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