Blepharitis

Blepharitis of the right eye.

Blepharitis (/blɛfərˈaɪtᵻs/ BLEF-ər-EYE-tis) is a common eye condition characterized by chronic inflammation of the eyelid, usually where eyelashes grow, resulting in inflamed, irritated, itchy, and reddened eyelids. A number of diseases and conditions can lead to blepharitis. It can be caused by the oil glands at the base of the eyelashes becoming clogged, a bacterial infection, allergies, or other conditions. The severity and course can vary. Onset can be acute, resolving without treatment within 2–4 weeks (this can be greatly reduced with lid hygiene), but more generally is a long-standing chronic inflammation of varying severity.

It may be classified as seborrhoeic, staphylococcal, mixed, posterior or meibomitis, or parasitic.^[1] It usually does not cause permanent damage.

Symptoms

Blepharitis is characterized by chronic inflammation of the eyelid, usually at the base of the eyelashes.^[2][3][4] This results in inflamed, irritated, itchy, and reddened eyelids.^[2][3]

It is typically caused by bacterial infection or blockage of the eyelid's oil glands, although sometimes it is caused by allergies.^[3] Various diseases and conditions can lead to blepharitis, such as rosacea, herpes simplex dermatitis, varicella-zoster dermatitis, molluscum contagiosum, allergic dermatitis, contact dermatitis, seborrheic dermatitis, staphylococcal dermatitis, and parasitic infections (e.g., Demodex and Phthiriasis palpebrarum).^[2][4]

Symptoms associated with blepharitis include:

• Watery eyes^[5]
• Red eyes^[5]
• Red/swollen eyelids^[5]
• Crusting at the eyelid margins/base of the eyelashes/medial canthus, generally worse on waking^[3][4][5]
• Eyelid sticking^[5]
• Eyelid itching^[5]
• Flaking of skin on eyelids^[5]
• Gritty/burning sensation in the eye, or foreign-body sensation^[5]
• Eyelids appear greasy^[5]
• Frequent blinking^[5]
• Light sensitivity/photophobia^[4][5]
• Misdirected eyelashes that grow abnormally^[5]
• Eyelash loss^[5]
• Infection of the eyelash follicle/sebaceous gland (hordeolum)
• Debris in the tear film, seen under magnification (improved contrast with use of fluorescein drops)

External hordeolum

Blepharitis usually does not cause permanent eyesight damage.^[2] Chronic blepharitis may result in damage of varying severity which may have a negative effect upon vision and therefore upon the eyeglass prescription.^[6] Long-term untreated blepharitis can lead to eyelid scarring, excess tearing, difficulty wearing contact lenses, development of a stye (an infection near the base of the eyelashes, resulting in a painful lump on the edge of the eyelid) or a chalazion (a blockage/bacteria infection in a small oil glands at the margin of the eyelid, just behind the eyelashes, leading to a red, swollen eyelid), chronic pink eye (conjunctivitis), keratitis, and cornea ulcer or irritation.^[3][7][8] The lids may become red and may have ulcerative, non-healing areas which may bleed.^[6]

Blepharitis can cause blurred vision due to a poor tear film.^[3] Also, the tears might seem frothy or bubbly in nature and mild scarring might occur to the eyelids. The symptoms and signs of blepharitis are often erroneously ascribed by the patient as being due to "recurrent conjunctivitis".^[9]

Staphylococcal blepharitis

Staphylococcal blepharitis is caused by infection of the anterior portion of the eyelid by Staphylococcal bacteria. Symptoms include a foreign body sensation, matting of the lashes, and burning. Collarette around eyelashes, a ring-like formation around the lash shaft, can be observed.^[10] Other symptoms include loss of eyelashes or broken eyelashes.^[11] The condition can sometimes lead to a chalazion or a stye.^[12]

Staphylococcal blepharitis is a condition which may start in childhood and continue through adulthood.^[13] It is commonly recurrent and it requires special medical care. The prevalence of Staphylococcus aureus in the conjunctival sac and on the lid margin varies among countries, probably due to climate.^[14] Chronic bacterial blepharitis may lead to ectropion. ^[15]

