Pictorial Case Study

The case - A 30-year-old woman presented with sore eyelids and dry eyes. She also had a chalazion of the inner lower eyelid and a red rash over her cheek, forehead and chin that was aggravated by sunlight. What is the diagnosis, management and differential diagnoses?

Diagnosis and management
The patient has meibomian gland dysfunction and rosacea.

Meibomian gland dysfunction is also known as posterior blepharitis, and is often associated with rosacea. It affects the meibomian glands. The secretions from the glands keep the eye moist. Dysfunction and inflammation cause dryness, burning and irritation of the eye.

Advice on lid hygiene was given and preservative-free drops for dry eyes were prescribed.

The rosacea was treated with oral antibiotics.

Possible different diagnosis

  • Seborrhoeic blepharitis.
  • Staphylococcal blepharitis.
  • Conjunctivitis.
  • Allergy to cosmetics.

Differential diagnosis

  • Seborrhoeic blepharitis.
  • Affects anterior lid margin.
  • Eyelash loss and misdirection is rare.
  • Mild conjunctival injection.
  • Oily and greasy eyelid deposits.
  • Associated with seborrhoeic dermatitis in other areas such as the face.

Contributed by Dr Vasa Gnanapragasam, a GP in Sutton, Surrey.

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