欢迎来到得力文库 - 分享文档赚钱的网站! | 帮助中心 好文档才是您的得力助手!
得力文库 - 分享文档赚钱的网站
全部分类
  • 研究报告 >
    研究报告
    其他报告 可研报告 医学相关 环评报告 节能报告 项目建议 论证报告 机械工程 设计方案 版权保护 对策研究 可行性报告 合同效力 饲养管理 给排水 招标问题
  • 管理文献 >
    管理文献
    管理手册 管理方法 管理工具 管理制度 事务文书 其他资料 商业计划书 电力管理 电信行业策划 产品策划 家电策划 保健医疗策划 化妆品策划 建材卫浴策划 酒水策划 汽车策划 日化策划 医药品策划 策划方案 财务管理 企业管理
  • 标准材料 >
    标准材料
    石化标准 机械标准 金属冶金 电力电气 车辆标准 环境保护 医药标准 矿产资源 建筑材料 食品加工 农药化肥 道路交通 塑料橡胶
  • 技术资料 >
    技术资料
    施工组织 技术标书 技术方案 实施方案 技术总结 技术规范 国家标准 行业标准 地方标准 企业标准 其他杂项
  • 教育专区 >
    教育专区
    高考资料 高中物理 高中化学 高中数学 高中语文 小学资料 幼儿教育 初中资料 高中资料 大学资料 成人自考 家庭教育 小学奥数 单元课程 教案示例
  • 应用文书 >
    应用文书
    工作报告 毕业论文 工作计划 PPT文档 图纸下载 绩效教核 合同协议 工作总结 公文通知 策划方案 文案大全 工作总结 汇报体会 解决方案 企业文化 党政司法 经济工作 工矿企业 教育教学 城建环保 财经金融 项目管理 工作汇报 财务管理 培训材料 物流管理 excel表格 人力资源
  • 生活休闲 >
    生活休闲
    资格考试 党风建设 休闲娱乐 免费资料 生活常识 励志创业 佛教素材
  • 考试试题 >
    考试试题
    消防试题 微信营销 升学试题 高中数学 高中政治 高中地理 高中历史 初中语文 初中英语 初中物理 初中数学 初中化学 小学数学 小学语文 教师资格 会计资格 一级建造 事业单位考试 语文专题 数学专题 地理专题 模拟试题库 人教版专题 试题库答案 习题库 初中题库 高中题库 化学试题 期中期末 生物题库 物理题库 英语题库
  • pptx模板 >
    pptx模板
    企业培训 校园应用 入职培训 求职竞聘 商业计划书 党政军警 扁平风格 创意新颖 动态模版 高端商务 工作办公 节日庆典 静态模板 卡通扁平 融资路演 述职竟聘 图标系列 唯美清新 相册纪念 政府汇报 中国风格 商业管理(英) 餐饮美食
  • 工商注册 >
    工商注册
    设立变更 计量标准 广告发布 检验检测 特种设备 办事指南 医疗器械 食药局许可
  • 期刊短文 >
    期刊短文
    信息管理 煤炭资源 基因工程 互联网 农业期刊 期刊 短文 融资类 股权相关 民主制度 水产养殖 养生保健
  • 图片设计 >
    图片设计
    工程图纸
  • 换一换
    首页 得力文库 - 分享文档赚钱的网站 > 资源分类 > DOCX文档下载
     

    Blepharitis_ current strategies for diagnosis and management_Password_Removed.docx

    • 资源ID:1133       资源大小:316.08KB        全文页数:10页
    • 资源格式: DOCX        下载权限:游客/注册会员    下载费用:2金币 【人民币2元】
    快捷注册下载 游客一键下载
    会员登录下载
    三方登录下载: 微信快捷登录 QQ登录  
    下载资源需要2金币 【人民币2元】
    邮箱/手机:
    温馨提示:
    支付成功后,系统会自动生成账号(用户名和密码都是您填写的邮箱或者手机号),方便下次登录下载和查询订单;
    支付方式: 微信支付    支付宝   
    验证码:   换一换

     
    友情提示
    2、PDF文件下载后,可能会被浏览器默认打开,此种情况可以点击浏览器菜单,保存网页到桌面,既可以正常下载了。
    3、本站不支持迅雷下载,请使用电脑自带的IE浏览器,或者360浏览器、谷歌浏览器下载即可。
    4、本站资源下载后的文档和图纸-无水印,预览文档经过压缩,下载后原文更清晰   

    Blepharitis_ current strategies for diagnosis and management_Password_Removed.docx

