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Blepharitis
Inflammation of the Eyelid
Blepharitis is an inflammation of the eyelid, characterized by swelling, redness, crusting at the lid margins, pruritus and reduced vision.

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Presentation

The eyelids become swollen and have ulcerative, non-healing areas that may even bleed. There is a yellowish sticky discharge which is more abundant in the morning and cause eyelid matting of the eyelashes. The other symptoms include itching, burning, gritty and foreign body sensation in the eyes.

Vision is usually not affected in blepharitis, although a poor tear film result into blurring of vision and sensitivity to light. The chronic inflammation of blepharitis can cause redness of the eyes.
In allergic blepharitis, the eyelids may appear dark. This condition is called “allergic shiner” and which tends to be more frequent in children as compared to adults.

Untreated cases of blepharitis can also present with various complications like stye, chalazion, trichiasis or even loss of eyelashes. Conditions like entropion and ectropion are not commonly associated with blepharitis.

Entire Body System

  • Inflammation

    Symptoms from the irritation and inflammation vary from minor occasional irritation and itching to redness, stinging, and burning. [bouldereyesurgeons.com]

    A number of factors that lead to inflammation of the eyelid and crusty eyelashes can cause it. [draxe.com]

    Tea tree oil treatments with either 50% lid scrubs or 5% lid massages are effective in eradicating mites and reducing ocular surface inflammation. Demodex blepharitis is a common but overlooked external eye disease. [ncbi.nlm.nih.gov]

    When these glands become clogged or irritated due to some kind of infection, it triggers inflammation. This is known as blepharitis or, in simple terms, eyelid inflammation. There are two types of eyelid inflammation – anterior and posterior. [top10homeremedies.com]

    Symptoms may include: Eye and eyelid irritation Itching and foreign body sensation Redness of the eye and eyelids Crusting along the eyelashes Blurred vision Anterior blepharitis refers to inflammation along the front of the eyelid where the eyelashes [ntxeye.com]

  • Pain

    Placing moist black or green tea bags over your closed eyelids can help reduce pain and inflammation. Place freshly grated potato over the inflamed eyelids to reduce swelling as well as pain and itching. [top10homeremedies.com]

    Sometimes a Chalazion can become infected and painful. Stye – This is a painful infected swelling most prominent on the outside of the eyelid. It is due to an infection of the root (follicle) of an eyelash. [avenova.com]

    However, some patients suffer an acute form of the condition, which can be extremely painful and result in loss of eyelashes, swelling inside the lid and disturbed vision. [eyecaretrust.org.uk]

    Although pain is not common among blepharitis symptoms, if the condition persists or becomes painful, the individual is recommended to seek medical attention. [eyeplastics.com]

    In most cases, chalazion is painless, but it can be painful and red if there is an infection. Problems with the tear film – The tear film is a layer of oil, water, and mucous that surrounds and protects the eye. [columbiaeye.org]

  • Asymptomatic

    Demodex mite is the most common age-related ectoparasite of human being and may be detected from asymptomatic normal population. Furthermore, the pathogenesis of demodicosis remains unclear. [ncbi.nlm.nih.gov]

    Its role has not been firmly established since Demodex can be found with nearly the same prevalence in asymptomatic patients. [eyewiki.aao.org]

    Demodex D folliculorum is an ectoparasite that occurs normally in the lash follicles D brevis, also an ectoparasite, is found in meibomian glands Long-term contact lens wear Ocular rosacea (a cause of posterior blepharitis) Symptoms Blepharitis may be asymptomatic [college-optometrists.org]

Eyes

  • Blepharitis

    Blepharitis Blepharitis is a common and persistent inflammation of the eyelids and eyelid margins. Symptoms include redness, irritation, and itching. Often, these symptoms are worse in the morning. [bouldereyesurgeons.com]

    What Is Blepharitis? Blepharitis is an inflammation of the eyelid that is often associated with an infection. Dry eye is one of the most common symptoms of blepharitis. [maitlandvisioncenter.com]

    What is blepharitis? Blepharitis is inflammation of the edges of the eyelids. They look crusty, flaky, and often red. This condition is very common. Another name for it is granulated eyelids. It does not usually affect your eyesight. [westbocaeyecenter.com]

    There are two main types of blepharitis: Anterior blepharitis: this affects the outside margins of the eyelid where the eyelashes are attached, often causing significant swelling Posterior blepharitis: this type of blepharitis occurs when the eyelids’ [visioneyeinstitute.com.au]

  • Dry Eyes

    Artificial tears, which are available without a prescription, may be used to relieve the symptoms of dry eyes (see Dry Eyes for additional information). [bouldereyesurgeons.com]

