Blepharitis
👁️ Blepharitis
🔍 Definition
Blepharitis is chronic inflammation of the eyelid margins, usually involving the base of the eyelashes and/or meibomian glands. It can affect one or both eyes, and often recurs if not managed properly.
🔁 It’s like "dandruff of the eyelids", and it can really bug the ocular surface!
🧬 Types of Blepharitis
| Type | Involvement | Common Associations |
|---|---|---|
| Anterior Blepharitis | Outside of eyelid margin, at base of lashes | Staphylococcal infection, seborrheic dermatitis |
| Posterior Blepharitis | Inner eyelid margin, involving meibomian glands | Meibomian gland dysfunction (MGD), rosacea |
| Mixed Type | Combo of anterior and posterior | Very common presentation |
🧪 Causes
🔹 Anterior Blepharitis
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Staphylococcus aureus (bacterial)
-
Seborrheic dermatitis
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Demodex mite infestation (tiny eyelash mites)
🔹 Posterior Blepharitis
-
Meibomian gland dysfunction (MGD)
-
Acne rosacea
-
Hormonal imbalance (esp. androgens)
👀 Symptoms
| Symptom | Description |
|---|---|
| Gritty, burning sensation | “Sand in the eyes” feeling |
| Red, swollen eyelids | Especially at lash line |
| Crusting or sticky lids | Worse in the morning |
| Tearing or dry eyes | Paradoxical, due to poor tear film |
| Blurred vision (intermittent) | From unstable tear film |
| Light sensitivity | Occasionally present |
| Lash abnormalities | Misdirected, missing, or coated lashes |
🧫 Signs on Exam
| Anterior Blepharitis | Posterior Blepharitis |
|---|---|
| Collarettes/scales at lash base | Capped meibomian gland orifices |
| Red, thickened lid margins | Frothy tears on lid margin |
| Ulcerated lash follicles (severe) | Expressible thickened gland secretions |
🧠 Diagnosis
Mostly clinical, based on history and slit lamp examination.
Demodex can be seen on lash sampling under the microscope, if needed.
💊 Treatment
🔹 General Eyelid Hygiene (Cornerstone of Management)
-
Warm compresses (5–10 minutes, 1–2x/day)
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Lid massage (to express meibomian glands)
-
Lid scrubs with diluted baby shampoo or commercial eyelid cleanser
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Good facial hygiene (especially in seborrheic types)
🔹 Topical Medications (If Moderate to Severe)
| Medication | Use |
|---|---|
| Topical antibiotics (e.g. erythromycin or bacitracin ointment) | For staphylococcal blepharitis |
| Topical corticosteroids (short course, e.g. loteprednol) | For inflammation (avoid long-term) |
| Topical cyclosporine (Restasis) | In chronic inflammatory cases |
| Tea tree oil scrubs | For Demodex blepharitis |
🔹 Systemic Medications (Severe/Chronic Posterior Type)
| Drug | Use |
|---|---|
| Oral doxycycline (50–100 mg/day) | For meibomian gland dysfunction, rosacea |
| Oral azithromycin | Alternative to doxycycline |
🔁 Follow-Up & Maintenance
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Chronic condition: requires ongoing lid hygiene
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Symptoms may recur if hygiene is neglected
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Avoid excessive screen time and environmental irritants
⚠️ Complications
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Recurrent chalazion or hordeolum
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Conjunctivitis
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Corneal damage (e.g., punctate keratopathy)
-
Dry eye syndrome
🧠 Mnemonic: BLEPHARITIS
Burning
Lid margin redness
Eyelash issues (crusting, loss)
Posterior or anterior types
Hygiene essential
Antibiotics/steroids (topical)
Rosacea, seborrhea associations
Inflammation chronic
Tear film instability
Intermittent blurred vision
Scrubs & compresses = key!
📋 Quick Summary Table
| Feature | Anterior | Posterior |
|---|---|---|
| Location | Base of eyelashes | Meibomian glands |
| Cause | Bacteria, seborrhea, Demodex | MGD, rosacea |
| Key signs | Scales on lashes | Thick oil, capped glands |
| Treatment focus | Hygiene + topical antibiotics | Warm compress + doxycycline |
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