Information
Editors
Blepharitis
Essentials
- Blepharitis (inflammation of the eyelid margin) tends to become chronic.
- Anterior blepharitis is due to inflammation of the eyelid skin and eyelash follicles.
- Posterior blepharitis is due to inflammation of the Meibomian glands.
Aetiology
- Prolonged infection http://www.dynamed.com/condition/blepharitis#CAUSES
- 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
Differential diagnosis
- Basal cell carcinoma, sebaceous gland carcinoma
- Dry eye Dry Eye Syndrome
- Chlamydial conjunctivitis
- Inflammation associated with a systemic disease (such as Crohn's disease, SLE, pemphigoid)
- If the symptoms are unilateral, the diagnosis is probably something other than blepharitis.
Treatment
- Bathing the eyelid margin http://www.dynamed.com/condition/blepharitis#EYELID_HYGIENE
- 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).
- Cleaning of the eyelid margin http://www.dynamed.com/condition/blepharitis#EYELID_HYGIENE
- For instance, with a cotton-tipped swab moistened with diluted baby shampoo (1:1)
- For fungal or seborrhoeic blepharitis, with diluted ketoconazole shampoo (1:5)
- An ointment with a combination of antimicrobial drug http://www.dynamed.com/condition/blepharitis#TOPICAL_ANTIBIOTICS and glucocorticoid http://www.dynamed.com/condition/blepharitis#TOPICAL_ANTIBIOTIC_STEROID_COMBINATIONS 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.
- 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.