Adult Blepharitis Clinical Presentation

Patients with blepharitis typically present with symptoms of eye irritation, itching, erythema of the lids, and/or changes in the eyelashes.

• Common complaints include the following:

  • Burning
  • Watering
  • Foreign body sensation
  • Crusting and mattering of the lashes and medial canthus
  • Red lids
  • Red eyes
  • Photophobia
  • Pain
  • Decreased vision
• The condition most typically has a chronic course with intermittent exacerbations and eruptions of symptomatic disease. Seborrheic dermatitis can be associated with symptoms of scalp itching, flaking, and oily skin. Rosacea can be associated with a red and swollen nose (rhinophyma), facial flushing, broken and distended vessels in the face, pustules, oily skin, and eye irritation.

• External examination of patients with blepharitis often demonstrates findings of associated conditions. Herpetic skin disease can be associated with erythema and vesicle formation. Seborrheic dermatitis is typified by oily skin and flaking from the scalp or brows. Rosacea is associated with pustules, rhinophyma, telangiectasias, erythema, and pustules.
• Gross examination of the eyelids shows erythema and crusting of the lashes and lid margins.
• Slit lamp examination shows additional features, including loss of lashes (madarosis), whitening of the lashes (poliosis), scarring and misdirection of lashes (trichiasis), crusting of the lashes and meibomian orifices, eyelid margin ulcers, plugging and "pouting" of the meibomian orifices, telangiectasias, and lid irregularity (tylosis).
• The conjunctiva usually shows papillary injection.
• Corneal findings can include punctate epithelial erosions, marginal infiltrates, marginal ulcers, pannus, and phlyctenule formation. Corneal involvement occurs most commonly at the positions where the limbus is crossed by the upper and lower lid margins, at the 2-, 4-, 8-, and 10-o'clock positions. Corneal infiltrates can progress to infection and even perforation.
• The anterior variant of blepharitis involves mainly the lashes and associated oil glands. Various formations of debris adhere to the lashes.

  • Crusting refers to flakes of material that adhere to the lashes and usually represents seborrheic disease. The epithelial material is often referred to as scurf.
  • A collarette is a ringlike formation around the lash shaft that occurs with staphylococcal disease. Staphylococcal blepharitis is typified by the formation of collarettes on the lashes.
  • A sleeve is a tube of material that also surrounds the lash. Sleeving is associated with infection by the eyelash parasite, Demodex.
  • Ulcers form at the base of the lashes. They are covered by a crust of fibrin, which is lifted up as the lash shaft grows.
  • Seborrheic blepharitis also involves primarily the anterior lid and is associated with the formation of greasy crusts of material, which are adherent to the eyelash shaft.
• Corneal disease is most common with the staphylococcal variant of anterior lid disease.
• Posterior blepharitis mainly is related to dysfunction of the meibomian glands. Alterations in secretory metabolism and function lead to disease. The meibomian secretions become more waxlike and begin to block the gland orifices. The stagnant material becomes a growth medium for bacteria and can seep into the deeper eyelid tissue layers, causing inflammation. These processes lead to gland plugging, inspissated material, inflamed orifices, and formation of chalazia.
• Various corneal changes can also result from posterior blepharitis.

• Some specific causes of blepharitis may include the following:

  • Rosacea
  • Herpes simplex dermatitis
  • Varicella-zoster dermatitis
  • Molluscum contagiosum
  • Allergic or contact dermatitis
  • Seborrheic dermatitis
  • Staphylococcal dermatitis
  • Parasitic infections, such as Demodex and Phthiriasis palpebrarum^{[1, 2, 3]}
• Chronic blepharitis has been associated with exposure to chemical fumes, smoke, smog, and other irritants.
• Acute blepharitis is most commonly due to allergic drug or chemical reaction.
• Sjogren syndrome may present as blepharitis.