Blepharitis

Common chronic inflammatory condition affecting the margin of the eyelids

Aetiology

  • Usually develops in middle-age but may occur at any age

Anterior blepharitis

  • Refers to inflammation of the base of the eyelashes (located on the anterior margin of the eyelid)
  • It can be caused by:
    • Bacteria (usually staphylococci) - staphylococcal blepharitis
    • Seborrhoeic dermatitis - seborrhoeic blepharitis
      • Characterized by less inflammation than staphylococcal blepharitis; however, it causes more excess oil or greasy scaling

Posterior blepharitis

  • Inflammation of the meibomian glands (often called meibomian gland dysfunction)
  • The meibomian glands are a set of glands that run along the posterior eyelid margin
  • They produce a lipid secretion which provides the lipid layer of the tear film
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Clinical presentation

Symptoms

  • Burning or stinging sensation
  • Foreign body sensation
  • Pruritus of the eyelids
  • Redness and irritation
  • Crusting of eyelids, especially upon awakening
  • Fluctuating vision due to tear film instability
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Signs

  • Hyperemic and thickened lid margins
  • Scales or crusts at the base of eyelashes
    • Hard scales (collarettes) in staphylococcal blepharitis
    • Greasy scales in seborrheic blepharitis
  • Capped or inspissated Meibomian gland orifices
  • Frothy tear film (posterior blepharitis)
  • Associated conjunctival hyperemia

Management

Blepharitis requires long-term, consistent management, as it is typically chronic.

Lid Hygiene (Mainstay of Treatment)

  • Warm compresses to liquefy meibum
  • Lid massage to express Meibomian glands
  • Lid scrubs using diluted baby shampoo or commercial lid cleansers

Medical Therapy

  1. Topical Antibiotics
      • For anterior staphylococcal blepharitis (e.g., erythromycin 1% or bacitracin ointment)
  1. Topical Antibiotic–Steroid Combination
      • Short-term use in severe inflammation under close supervision
  1. Oral Antibiotics
      • Tetracyclines for posterior blepharitis and rosacea-associated disease
        • Doxycycline 100mg BID
        • Erythromycin 500mg QID (for pregnancy and children <12 y.o)
  1. Artificial Tears
      • To address associated evaporative dry eye
  1. Anti-Demodex Therapy
      • Tea tree oil–based lid scrubs or ivermectin in confirmed cases

Complications

Untreated or poorly controlled blepharitis may result in:
  • Chronic conjunctivitis
  • Recurrent hordeolum or chalazion
  • Meibomian gland dropout
  • Dry eye disease
  • Trichiasis or madarosis (lash loss)
  • Marginal keratitis