What is Blepharitis?

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Blepharitis refers to a range of conditions characterized by dermatTitis or eczema of the eyelids that may be acute or chronic, with either inflammatory or infectious causes.

Because the eyelids play an important role in producing and distributing the tear film, blepharitis can affect vision by disrupting the surface of the cornea and the bulbar conjunctiva. Most forms are chronic although acute forms exist.

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Common classifications:

1. Staphylococcal

Usually caused by bacteria (staphylococcus aureus or staphylococcus epidermis)

Produces a moderately acute inflammation of relatively short duration

More prevalent in warmer climates

Most staphylococcal blepharitis occurs in younger females (mean age 42) who have no other skin abnormalities

Hordeolum and Chalazion may also occur

Associated signs:

Lid swelling

Erythema of the lid margins (redness)

Scaly debris and protein build-up (referred to collarettes) at the base of the lashes

Possible skin ulceration

Aqueous-deficient dry eye frequently results

2. Seborrheic Blepharitis

Associated with a skin disorder that includes the scalp, face, and eyebrows, all of which culture a normal growth of surface organisms

The base of the lashes are surrounded by greasy, foamy scales called scurfs

The foamy secretions can get in the eye and result in the complaint of burning of the eyes

More common in older adults

Can be associated with a secondary inflammation of the meibomian glands (oil glands found at the lid margins). This type of blepharitis is marked by sporadic episodes of clogged meibomian glands with lipid secretions of toothpaste consistency, producing an unstable tear film.

3. Mixed (Blepharitis)

Least common

Associated with Seborrheic Dermatitis

Chronic in nature

Associated with secondary infection of the cornea and conjunctiva

Inflammation is also involved

4. Meibomian Seborrheic Blepharitis

Can be identified by the presence of increased meibomian and seborrheic secretions without acute inflammation

Tears are sudsy and foamy, and as described above produce a burning sensation, especially in the morning

Lid glands are dilated, leading to copious meibomian secretions (oily discharge) and eye redness

5. Meibomian Keratoconjunctivitis

Also referred to as Primary Meibomianitis Blepharitis is the most severe lid margin inflammation

Typically occurs in persons in their fifties

More common in colder climates

Frequently associated with acne rosacea, and is part of a generalized sebaceous gland dysfunction which clogs the meibomian openings with desquamated epithelial cells

Because lipid secretions have a higher melting point than the ocular surface temperature, stagnation of free fatty acids within the gland and thickened openings of the gland result in a lipid-deficient tear film

6. Angular Blepharitis

Localized on the lid at the outer canthus (or corner of the eye on the ear side as opposed to the nose side)

Categorized in two forms

Staphylococcal is typically dry and scaly

Moraxella is caused by Morax-Axenfeld diplobacillus bacteria and is wet with a whitish, frothy discharge

What are the signs and symptoms?

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Symptoms include itching, burning, foreign-body sensation, and sticky, crusted eyelids on waking. This chronic irritation leads to unconscious eye rubbing causing reddened eyelid margins or excessive blinking.

Flaky scales on lashes (resembling dandruff), loss of lashes, and ulcerated areas on lid margins are other signs of the condition. The degree of the inflammation will determine the severity of the symptoms.

Associated tear film disorders resulting in dry eyes can also occur. In more severe forms, secondary conjunctival and corneal inflammation and/or infection may occur.

How is it managed or treated?

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Your eye doctor will perform a thorough external examination of the lids and other parts of the surrounding eye in order to determine the severity of the inflammation.

Daily cleaning of accumulated debris from the lid margins removes a potential breeding ground for microorganisms. Normal face washing, with attention to the surrounding eye area, is sufficient for most people.

However, if extra attention is needed to remove debris from the base of the lashes, there are a number of commercial lid cleansing pads available. Regular use of warm compresses is often helpful when you have clogged meibomian glands.

If you have a hordeolum or chalazion, you may find it helpful to use a hot compress twice per day. One way to ensure that the compress remains hot is to use a hardboiled egg wrapped around in a washcloth that allows enough heat to penetrate your lid.

Each type may require its own treatment:

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1. Staphylococcal Blepharitis

Treatment includes an antibiotic ointment to control the infection, along with the lid hygiene described above. Antibiotic eyedrops can be used, but they do not work as well as ointments.

Use artificial tears to alleviate symptoms of dry eyes

If corneal inflammation exists, topical steroids may be used with caution

2. Seborrheic (Blepharitis)

Lid hygiene consisting of warm compresses and lid cleansing is indicated.

The scalp and eyebrows should be washed with an antidandruff shampoo.

For resistant cases, oral doxycycline (100 mg/day) for 3-4 weeks may be needed. It is not unusual for patients with this condition to require lower maintenance doses after tapering. This drug or its derivatives should not be given to children or pregnant women.

3. Mixed (Blepharitis)

Appropriate antibiotic ointments are required. When the lid’s inflammation is better, resume lid hygiene practices.

4. Meibomian Seborrheic Blepharitis

Lid hygiene and shampoo regimen as described above

Meibomian glands should be massaged or expressed to remove the plugs at the openings

Antibiotic or antibiotic/steroid ointment can be helpful

5. Meibomian Keratoconjunctivitis

Responds to warm compresses and massage of the lid to express the meibomian contents

When infection is present, topical antibiotic or antibiotic/steroid ointments should be used

Oral doxycycline may be beneficial, especially when acne rosacea is present. A lower maintenance dose may be needed for a longer period

6. Angular (Blepharitis)

Both forms are treated with antibiotic ointment

Treatment of requires close, ongoing cooperation between patient and practitioner. Your eye doctor should discuss with you the rationale for treatment and the expected results. As you read above, the chronic forms of blepharitis require long term management of the condition as there is no cure for the chronic variations.

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