    Easy-to-spot blepharitis dry eye symptoms include: Crusty eyelids Dry Eyes Redness/ inflammation of eyelids Gritty eyes Blepharitis relief can be achieved naturally with the use of TheraLife Eye products. [theralife.com]

    OBJECTIVE: To assess the changes in eyelid margins associated with eyelid hygiene using Blephaclean eye pads to manage anterior blepharitis or meibomian gland dysfunction (MGD) associated with dry eye complaints. [ncbi.nlm.nih.gov]

    They include: A foreign body or burning sensation in the eye Excessive tearing Itching Sensitivity to light Red and swollen eyelids Eye redness Blurred vision Frothy tears Dry eye Crusting of the eyelashes during sleep What other conditions are associated [columbiaeye.org]

  • Photophobia

    Average subjective symptom grading improved statistically after treatment with oral azithromycin, except for eyelid hyperemia, photophobia, and foreign body sensation. [ncbi.nlm.nih.gov]

    Signs & Symptoms Itchy, burning and/or gritty eyes Red eye Sore eyes Sticky eyelids Eyelid margin swelling Crusty or greased eyelashes Mild light sensitivity (photophobia) Loss of eyelashes or irregular eyelash growth Recurrence of styes If you think [dfoptometrists.com]

    Blepharitis Symptom Light Sensitivity (Photophobia) Sensitivity to light is the inability to tolerate light, medically known as photophobia. [medicinenet.com]

    MARAZZI/SCIENCE PHOTO LIBRARY Blepharitis can develop at any age, and symptoms can include: itchy, sore and red eyelids that stick together crusty or greasy eyelashes a burning, gritty sensation in your eyes increased sensitivity to light (photophobia [nhs.uk]

    Symptoms include itching of the eye, a burning sensation in the eye, excessive tear production, photophobia, swollen and red eyelids, sticky eyelids, and crusting and loss of the eyelashes. Blepharitis typically is chronic and difficult to treat. [britannica.com]

  • Foreign Body Sensation

    Extra lubrication in the form of artificial tears 4-5 times daily can help with foreign body sensation. Many brands are available over-the-counter (Refresh, Systane, Genteal, Theratears, etc.) including many generics. [ntxeye.com]

    Gritty sensation of the eye. Reduced vision. Common signs and symptoms of blepharitis also include itching, irritation and burning as well as a foreign body sensation. [eyeplastics.com]

    Symptoms and Signs Symptoms common to all forms of blepharitis include itching and burning of the eyelid margins and conjunctival irritation with lacrimation, photosensitivity, and foreign body sensation. [merckmanuals.com]

    Average subjective symptom grading improved statistically after treatment with oral azithromycin, except for eyelid hyperemia, photophobia, and foreign body sensation. [ncbi.nlm.nih.gov]

    Common signs and symptoms include: Itchy, flaky eyelid margins Red/blood-shot eyes Foreign body sensation Excessive or frothy tears Crusty or sticky lashes Sensitivity to light Rough, scaly eyelids Excessive blinking. [visioneyeinstitute.com.au]

  • Lacrimation

    ICD-10-CM Codes › H00-H59 Diseases of the eye and adnexa › H00-H05 Disorders of eyelid, lacrimal system and orbit › H01- Other inflammation of eyelid › Unspecified blepharitis unspecified eye, unspecified eyelid 2016 2017 2018 2019 Billable/Specific Code [icd10data.com]

    Symptoms and Signs Symptoms common to all forms of blepharitis include itching and burning of the eyelid margins and conjunctival irritation with lacrimation, photosensitivity, and foreign body sensation. [merckmanuals.com]

    Instead, it is likely an adaptive response of the ocular surface to the lack of tears, possibly increasing meibum fluidity, thus enhancing lacrimal film stability. [ncbi.nlm.nih.gov]

    With every blink, oil is spread evenly over the eye through the lacrimal fluid, so that the eyelids can slide unhindered over the eye and tears cannot easily evaporate. [hylo.de]

Skin

  • Dermatitis

    From Wikidata Jump to navigation Jump to search eyelid disease that is characterized by often chronic inflammation of the eyelid, generally the part where eyelashes grow Infective dermatitis of eyelid of types resulting in deformity Infective eyelid dermatitis [wikidata.org]

    Seborrheic dermatitis is an inflammation of the top layers of skin, characterized by red, itchy skin that sheds scales. What are the symptoms of blepharitis? The following are the most common symptoms of blepharitis. [stanfordchildrens.org]

    The two most common causes of anterior blepharitis are bacteria and a skin disorder that causes itchy, flaky skin called seborrheic dermatitis. [maitlandvisioncenter.com]

  • Eczema

    Sebum production is, however, not related to the severity of the eczema. Some individuals are free from eczema even though the sebum production is higher. [news-medical.net]

