Case
Initial presentation
A male elderly patient, aged 79 years, attended the eye clinic with the complaint of constant accumulation of mucus-like discharge at the canthus, particularly of the left eye. He wore a minor, myopic, astigmatic, presbyopic spectacle correction in the form of progressive power lenses. His best corrected acuity in each eye was 6/6 and N6.
Fundus examination did not reveal any abnormality in either eye. However, it was found that he suffers from chronic blepharitis (figure 1). Also, there was a significant finding of facial dermatitis (figure 2). History-taking revealed the patient had been suffering from dandruff for around six months.
Figure 1: Blepharitis; before treatment; Figure 2: Facial dermatitis; before treatment
Management
He was referred to a dermatologist,1 who made the diagnosis of seborrheic dermatitis and prescribed the following treatment:
- Scalpe Plus shampoo to be used daily
- Cetaphil face wash to be used three times a day,
- Hhzole cream (a combination of two medicines that effectively treats fungal infections of skin) to be applied on affected areas once daily for about two weeks
- SporanoX 100mg (an antifungal fluid preparation taken orally) to be taken once daily for 10 days
- Allegra 180mg (an anti-allergy medicine taken as tablets) to be taken once daily for 10 days
Seborrheic dermatitis is a skin condition that mainly affects the scalp, causing scaly patches, red skin and stubborn dandruff. It can also affect other areas of the body (like the face, sides of the nose, eyebrows, ears, eyelids and chest). The condition may go away on its own without treatment or may require repeated treatments. Daily cleaning with a gentle soap and shampoo can help reduce oiliness and dead skin buildup. Itching may or may not be present.2
The ophthalmologist3 prescribed Ocupol (chloramphenicol & polymyxin-b sulphate ophthalmic ointment) for the blepharitis (figure 3), with an instruction to apply a small quantity of the ointment (less than half the size of a rice-grain) to the skin where the deposit appears.
Figure 3: Ocupol ophthalmic ointment
Improvement has already started after three days of treatment (figures 4 and 5).
Figure 4 & 5: Blepharitis; undergoing treatment; Dermatitis; undergoing treatment
Blepharitis is inflammation of the eyelids, which may appear red, swollen or with burning sensation. There may be crusts at the base of eyelashes. The condition is common, especially among people who have dandruff. It is important to keep the eyelids, skin and hair clean. Symptomatic treatment includes warm compresses (to help open the meibomian glands), antibiotics, eye drops and skin and eyelid hygiene.4
View from India
Interprofessional or interdepartmental (especially in government hospitals) is an accepted, common and useful practice in India. It is usually, however, a health care professional such as a physician, cardiologist, paediatrician or dermatologist, who refers a case to the ophthalmologist when the patient complains of any ocular problem (like dimness of vision, pain in eyes, itching or watering).
However, here is a case of a patient essentially suffering from facial dermatitis, who attends an eye clinic for an eye ailment, and from where he is referred to a dermatologist for management of an associated systemic problem.
Near Acuity Chart
My practice has recently produced a new near acuity test type card, which is aimed not only at assessing near acuity, but also offers useful information about eye health. In a community where health education is so important, we have found the initial response to this card as very useful. This may be of some interest to UK readers.
Figure 6: The new near acuity test chart
- Dr Narendra Kumar, BAMS, DROpt, PGCR is Editor, Optometry Today and a clinician at Ophthacare Eye Centre, Janakpuri, New Delhi.
References
- Dr Annu Jain: www.practo.com/delhi/doctor/dr-annu-jain-dermatolo...
- www.mayoclinic.org
- Dr Maneesh Kumar and Dr Charu Gupta (ophthacare@gmail.com)
- www.aao.org