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Saturday, August 16, 2025

Blepharitis


Blepharitis is a common, chronic inflammatory condition that affects the eyelid margins. It occurs when the tiny oil glands (meibomian glands) located near the base of the eyelashes become blocked or inflamed, leading to irritation, redness, and discomfort. While the condition is usually not sight-threatening, it can be persistent, uncomfortable, and recurrent, often requiring long-term management.

Types of Blepharitis

Blepharitis is generally classified into two main types, though overlap is common:

  1. Anterior blepharitis

    • Affects the outer edge of the eyelid where the eyelashes attach.

    • Commonly associated with bacterial infections (usually Staphylococcus aureus) or seborrheic dermatitis (dandruff of the scalp/eyebrows).

  2. Posterior blepharitis

    • Involves inflammation of the inner eyelid, where the meibomian glands are located.

    • Commonly associated with meibomian gland dysfunction, rosacea, and oily skin conditions.

Causes and Risk Factors

  • Bacterial colonization: Staphylococcal bacteria often contribute to anterior blepharitis.

  • Seborrheic dermatitis: Excessive oil production and dandruff in the scalp or eyebrows can extend to eyelids.

  • Meibomian gland dysfunction: Poor-quality oil secretion leads to blocked glands and posterior blepharitis.

  • Skin conditions: Rosacea, eczema, psoriasis increase susceptibility.

  • Parasitic infestation: Demodex mites on eyelashes may cause blepharitis.

  • Contact lens use: Poor hygiene or prolonged wear can worsen eyelid inflammation.

Symptoms

  • Red, swollen eyelids

  • Itching and burning sensation in the eyes

  • Crusts or flakes around the eyelashes, especially upon waking

  • Gritty or sandy feeling in the eyes

  • Excessive tearing (epiphora) or dryness

  • Sensitivity to light (photophobia)

  • Blurred vision (from tear film instability)

  • Eyelash loss or misdirection (trichiasis) in severe or chronic cases

Complications

  • Chronic conjunctivitis (due to ongoing irritation)

  • Dry eye syndrome (from poor tear quality)

  • Stye (hordeolum) or chalazion (blocked meibomian gland)

  • Keratitis (corneal inflammation, rare but serious)

  • Permanent eyelid margin changes if untreated

Diagnosis

Blepharitis is diagnosed through:

  • Clinical history: Noting chronic irritation, recurrent styes, or eyelid crusting.

  • Slit-lamp examination: Helps detect blocked glands, redness, scaling, and eyelash abnormalities.

  • Microbiological swabs: In resistant cases, to identify bacterial or parasitic involvement.

Management and Treatment

Blepharitis is usually chronic and requires consistent eyelid hygiene along with medical treatment when necessary.

1. Eyelid hygiene (first-line management)

  • Warm compresses: Applied for 5–10 minutes, 2–4 times daily, to loosen crusts and soften oil blockages.

  • Lid scrubs: Cleaning eyelid margins with diluted baby shampoo or commercial lid wipes to remove scales and bacteria.

  • Massage: Gentle massage of eyelid margins after warm compresses to express blocked oils.

2. Pharmacological treatment

Topical antibiotics (for bacterial anterior blepharitis):

  • Erythromycin 0.5% ophthalmic ointment: Apply to eyelid margin 1–2 times daily for 1–2 weeks.

  • Bacitracin ophthalmic ointment: Apply once or twice daily for 7–10 days.

Oral antibiotics (for posterior blepharitis or rosacea-associated cases):

  • Doxycycline 100 mg once daily for 4–6 weeks (reduced to 50 mg once daily for maintenance).

  • Tetracycline 250 mg twice daily for several weeks (less commonly used now).

  • Azithromycin 500 mg once daily for 3 days per month, or 250 mg once daily for 1–2 weeks may be used off-label.

Topical corticosteroids (short-term use in severe inflammation, prescribed by ophthalmologist only):

  • Loteprednol 0.5% ophthalmic suspension: 1 drop in affected eye(s) 2–4 times daily for 1–2 weeks.

  • Fluorometholone 0.1% ophthalmic suspension: 1 drop 2–4 times daily for up to 2 weeks.
    (Note: Prolonged use increases risk of glaucoma and cataracts.)

Lubricating eye drops (for associated dry eye):

  • Artificial tears (preservative-free formulations recommended for long-term use).

  • Carboxymethylcellulose 0.5–1% or hypromellose 0.3–0.5%, used 3–6 times daily as needed.

Antiparasitic treatment (for Demodex blepharitis):

  • Tea tree oil lid scrubs (commercial wipes containing 50% tea tree oil extract).

  • Oral ivermectin (200 mcg/kg single dose, repeat after 1–2 weeks) in resistant cases, under specialist guidance.

Prevention and Long-term Care

  • Daily eyelid cleaning, even when asymptomatic, helps prevent recurrence.

  • Manage associated skin conditions like seborrheic dermatitis or rosacea.

  • Limit eye makeup use, especially eyeliner on eyelid margins.

  • Replace eye cosmetics regularly to avoid bacterial contamination.

  • Ensure good contact lens hygiene.

When to Seek Medical Help

  • Severe eye pain or swelling

  • Sudden changes in vision

  • Persistent irritation despite hygiene measures

  • Recurrent styes or chalazia

  • Signs of corneal involvement (redness, severe photophobia, decreased vision)




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