blepharitis
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Introduction
Chronic inflammatory condition involving the margins of the eyelids.
Classification
There are 2 types of blepharitis:[2]
- anterior (outer part of eyelid margin containing cilia)
- posterior (inner part of eyelid margin containing meibomian glands)
Etiology
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
- foreign body sensation - ocular gritty sensation
- eye irritation & excessive tear production may be noted
- symptoms may worsen in dry weather
- often associated with:
- Herpes infections may also ulcerate or form vesicles
- generally affects both eyes in chronic condition
Differential diagnosis
- 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
- eyelid hygiene (anterior blepharitis)
- ophthalmic antibiotics improve, but may not resolve posterior blepharitis infection[2]
- erythromycin ophthalmic
- bacitracin ointment
- oral antibiotics: (anterior blepharitis)
- association with Staphylococcus aureus, rosacea or Demodex
- tetracycline or doxycycline[2]
- tear replacement: natural tears, etc.
- referral to an ophthalmologist for persistent symptoms or for evaulation of corneal damage