    A history of acne, rosacea, or eczema should be evaluated. DIAGNOSIS 18. EXAMINATION OF THE TEAR FILM Bubbles, also called frothing, can sometimes be seen in the tear film, especially along the lid margins. This can indicate meibomianitis. 19. [de.slideshare.net]

    Blepharitis can present with a range of signs and symptoms, and is associated with various dermatological conditions, namely, seborrheic dermatitis, rosacea, and eczema. [ncbi.nlm.nih.gov]

    It may be caused by bacteria or by other skin conditions such as dandruff, skin allergies, or eczema. If you have blepharitis, you're also more likely to get styes. [stanfordhealthcare.org]

    It is more common is people who have skin conditions like eczema, acne and rosacea. Blepharitis tends to be a long-term, ongoing condition. Although it can occur at any age, it tends to be more common in older people. [healthnavigator.org.nz]

  • Alopecia

    Abstract An immune deficiency state is proposed as the cause of a disorder affecting a father and son with chronic dermatitis, purulent blepharitis with corneal ulceration, and scarring pyodermatous alopecia of the scalp. [ncbi.nlm.nih.gov]

    Patients may exhibit alopecia areata of eyelashes and/or growth misdirection, trichiasis. [en.wikipedia.org]

  • Pruritus

    As for the symptoms score, we observed statistical difference in the symptoms scoring for pruritus and dry eye sensation in the tacrolimus group. [ncbi.nlm.nih.gov]

    Blepharitis is an inflammation of the eyelid, characterized by swelling, redness, crusting at the lid margins, pruritus and reduced vision. The eyelids become swollen and have ulcerative, non-healing areas that may even bleed. [symptoma.com]

Neurologic

  • Irritability

    Symptoms from the irritation and inflammation vary from minor occasional irritation and itching to redness, stinging, and burning. [bouldereyesurgeons.com]

    Bacteria like Staphylococcus, which are normally found on the skin and hair, grow along the affected lashes and cause build-up of debris, which can further irritate the eye. [ntxeye.com]

    […] or allergens that lead to inflammation and irritation of the eyelids. [draxe.com]

    Then your eyes may look red and feel irritated. How is it diagnosed? Your doctor will examine your eyes using a magnifying instrument. He or she may also examine your scalp. [westbocaeyecenter.com]

    This debris can cause irritation as well as the eyelashes to be stuck together upon waking up in the morning. Lid scrubs allow you to keep your eyelids clean and free from this irritating buildup of debris. [mhei.com]

Workup

Thorough careful routine examination of the eyelids and eyelashes is usually sufficient to establish the diagnosis of blepharitis [7]. Further tests and procedures used to diagnose blepharitis include the following.

Examination of eyelids: Blepharitis can be diagnosed by routine examination of eyelids and eyelashes. A slit lamp microscope can be used for detailed examination of cornea, iris and lens under high magnification.

Skin swab for test: In certain cases, a swab can be used to collect a sample of oil or crusts that is formed on eyelids. This sample can be used to analyze bacterial, fungal or allergic cause of blepharitis.

Treatment

Blepharitis can be treated through proper eyelid hygiene. If left untreated, it can lead to severe complications. Treatment of blepharitis consists of the following elements.

  • Cleaning of the eyes: Carefully clean the eyelids with a warm wash cloth for about 2 minutes. The edges of the eyelids can be gently scrubbed with tearless shampoo to remove the lid margin debris. Warm compresses applied to the eyelids can loosen crusted secretions. The procedure should be repeated several times a day until the symptoms are resolved.
  • Antibiotics: After cleaning of the lid margins, a small amount of antibiotic ointment can be applied to treat bacterial infection. The antibiotics most commonly used include erythromycin, sulphacetamide, doxycycline and tetracycline etc. These can be administered in cream, ointment or pill form. Ulcerative forms of blepharitis may require antibiotic injection in the ciliary edges of the lids [8].
  • Steroid eye drops: The corticosteroids are helpful to control inflammation of eyelids. In corneal disease, they may be combined with antibiotics [9].
  • Artificial tears: In certain cases, eyes become dry due to poor tear film. Lubricating eye drops or artificial tears can help prevent dry eye syndrome.
  • Control dandruff: In patients with seborrheic dermatitis or dandruff, there is a need to use an anti-dandruff shampoo on the scalp and eyebrows. And similarly, if lice are the cause, petroleum jelly can be applied along the base of eyelashes to prevent them.
  • Nutritional support: A diet rich in Omega-3 fatty acids or supplements containing Omega-3 fatty acids may also help prevent blepharitis [10].

Despite proper treatment, the disease may recur in certain cases.