Posterior blepharitis or rosacea-associated blepharitis

Posterior blepharitis is inflammation of the eyelids secondary to dysfunction of the meibomian glands. Like anterior blepharitis, it is a bilateral chronic condition and is manifested by a broad spectrum of symptoms involving the lids including inflammation and plugging of the meibomian orifices and production of abnormal secretion upon pressure over the glands. It may be associated with skin rosacea,^[1] and there is growing evidence that in some cases it is caused by demodex mites.^[16]

Diagnosis

The doctor typically diagnoses the condition on physical examination of the area. A specimen of material is occasionally collected for bacterial or fungal testing.^[17][18]

Prevention (eyelid hygiene)

Careful daily washing of the eyelids seems to prevent blepharitis. A simple routine is to wash each eyelid for 30 seconds twice a day, using a clean face flannel with a single drop of nonirritant soap (e.g. baby shampoo) and ample water.

Treatment

Blepharitis does not often disappear entirely, and even successful treatment is often followed by relapses.^[19]

A Cochrane Systematic Review of topical antibiotics were shown to be effective in providing symptomatic relief and clearing bacteria for individuals with anterior blepharitis.^[20] Topical steroids provided some symptomatic relief but were ineffective in clearing bacteria from the eyelids.^[20] Lid hygiene measures such as warm compresses and lid scrubs were found to be effective in providing symptomatic relief for participants with anterior and posterior blepharitis.^[20] There is now also a form of treating blepharitis called Lipflow which is very fast and effective and improvements have been known to last up to 12 months.

Home care

1. Soften lid margin debris and oils: Place a very warm wet compress such as a warm wet washcloth over the closed eyelids for five minutes.^[3][21] Re-wet and reapply it as it cools.^[3][8] This warms, softens, and loosens crusty and oily eyelid gland deposits.^[3][8][21]
2. Remove lid margin debris: Immediately after, gently wash the eyelids with a warm, wet, soapy washcloth to remove accumulated debris.^[8][19] Use diluted non-burning baby shampoo.^[3][21] Gently and repeatedly rub along the lid margins while eyes are closed. Too much soap or shampoo may remove the essential oily layer of the eyes' own tear film and create further problems with dry eye discomfort. A moist cotton swab soaked in a cup of water with a drop of baby shampoo may be used to rub along the lid margins while tilting the lid outward with the other hand. Rinse the eyelid with warm water and gently dry with a towel.^[21]
3. Antibiotics (if prescribed): To reduce lid margin bacteria to help control blepharitis caused by a bacterial infection, antibiotics such as erythromycin or sulfacetamide may be used via eyedrops, cream, or ointment on the eyelid margin. Oral medication is sometimes prescribed.^[8][19] If used by cream or ointment, after lid margin cleaning, spread small amount of prescription antibiotic ophthalmic ointment with finger tip along lid fissure while eyes closed. Use prior to bedtime to avoid blurry vision.
4. Steroid eyedrops/ointments. Eyedrops or ointments containing corticosteroids, sometimes combined with antibiotics, can help control eye and eyelid inflammation.^[3][8][19]
5. Treat underlying conditions. Blepharitis caused by seborrheic dermatitis, rosacea, or other diseases may be controlled by treating the underlying disease.^[19]
6. Eye make-up should be discontinued while inflammation is present.^[3][21]
7. Dandruff shampoo. If dandruff is contributing to the blepharitis, using a dandruff-controlling shampoo may relieve blepharitis symptoms.^[21]

Microbial blepharitis is treated with antibiotics such as sulfacetamide eye ointment applied on a cotton applicator once daily to the lid margins. Ophthalmologists or optometrists may prescribe low-dose oral antibiotics such as Doxycycline and occasionally weak topical steroids.^[1]

Blepharitis caused by demodex mites can be treated using a diluted solution of tea tree oil and using a cotton swab for 5–10 minutes per day.^[22]

References

External links

Wikimedia Commons has media related to Blepharitis.

• Blepharitis Resource Guide from the National Eye Institute (NEI).
• Mayo Clinic
• Basic Guide for Effective Self Treatment of Blepharitis
• Blepharitis description from the American Optometric Association
• eMedicine Health: Eyelid Inflammation (Blepharitis)
• Blepharitis Fact Sheet
• Blepharitis Causes and Symptoms
• Blepharitis