Acute Blepharitis
Related Subjects:
|Episcleritis
|Scleritis
|Assessing a Red eye
|Acute Angle Closure Glaucoma
|Allergic and Infective Conjunctivitis
|Anterior and Posterior Uveitis
|Herpes simplex keratitis (HSK)
|Acute Blepharitis
|Chalazion
📌 About
- Blepharitis = chronic inflammation of the eyelid margins.
- Usually bilateral, recurrent, and causes significant discomfort but rarely threatens sight.
- Commonly associated with dry eye disease, chalazion, and marginal keratitis.
🧬 Aetiology
- Multifactorial: infection, inflammation, dermatological associations.
- Risk factors: seborrhoeic dermatitis, atopic eczema, acne rosacea, psoriasis, contact lenses.
- Causative organisms:
- Bacterial: Staphylococcus epidermidis, Staphylococcus aureus.
- Viral: Herpes simplex, molluscum contagiosum.
- Parasitic: Demodex folliculorum (eyelash mite).
👁️ Clinical Features
- Symptoms: irritation, gritty sensation, itching, dryness, burning, morning crusting.
- Anterior blepharitis:
- Inflammation at lash roots and lid margins.
- Staphylococcal → lash loss, ulceration, lid telangiectasia.
- Seborrhoeic → greasy scaling around lashes, often linked to dandruff.
- Posterior blepharitis:
- Meibomian gland dysfunction ± rosacea.
- Thickened/tender lid margins, foamy tears, evaporative dry eye.
- Conjunctival injection may be present in flares.
🔎 Investigations
- Primarily a clinical diagnosis (slit lamp exam).
- Consider derm/ocular history (eczema, psoriasis, rosacea).
- Swabs rarely needed unless infection is severe/refractory.
💊 Management
- Lid hygiene (first-line): warm compresses, lid massage, gentle cleaning with diluted baby shampoo or commercial lid wipes, performed daily long-term.
- Lubricants: artificial tears to improve comfort and reduce dryness.
- Topical antibiotics: e.g. fusidic acid gel or chloramphenicol ointment at night for 4 weeks if staphylococcal infection suspected.
- Posterior blepharitis: may respond to systemic tetracyclines (e.g. doxycycline 100 mg OD for 6–12 weeks) in rosacea-related disease.
- Demodex blepharitis: tea tree oil scrubs or ivermectin (specialist guidance).
- Patient education is crucial — this is a chronic relapsing condition requiring ongoing lid hygiene.
⚠️ Complications
- Chronic conjunctivitis.
- Ciliary loss or misdirection.
- Cornmeal involvement → marginal keratitis, punctate epithelial erosions, rarely corneal ulceration.
- Chalazion recurrence due to blocked Meibomian glands.
- Cosmetic concerns (red/swollen eyelids, lash changes).
🩺 Differentials
- Allergic or infective conjunctivitis.
- Chalazion or hordeolum.
- Basal cell carcinoma (persistent, unilateral lid margin lesion).
📚 References
