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