Information
Editors
Blepharitis
Essentials
- Blepharitis (inflammation of the eyelid margin) tends to become chronic.
- Atopy and other skin diseases are common causes of blepharitis.
- Anterior blepharitis can be due to inflammation of the eyelid skin and eyelash follicles.
- Posterior blepharitis is often due to inflammation of the Meibomian glands.
Aetiology
- Blepharitis associated with skin diseases (atopy, rosacea, psoriasis)
- 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 picture 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 a pimple-like inflammation, i.e. meibomitis, which may lead to the development of a chalazion Hordeolum and Chalazion.
- The inflammation may lead to a disturbance of tear secretion and dry eye Dry Eye Syndrome.
- Allergy
- Prolonged infection of the eye area
- 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
- Eye medication
- Basically, any eye medicine that can cause allergies or contains preservatives can irritate the front of the eye. The most common causes are glaucoma drugs. Switching to single-dose packs may help.
- Isotretinoin (orally)
Symptoms and findings
- The lid margin is red, scaly, and crusty at the eyelash roots
- Dry eyes
- 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. The characteristic symptom is the champagne bubble-like consistency of the tear fluid at the margin of the eyelid.
Differential diagnosis
- Basal cell carcinoma, sebaceous gland carcinoma
- Chlamydial conjunctivitis
- Eye symptom associated with a systemic disease (such as Crohn's disease, SLE, pemphigoid, thyroid dysfunction)
- If the symptoms are unilateral, the diagnosis is probably something other than blepharitis.
Treatment
- Bathing with a warm compress and cleaning the eyelid margin
- 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 using the compress, the eyelid margin is cleaned with a cotton swab or gauze dressing moistened with water or diluted baby shampoo (1:1). For fungal blepharitis or seborrhoeic blepharitis, diluted ketoconazole shampoo (1:5) is used.
- 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).
- If necessary, as prescribed by an ophthalmologist, an ointment with a combination of antimicrobial drug and glucocorticoid applied to the eyelid margin once or twice daily for 2 weeks. The ointment should be applied to the roots of the eyelashes immediately after bathing the eye. In most cases, this is not necessary.
- 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 or pimecrolimus 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!), should be considered.