Blepharitis

What is Blepharitis?

Blepharitis is a very common condition in which the eyelid margins become chronically inflamed. It affects people of all ages and is one of the most frequent reasons patients attend an eye clinic. Although blepharitis is rarely sight-threatening, it causes significant discomfort and tends to recur. It is closely linked to dry eye disease — the two conditions frequently co-exist and exacerbate each other. Treatment focuses on controlling symptoms through good lid hygiene.

Symptoms

• Red, itchy, or burning eyelid margins
• Crusting or flaking at the base of the eyelashes, particularly on waking
• Sticky eyes on waking
• A gritty, sandy sensation in the eyes
• Temporary blurring of vision that improves with blinking
• Sensitivity to light

Causes

• Anterior blepharitis — staphylococcal bacteria on the lid margin; seborrhoeic dermatitis
• Posterior (meibomian gland) blepharitis — dysfunction of the meibomian oil glands in the lid margins, causing evaporative dry eye
• Demodex mites — microscopic mites living in the eyelash follicles

Diagnosis

Clinical examination of the eyelid margins with a slit-lamp microscope. The pattern of inflammation, type of crusting, and meibomian gland expressibility guide the assessment.

Treatment

Daily warm compresses (heated eye mask for 10 minutes) to loosen and express meibomian secretions, followed by lid margin scrubs (specialist wipes or dilute baby shampoo). Topical antibiotic ointment for bacterial blepharitis. Oral tetracyclines (doxycycline) for severe meibomian gland disease. Lubricating eye drops for co-existing dry eye.