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blepharitis
Chronic inflammatory condition involving the margins of the eyelids.
Classification:
There are 2 types of blepharitis: [2]
1) anterior (outer part of eyelid margin containing cilia)
2) posterior (inner part of eyelid margin containing meibomian glands)
Etiology:
1) Staphylococcus aureus
2) seborrhea
3) rosacea
4) Herpes simplex
5) Varicella-zoster
6) Demodex
Pathology:
1) inflammation of the eyelid margins
2) poor glandular flow & build up of bacteria, especially bacteria around eyelids
2) oil-producing meiboman glands become plugged with highly viscous secretions that build up during sleep
3) blurring of morning vision by changing properties of the tear film
Clinical manifestations:
1) burning, tearing, irritation or itching of the eyelids
2) awakening with eyelids stuck together with discharge
- crusting of the eyelashes
- flaky material at the base of the eyelashes
3) foreign body sensation - ocular gritty sensation
4) eye irritation & excessive tear production may be noted
5) symptoms may worsen in dry weather
6) often associated with:
a) conjunctivitis
b) corneal irritation
c) hordeolum
d) chalazion
7) Herpes infections may also ulcerate or form vesicles
8) generally affects both eyes in chronic condition
Differential diagnosis:
- viral conjunctivitis
- generally starts in one eye, spreads to the other within a few days
- resolution generally occurs within 2 weeks, not a chronic condition
Management:
1) eyelid hygiene (anterior blepharitis)
a) warm compresses
b) eyelid scrubs with baby shampoo
2) ophthalmic antibiotics improve, but may not resolve posterior blepharitis infection [2]
a) erythromycin ophthalmic
b) bacitracin ointment
3) oral antibiotics: (anterior blepharitis)
- association with Staphylococcus aureus, rosacea or Demodex
- tetracycline or doxycycline [2]
4) tear replacement: natural tears, etc.
5) referral to an ophthalmologist for persistent symptoms or for evaulation of corneal damage
Related
chalazion; chalasia
conjunctivitis
hordeolum (sty)
Specific
blepharoconjunctivitis
General
eyelid disease
eye infection (ocular inflammation including eyelid inflammation)
References
- Medical Knowledge Self Assessment Program (MKSAP) 11, American
College of Physicians, Philadelphia 1998
- Geriatrics Review Syllabus, American Geriatrics Society,
5th edition, 2002-2004
- Yen MT et al
Blepharitis
EyeWiki. 2023. Sept 4.
https://eyewiki.aao.org/Blepharitis