Blepharitis

Definition | Aetiology | Pathophysiology | Risk Factors | Signs and Symptoms | Investigations | Management | References

Definition

Blepharitis is a common inflammatory condition affecting the eyelids, characterised by redness, irritation, and scaling at the base of the eyelashes. It can be classified as anterior or posterior based on the location of the inflammation.

Aetiology

Blepharitis can be caused by a variety of factors, including:

• Bacterial infection (e.g., Staphylococcus aureus)
• Meibomian gland dysfunction
• Seborrheic dermatitis
• Rosacea
• Allergic reactions
• Demodex mite infestation

Pathophysiology

The underlying inflammation in blepharitis can lead to dysfunction of the eyelid glands, particularly the meibomian glands, resulting in altered tear film composition, ocular surface irritation, and bacterial overgrowth. Chronic inflammation can also lead to structural changes in the eyelids and eyelashes.

Risk Factors

• Age (more common in older adults)
• Chronic skin conditions (e.g., rosacea, seborrheic dermatitis)
• Allergies
• Contact lens wear
• Poor eyelid hygiene
• Ocular rosacea

Signs and Symptoms

Common signs and symptoms of blepharitis include:

• Red, swollen eyelids
• Itchy or burning eyes
• Crusting or flaking at the base of the eyelashes
• Gritty or foreign body sensation
• Excessive tearing or dry eyes
• Light sensitivity
• Recurrent chalazia or styes

Investigations

• Clinical history and physical examination, focusing on the eyelids and ocular surface
• Slit-lamp examination to assess the eyelid margins and meibomian glands
• Microbiological swabs if infection is suspected
• Evaluation for underlying skin conditions (e.g., rosacea, seborrheic dermatitis)

Management

Primary Care Management

• Eyelid hygiene: Regular cleaning of the eyelid margins with a warm compress and gentle scrubbing using diluted baby shampoo or commercial eyelid cleanser
• Topical antibiotics: (e.g., chloramphenicol, fusidic acid gel) if bacterial infection is suspected
• Lubricating eye drops: To relieve dry eye symptoms
• Referral to an ophthalmologist if symptoms persist or are severe

Specialist Management

• Topical corticosteroids: Short-term use for severe inflammation (e.g., prednisolone eye drops)
• Oral antibiotics: (e.g., doxycycline) for meibomian gland dysfunction or severe cases
• Management of underlying conditions: Such as rosacea or seborrheic dermatitis
• Intense pulsed light (IPL) therapy: For refractory meibomian gland dysfunction
• Regular follow-up to monitor treatment response and manage any complications

References

1. NICE. (2024). Blepharitis: Diagnosis and Management. Retrieved from NICE
2. NHS. (2023). Blepharitis. Retrieved from NHS
3. British Medical Journal (BMJ). (2022). Blepharitis: Diagnosis and Management. Retrieved from BMJ
4. American Academy of Ophthalmology (AAO). (2021). Clinical Practice Guidelines: Blepharitis. Retrieved from AAO

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