Blepharitis

BASICS

DESCRIPTION

  • Inflammatory or infectious process of the eyelid margin, typically involving skin, lashes, and meibomian glands
    • Associated with itchiness, redness, flaking, and crusting of the eyelids
    • Usually chronic, intermittent with exacerbations and remissions
    • Typically bilateral
  • Historically classified according to location, anterior versus posterior
    • Anterior blepharitis: affects the base of the eyelashes and eyelash follicles
    • Posterior blepharitis: affects the meibomian glands
  • Can also be classified by etiology
    • Inflammatory: seborrheic, meibomian gland dysfunction, allergic, associated with rosacea
    • Infectious: bacterial (most commonly Staphylococcus aureus or Staphylococcus epidermidis), viral, fungal, or parasitic

EPIDEMIOLOGY

  • One of the most common ocular disorders; seen by ophthalmologists and optometrists in approximately 40% of patients
  • Presents in patients of all ages but anterior blepharitis is typically seen in younger females

ETIOLOGY

  • Complex and poorly understood
  • Likely multifactorial
    • Infectious conditions
    • Systemic diseases
    • Environmental factors
  • Posterior blepharitis more commonly associated with seborrhea or rosacea

RISK FACTORS

  • Presence of atopic, allergic, or seborrheic dermatitis
  • Rosacea
  • Tear deficiency and dysfunction
  • Contact lenses use
  • Dry eyes
  • Isotretinoin used to treat severe cystic acne
  • Less common risk factors include underlying immunologic disorders such as lupus, eyelid tumors, trauma, psoriasis, and other dermatoses.

PATHOPHYSIOLOGY

  • Multifactorial:
    • Results from the complex interplay between abnormal lid margin secretions, lid margin organisms, and dysfunction of the tear film
  • Infectious blepharitis:
    • Bacteria such as Staphylococcus may cause direct infection of the eyelids, evoke reaction to the exotoxin, or provoke an allergic reaction to the staphylococcal antigens.
  • Inflammatory blepharitis:
    • Inflammation of the meibomian glands leads to impaired gland secretions and instability of the tear film.
  • This condition can have a direct toxic effect and promote bacterial overgrowth.

COMMONLY ASSOCIATED CONDITIONS

  • Seborrheic dermatitis
  • Allergic or contact dermatitis
  • Down syndrome (trisomy 21)
  • Ocular rosacea
  • Dry eye (keratoconjunctivitis sicca)
  • Hordeolum
  • Chalazion

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