Makindo Medical Notes.com

Related Subjects: |Episcleritis |Scleritis |Assessing a Red eye |Acute Angle Closure Glaucoma |Allergic and Infective Conjunctivitis |Anterior and Posterior Uveitis |Herpes simplex keratitis (HSK) |Acute Blepharitis

About

• Blepharitis is localised eyelid margin inflammation, usually with minimal ocular involvement
• A largely benign condition but can cause significant discomfort.
• It may be associated with marginal keratitis, chalazion or dry eyes.

Aetiology

• Multifactorial but likely relating to infection (either bacterial, viral, and/or parasitic) and/or inflammation.
• Risk factors include dermatitis (both atopic and seborrheic), acne rosacea, psoriasis and use of contact lenses.
• In cases of infection, causative organisms include:
  • Bacterial: Staphylococcus Epidermidis, Staphylococcus Aureus
  • Viral: Herpes Simplex Virus, Molluscum Contagiosum
  • Parasitic: Demodex Folliculorum

Clinical

• Irritation, itching, dryness, and lid hyperaemia.
• Worse in the morning due to crusting of the lids while sleeping.
• Anterior blepharitis:
  • Inflammation of the lashes and lid margins.
  • Two types; seborrheic and staphylococcal.
  • Symptoms include crusting of the lashes and oily lid margins as well as hyperaemia and lid telangiectasia.
• Posterior Blepharitis
  • Inflammation of the Meibomian glands associated with acne rosacea and Meibomian gland dysfunction.
  • Patients may report dry eye as a result of poor Meibomian gland function, leading to excessive tear film evaporation.

Investigations

• Clinical examination under slit lamp is required for diagnosis, further investigations and a full history may be considered to elucidate the underlying cause.

Management

• Treat with daily eyelid hygiene and lubrication as required. Instructions for bathing the eyelids are available here.
• Treat with antibiotic ointment if indicated, at night, for 1 month.
• In instances of demodex infection, tea tree oil may be used.

Complications

• Blepharitis is generally a benign condition and complications are rare.
• Conjunctival hyperaemia may occur.
• In severe cases, instances of corneal ulceration have been reported.

References and further reading

• Eye manual