    170 CAN J OPHTHALMOLVOL. 43, NO. 2, 2008 Blepharitis current strategies for diagnosis and management W. Bruce Jackson, MD, FRCSC ABSTRACT RSUM Background The aim of this article is to present a consensus on the appropriate identification and management of patients with blepharitis based on expert clinical recommendations for 4 representative case studies and evidence from well-designed clinical trials. s The case study recommendations were developed at a consensus panel meeting of Canadian ophthalmologists and a guest ophthalmologist from the U.K., with additional from family doctors and an infectious disease/medical microbiologist, which took place in Toronto in June 2006. A MEDLINE search was also conducted of English language articles describing randomized controlled clinical trials that involved patients with blepharitis. Results Blepharitis involving predominantly the skin and lashes tends to be staphylococcal and or seborrheic in nature, whereas involvement of the meibomian glands may be either seborrheic, obstructive, or a combination mixed. The pathophysiology of blepharitis is a complex interaction of various factors, including abnormal lid-margin secretions, microbial organisms, and abnormalities of the tear film. Blepharitis can present with a range of signs and symptoms, and is associated with various dermatological conditions, namely, seborrheic dermatitis, rosacea, and eczema.The mainstay of treatment is an eyelid hygiene regimen, which needs to be continued long term. Topical antibiotics are used to reduce the bacterial load. Topical corticosteroid preparations may be helpful in patients with marked inflammation. Interpretation Blepharitis can present with a range of signs and symptoms, and its management can be complicated by a number of factors. Expert clinical recommendations and a review of the evidence on treatment supports the practice of careful lid hygiene, possibly combined with the use of topical antibiotics, with or without topical steroids. Systemic antibiotics may be appropriate in some patients. Contexte Prsentation d’un consensus d’experts en clinique sur l’identification et le traitement appropris des patients atteints de blpharite. Les recommandations rsultent d’un examen de 4 tudes de cas et de donnes d’essais cliniques bien penss. Mthodes Les recommandations rsultant de l’tude de cas ont t mises au point par consensus lors d’une runion d’experts laquelle ont particip en juin 2006, Toronto, un groupe d’ophtalmologistes canadiens et un ophtalmologiste invit du Royaume-Uni, avec l’apport de mdecins de famille et d’un microbiologiste mdical et spcialiste en maladies infectieuses. On a aussi effectu sur MEDLINE une recherche dans les articles publis en anglais et dcrivant des essais cliniques contrls et randomiss chez des patients atteints de blpharite. Rsultats La blpharite, qui affecte surtout la peau et les cils, a tendance tre de nature staphylococcique et ou sborrhique, alors que l’implication des glandes de Mibomius peut tre sborrhique, obstructive, ou une combinaison des deux. La pathophysiologie de la blpharite montre une interaction compl de divers facteurs comprenant des scrtions anormales sur la marge de la paupire, des organismes microbiens et des anomalies du film lacrymal. La blpharite peut s’accompagner d’un ventail de signes et de symptmes et s’associer diverses conditions dermatologiques, notamment la dermatite sborrhique, l’acn rosace et l’eczma. Le traitement de base porte sur l’hygine des paupires, qu’il faut maintenir long terme. Les antibiotiques topiques servent rduire la charge bactrienne. Les prparations topiques de corticostrodes peuvent aider les patients qui ont une inflammation marque. Interprtation La blpharite peut prsenter un v entail de signes et de symptmes, et un certain nombre de facteurs peuvent en compliquer le traitement. Les recommandations des experts en clinique et une revue des donnes sur le traitement appuie la pratique attentive de l’hygine des paupires laquelle on peut ajouter des antibiotiques topiques, avec ou sans strodes topiques. Les antibiotiques systmiques peuvent tre indiqus pour certains patients. From the University of Ottawa Eye Institute, Ottawa, Ont. Originally received Aug. 22, 2007. Revised Dec. 28, 2007 Accepted for publication Jan. 9, 2008 Published online Mar. 12, 2008 Correspondence to W. Bruce Jackson, MD, University of Ottawa Eye Institute, The Ottawa Hospital, General Campus, 501 Smyth Rd., Suite W6253, Box 307, Ottawa ON K1H 8L6; bjacksonohri.ca This article has been peer-reviewed. Cet article a t valu par les pairs. Can J Ophthalmol 2008;43170–9 doi10.3129/i08-016 CAN J OPHTHALMOLVOL. 