Blepharitis is a chronic inflammation of the eyelid margins that is often refractory to treatment with infectious and noninfectious etiologies.

Eyelid infection or inflammation

Eczema of the eyelids

Dermatoblepharitis

Angular blepharitis

• Common in children, particularly those with atopic dermatitis and eczema
• Adults with seborrhea involving the eyelids

• Common symptoms: Red eyes, burning sensation, excessive tearing, blurred vision, pruritic eyelids.
• Chronically infected lids are usually diffusely erythematous with collarettes (fibrin exudate) at the base of the lashes.
• Lid margins thicken over time, with associated loss of eyelashes (madarosis), misdirected growth of lashes (trichiasis), and overflow or inspissation of the meibomian glands (Fig. E1).
• Associated conjunctivitis with erythema and edema but no discharge.
• Chalazion: Chronic sterile inflammation of an oil gland of the eyelid.
• Superficial punctate erosions of the inferior corneal epithelium are common.
• More severe findings, such as corneal pannus, ulcerative keratitis, or lid ectropion, are less common.

Multiple: Bacterial and nonbacterial causes:

• Staphylococcal infection most common but streptococcal, Moraxella, and other bacterial infections; viral infections (e.g., herpes simplex, herpes zoster, Molluscum contagiosum); and a number of ectoparasites (Fig. E2), including pediculosis, may cause blepharitis
• Seborrheic dermatitis
• Rosacea
• Dry eye (keratoconjunctivitis sicca): Decrease in tear volume
• Meibomian gland dysfunction
• Contact lens intolerance
• Two categories of blepharitis (Table E1):
  1. Anterior blepharitis, most often associated with staphylococcal infection
  2. Posterior blepharitis, associated with meibomian gland dysfunction and seborrheic dermatitis or rosacea

• Keratoconjunctivitis sicca
• Eyelid malignancies
• Herpes simplex blepharitis
• Molluscum contagiosum
• Phthiriasis palpebrarum
• Phthirus pubis (pubic lice)
• Demodex folliculorum (transparent mites)
• Allergic blepharitis

Scrapings of the eyelids to show polymorphonuclear leukocytes and gram-positive cocci

Eyelid cultures and antibiotic sensitivity testing (usually not done unless patient fails to respond to initial treatment regimen)

• Alkaline soaps may be beneficial; alcohol and some detergents remove surface lipids and microflora.
• Hot compresses applied to closed lids for 5 to 10 min: Heat loosens debris from lid margins and increases meibomian gland fluidity.
• Firm massage of the lid margins to enhance the flow of secretions from glands, followed by cleansing of the lids with cotton-tipped applicators dipped in a 50:50 mixture of baby shampoo and water.
• Lashes and lid margins scrubbed vigorously while the eyelids are closed, followed by thorough rinsing.
• Following local massage and cleansing, the mainstay of treatment is application of topical antibiotic ointment to the eyelid margins.
  1. Most effective topical antibiotics include bacitracin, erythromycin or 1% azithromycin solution, aminoglycoside and fluoroquinolone ophthalmic ointments.
  2. Ointment is applied 1 to 4 times daily, depending on the severity, for 1 to 2 wk, followed by once daily, at bedtime, for another 4 to 8 wk until all signs of inflammation have disappeared.
• Oral antibiotics: Long-term use of doxycycline or tetracycline in a tapering dose may be helpful in severe cases for patients older than 12 yr of age.
• Topical glucocorticoids: Short-term use in acute exacerbations of blepharitis.
• For patients with rosacea: Tetracycline 250 mg orally 4 times daily or doxycycline 100 mg orally bid along with local treatment for several months.
• Recalcitrant cases with antibiotic resistance:
  1. Vancomycin eye drops 1%
  2. Ciprofloxacin or ofloxacin eye drops

• By definition, this is a chronic condition for which there is frequently no cure.
• Some newer agents being evaluated are topical cyclosporine 0.05% eye drops, thermal pulsation systems to break up material in meibomian glands, topical metronidazole and topical tacrolimus and voclosporin (which are like cyclosporin: Calcineurin inhibitors), and tear lipid substitutes.

This condition may be refractory to treatment.

To an ophthalmologist if patient fails to respond to local therapy