Blepharitis

Diagnosis

1. sore/itchy
2. inflammation of lid margin w/ ocular irritation, matted lashes
3. Distinguish anterior from posterior blepharitis using slit lamp
   1. Posterior - swelling and pluggin of meibomian gland openings
   2. Anterior - on external exam, material such as greasy flakes (seborrheic) or hard crust (staph) surrounds eyelashes

Differential Diagnosis

Periorbital swelling

Proptosis

• Normal IOP
  • Orbital cellulitis
  • Orbital pseudotumor
  • Orbital tumor
• Increased IOP
  • Retrobulbar abscess
  • Retrobulbar emphysema
  • Retrobulbar hemorrhage
  • Ocular compartment syndrome
  • Orbital tumor

No proptosis

• Periorbital cellulitis/erysipelas
• Dacryocystitis (lacrimal duct)
• Dacryocele/Dacryocystocele
• Dacryostenosis
• Dacryoadenitis (lacrimal gland)
• Allergic reaction
• Nephrotic Syndrome (pediatrics)

Lid Complications

• Blepharitis (crusts)
• Chalazion (meibomian gland)
• Stye (hordeolum) (eyelash folicle)

Other

• Subperiosteal abscess
• Orbital abscess
• Cavernous sinus thrombosis
• Conjunctivitis
• Contact dermatitis
• Herpes zoster
• Herpes simplex
• Sarcoidosis
• Granulomatosis with polyangiitis

Treatment

1. Lid hygiene most important for both anterior and posterior blepharitis
2. Warm compresses 15min 4x/day
3. Scrub w/ mild shampoo BID
4. Consider topical erythromycin or bacitracin directly onto lid margin
5. No conclusive evidence for oral antibiotics or topical steroids
6. Outpt ophtho - chronic condition without definitive cure

See Also

Red Eye (Bilateral)

Sources

• UpToDate