Blepharitis is an eye condition characterized by chronic inflammation of the eyelid, the
severity and time course of which can vary.
Onset can be acute, resolving without treatment within 2–4 weeks, but more generally is
a long standing inflammation varying in severity.
It may be classified as seborrhoeic, staphylococcal, mixed, posterior or meibomitis, or parasitic.
Symptoms
Signs and symptoms that are associated with the chronic inflammation include:
Redness of the eyelids Flaking of skin on the lids
Crusting at the lid margins, generally worse on waking
Infection of the eyelash follicle/sebaceous gland
Red eye Debris in the tear film, seen under magnification
Gritty sensation of the eye or foreign-body sensation
Eye itching The lids may become red and may have ulcerative,
non-healing areas which may actually bleed.
Blepharitis does not tend to cause problems with the patient's vision whatsoever, but
due to a poor tear film, one may experience blurred vision.
Eye redness and swelling tend to appear in more advanced cases, and they are rarely primary
symptoms.
The symptoms can slightly vary based on the exact cause of the condition.
Blepharitis due to an allergy can cause dark lids, a symptom which is known as "allergic
shiner" and which tends to be more frequent in children rather than adults.
Infectious blepharitis is accompanied by a yellow- or green-colored discharge which is
more abundant in the morning and which leads to stuck lids.
Blepharitis may also cause eyelid matting or "gluing" of the lashes.
Other blepharitis symptoms include sensitivity to light, eyelashes that grow abnormally or
even loss of eyelashes.
Also, the tears might seem frothy or bubbly in nature and mild scarring might occur to
the eyelids.
The symptoms and signs of blepharitis are often erroneously ascribed by the patient
as being due to "recurrent conjunctivitis".
Blepharitis that localizes in the skin of the eyelids may cause styes or chalazia, which
appear like red bumps, sometimes with a yellow spot if infection is present.
Although pain is not common among blepharitis symptoms, if the condition persists or becomes
painful, the individual is recommended to seek medical attention.
Chronic blepharitis may result in damage of varying severity which may have a negative
effect upon vision and therefore upon the eyeglass prescription.
Infectious blepharitis can cause hard crusts around the eyelashes which leave small ulcers
that may bleed or ooze after cleaning.
As a general rule, blepharitis symptoms which do not improve, despite good hygiene consisting
of proper cleaning and care of the eye area, should be referred to a doctor.
People who usually wear contact lenses may have more trouble in coping with their symptoms,
because the lenses cause further irritation to the eye.
Staphylococcal blepharitis Staphylococcal blepharitis is caused by infection
of the anterior portion of the eyelid by Staphylococcal bacteria.
Patients notice a foreign body sensation, matting of the lashes, and burning.
Collarette around eyelashes, a ring-like formation around the lash shaft, can be observed, which
is an important sign of this condition.
Other symptoms include loss of eyelashes or broken eyelashes.
The condition can sometimes lead to a chalazion or a stye.
Staphylococcal blepharitis is a condition which may start in childhood and continue
through adulthood.
It is commonly recurrent and it requires special medical care.
The prevalence of Staphylococcus aureus in the conjunctival sac and on the lid margin
varies among countries, probably due to climate.
Staphylococcal blepharitis is normally treated with antibiotics such as Chloramphenicol ointment.
Fusidic acid is usually the choice of antibiotics in cases when Chloramphenicol is contraindicated.
Antibiotics are given for at least four to six weeks, which may be enough to completely
cure the infection.
A short course of topical steroids are administered to control the inflammation.
The infection is only treated effectively if given at the same time with extra cautious
eyelid hygiene.
This consists of proper cleaning of the eyelid, removing crusts and debris.
Posterior blepharitis or rosacea-associated blepharitis
Posterior blepharitis is inflammation of the eyelids secondary to dysfunction of the meibomian
glands.
Like anterior blepharitis it is a bilateral chronic condition and manifested by a broad
spectrum of symptoms involving the lids including inflammation and plugging of the meibomian
orifices and production of abnormal secretion upon pressure over the glands.
It may be associated with skin rosacea, and there is growing evidence that in some cases
it is caused by demodex mites.
Treatment and management The single most important treatment principle
is a daily routine of lid margin hygiene, as described below.
Such a routine needs to be convenient enough to be continued for life to avoid relapses
as blepharitis is often a chronic condition.
But it can be acute, and one episode does not mean it is a lifelong condition.
A typical lid margin hygiene routine consists of four steps.
The steps are more challenging to perform by visually disabled or frail patients as
they require good motor skills: Softening of lid margin debris and oils: Apply
a warm wet compress to the lids - such as a washcloth with hot water - for about two
minutes.
Warm wet cloths do not stay warm for long enough but dry compress masks can be conveniently
warmed in a micro-wave oven and maintain a comfortable 40C temperature for 10 minutes
while the waxy oils blocking the glands are cleared.
The humidity created also helps to reduce the evaporation of natural tears which are
important in soothing the cornea.
Mechanical removal of lid margin debris: After warm compresses, wash your face with a wash
cloth.
Use facial soap or non-burning baby shampoo.
Gently and repeatedly rub along the lid margins while eyes are closed.
Too much soap or shampoo may remove the essential oily layer of the eyes' own tear film and
create further problems with dry eye discomfort.
A moist cotton swab soaked in a cup of water with a drop of baby shampoo may be used to
rub along the lid margins while tilting the lid outward with the other hand.
Antibiotic reduction of lid margin bacteria: After lid margin cleaning, spread small amount
of prescription antibiotic ophthalmic ointment with finger tip along lid fissure while eyes
closed.
Use prior to bed time as opposed to in the morning to avoid blurry vision.
Avoid the use of eye make-up until symptoms subside.
Often the above is advised together with mild massage to mechanically empty glands located
at the lid margin.
Microbial blepharitis is treated with antibiotics such as sulfacetamide eye ointment applied
on a cotton applicator once daily to the lid margins.
Ophthalmologists may prescribe low-dose oral antibiotics such as Doxycycline and occasionally
weak topical steroids.
Blepharitis caused by demodex mites can be treated using a diluted solution of tea tree
oil and using a cotton swab for 5–10 minutes per day.
It is typically necessary to continue the treatments for 4–6 weeks to eliminate the
infestation.
Physicians may consider allergy testing and ocular antihistamines.
Allergic responses to dust mite feces and other allergens can cause lid inflammation,
ocular irritation, and dry eyes.
Prescription ocular antihistamines and over-the-counter ocular antihistamines can bring relief to
patients whose lid inflammation is caused by allergies.
Researchers have found Omega-3 supplementation in the form of fish oil or flaxseed to be
beneficial in reducing the primary symptoms of blepharitis.
A Cochrane Systematic Review examined 34 studies, consisting of over 2,000 participants suffering
from blepharitis or blepharoconjunctivitis.
Topical antibiotics were shown to be effective in providing symptomatic relief and clearing
bacteria for individuals with anterior blepharitis.
Topical steroids provided some symptomatic relief but were ineffective in clearing bacteria
from the eyelids.
Lid hygiene measures such as warm compresses and lid scrubs were found to be effective
in providing symptomatic relief for participants with anterior and posterior blepharitis.
See also List of eye diseases and disorders
List of skin diseases Chalazion
Conjunctivitis Seborrhoeic dermatitis
Stye References
External links Blepharitis Resource Guide from the National
Eye Institute.
Mayo Clinic Basic Guide for Effective Self Treatment of
Blepharitis Blepharitis description from the American
Optometric Association eMedicine Health: Eyelid Inflammation
Blepharitis Fact Sheet Blepharitis Causes and Symptoms