Blepharitis

Subacute chronic inflammation of lid margins.

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Etiology

Bacterial blepharitis:

Chronic infection of anterior part of lid margin.

• Primary: Coagulase positive Staphylococci 
• Others: Streptococci, Propionibacterium acnes, Moraxella

Seborrheic/squamous blepharitis

Anterior blepharitis with some spill over posteriorly.

Mixed staphylococcal with seborrhoeic blepharitis

Posterior blepharitis (meibomitis)

Inflammation of the Meibomian glands

• Chronic Meibomitis
• Acute Meibomitis

Parasitic blepharitis:

Lice infestation

• Demodex folliculorum: Demodex blepharitis or blepharitis acarica
• Crab louse: Phthiriasis palpebrarum

Predisposing factors:

• Chronic conjunctivitis
• Dacryocystitis

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Presentation

Symptoms:

• Chronic irritation, itching , mild lacrimation, glueing of cilia, mild photophobia
• Worse in the morning
• Remission and exacerbations common

Signs

• Yellow crusts
• Small ulcers
• Red, thickened lid margins
• Mild papillary conjunctivitis

Complications:

• Lash abnormalities
  • Madarosis
  • Trichiasis
  • Poliosis
• Tylosis
• Eversion of punctum
• Exzema of skin and entropion
• Recurrent styes
• Marginal keratitis
• Tear film instability & Dry Eye
• Secondary inflammatory and mechanical changes in the conjunctival and cornea

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Management

1. Lid Hygiene
   • Warm compress
   • Crust removal and lid margin cleaning
   • Avoid rubbing of the eyes
2. Antibiotics
   • Eye ointment
   • Antibiotic eye drops
   • Oral antibiotics: Erythromycin or Doxycycline
3. Topical Steroids (weak)
   • Fluorometholone
     • For patients with papillary conjunctivitis, marginal keratitis, phlyctenulosis
4. Ocular lubricants
   • Artificial tear drops
     • For associated tear film instability and dry eye