BLEPHARITIS AND BLEPHARAD ENITIS.
Definition. — Blepharitis can best be defined as an inflammation of the Mei bomian, or sebaceous, glands of the hair follicles, and, secondarily, of the follicles themselves. It may occur as a symptom of some form of reflex irritation from refraction errors, or may accompany conjunctival irritations, stricture of the tear-duct, and inflammations of all sorts.
Symptoms. — Slight localized swelling at the edge of the lid is the first mani festation of the disease. This gradually spreads until the entire edge of the upper' lid is involved. Crusts then appear around the bases of the cilia of the swollen part and, the secretions being infectious, gradual extension to the lower lid follows. Some of the cilia in the inflamed follicles become loosened, and may easily be withdrawn without causing pain, or they may fall out imbedded in the crusts. Chronic conjunctivitis, phlyctenular conjunctivitis, and tra choma frequently occur as concomitants or complications.
Etiology. — Blepharitis is more com mon in strumous persons. It frequently presents itself as a result of excessive use of the eyes in reading, etc. Apart from the parasitic and traumatic varieties of blepharitis, it is usually of reflex origin. due to uncorrected refraction errors. As a. rule, blepharitis ciliaris may be re garded as a sort of optical barometer or as an expression of the amount of func tional strain; this is made manifest by a more or less intense variety of blepha ritis or blepharadenitis (chronic blepha ritis), and in my experience usually ac companies errors of refraction other than myopia. So-called "styes"—hordeola accompany blepharitis, and, with reten tion-cysts and tarsal tumors, are the re sult of blepharadenitis or chronic bleph aritis, with stenosis or stricture of the excretory ducts and abscesses of the Meibomian glands as a sequence. The varieties are: 1. Blepharitis ciliaris: acute, simple; caused by reflex refraction error.
2. Blepharitis ciliaris: marginal and ulcerative, acute or chronic, conjunc tival, trachomatous, diphtheritic, strict ure of lacrymal duct, etc.
3. Blepharitis ciliaris: eczematous, squamous, exudative, pedicular.
4. Blepharitis ciliaris: furunculous, infectious. autoinfectious.
5. Blepharitis ciliaris: exanthematous, erysipelatous, phlegmonous, traumatic.
6. Blepharitis ciliaris: blepharadeni tis, chronic Meibomian and follicular inflammation and obstruction.
Pathology.—If the crusts are washed off and the base of the lashes are mag nified and carefully examined, it will be seen that the mouths of the follicles no longer closely surround the cilia. The latter are thus loosened. In more ad vanced cases the follicles are destroyed by the inflammatory process and the lashes are no longer reproduced, the seat of their former implantation becoming bare cicatricial tissue. The loss of the protection afforded the eye from light and the mucous surfaces of the lid by the cilia increases the sources of irritation and inflammation; involvement of the lacrymal puncta may then give rise to lacrymation and eversion of the lid; con junctival and corneal inflammations fol low as formidable complications.
Prognosis.—Chronic congestion of the edge of the lids, with slight swelling, is a trivial condition which is promptly cured if judiciously treated. The ulcer ative form is less easily mastered, and the complications that are likely to fol low make it important that blepharitis receive attention in its early stages.
Treatment.—In the first and second varieties the crusts must be carefully soaked and mopped with a warm, alka line solution in the hands of the patient until softened. They should not be forcibly removed. Pledgets of absorbent cotton should be used to sop or mop the crusts and not disturb the cilia, which are ever ready to drop out. This tedious soaking process seldom occupies less than half an hour. In softening the crusts the head should be held erect and the basin containing the solution held under the chin, otherwise the blood by gravity congests the tutamina and partially de feats our purpose. The pledget of wet cotton should be held between the thumb and forefinger only, of the hand on the side to be soaked. If the back of the hand be kept uppermost and the other three fingers extended, the solu tion will not run down the arm nor wet nor soil the patient.