2020–2021 BCSC Basic and Clinical Science Course™
11 Lens and Cataract
Chapter 12: Preparing for Cataract Surgery in Special Situations
External Ocular Abnormalities
Blepharitis and Acne Rosacea
To reduce bacterial colony counts on the ocular surface, preoperative control of blepharitis, which is particularly common in patients with acne rosacea, is recommended. Uncontrolled blepharitis that causes irritation and an unhealthy tear film may adversely affect the quality of the patient’s vision after cataract surgery. Treatments for anterior blepharitis include hot compresses and eyelid scrubs. The mainstay of therapy for meibomian gland dysfunction involves saponification of inspissated meibomian secretions with systemic tetracycline, doxycycline, or minocycline. Topical ointments poorly penetrate meibomian orifices, but newer topical eyedrops, such as azithromycin, reduce bacterial flora at the surface of the meibomian glands. Thermal pulsation or devices that clean the eyelid margin may improve eyelid hygiene preoperatively in severe cases. For a detailed description of the signs and symptoms of blepharitis, see BCSC Section 8, External Disease and Cornea.
Packer M, Chang DF, Dewey SH, et al. Prevention, diagnosis, and management of acute postoperative bacterial endophthalmitis. J Cataract Refract Surg. 2011;37(9):1699–1714.
Wykoff CC, Parrott MB, Flynn HW Jr, Shi W, Miller D, Alfonso EC. Nosocomial acuteonset postoperative endophthalmitis at a university teaching hospital (2002–2009). Am J Ophthalmol. 2010;150(3):392–398.
Excerpted from BCSC 2020-2021 series: Section 11 - Lens and Cataract. For more information and to purchase the entire series, please visit https://www.aao.org/bcsc.