Inflammation of the eyelids.
Types of blepharitis
- Anterior blepharitis- inflammation of the eyelashes/follicles
- Staphylococcal
- ulcerative, red and scale
- Seborrheic
- non-ulcerative, greasy scale
- Staphylococcal
- Posterior blepharitis- inflammation of the meibomian gland orifices- NOT lash/lid
Causes
- Rosacea, Herpes simplex dermatitis, Varicella zoster dermatitis, molluscum contagiosum, allergic or contact dermatitis, seborrheic dermatitis, staphylococcal dermatitis, parasitic infection
- chronic cases may be due to exposure to chemical fumes, smoke, irritants etc
- NB Sjogren’s can present with blepharitis
Symptoms/Signs
- Anterior Blepharitis
- Burning, watering, foreign body sensation
- Crusting/mattering of the lashes and medial canthus
- Redness (lids and eyes)
- Photophobia
- Pain
- Decreased Vision
- Loss of lashes (madarosis)
- Whitening of lashes (poliosis)
- Scarring/misdirection of lashes (trichiasis)
- Styes/ulcers of lid margin
- Corneal staining, marginal ulcers
- Seborrheic
- No ulceration
- Scales and dandruff +++
- Meibomian gland openings swollen and pouting
- Dried secretions at the gland openings
- Meibomian cysts may be present
- Redness, pain etc still present but lashes are largely unaffected
- Other
- Signs/symptoms of other (local or systemic) causes
- Malar flush (rosacea- especially posterior blepharitis); scalp flaking/oily skin (seborrheic dermatitis
- Signs/symptoms of other (local or systemic) causes
Management
- Usually conservative (self-limiting) but warming and compression of the eyelid (to promote evacuation/cleansing), mechanical washing;
- topical chloramphenicol may be used 2nd line (fusidic acid if no response)
- NB Blepharitis may directly precede conjunctivitis or scleritis. It is therefore recommended that antibiotics/steroids are not used first line as they will mask the symptoms of this.
- Also, if there is an underlying cause e.g. rosacea or seborrhoeic dermatitis, it may be appropriate to treat these conditions