Summary
Definition
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 hyperemia
- unstable tear film with rapid tear break-up time
Other diagnostic factors
- chalazion
- scalp changes
- contact lens intolerance
- photophobia
- facial telangiectasias, erythema, pustules, papules
- depigmentation of lashes
- trichiasis
- madarosis
- lid margin thickening, notching, and ulceration
- corneal changes
- decreased vision
Risk factors
- Demodex infection
- age ≥50 years
- female
- dermatologic disease
- intraocular or lid surgery/injury
Diagnostic tests
Tests to consider
- lid biopsy
- lid margin culture
- microscopic evaluation of epilated eyelashes
Treatment algorithm
no visual impairment
visual impairment secondary to corneal involvement
Contributors
Authors
Elaine Wu, MD
Ophthalmology Clinician
Kaiser Permanente
Union City
CA
Disclosures
EW declares that she has no competing interests.
Acknowledgements
Professor Elaine Wu would like to gratefully acknowledge Professor Esen Akpek, a previous contributor to this topic.
Disclosures
EA declares that she has no competing interests.
Peer reviewers
Gus Gazzard, MA, MBBChir, MD, FRCOphth
Consultant Ophthalmic Surgeon
King's College Hospital
Honorary Research Fellow
Institute of Ophthalmology
London
UK
Disclosures
GG declares that he has no competing interests.
Leejee H. Suh, MD
Assistant Professor of Ophthalmology
Bascom Palmer Eye Institute
Miami
FL
Disclosures
LS declares that she has no competing interests.
References
Key articles
Lin A, Ahmad S, Amescua G, et al. Blepharitis preferred practice pattern®. Ophthalmology. 2024 Apr;131(4):P50-86.Full text
American Academy of Ophthalmology. Cornea/external disease summary benchmarks - 2023. Dec 2023 [internet publication].Full text
Reference articles
A full list of sources referenced in this topic is available to users with access to all of BMJ Best Practice.
Differentials
- Dry eye syndrome
- Chalazion
- Squamous cell carcinoma
More DifferentialsGuidelines
- Blepharitis preferred practice pattern
- Meibomian gland dysfunction clinical practice guidelines
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