Blepharitis

Background

• Inflammation of eyelids
• Acute (ulcerative or nonulcerative)
  • Usually bacterial (typically staph), less often viral (VZV, herpes)
• Chronic (meibomian gland dysfunction, seborrheic blepharitis)

Clinical Features

Blepharitis of right eye.

Scaling and bacterial debris at the base of the eyelashes.

Infant with blepharitis of right side.

• Sore/itchy
• Inflammation of lid margin with ocular irritation, matted lashes
• Blurry vision
• Tearing
• Crusting at the lid margins
• Distinguish anterior from posterior blepharitis using slit lamp
  • Posterior - swelling and plugging of meibomian gland openings
  • 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

Evaluation

• Clinical diagnosis

Management

• Lid hygiene most important for both anterior and posterior blepharitis
• Avoid eye-makeup
• Warm compresses 15min 4x/day
• Scrub with mild shampoo BID
• Consider topical erythromycin or bacitracin directly onto lid margin
• No conclusive evidence for oral antibiotics or topical steroids

Disposition

• Outpatient optho - chronic condition without definitive cure

See Also

• Red Eye (Bilateral)