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Blepharitis

Last reviewed: 3 Apr 2025
Last updated: 20 Nov 2024

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
Full details

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
Full details

Risk factors

  • Demodex infection
  • age ≥50 years
  • female
  • dermatologic disease
  • intraocular or lid surgery/injury
Full details

Diagnostic tests

Tests to consider

  • lid biopsy
  • lid margin culture
  • microscopic evaluation of epilated eyelashes
Full details

Treatment algorithm

ACUTE

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

Our in-house evidence and editorial teams collaborate with international expert contributors and peer reviewers to ensure that we provide access to the most clinically relevant information possible.

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.

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