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Blepharitis

Blepharitides

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


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.

Erythema
  • Rosacea is associated with pustules, rhinophyma, telangiectasias of the cheeks and eyelid margins, erythema, and pustules. Gross examination of the eyelids shows erythema and crusting of the lashes and lid margins.[emedicine.medscape.com]
  • Grading of the photographic images and the clinical assessments of erythema and lid debris were moderately correlated (r 0.27-0.45).[ncbi.nlm.nih.gov]
  • Exam showed diffuse quad-eyelid erythema, discharge, edema, madarosis, and scale. He also had insufficient tear drainage due to bilateral upper eyelid cicatricial punctal atresia with bilateral lower eyelid punctal stenosis.[ncbi.nlm.nih.gov]
  • Blepharitis was diagnosed based on clinical evidence of greasy scales between the cilia, lid margin erythema, conjunctival hyperemia, telangiectasia, thickening, or irregularity of the eyelid margins by slit-lamp biomicroscopy.[ncbi.nlm.nih.gov]
  • Typical findings include lid erythema, collarettes around eyelashes, and capped meibomian glands. In severe cases, corneal changes, including neovascularisation, scarring, ulceration, and perforation, can lead to visual impairment.[bestpractice.bmj.com]
Insect Bite
  • Herein, we report a 61-year-old ethnic Han Taiwanese male who had suffered from pain with burning and foreign body sensation after an insect bite on his left eye.[ncbi.nlm.nih.gov]
  • Although Staphylococcus bacteria are commonly present in the skin, nose, buttocks, and the surface of the armpits, they can enter the human body through a cut or insect bite in the skin or through skin openings while using medical equipment (for example[news-medical.net]
Blepharitis
  • 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.[symptoma.com]
  • Two hundred fifty consecutive patients with symptomatic blepharitis and 250 control subjects without blepharitis symptoms were evaluated.[ncbi.nlm.nih.gov]
  • Blepharitis may be acute (ulcerative or nonulcerative) or chronic (meibomian gland dysfunction, seborrheic blepharitis).[merckmanuals.com]
  • In this study, a total of 10 093 patients with blepharitis were included in the study group, and another 40 372 participants without blepharitis were included in the control group.[ncbi.nlm.nih.gov]
Dry Eyes
  • Abstract Like dry eye disease 15 years ago, blepharitis today is a poorly defined condition about which there is considerable misunderstanding.[ncbi.nlm.nih.gov]
  • The test population included dry eye sufferers with at least mild symptoms (Ocular Surface Disease Index 13) who presented with mild to moderate anterior blepharitis or MGD.[ncbi.nlm.nih.gov]
  • There may be symptoms of associated dry eye syndrome : watery eyes, blurred vision, dry eyes and intolerance of contact lenses. There may be symptoms of associated seborrhoeic dermatitis : dandruff, oily skin, facial rashes.[patient.info]
  • Eye Dry eye has been reported to be present in 50% of patients with staphylococcal blepharitis. [9] [10] Conversely, in a series of 66 patients with dry eye, 75% were reported to have staphylococcal conjunctivitis or blepharitis. [11] It has been postulated[eyewiki.aao.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]
  • Common symptoms associated with blepharitis are burning sensation, irritation, tearing, photophobia, blurred vision, and red eyes.[ncbi.nlm.nih.gov]
  • 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]
  • Blepharitis Symptom Light Sensitivity (Photophobia) Sensitivity to light is the inability to tolerate light, medically known as photophobia.[medicinenet.com]
  • 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]
Eye Pain
  • American Academy of Ophthalmology 655 Beach Street Box 7424 San Francisco, CA 94120 415-561-8500 American Academy of Ophthalmology How Do You Treat Eye Pain? If you have eye pain, call your doctor for an evaluation.[emedicinehealth.com]
  • Some Conditions Affect Eyelashes, Eyelids Blepharitis and meibomitis are conditions of the eyelashes and eyelids that can cause itching, redness, irritation, burning, blurred vision and/or eye pain.[nweyes.com]
  • For example, if you have eye pain or a lot of swelling and redness, you may need to see a doctor for treatment. While your eyelids are healing, it may be a good idea to avoid wearing contact lenses or eye makeup.[northshore.org]
Crusted Eyelids
  • Blepharitis, common inflammation of the eyelids that is marked by red, scaly, crusting eyelids and a burning, itching, grainy feeling in the eye. The eye itself often has some redness.[britannica.com]
  • Red, swollen eyelid margins Abnormal growth of eyelashes due to scarring of the eyelid margins Flaking skin around the eyes resulting in matting of the lashes Crusted eyelids Scales may cling to the lashes Frothy tear formation What are the complications[dermnetnz.org]
  • Symptoms and complications of blepharitis Symptoms of blepharitis include: Watery eyes Red eyes A gritty, burning, or stinging sensation Greasy-looking eyelids Red, swollen eyelids Flaking of the skin around the eyes Crusted eyelids upon awakening Eyelids[belmarrahealth.com]
  • Blepharitis is a common condition causing red, irritated, flaky and sometimes crusted eyelids. Symptoms of blepharitis include redness, increasing the thickness of the eyelids, stinging and burning.[verywell.com]
Headache
  • However, they may include: nausea (feeling sick) vomiting stomach ache diarrhoea yeast infections, such as thrush , in women If you develop a severe headache or notice any changes in your vision, see your GP immediately.[hse.ie]
  • Photophobia typically causes a need to squint or close the eyes, and headache, nausea, or other symptoms may be associated with photophobia. Symptoms may be worse with bright light.[medicinenet.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.

Sex distribution
Age distribution

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

Article

  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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Last updated: 2019-07-11 22:27