NURS 6531 Week 3 Case Study 1: Blepharitis

An 86-year-old widowed female is brought to the office by her daughter-in-law. The patient complains of constant tearing and an itchy, burning sensation in both eyes. The patient states this is not a new problem, but it has worsened in the past week and is affecting her vision. The patient complains that her eyes are dry. She thinks the problem must be caused by one of her medications. Her patient medical history is positive for hypertension, atrial fibrillation, and heart failure. She has an allergy to erythromycin that causes rash and elevated liver enzymes.

Medications currently prescribed include Furosemide 40 milligrams po twice a day, diltiazem 240 milligrams po daily, lisinopril 20 milligrams po daily, and warfarin 3 milligrams po daily.

The physical examination reveals a frail older female with some facial dryness and slight scaling.

Her visual acuity is 20/60 OU, 20/40 OD, 20/60 OS.

The eyelids are erythematous and edematous with yellow crusting around the lashes. Sclera is injected, conjunctiva are pale, and pupils are equal and reactive to light and accommodation. NURS 6531 Week 3 Case Study 1: Blepharitis.

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Primary Diagnosis: Blepharitis

Blepharitis is a disorder that is associated with the patient with oily skin or skin disorders such as seborrhea dermatitis or rosacea. Blepharitis is inflammation that affects the base of the eyelashes that occurs when you have an accumulation of bacteria and oil in that area.

The symptoms associated with Blepharitis are “crusty discharge on the lashes or lids, especially when first awakening, redness of the eye or eyelids, swelling of eyelids and skin around eyes, itching, burning, excessive tearing, dry eyes, blurring of vision, loss of eyelashes, photophobia (sensitivity to bright light), Gritty sensation when blinking, Fluctuating vision due to secondary dryness and an unstable tear film” (Dale, 2016).

The patient reports she has facial dryness and slight scaling which can be associated with seborrheic dermatitis, which is one of the skin disorders associated with Blepharitis. The role of the patient history and physical exam is to guide the provider on the possible diagnosis associated with the patient’s symptoms and give the provider the opportunity to rule out certain diagnosis according to the data collected. Gathering a sufficient amount of subjective and objective information on a patient will give the provider the opportunity to provide the patient with the best treatment possible.

Differential Diagnosis

Dry Eye Syndrome: caused by the decreased amount of lubricant production to provide moisture to the eye. Symptoms associated with this disorder are “irritated, gritty, scratchy or burning eyes; a feeling of something in their eyes; excess watering; and blurred vision. Advanced dry eyes may damage the front surface of the eye and impair vision” (American Optometric Association, 2018).

Atopic Keratoconjunctivitis: an inflammatory eye disorder that is recurrent due to its allergic tendencies. The cause of this disorder is related to the person immune system produce an increased amount of normal antibiotics due to an allergen. The symptoms associated with this disorder are “Ocular symptoms with little or no seasonal variation (as opposed to vernal conjunctivitis that is seen only in warm weather), including itching, tearing, ropy discharge, burning, photophobia, and/or decreased vision” (Chang-Godinich, 2017).

Hordeolum: an infection of the eyelid that forms an abscess. Symptoms associated with this disorder are “acute inflammation, such as a painful, warm, swollen, red lump on the eyelid” (Ehrenhaus, 2017). NURS 6531 Week 3 Case Study 1: Blepharitis

Treatment for Blepharitis

Apply warm compresses to eyelid for 5-10 minutes twice a day for 30 days.

Use Johnson’s baby shampoo or an eyelid cleaner twice a day to eyelids for 30 days.

Doxycycline 100mg twice a day for 30 days.

Schedule follow-up appointment for the patient to return for reassessment.

Reference

American Optometric Association (2018). Dry Eye.