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Blepharitis

Specialties > Ophthalmology

Background knowledge 🧠

Definition

  • Blepharitis is a chronic inflammatory condition affecting the eyelid margins.
  • Commonly associated with irritation, redness, and crusting of the eyelashes.
  • Can affect both anterior (front) and posterior (back) parts of the eyelid margin.

Epidemiology

  • Common condition, particularly in adults and elderly.
  • Prevalence increases with age.
  • No significant gender predilection.
  • Often associated with other skin conditions like rosacea and seborrheic dermatitis.

Aetiology and Pathophysiology

  • Often multifactorial in origin.
  • Bacterial colonisation, particularly Staphylococcus species, is common.
  • Malfunction of the meibomian glands can lead to posterior blepharitis.
  • Allergic reactions, such as to cosmetics, can exacerbate symptoms.
  • Chronic inflammation leads to disruption of the normal eyelid margin architecture.

Types

  • Anterior blepharitis: Affects the outer eyelid margin, often linked to bacterial infection or seborrheic dermatitis.
  • Posterior blepharitis: Involves the inner eyelid margin and is usually due to dysfunction of the meibomian glands.
  • Mixed blepharitis: Features of both anterior and posterior types.

Clinical Features 🌡️

Symptoms

  • Itching, burning, or stinging sensation in the eyes.
  • Gritty or foreign body sensation.
  • Crusting or stickiness of the eyelids, particularly upon waking.
  • Photophobia in severe cases.
  • Possible blurring of vision due to tear film instability.

Signs

  • Redness and swelling of the eyelid margins.
  • Crusting around the base of the eyelashes.
  • Telangiectasia on the eyelid margin.
  • Blocked or capped meibomian glands.
  • In severe cases, anterior blepharitis may cause loss of eyelashes (madarosis).
  • Conjunctival injection (redness) may also be present.

Investigations 🧪

Tests

  • Primarily a clinical diagnosis based on history and examination.
  • Slit-lamp examination to assess eyelid margins and meibomian gland function.
  • Microbiological swabs may be taken if an infectious cause is suspected.
  • Tear break-up time (TBUT) may be reduced in cases with tear film instability.

Management 🥼

Management

  • Eyelid hygiene: Regular cleaning of eyelid margins with warm compresses and diluted baby shampoo or commercial lid scrubs.
  • Topical antibiotics: E.g., fusidic acid gel or chloramphenicol ointment for bacterial involvement.
  • Oral antibiotics: E.g., doxycycline for severe or chronic cases, particularly if associated with rosacea.
  • Lubricating eye drops: To alleviate dry eye symptoms.
  • Steroid eye drops: Short-term use for significant inflammation, prescribed by a specialist.

Complications

  • Chronic conjunctivitis due to persistent inflammation.
  • Meibomian cysts (chalazia) due to blocked meibomian glands.
  • Corneal involvement: Punctate epithelial erosions or marginal keratitis.
  • In rare cases, scarring of the eyelid margin or loss of eyelashes.

Prognosis

  • Chronic condition with potential for recurrent episodes.
  • Symptoms often improve with consistent management and good eyelid hygiene.
  • Long-term prognosis is generally good with appropriate treatment, but complete resolution may not be achievable.
  • Patient education and adherence to treatment are key to managing recurrences.

Key points

  • Blepharitis is a common and often chronic condition requiring long-term management.
  • Good eyelid hygiene is the cornerstone of treatment.
  • Recognising associated conditions, such as rosacea, can guide appropriate management.
  • Referral to a specialist may be necessary for persistent or complicated cases.
  • Education on the chronic nature of the condition helps set realistic patient expectations.

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Ophthalmology