Blepharitis

• Chronic inflammation of the eyelid margins
• most common cause of dry eye disease and accounts for 5% of ophthalmology-related presentations in primary care
• Presentation:

  • Bilateral
  • Ocular irritation
  • Foreign body sensation
  • Burning
  • redness
  • Crusting
  • May be watering of the eye
• underlying disease process involves congestion and inflammation of eyelash follicles and meibomian glands.
• Causes:

  • Atopic dermatitis (staphylococcal)
  • Epidermidis
  • Seborrheic dermatitis
  • Acne rosacea
  • Demodex infestation (mites)
• Blepharitis commonly presents with appears as erythematous and thickened eyelid margins. The base of eyelashes may reveal crusting 
• There are three steps to cleaning eyelids that should be performed at least once a day:

  • Warm compression of the eyelids with a warm compress to loosen debris
  • Eyelid massage to empty glands of debris
  • Cleaning eyelids with cotton wool to remove debris
• Topical antibiotic ointments (e.g. chloramphenicol) can be applied to the eyelid margin for a few weeks to reduce bacterial colonisation.
• An extended course of low-dose oral tetracyclines (doxycycline) and regular omega-3 fatty acid supplements may have a useful anti-inflammatory effect.

  Antibiotic not used as antibiotic, more effectively express content of glands