43, NO. 2, 2008 171 Management of blepharitis Jackson Table 1 Etiological classification of blepharitis* Inflammatory Infectious Seborrheic Bacterial most commonly Staphylococcus aureus, S. epidermidis and Propionibacterium acnes Meibomian gland dysfunction Viral Molluscum contagiosum, Herpes simplex, varicella-zoster, common warts Allergic atopic and contact Fungal uncommon; immunosuppressed dermatitis pts Associated with dermatosis Parasitic Demodex folliculorum, rosacea Pediculosis pubis *Adapted with permission from McCulley et al.,3 Mathers et al.,4 and Tasman et al.5 B lepharitis is a generic term for eyelid inflammation but generally refers to different types of inflammation involving the skin, lashes, and meibomian glands and is among the most frequently encountered ocular diseases. The condition is usually chronic, intermittent with exac- erbations and remissions, and typically bilateral. It is a complex disorder with a number of causes and overlap- ping signs and symptoms, and its management can be frustrating and challenging.1,2 The aim of this article is to present a consensus on the appropriate identification and management of patients with blepharitis based on expert clinical recommendations for 4 representative case studies and evidence from well- designed clinical trials. The case study recommendations were developed at a consensus panel meeting of Canadian ophthalmologists and a guest ophthalmologist from the U.K., with addi- tional from family doctors and an infectious disease/medical microbiologist, which took place in Toronto in June 2006. The members of the panel are listed in the Acknowledgements section. S Classification and etiology There is no single, universally accepted classification system for the various presentations of blepharitis. The ideal system may eventually be structured according to underlying disease pathophysiology, but this is incom- pletely understood. Historically, blepharitis has been divided into anterior s affecting the anterior lid margin and eyelashes and posterior s affecting the meibomian glands.1,2 Both s can be inflammatory or infectious, as shown in Table 1. Alternatively, blepharitis can be classified according to the most commonly presenting signs and symptoms into staphylococcal, seborrheic, mixed staphylococcal and seb- orrheic, and meibomian gland dysfunction MGD. Pathophysiology The pathophysiology of blepharitis is complex and thought to represent the interaction of various factors, including abnormal lid-margin secretions, lid-margin organisms, and a dysfunctional precorneal tear film. The tear film lipid layer the outer layer of the ocular tear film reduces evaporation of water from the underlying aqueous layer of the film. Meibomian gland secretions, which contain lipids, help maintain the stability of the tear film. The polar lipids principally phospholipids in the meibomian oil interact with the aqueous layer of the tear film and enable the film to spread over the eye. In blepharitis, various changes can occur that may desta- bilize the film. In particular, a reduction in the quantity of secretions reaching the eyelid margin and therefore the tear film and changes in the composition of the secretions can have this effect.6,7 The orifices leading to the meibomian glands can become keratinized and obstructed secondary to an inflamed lid margin. In seborrheic blepharitis, there may actually be excess lipid production initially, but this leads to encrustation of the lid margin, which eventually blocks the gland orifices.8 Finally, scarring can lead to retraction of the orifice such that secretions are not delivered to the correct part of the eyelid margin.6 Alterations in the composition of the meibomian secre- tions occur in patients with chronic blepharitis.6,7 Decreased amounts of polar lipids may result in destabi- lization of the lipid tear layer, uneven spreading, and increased aqueous tear evaporation. In obstructive meibo- mian gland disease the altered nonpolar lipids, including triglycerides and cholesterol esters, will raise the melting point, leading to thickening of the meibum, ductal plug- ging stagnation, and pouting of the meibomian gland ori- fices. Further clarification of the specific lipid changes in patients with blepharitis is necessary, but even our limited understanding helps to explain the associated evaporative dry eye seen in these patients. The most common organisms isolated from patients with chronic blepharitis include Staphylococcus epidermidis, Propionibacterium acnes, corynebacteria, and Staphylococcus aureus.9– 11 Groden et al.10 found that the first of these 3 organisms was present in patients with blephari- tis more often than in control patients. In addition, ble- pharitis patients were found to be more heavily colonized than control patients. McCulley and Dougherty11 found that S. aureus was isolated from the subgroup of blephari- tis patients in the mixed staphylococcal/seborrheic group more than in controls. Lipolytic exoenzymes produced by S. epidermidis and S. aureus, including triglyceride lipase, cholesterol esterase, and wax esterase, hydrolyze wax and sterol esters with the release of highly irritating free fatty acids and other products, resulting in the disruption of the tear film integrity.6 Some patients are more heavily colo- nized than others, and this could also be the effect of the altered lipids stimulating the growth of S. epidermidis and S. aureus on the eyelid margin.6 Over time, the interaction of these various factors results in instability and thinning of the tear film. This allows more of the aqueous component of tears to evaporate, 172 CAN J OPHTHALMOLVOL. 