Chronic Blepharitis

1. Types
   1. Anterior Blepharitis
      1. Affects base of eyelashes
      2. Associated with staphylococcal infection or Seborrhea
   2. Posterior Blepharitis
      1. Affects meibomian gland openings
      2. Associated with meibomian gland dysfunction
2. Symptoms
   1. Pruritus
   2. Local irritation and burning
3. Signs
   1. Inflammation of Eyelid margin at the lash follicles
   2. Moderate lid swelling along lash line
   3. Lower Eyelid is usually more affected
   4. Soft, oily Yellow SkinScaling
4. Differential Diagnosis
   1. See Eyelid Inflammation
5. Associated Conditions
   1. Seborrheic Dermatitis
   2. Staphylococcal infection
   3. Rosacea
   4. Sjogren's Syndrome
6. Labs
   1. Eyelid margin culture
      1. Indicated in recurrent anterior Blepharitis
   2. Biopsy
      1. Indicated in refractory cases where skin cancer is considered
7. Management
   1. Clean lid margins twice daily
      1. Pull lower lid down to scrub against orbital rim
      2. Apply warm compress for 2 minutes
         1. Loosens debris
         2. Helpful in severe Blepharitis
      3. Gently massage posterior lid to express meibomian gland contents
      4. Scrub lid margins with warm cloth
      5. Scrub lashes and lid margins with dilute baby Shampoo on cotton swab
      6. Wipe lid margins with warm cloth after scrubbing
   2. Acute infectious flare-up (e.g. staphylococcal Blepharitis)
      1. Erythromycin or Bacitracin ophthalmic ointment to lid margin at bedtime for 1-2 weeks
   3. Meibomian gland dysfunction
      1. Tetracycline 250 mg four times daily orally for 4 weeks or
      2. Doxycycline 100 mg twice daily orally for 4 weeks
   4. Refractory cases
      1. Consider brief use of Topical Corticosteroids (e.g. Tridesilon 0.05% bid for 5-10 days)
   5. Treat associated Seborrheic Dermatitis
8. Complications
   1. Eyelash loss
   2. Eyelash loss with Corneal scarring
9. References
   1. Papier (2007) Am Fam Physician 76:1815-24