Blepharitis refractory to conventional treatment: dilemmas in differential diagnosis and management

Session Details

Session Title: Presented Poster Session: Dry Eye and Inflammation

Session Date/Time: Monday 07/09/2015 | 15:00-16:30

Paper Time: 15:10

Venue: Poster Village: Pod 3

First Author: : T.Lalias GREECE

Co Author(s): :    E. Kanonidou              

Abstract Details

Purpose:

To present a case of blepharitis with chronic course, little compliance with conventional treatment and the dilemmas in differential diagnosis and management.

Setting:

Department of Ophthalmology, 212 Military Hospital of Xanthi, Xanthi, Greece/ Department of Ophthalmology, ‘'Hippokrateion'' General Hospital of Thessaloniki, Thessaloniki, Greece.

Methods:

16-year-old male presented with blepharitis to both lids of LE with inflammation of forniceal and palpebral conjunctiva,lid edema,discharge,crusting,redness and periorbital dermatitis.The inflammation had started 6 months ago.He had received topical tobramycin, dexamethazone and fucidic acid for one month with no improvement.He was given topical acyclovir ointment and valacyclovir per os for two months,during which after initial recovery there was significant relapse of inflammation.He had topical fluoroquinolone,mast cell stabilizers and antiistamines with no result.VA was 10/10 sc bilaterally and there were no other pathological findings.Medical history was negative.Cultures of conjuctival discharge were negative as well as MRI of brain and orbits.

Results:

The patient was treated with topical azithromicyn 1x1 for three weeks and topical hygiene with complete recovery of symptoms.One week after discontinuation of treatment he deteriorated with a mild inflammation also on the right upper lid and outer canthus.He was treated with topical azithromycin 1x1 to BE and with azithromicyn per os 3x500mg for three days every ten days.After 4 weeks of treatment he was completely healed.15 days later he deteriorated again with a rash to the left cheek, the back of right palm and the left foot.He was referred to dermatologist and the rash was attributed to fungal infection.Ketoconazole per os was prescribed and the condition cleared in four weeks time,with no recurrence after 3 months.

Conclusions:

Blepharitis is a common disodrer with various known causes. In some chronic cases with resistance to conventional therapy and relapses, one should consider other less common causes such as fungal infection. In these cases cultures with emphasis to fungal infection should be given.

Financial Interest:

NONE