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EYE DISEASES OR DISORDERS – Presbyopia and Blepharitis (Etiology and Management)

EYE DISEASES OR DISORDERS – Presbyopia and Blepharitis (Etiology and Management) 

EYE DISEASES OR DISORDERS – Presbyopia and Blepharitis (Etiology and Management)


Presbyopia is not an error of refraction but a condition of age – related physiological anomaly of accommodation, leading to failing vision for near. The amplitude of accommodation gradually diminishes throughout life. Near vision difficulty starts about the age of 40 years, because of less flexible lens resulting in loss of accommodation. The neuromuscular mechanism of accommodation is not at fault. But on accommodation the lens fails to have the desired convexity.


Decrease in the elasticity and plasticity of the lens with age.

Age – related decrease in the power of cilliary muscle

Causes of premature presbyopia


Primary open-angle glaucoma

Premature sclerosis of the lens

Excessive close work



Presbyopia is treated by prescribing convex spherical lens, which added to the glasses, if any, for the distant vision in the following manner:

At the age of 40 years – reading correction is +1D

At the age of 45 years – reading correction is +1.5D

At the age of 50 years – reading correction is +2D

At the age of 55 years – reading correction is +2.5D


Surgical techniques under trial are monovision LASIK, bifocal or multifocal or accommodating IOL, anterior cilliary sclerotomy, and conductive keratoplasty.




Blepharitis is a chronic bilateral inflammatory reaction of the eyelid margins. It can be anatomically divided into anterior blepharitis which primarily affects the lashes and posterior blepharitis which involves the meibomian glands.

Anterior Blepharitis

Anterior blepharitis is broadly divided into staphylococcal blepharitis and seborrhoeic blepharitis

Staphylococcal blepharitis: it is usually ulcerative and is more serious due to the involvement of the base of hair follicles. Permanent scarring can result
Seborrhoeic blepharitis: Hyperemia and greasy appearance to anterior lid margin with lashes stuck together. Soft scaling occurs along length of lash


Posterior Blepharitis

Meibomian seborrhea: Meibomian gland orifices (lining the lid margin) are covered with small oil globules. Pressing the tarsus (firm bit within the lid) results in copious expression of meibomian
Meibomianitis: Inflammation of the meibomian glands which may be obstructed



  • Sore eyes: Burning and itching of eyelid margins
  • Dry eye or epiphora (tearing)
  • Redness and flaking
  • Irritation
  • Photophobia



Lid hygiene: This is the mainstay of treatment and may be sufficient to control simple low grade blepharitis. Lid hygiene should be carried out twice a day in the acute phase and once daily at other times. There are three main aspects to this:

  • Warm compress: Soak a cloth or make-up pad with hot water – apply to each eye for 5 (ideally 10) minutes
  • Lid massage: Mild cases treated with eyelid margin hygiene at least once daily. Close lids and gently rotate clean finger along lid, ending in a down ward stroke (upper lid) and upward stroke (lower lid). Move along length of each lid.
  • Lid cleansing: Mix baby shampoo with water. Dip cotton bud in and run along margin, cleaning off debris from lash base. Bicarbonate of soda or commercial lid scrubs may also be used.

 Antibiotic ointment: Chloramphenicol ointment is prescribed 1-4 times per day to lid margin. Teach patient to scrub eyelid margin with cotton swab to remove flaking and then apply ointment with cotton swab
Systemic antibiotics: Meibomitis responds better to systemic antibiotics over a minimum of six weeks (12 weeks provides a prolonged effect). Option include:

  • Tetracycline: 500 mg b.d. for 4 weeks then 250 mg b.d. for 8 weeks
  • Oxytetracyclines: 500 mg b.d. for 4 weeks then 250 mg b.d. for 8 weeks
  • Lymecycline: 408 mg o.d. for 12 weeks
  • Doxycycline: 100 mg o.d. for 4 weeks then 50 mg o.d. for 8 weeks