Prognosis

Overall, the prognosis for patients with blepharitis is good. Blepharitis usually responds to treatment, but in some cases the disease may recur and develop into chronic blepharitis. Chronic blepharitis is usually resistant to treatment and can lead to complications. In severe cases, patients may develop corneal complications which can cause loss of vision.

Etiology

Blepharitis can result from many causes. The most common of them is bacterial infection causes by staphylococcal species [1]. Seborrheic dermatitis is most commonly caused by dandruff of the scalp and eyebrows [2].

Allergic reactions caused by medications, contact lenses or eye makeup may also result in blepharitis [3]. Poor nutrition and poor hygiene can be a contributory factor for the development of blepharitis. Eyelash mite or lice can also cause blepharitis [4] [5] [6].

Moreover, certain medications such as isotretinoin can also lead to an increase in the number of bacteria on eyelids, thus increasing the risk for the development of blepharitis.

Epidemiology

Blepharitis is a common eye disorder throughout the world. There are no racial differences in the incidence of blepharitis, and the disease is found equally in both men and women. It affects people of all ages; however, seborrheic dermatitis is seen more frequently in an older age group.

Pathophysiology

Blepharitis is most commonly caused by bacterial infection. The microbial invasion into tissues causes an inflammatory processes. This is the release of a number of bacterial toxins, chemical mediators and enzymes. The eyelid tissues being sensitive to the toxins secreted by these bacteria result into a thick, sticky discharge which may cause the eyelids to stick overnight.

The meibomian glands found in the lids produce secretions that maintain the outer lipid layer in the lid. This lipid layer reduces the evaporation of the aqueous component of tears. In patients with blepharitis, there is an obstruction in the meibomian gland ducts that reduces the amount of lipid secretion. This can result in increased evaporation of the aqueous component, leading to dry eyes.

Prevention

The most effective way to prevent blepharitis and its recurrence is to keep the eyelids and face clean. Care must be taken to avoid exposure to smoke and chemical fumes, and exposure to sunlight should be avoided as well while taking antibiotics. The use of an anti-dandruff shampoo may help prevent blepharitis if dandruff is contributing to the blepharitis. The use of eye makeup should also be avoided to prevent further irritation.

Summary

Blepharitis is the inflammation of the eyelids that usually involves the lower part of the lids and eyelashes. It is characterized by itching, burning, swelling and redness in both eyes, excessive tear production and loss of eyelashes. It is the most common eye disease.

Blepharitis  may be classified into seborrheic, ulcerative, staphylococcal and parasitic varieties. It is sometimes a chronic condition that can be difficult to treat, but it does not usually affect vision or damage the eye.

Patient Information

Blepharitis is the swelling and irritation of the eyelids. The patients usually have red and itchy and eyelids. It is a common disorder that can occur in people of any age. With proper treatment, eyelid hygiene and lifestyle changes, the disease has a good prognosis.

References

  1. Vena Rodriguez A. [Etiology of blepharitis]. Medicamenta. Feb 10 1951;9(195):121-122.
  2. Thygeson P, Vaughan DG, Jr. Seborrheic blepharitis. Transactions of the American Ophthalmological Society. 1954;52:173-188.
  3. Lemp MA. Contact lenses and associated anterior segment disorders: dry eye, blepharitis, and allergy. Ophthalmology clinics of North America. Sep 2003;16(3):463-469.
  4. Pinckney J, 2nd, Cole P, Vadapalli SP, Rosen T. Phthiriasis palpebrarum: a common culprit with uncommon presentation. Dermatology online journal. 2008;14(4):7.
  5. Divani S, Barpakis K, Kapsalas D. Chronic blepharitis caused by Demodex folliculorum mites. Cytopathology : official journal of the British Society for Clinical Cytology. Oct 2009;20(5):343-344.
  6. Dhingra KK, Saroha V, Gupta P, Khurana N. Demodex-associated dermatologic conditions--A coincidence or an etiological correlate. Review with a report of a rare case of sebaceous adenoma. Pathology, research and practice. 2009;205(6):423-426.
  7. Jackson WB. Blepharitis: current strategies for diagnosis and management. Canadian journal of ophthalmology. Journal canadien d'ophtalmologie. Apr 2008;43(2):170-179.
  8. Enaliev FS. [Treatment of ulcerative blepharitis by injections of antibiotics into the region of ciliary edges of the lids]. Vestnik oftalmologii. May-Jun 1966;79(3):77-78.
  9. Luchs J. Efficacy of topical azithromycin ophthalmic solution 1% in the treatment of posterior blepharitis. Advances in therapy. Sep 2008;25(9):858-870.
  10. Macsai MS. The role of omega-3 dietary supplementation in blepharitis and meibomian gland dysfunction (an AOS thesis). Transactions of the American Ophthalmological Society. 2008;106:336-356.
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