Blepharitis
Definition | Aetiology | Pathophysiology | Risk Factors | Signs and Symptoms | Investigations | Management
Definition
Blepharitis is a chronic inflammatory condition affecting the eyelid margins, leading to irritation, redness, and crusting. It is often associated with meibomian gland dysfunction or bacterial colonisation.
Aetiology
- Anterior blepharitis: associated with bacterial infection (Staphylococcus aureus) or seborrhoeic dermatitis.
- Posterior blepharitis: due to meibomian gland dysfunction, leading to altered tear film composition.
- Mixed blepharitis: combination of anterior and posterior blepharitis.
Pathophysiology
- Inflammation of the eyelid margins disrupts the normal tear film.
- Chronic irritation and bacterial overgrowth lead to crusting and eyelid redness.
- Meibomian gland dysfunction contributes to evaporative dry eye.
Risk Factors
- History of seborrhoeic dermatitis, rosacea, or acne.
- Contact lens wear.
- Ocular surface disorders (dry eye disease).
- Poor eyelid hygiene.
Signs and Symptoms
- Eyelid redness, irritation, and crusting at the base of eyelashes.
- Burning or gritty sensation in the eyes.
- Watery or dry eyes.
- Intermittent blurry vision.
- Occasional eyelash loss or misdirection.
Investigations
- Slit-lamp examination: assesses eyelid margins, meibomian gland function, and tear film quality.
- Swab for culture: if infection is suspected and resistant to standard treatment.
Management
1. Conservative Management:
- Warm compresses to soften eyelid debris and improve meibomian gland function.
- Eyelid hygiene with diluted baby shampoo or commercial lid wipes.
- Artificial tears for associated dry eye symptoms.
2. Medical Management:
- Topical antibiotics (e.g., chloramphenicol ointment) if bacterial involvement suspected.
- Oral tetracyclines (e.g., doxycycline) for persistent posterior blepharitis.
- Short term topical steroids in severe inflammatory cases (under specialist supervision).
3. Referral:
- Ophthalmology: if symptoms persist despite treatment or if significant meibomian gland dysfunction is present.
- Dermatology: if underlying seborrhoeic dermatitis or rosacea requires management.