A 34-year-old previously healthy woman comes to the office due to itchy eyes for the past several months. The patient also reports frequent gritty sensations in her eyes and crusting of her eyelashes in the morning. She has had no eye pain, photophobia, or vision disturbances. The patient has not been exposed to ill contacts, uses no facial cosmetic products, and has not changed bath products recently. Eye examination is shown in the exhibit. Seborrhea is present at the scalp and eyebrows, but the skin of the face is otherwise normal. Nasal and oropharyngeal mucosa are normal. Which of the following is the most likely diagnosis?

Question

A 34-year-old previously healthy woman comes to the office due to itchy eyes for the past several months.  The patient also reports frequent gritty sensations in her eyes and crusting of her eyelashes in the morning.  She has had no eye pain, photophobia, or vision disturbances.  The patient has not been exposed to ill contacts, uses no facial cosmetic products, and has not changed bath products recently.  Eye examination is shown in the exhibit.  Seborrhea is present at the scalp and eyebrows, but the skin of the face is otherwise normal.  Nasal and oropharyngeal mucosa are normal.  Which of the following is the most likely diagnosis?

Quizplus · Accepted Answer

This patient has typical symptoms of chronic blepharitis. Blepharitis is a common disorder characterized by inflammation at the eyelid margin, usually most prominent at the opening of the meibomian glands. The etiology is variable and can be multifactorial; common contributors include seborrheic dermatitis, rosacea, allergic disorders, bacterial infection (especially Staphylococcus species), viral infection (eg, herpes simplex), and Demodex mite infestation. Blepharitis presents with burning or itching of the lids, discharge (which may be associated with crusting of the eyelashes in the morning), and often a foreign body sensation in the eye. Examination shows redness, swelling, and scaling at the lid margin, and the adjacent conjunctiva may also be inflamed. Close inspection may reveal lipoid plugs at the meibomian glands. Findings are frequently bilateral. The diagnosis is primarily based on clinical features. Treatment is generally supportive and includes warm compresses, gentle scrubs, and lid massage. (Choice A) Allergic conjunctivitis causes conjunctival erythema, discharge, and foreign body sensation; itching may be severe. However, conjunctival edema is usually prominent (often with papilla formation), the findings are primarily at the conjunctivae rather than lid margin, and patients typically have seasonal allergies or other atopic disorders. (Choice C) Dry eye disease (eg, Sjögren syndrome) can cause discomfort, a foreign body sensation, and conjunctival erythema, and it can occur concurrently with blepharitis. However, it would not cause erythema, swelling, or scaling of the lid margin. (Choice D) A hordeolum (ie, stye) is an acute inflammatory disorder of the eyelash follicle or tear gland and presents as a tender, erythematous nodule at the lid margin. Findings are focal, rather than diffuse/bilateral. erythematous nodule (Choice E) Preseptal cellulitis presents with acute, unilateral eyelid swelling and erythema. The swelling typically involves the entire lid (not just the margin), and patients often have a recent insect bite or another break in the skin. eyelid swelling and erythema Educational objective: Blepharitis presents with burning or itching of the lids, discharge, and often a foreign body sensation in the eye. Examination shows redness, swelling, and scaling at the lid margin, and the adjacent conjunctiva may also be inflamed. Common contributors include seborrheic dermatitis, rosacea, allergic disorders, bacterial infection, viral infection, and Demodex mite infestation. References: Medical management of blepharitis. (http://www.ncbi.nlm.nih.gov/pubmed/26058027)

A 34-Year-Old Previously Healthy Woman Comes to the Office Due