Blepharitis refers to inflammation of the eyelid margins.
Blepharitis refers to inflammation of the eyelid margins and may be divided into two types:
Blepharitis most commonly presents as a chronic condition. The mean age of affected patients is 50 years old. It is a clinical diagnosis based on the history and examination with the most common symptoms being a gritty or burning sensation in both eyes, crusted eyelashes, red eyes, and swollen or greasy eyelids. The condition is managed with a combination of conservative treatment (e.g. lid hygiene) and medical treatment (e.g. ocular lubricants).
Blepharitis is a common condition.
Blepharitis accounts for at least 5% of ophthalmological presentations in primary care. Blepharitis can affect all ages but is most commonly seen in middle-aged individuals with the average age of presentation 50 years old. Women are more likely to develop Staphylococcal blepharitis compared to men, while other forms of blepharitis affect the sexes equally.
The causes of blepharitis can be divided into anterior and posterior.
The causes of blepharitis differ depending on whether it is anterior or posterior.
The two predominant causes of anterior blepharitis are Staphylococci infection and Seborrhoeic type
Other infections that can lead to anterior blepharitis include: Pseudomonas, Streptococci, Propionibacterium, Corynebacterium, Moraxella
Posterior blepharitis is also known as meibomian gland dysfunction (MGD).
In health, meibomian glands produce an oil called meibum. Meibum forms the outer layer of the tear film. The oil assists in reducing tear evaporation from the ocular surface. The underlying pathophysiology of MGD / posterior blepharitis is thought to be epithelial hyperkeratinisation, which results in gland obstruction, stasis of meibum, dilation of glands, and gland dropout. Some chronic skin conditions such as seborrhoeic dermatitis and rosacea can predispose to posterior blepharitis (not just anterior!).
The clinical features of blepharitis are typically red, swollen, or itchy eyes.
Blepharitis typically leads to chronic, recurrent eye symptoms and is commonly associated with dry eyes.
The symptoms associated with blepharitis are often bilateral.
It is important to enquire about extra-ocular symptoms linked to associated conditions (particularly chronic skin conditions) that may include oily skin, flaky scalp or facial rash.
The severity of symptoms does not always match the examination findings (of which there may be none).
The cornea may be affected by severe disease with features of epithelial erosions, ulcerations, and scarring.
Some clinical signs are more specific to either anterior or posterior blepharitis
Blepharitis is a clinical diagnosis.
Blepharitis is a clinical diagnosis based on a detailed history and examination (including slit-lamp). Routine investigations are typically not required. However, in severe or treatment-resistant cases, a swab for microscopy, culture, and sensitivity can be useful.
Persistent unilateral eyelid inflammation is concerning for possible malignancy. In these cases, a biopsy is critical.
A wide number of differentials should be considered in patients with suspected blepharitis.
Blepharitis is a long-term condition that requires regular lid hygiene and avoidance of exacerbating factors.
There are a variety of treatment options for blepharitis but the main focus should be on good lid hygiene, environmental changes, and the use of ocular lubricants for dry eyes.
When a diagnosis is confirmed, patients should be appropriately counselled. Blepharitis is a chronic condition and there is no 'quick fix'. While a course of antibiotics may be a management option, it is unlikely to benefit a patient if not used in conjunction with other long-term measures including regular lid hygiene and avoidance of exacerbating factors. It is important to treat any co-existing conditions, particularly skin conditions.
Patients should be given advice on self-care measures for the eyes. These include:
Dietary changes are interesting and there is some evidence to suggest consuming omega-3 and omega-7 fats can improve dry eye disease and contribute to the ocular surface and meibomian gland health.
Ocular lubricants can be advised, particularly for patients with dry eyes. In general, thicker lubricants are used at night, with artificial eye drops used during the day. These are generally reserved for patients with mild-to-moderate symptoms.
In patients with more severe or refractory disease antibiotics and steroids can have a role.
A referral to an ophthalmologist for specialist review should be considered in the following patients:
Dry eye disease is one of the most frequent complications of blepharitis.
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