blepharitis

Introduction

Chronic inflammatory condition involving the margins of the eyelids.

Classification

There are 2 types of blepharitis:

• anterior (outer part of eyelid margin containing cilia)
• posterior (inner part of eyelid margin containing meibomian glands)

Etiology

• Staphylococcus aureus
• seborrhea
• rosacea
• Herpes simplex
• Varicella-zoster
• Demodex

Pathology

• inflammation of the eyelid margins
• poor glandular flow & build up of bacteria, especially bacteria around eyelids
• oil-producing meiboman glands become plugged with highly viscous secretions that build up during sleep
• blurring of morning vision by changing properties of the tear film

Clinical manifestations

• burning, tearing, irritation or itching of the eyelids
• awakening with eyelids stuck together with discharge
  • crusting of the eyelashes
  • flaky material at the base of the eyelashes
• foreign body sensation - ocular gritty sensation
• eye irritation & excessive tear production may be noted
• symptoms may worsen in dry weather
• often associated with:
  • conjunctivitis
  • corneal irritation
  • hordeolum
  • chalazion
• Herpes infections may also ulcerate or form vesicles
• generally affects both eyes in chronic condition

Differential diagnosis

• dry eyes (xerophthalmia)
  • dry eyes affects up to 30% of people >50 years old
  • eyelid crusting: most common cause
• viral conjunctivitis
  • generally starts in one eye, spreads to the other within a few days
  • resolution generally occurs within 2 weeks, not a chronic condition

Management

• adequately treat xerophthalmia
  • prn artificial tears inadequate, schedule artificial tears 4 times a day
  • add artifical tear ointment at bedtime
• eyelid hygiene (anterior blepharitis)
  • warm compresses
  • eyelid scrubs with baby shampoo
• ophthalmic antibiotics improve, but may not resolve posterior blepharitis infection
  • erythromycin ophthalmic
  • bacitracin ointment
• oral antibiotics: (anterior blepharitis)
  • association with Staphylococcus aureus, rosacea or Demodex
  • tetracycline or doxycycline
• referral to an ophthalmologist for persistent symptoms or for evaulation of corneal damage

More general terms

• eyelid disease
• eye infection (ocular inflammation including eyelid inflammation)

More specific terms

• blepharoconjunctivitis

Additional terms

• chalazion; chalasia
• conjunctivitis
• hordeolum (sty)