Blepharitis

Question 1

Define blepharitis

Answer 1

Chronic inflammatory condition affecting the margin of the eyelids

Question 2

Aetiology of blepharitis

Answer 2

Anterior:
Bacterial:
- Staphylococcal infection e.g. staphylococcal blepharitis
- (Streptococci, pseudomonas, Propionibacterium, corynebacteria, Moraxella)
Seborrheic dermatitis at the base of the eyelashes

Posterior: Meibomian gland dysfunction (MGD)
- Meibomian glands = set of glands running along the posterior eyelid margin
- Produces a lipid secretion that provides the lipid layer of the tear film
- MGD → lipid secretions abnormal → tear film instability → dry eye disease

Question 3

Risk factors for blepharitis

Answer 3

Dry eye disease
Rosacea
Isotretinoin

Question 4

Symptoms of blepharitis

Answer 4

Burning, itching and/or crusting of the eyelids
- Worse in the morning - eyelids stick together upon waking
- Bilateral
Recurrent hordeolum (stye)
Contact lens intolerance

Question 5

Management for blepharitis

Answer 5

Advice:
Blepharitis is a chronic, intermittent condition which requires ongoing maintenance treatment — cure is generally not possible
Symptom control measures:
- Clean eyelid with a wet cloth/cotton bud and cleanser e.g. baby shampoo. Diluted 1:10 in warm water or sodium bicarbonate solution (twice daily)
- Warm compress for 5-10 minutes once or twice daily
- Continue even when well
- Brief gentle eyelid massage
- Avoid eye makeup

Anterior blepharitis → self care measures → topical Abx e.g. chloramphenicol
Posterior blepharitis → PO abx e.g. doxycycline

Question 6

Complications of blepharitis

Answer 6

Eyelid:
Meibomian cyst (chalazion)
External stye (hordeolum)
Madarosis (loss of eyelashes)
Trichiasis (misdirection of the eyelashes towards the eye)
Poliosis (depigmentation of the eyelashes)
Eyelid thickening, ulceration, and scarring → entropion or ectropion
Eye:
Contact lens intolerance
Dry eye disease (keratoconjunctivits sicca)
Conjunctivitis
Corneal inflammation (keratitis): ulceration, scarring, perforation, corneal pain, red eye, rapid onset decreased visual acuity

Question 7

prognosis for blepharitis

Answer 7

Blepharitis is a chronic condition. Periodic remissions, relapses, and exacerbations are typical.
Maintenance therapy is required to minimise the number and severity of relapses
Serious complications are uncommon