43, NO. 2, 2008 Management of blepharitis Jackson increasing tear osmolarity and the level of inflammatory cytokines; it ultimately damages the ocular surface and results in the dysfunctional tear syndrome.2,8 The fungus Pityrosporum has been found to be associated more frequently with meibomianitis in patients with ble- pharitis than in controls, likely because of copious secre- tions containing fatty acids, which support the growth of the fungus, on the lid margin.12 Demodex infestation of the facial skin has been implicated in rosacea and blepharitis. Microscopic examination of epilated eyelashes with cylin- drical dandruff sleeves that cuff the lashes will reveal the mite. It is suggested that ocular irritation, conjunctival inflammation, and keratitis may be found in patients with Demodex infestation of the eyelids, which may improve with lid scrubs with 50 tea tree oil, a new treatment to eradicate the mites.13 Clinical presentation General ocular symptoms that may accompany blephar- itis are sore eyelids, eyes feeling irritated, itchy, burning, or gritty, red eyes, dry or watery eyes, increased frequency of blinking, foreign body sensation, photophobia, contact lens intolerance, and eyelids sticking together particularly in the morning.1,2 Signs include swollen eyelids, inflamed lid margins with redness and thickening, scaling, crusting, irregularity tylosis and or ulceration of the lid margins, and altered eyelash appearance loss [madarosis], individual lash polio- sis, and lashes broken, misdirected, or crusted with fibri- nous or sebaceous matter [collarettes, scurf, and sleeves], as well as secondary alterations to the conjunctiva such as conjunctivitis and cornea corneal inflammation and ulceration. Sties and chalazia are also common.1,2 Typical presentations for the major subtypes of blephari- tis are summarized in Table 2. Inflammation of the anterior margin is usually caused by staphylococcal, seborrheic, or mixed blepharitis, whereas inflammation of the posterior margin is associated with MGD.2 A patient history that includes symptoms associated with systemic disease e.g., lupus erythematosus, scleroderma, recent systemic and topical medications, and contact lens use can be important in determining the diagnosis.1 Evidence of various dermatological conditions that can occur in association with blepharitis should be sought. These include seborrheic dermatitis, rosacea, and atopic dermatitis Table 2. MGD MGD is the most common affliction of the meibomian gland. It is characterized by inflammatory changes at the lid margins and changes in the anatomy of the orifices and character of the secretions, which distinguish it from more anterior inflammation. With a prence of 39– 50 among patients that have disease of the mei- bomian glands, the changes can be primary or secondary, focal or diffuse. Secondary changes are seen with cuta- neous and dermatological diseases that involve the seba- ceous glands, such as seborrheic dermatitis and seborrhea. Table 2 Summary of typical clinical presentations for the most common s of blepharitis* Anterior blepharitis Anterior blepharitis Posterior blepharitis Meibomian Presentation Staphylococcal Seborrheic gland dysfunction Demographics Predominantly young to Older age group, middle-aged women no gender difference Eyelid deposits Collarettes or cuffs of fibrin Greasy scales scurf‖ Thick lipid secretions matted, hard scales extending on lid margins may be foamy, with plugged from the base of and along and around lashes and pouting meibomian gland lashes as a sleeve orifices Eyelid ulcerations Fine at the base of lashes Eyelid scarring May occur Common with longstanding disease Eyelash absence and/or breakage Frequent Rare Unusual Eyelash misdirection Frequent Rare May occur with longstanding disease Chalazion Rare Rare Occasional to frequent may be multiple Sty May occur Conjunctiva Mild to moderate injection, Mild injection occasional phlyctenules Mild to moderate injection, papillary reaction on tarsal conjunctiva Aqueous tear Frequent 50 have Frequent 25–40 Frequent 50 with ocular deficiency keratoconjunctivitis sicca have dry eye rosacea have dry eye Cornea Inferior punctate epithelial erosions, marginal infiltrates, neovascularization, pannus, scarring, thinning, and phlyctenule

    注意事项

    本文(Blepharitis_ current strategies for diagnosis and management_Password_Removed.docx)为本站会员(admin)主动上传,得力文库 - 分享文档赚钱的网站仅提供信息存储空间,仅对用户上传内容的表现方式做保护处理,对上载内容本身不做任何修改或编辑。 若此文所含内容侵犯了您的版权或隐私,请立即通知得力文库 - 分享文档赚钱的网站(发送邮件至8877119@qq.com或直接QQ联系客服),我们立即给予删除!

    温馨提示:如果因为网速或其他原因下载失败请重新下载,重复下载不扣分。




    关于得利文库 - 版权申诉 - 免责声明 - 上传会员权益 - 联系我们

    工信部备案号:黑ICP备15003705号-8 |经营许可证:黑B2-20190332号 |营业执照:91230400333293403D|公安局备案号:备案中

    © 2017-2019 www.deliwenku.com 得利文库. All Rights Reserved 黑龙江转换宝科技有限公司  


    收起
    展开