Bacterial infection (Staphylococcus aureus) is common
Viral or fungal infection is rarer
Pubic lice (Phthirus pubis) and hair follicle mites (Demodex folliculorum) may occur
Increased sebum formation (seborrhoea) creates favourable conditions for bacterial growth
Allergy
Associated with skin disorders (atopy, rosacea, psoriasis)
Eye medication
Isotretinoin
Meibomian gland dysfunction (MGD)
Sebum formed at the eyelid margin and skin scales remain at the root of the eyelashes, blocking the Meibomian gland orifices and causing inflammation spreading to the gland ducts. For structure of the eyelids and tear channels: see Image http://www.lea-test.fi/en/eyes/lidsncha.html.
Oil secreted by the Meibomian glands accumulates, becoming rancid and hard. Eventually the gland duct becomes obstructed. The rancid oil causes inflammation, or meibomitis, which may lead to the formation of a pimple-like swelling called a chalazion Hordeolum and Chalazion.
The inflammation may lead to a disturbance of tear secretion and dry eye Dry Eye Syndrome.
Symptoms and findings
The lid margin is red, scaly, and crusty at the eyelash roots
Itching and mild pain
Foreign body sensation
Purulent discharge
Symptoms worse in the morning and late at night
Madarosis (loss of eyelashes)
Rounded and possibly red eyelid margins
In meibomitis, swollen and obstructed Meibomian glands, excreting a thick pasty mass when pressed with a cotton-tipped swab
Place a warm compress, such as a terry cloth soaked in warm water, on closed eyelids for 10 min. once or twice daily for 2 weeks.
After the 2-week period, the treatment can be continued, once or twice weekly for a month, for instance.
The course of bathing should be repeated, as necessary.
Mechanical emptying of the glands
Some patients may benefit from emptying of the Meibomian glands with appropriate tweezers or forceps (best done by an ophthalmologist using a biomicroscope).
Regular use of moisturizing eye drops without preservative 2-4 times daily may reduce the dry eye symptoms.
If regular use of moisturizing eye drops for several months does not provide sufficient relief, referral to an ophthalmologist should be considered for possible prescription of other medication, such as ciclosporine eye drops or a tacrolimus ointment (prescription by an ophthalmologist).
For patients with rosacea, a long course of oral doxycycline, 100-150 mg/day for as long as 1-3 months (sic!) under the supervision of an ophthalmologist, should be considered.