine the appointment of antiparasitic agents and antibiotics. With meibomitis, it is necessary to carry out hygienic treatment of the eyelids with disinfectant solutions 2-3 times a day in order to remove dry crusts.
The indication for surgical opening of the infiltrate is the ineffectiveness of conservative therapy, the proliferation of granulations and the development of an abscess of the eyelid. Hardware treatment of meibomitis is an auxiliary method that promotes spontaneous opening of the infiltrate. UHF, magnetotherapy and helium-neon laser stimulation are used. Thermal procedures are recommended to be carried out from the side of the lesion. Only dry heat is used. For the entire period of treatment, the use of tear-replacement drugs is contraindicated. Relapse of the disease is an indication for the early appointment of antibacterial agents from the group of fluoroquinolones of the 3rd generation.
Prognosis and prevention
Specific prevention of meibomitis has not been developed. Nonspecific preventive measures consist in observing the hygiene of the eyelids and increasing the resistance of the body. At the first manifestations of the disease, it is recommended to consult an ophthalmologist. Frequent relapses of meibomitis in the anamnesis with the concomitant development of secondary conjunctivitis require special care, excluding the use of artificial tear preparations for the entire period of treatment until the pathogen is completely eradicated.
The prognosis with timely diagnosis and treatment of meibomitis is favorable for life and work capacity. The development of secondary complications in the form of an abscess of the eyelid and purulent melting of cartilage tissues is characterized as prognostically unfavorable.