Source: Manual of Ambulatory Pediatrics 2010
SOAP Note – Marginal Blepharitis
A chronic inflammation of the eyelid margins with accumulation of yellowish scales. It is often associated with seborrheic dermatitis.
I. Etiology
A. Seborrhea (see Seborrhea of the Scalp, p. 384)
B. May be associated with S. aureus
II. Incidence
A. Seen in all age groups but most often seen in infancy and adolescence
B. Often occurs in conjunction with seborrhea of the scalp
III. Subjective data
A. Scaling and inflammation of the eyelid margins
B. Crusting, itching, or burning may be present.
C. May be asymptomatic, identified on routine physical examination
IV. Objective data
A. Yellowish, oily scales on eyelashes
B. Lashes often matted
C. Eyelashes may not grow.
D. Inflammation, scaling, and exudate on eyelid margins
E. Mild conjunctivitis may be present.
F. Ulcerations of lid margins if severe
G. Check entire body for presence of seborrhea elsewhere, particularly on the scalp and eyebrows.
V. Assessment: Diagnosis easily made by typical appearance
VI. Plan
A. Warm, moist compresses 4 times a day to remove crusts and scales
B. CIBA Eye Scrub or Johnson’s Baby Shampoo: Use to cleanse lashes daily.
C. Blephamide ointment: For children 6 years or older
1. Apply at bedtime
2. Use qid if inflammation is present or
D. Ilotycin ophthalmic ointment
1. Apply at bedtime
2. Use if inflammation is present.
E. Treat concurrent seborrhea of the scalp according to protocol, p. 384.
VII. Education
A. Use warm, moist compresses for 10 minutes.
B. Use soft facecloth for compresses.
C. Pull down lower eyelid, and apply a thin ribbon of ointment along inner margin of lower lid.
D. Continue treatment for 1 week after symptoms have cleared.
E. Use of ointment may cause temporary blurring of vision.
F. Sodium Sulamyd may cause stinging or burning if child is sensitive to it. Discontinue use and call office.
G. Problem is chronic.
H. Treatment will control the condition but generally will not offer a complete cure.
I. Once cleared, teach parent or child to be alert for symptoms of recurrence so treatment can be instituted early. Warm compresses should be used immediately if symptoms recur.
J. Does not affect visual acuity
VIII. Follow-up
A. Return in 3 to 4 days if no improvement is noted or symptoms seem worse.
B. Call back immediately if any reaction to medication occurs.
IX. Consultation/referral
A. No response to treatment after 1 week
B. Refer to ophthalmologist for monitoring of intraocular tension with intermittent or chronic use of steroid therapy.