Blepharitis

Inflammation of the eyelids.

Types of blepharitis

  • Anterior blepharitis- inflammation of the eyelashes/follicles
    • Staphylococcal
      • ulcerative, red and scale
    • Seborrheic
      • non-ulcerative, greasy scale
  • 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

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

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