Blepharitis

Blepharitis is a disorder of the eyelids characterized by redness, thickening, and crusting as a result of chronic inflammation. Symptoms include burning, stinging, crusting, and foreign body sensation. It is a very common external eye problem whose etiology is not entirely clear. It is often divided into anterior and posterior blepharitis. Anterior blepharitis is further characterized by its association with staphylococcal overgrowth or seborrheic dermatitis. Posterior blepharitis is related to meibomian gland dysfunction with or without accompanying acne rosacea.

Staphylococcal blepharitis is caused by a chronic infection of the base of the lashes. Secondary skin ulceration, crusting of the lashes, and recurrent sty formation result. It is characterized by itching, tearing, burning, and light sensitivity. Pustules in these areas eventually become ulcerated and form a crust that bleeds when removed. This can be a recurrent problem; scarring of eyelids or sparse, misdirected eyelashes (trichiasis) can occur. The first-line treatment of staphylococcal blepharitis is an antibiotic ointment along with lid hygiene. Lid hygiene consists of warm compresses followed by lid massage and scrubs three times a day. Seborrheic blepharitis is characterized by dry or greasy flakes, easily removed from the lid margin. It is often associated with seborrheic dermatitis (dandruff of scalp and eyebrows and facial scaling). Secondary bacterial colonization often occurs with a propensity for oil and skin cells. Appropriate treatment includes treating the underlying seborrhea and also lid hygiene. If bacterial overgrowth develops, an antibiotic may be added to the treatment regimen.

Meibomian gland dysfunction is characterized by dilated meibomian glands on the back surface of the [Page 267]eyelid margin. Copious amounts of inspissated lipid material can be expressed. The tear film layer appears oily and foamy. This type of blepharitis is easy to miss and the symptoms appear out of proportion to the minimal clinical findings. When associated with acne rosacea, telengiectatic (dilated) blood vessels and thickening of the lid margins are also present. The patient will also have associated skin redness, acne, and telangiectasias on the forehead, upper cheekbones, and nose. Treatment for posterior blepharitis includes lid hygiene, antibiotics, mild topical steroids, and occasionally doxycycline. Doxycycline alters the underlying composition of the oil glands and allows for improvement of function. Any underlying skin disorders also need to be treated concomitantly.

Although this is a prevalent ocular disease worldwide, certain risk factors have been associated with its occurrence, including autoimmune disorders and acquired immunodeficiency states. It is also important to note that while many cases of blepharitis may be benign and chronic, any prolonged inflammation of the eyelid must also be differentiated from sebaceous cell, squamous cell, or basal cell carcinoma, as all may present with similar clinical findings.