Blepharitis

Blepharitis is a chronic inflammation of the eyelid margins that is often refractory to treatment with infectious and noninfectious etiologies. Common in children, particularly those with atopic dermatitis and eczema. Adults with seborrhea involving the eyelids.

SYMPTOMS

_ Common symptoms: red eyes, burning sensation, excessive tearing, blurred vision, pruritic eyelids.

_ Chronically infected lids are usually diffusely erythematous, with collarettes (fibrin exudate) at the base of the lashes

_ Lid margins thicken over time, with associated loss of eyelashes (madarosis), misdirected growth of lashes (trichiasis), and overflow or inspissation of the meibomian glands.

_ Associated conjunctivitis with erythema, edema but no discharge

_ Chalazion: chronic sterile inflammation of an oil gland of the eyelid

_ Superficial punctate erosions of the inferior corneal epithelium are common

CAUSES

• Staphylococcal infection
• Seborrheic dermatitis
• Rosacea
• Dry eye (keratoconjunctivitis sicca): decrease in tear volume
• Meibomian gland dysfunction

Two categories of blepharitis

_ Anterior blepharitis, most often associated with staphylococcal infection

_ Posterior blepharitis, associated with meibomian gland dysfunction and seborrheic dermatitis or rosacea

LABORATORY TEST

_ Eyelid cultures and antibiotic sensitivity testing (usually not done unless patient fails to respond to initial treatment regimen)

MANAGEMENT

_ Alkaline soaps may be beneficial; alcohol and some detergents remove surface lipids and microflora.

_ Hot compresses applied to closed lids for 5 to 10 min: heat loosens debris from lid margins and increases meibomian gland fluidity.

_ Most effective topical antibiotics include bacitracin, erythromycin or 1% azithromycin solution, aminoglycoside and fluoroquinolone ophthalmic ointments

_ Ointment is applied 1 to 4 times daily, depending on the severity, for 1 to 2 wk, followed by once daily, at bedtime, for another 4 to 8 wk until all signs of inflammation have disappeared.

_ Oral antibiotics: long-term use of doxycycline or tetracycline in a tapering dose may be helpful in severe cases for patients older than 8 years of age.

_ Tetracycline 250 mg orally 4 times daily or doxycycline 100 mg orally bid along with local treatment for several months.