Tests
Tests to consider
lid biopsy
Test
Indicated in atypical cases to exclude malignant conditions. This includes patients with unilateral lid changes, significant lid architecture alteration, lash changes or loss, recurrent chalazion, and cases not responsive to treatment for blepharitis.[33][34]
Lipogranulomatous inflammation is seen with chalazions.
Atypical squamous cells are seen in squamous cell carcinomas.
Palisading basal cells are seen in basal cell carcinomas.
Nests with central necrosis and cells with foamy cytoplasm are seen in sebaceous cell carcinoma.
Result
result varies depending on etiology
lid margin culture
Test
May be indicated in patients with recurrent anterior blepharitis with severe inflammation or cases not responding to therapy.[1]
The most commonly isolated organisms from blepharitic lids are Staphylococcus epidermidis (95.8%), Propionibacterium acnes (92.8%), and Corynebacterium species (76.8%).[11][12]Staphylococcus aureus is cultured in 46% to 51% of patients with anterior blepharitis, as compared with 8% of normal patients.[13]
Result
isolation of causative organism
microscopic evaluation of epilated eyelashes
Test
Demodex mites are reported to be present in 94% of ophthalmology outpatients, correlating with the presence of cylindrical dandruff (92% affected), collarettes (58%), and blepharitis (14%).[9] Epilated eyelashes can be evaluated for the presence of mites, especially in patients with cylindrical collarettes around the lashes.[35] However, given that collarettes are pathognomonic of Demodex infection, a Delphi panel agreed that epilation and direct visualization of mites was unnecessary for diagnosis if collarettes are seen on slit lamp exam.[36]
Result
may reveal Demodex mites; collarettes
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