Blepharitis is a significant cause of discomfort, causing foreign body sensation, burning, itching, and crusting around eyelashes.
Typical findings include lid erythema, collarettes around eyelashes, and capped meibomian glands.
In severe disease, corneal changes, including neovascularisation, scarring, ulceration, and perforation, can lead to visual impairment.
Treatment is directed at maintaining eyelid hygiene and may require use of topical corticosteroids and topical or oral antibiotics.
Treatment of associated or underlying medical conditions is essential for successful management of blepharitis.
Blepharitis refers to a group of disorders characterised by inflammation of the eyelids and associated adnexal structures including skin, lashes, and meibomian glands. It typically occurs bilaterally. Disease is usually chronic with intermittent exacerbations.
History and exam
Key diagnostic factors
- burning sensation
- itching sensation
- foreign body sensation
- crusting of eyelids
- dry eye
- lid erythema, telangiectasias
- collarettes around lashes
- capped meibomian glands
- conjunctival hyperaemia
- unstable tear film with rapid tear break-up time
Other diagnostic factors
- scalp changes
- facial telangiectasias, erythema, pustules, papules
- depigmentation of lashes
- lid margin thickening, notching, and ulceration
- corneal changes
- decreased vision
- age ≥50 years
- dermatological disease
- intraocular or lid surgery/injury
Investigations to consider
- lid biopsy
- lid margin culture
- microscopic evaluation of epilated eyelashes
no visual impairment
with visual impairment secondary to corneal involvement
- Dry eye syndrome
- Squamous cell carcinoma
- Clinical management guidelines: blepharitis (lid margin disease)
- Preferred practice pattern: blepharitis
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