A patient is presenting with c/o itching at the lid and swelling for the past 1 month. On examination, there are crusting, scaling with small ulcers near eyelid margin. If untreated, it can lead to:

Ans: (b) Ectropion and EpiphoraRef: A.K. Khurana's Comprehensive Ophthalmology, 6th edition, Page 365 and 368; Parson's Diseases of the Eye, 22nd edition, Page 451The diagnosis is ulcerative blepharitis.BLEPHARITISSubacute or chronic inflammation of the lid margins. TypesEtiology and pathogenesisClinical featuresTreatmentSquamous*. Associated with seborrhea of the scalp*. Zeiss gland - abnormal excessive neutral lipids which are split by corynebacterium acne into irritating free fatty acids*. White dandruff like deposition among the lashes*. On removal, no ulcer*. Lid hygiene*. Treat the seborrheaUlcerative / staphylococcalDue to staphylococcal infection*. Yellow crusts at the root of the cilia with matting of lashes*. On removal of the crusts, bleeding small ulcers are seen*. Red, thickened lid margins*. Lid hygiene*. Topical and systemic antibioticsPosterior/Meibomianitis*. Associated with acne rosacae*. Meibomian gland dysfunction. Bacterial lipases play a role*. Meibomian Seborrhea* - white frothy discharge at the lid margin*. Toothpaste like thick secretion on expressing the meibomian gland*. Meibomian gland appears like vertical yellow streaks due to thick secretion*. Lid hygiene and warm compress*. Topical and systemic antibioticsParasitic*. Phthiriasis palpebrum - Phthirus pubis (crab louse). It is sexually transmitted*. Peduculosis->>pediculus humanis corporis/capitus (head louse). Spill over from the head if severely infested* Lice and Nits anchoring the lashes*. Mechanical removal of the lice and nits with forceps*. Yellow mercuric oxide 1 % application*. Delousing the whole familyComplications of chronic blepharitis:Lash abnormalities: Madarosis, trichiasis, poliosis.Tylosis.Punctual eversion - chronic watering of the eyes - eczema of the surrounding skin - cicatrization - ectropion.Recurrent hordeolum externum.Marginal keratitis.Dry eyes.Chronic inflammatory changes in the cornea and conjunctiva.