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Blepharitis, Adult: Differential Diagnoses & Workup

Author: R Scott Lowery, MD, Assistant Professor of Ophthalmology, Department of Pediatric Ophthalmology and Strabismus, University of Arkansas for Medical Center, Arkansas Children's Hospital
Contributor Information and Disclosures

Updated: Jul 30, 2009

Differential Diagnoses

Basal Cell Carcinoma, Eyelid
Hordeolum
Cellulitis, Preseptal
Keratitis, Bacterial
Chalazion
Keratoconjunctivitis, Atopic
Conjunctivitis, Bacterial
Keratoconjunctivitis, Epidemic
Conjunctivitis, Viral
Keratoconjunctivitis, Sicca
Contact Lens Complications
Keratoconjunctivitis, Superior Limbic
Dermatitis, Contact
Ocular Rosacea
Dry Eye Syndrome
Trichiasis

Other Problems to Be Considered

Seborrheic dermatitis
Herpetic eye disease
Parasitic infections, such as Demodex or Phthiriasis palpebrarum1,2,3

Workup

Laboratory Studies

  • In general, diagnostic tests do not typically need to be performed for suspected blepharitis. Research and other rare protocols may involve eyelid margin cultures, transillumination studies of the meibomian glands, marginal biopsies, or even analysis of gland secretions.
  • Testing patients with blepharitis for tear insufficiency or nasolacrimal drainage problems is appropriate because these can be associated with blepharitis and can often complicate management.

Histologic Findings

Seborrheic dermatitis is characterized histologically by spongiosis, mild perivascular, lymphohistiocytic, mononuclear cellular infiltrates in the superficial dermis. Staphylococcal blepharitis is a chronic nongranulomatous inflammation, usually with neutrophils and, often, acanthosis or parakeratosis.

More on Blepharitis, Adult

Overview: Blepharitis, Adult
Differential Diagnoses & Workup: Blepharitis, Adult
Treatment & Medication: Blepharitis, Adult
Follow-up: Blepharitis, Adult
References
Further Reading
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References

  1. Pinckney J 2nd, Cole P, Vadapalli SP, Rosen T. Phthiriasis palpebrarum: a common culprit with uncommon presentation. Dermatol Online J. Apr 15 2008;14(4):7. [Medline].

  2. Divani S, Barpakis K, Kapsalas D. Chronic blepharitis caused by Demodex folliculorum mites. Cytopathology. Mar 7 2009;[Medline].

  3. Dhingra KK, Saroha V, Gupta P, Khurana N. Demodex-associated dermatologic conditions - A coincidence or an etiological correlate. Review with a report of a rare case of sebaceous adenoma. Pathol Res Pract. Jan 22 2009;[Medline].

  4. Jackson WB. Blepharitis: current strategies for diagnosis and management. Can J Ophthalmol. Apr 2008;43(2):170-9. [Medline].

  5. Luchs J. Efficacy of topical azithromycin ophthalmic solution 1% in the treatment of posterior blepharitis. Adv Ther. Sep 2008;25(9):858-70. [Medline].

  6. Arky R. Acromycin V tetracycline HCl. In: Physicians' Desk Reference. 53rd ed. 1999:1514-1515. [Full Text].

  7. Cohen EJ. Cornea and external disease in the new millennium. Arch Ophthalmol. Jul 2000;118(7):979-81. [Medline].

  8. Diaz-Valle D, Benitez del Castillo JM, Fernandez Acenero MJ. Bilateral lid margin ulcers as the initial manifestation of Crohn disease. Am J Ophthalmol. Aug 2004;138(2):292-4. [Medline].

  9. Fraunfelder FT, Roy FH, Steinemann TL. Current Ocular Therapy. 5th ed. 2000:72, 374, 378, 450.

  10. Held KS. Blepharitis. In: Decision Making in Ophthalmology. 2nd ed. 2000:50-51.

  11. Kanski JJ. Marginal blepharitis. In: Clinical Ophthalmology. 1984:1.2-1.4.

  12. Roy FH. Ocular Differential Diagnosis. 7th ed. 2002.

  13. Sullivan JH. Lids and lacrimal apparatus. In: General Ophthalmology. 14th ed. 1995:78-81.

  14. Weisbecker CA, Fraunfelder FT, Rhee D. Physicians' Desk Reference for Ophthalmology. 28th ed. 2000.

  15. Yanoff M, Fine BS. Inflammation. In: Ocular Pathology. 4th ed. 1996:166-168.

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Keywords

adult blepharitis, seborrheic blepharitis, eyelid inflammation, inflammation of the eyelid, bacterial colonization of the eyelid, bacterial infection, anterior blepharitis, posterior blepharitis

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Contributor Information and Disclosures

Author

R Scott Lowery, MD, Assistant Professor of Ophthalmology, Department of Pediatric Ophthalmology and Strabismus, University of Arkansas for Medical Center, Arkansas Children's Hospital
R Scott Lowery, MD is a member of the following medical societies: American Academy of Ophthalmology
Disclosure: Nothing to disclose.

Medical Editor

Fernando H Murillo-Lopez, MD, Senior Surgeon, Unidad Privada de Oftalmologia CEMES
Fernando H Murillo-Lopez, MD is a member of the following medical societies: American Academy of Ophthalmology
Disclosure: Nothing to disclose.

Pharmacy Editor

Simon K Law, MD, PharmD, Assistant Professor of Ophthalmology, Jules Stein Eye Institute; Chief of Section of Ophthalmology Surgical Services, Department of Veterans Affairs Healthcare Center, West Los Angeles
Simon K Law, MD, PharmD is a member of the following medical societies: American Academy of Ophthalmology, American Glaucoma Society, and Association for Research in Vision and Ophthalmology
Disclosure: Nothing to disclose.

Managing Editor

Christopher J Rapuano, MD, Professor, