Blepharitis Disease

BASICS

DESCRIPTION

An inflammatory reaction of the eyelid margin. It usually occurs as seborrheic (nonulcerative) or as staphylococcal (ulcerative) blepharitis. Both types may coexist.

System(s) affected: Skin/Exocrine
Genetics: N/A
Incidence/Prevalence in USA: Common (the most frequent ocular disease)
Predominant age: Adult
Predominant sex: Male = Female

SIGNS AND SYMPTOMS

Staphylococcus aureus blepharitis
- Itching
- Lacrimation; tearing
- Burning
- Photophobia (light sensitivity)
- Usually worse in morning
- Recurrent stye (external hordeolum, or internal hordeolum)
- Recurrent chalazia (chronic inflammation of meibomian glands)
- Fine, epithelial keratitis, lower half of cornea
- Ulcerations at base of eyelashes
- Broken, sparse, misdirected eyelashes(trichiasis)
Seborrheic blepharitis
- Lid margin erythema
- Dry flakes, oily secretions on lid margins and/or lashes
- Associated dandruff of scalp, eyebrows
- Sometimes nasolabial erythema, scaling
Mixed blepharitis (seborrheic with associated Staph aureus)
- Most common type of blepharitis
- Symptoms and signs of both staph and seborrheic present

CAUSES

Seborrheic
- Accelerated shedding of skin cells with associated sebaceous gland dysfunction
- P. ovale and P. orbiculare yeasts often colonize
- Oil and skin cells foster staph growth
Staphylococcus
- Usually part of mixed blepharitis
- Colonization of Zeis glands of lid margin and meibomian glands posterior to lashes, with Staphylococcus aureus
- Impetigo contagiosa-staph
- Infectious eczematoid dermatitis-Staphylococcus is the hapten
- Staphylococcus scalded skin syndrome - entire body involved (in young children)
- Angular blepharitis staph - most frequent bacteria involved
Other types of blepharitis
- Contact dermatitis with or without secondary Staphylococcus infection
- Meibomian gland dysfunction

RISK FACTORS

Candida
Seborrheic dermatitis
Acne rosacea
Diabetes mellitus
Immunocompromised state (AIDS, chemotherapy, etc.)

DIAGNOSIS

LABORATORY

N/A

Drugs that may alter lab results: N/A
Disorders that may alter lab results: N/A

PATHOLOGICAL FINDINGS

Acute or chronic inflammatory cell types

SPECIAL TESTS

Cultures in atypical blepharitis
Biopsy in atypical cases that are suspect for carcinoma

IMAGING

N/A

DIAGNOSTIC PROCEDURES

See Special Tests

TREATMENT

APPROPRIATE HEALTH CARE

Outpatient

GENERAL MEASURES

Mild seborrheic blepharitis (dry flakes, minimal inflammation) - apply eyelid margin scrubs with eyelid cleanser at least once daily
If Staphylococcus likely, follow lid scrubs with application of bacitracin, or (second choice), erythromycin ophthalmic ointment, to eyelid margins, using cotton tipped applicator
Clean lids and apply ointment nightly in mild cases, up to four times daily in severe cases
Discontinue soft contact lenses until condition cleared
Chronic recurrent blepharitis requires referral to ophthalmologist for evaluation as to whether patient should continue in lenses

SURGICAL MEASURES

N/A

ACTIVITY

No restrictions

DIET

No restrictions

PATIENT EDUCATION

Blepharitis "Fact Sheet" from American Academy of Ophthalmology (see References for ordering information)
Advise patient that blepharitis is a chronic condition, prone to recurrence if hygiene (lid scrubs) are not maintained after antibiotic treatment is discontinued

FOLLOW UP

PREVENTION/AVOIDANCE

Follow treatment guidelines

POSSIBLE COMPLICATIONS

Hordeolum (stye)
Scarring of eyelid margin
Misdirection of eyelashes (trichiasis)
Corneal infection

EXPECTED COURSE AND PROGNOSIS

Long-term eyelid hygiene required to control

MISCELLANEOUS

ASSOCIATED CONDITIONS

See diagnosis section above regarding blepharitis masquerade syndromes

AGE-RELATED FACTORS

Pediatric: N/A
Geriatric: N/A
Others: N/A

PREGNANCY

N/A

OTHER NOTES

N/A

ABBREVIATIONS

N/A

Clinical Investigations

ROLE OF HOMOEOPATHY

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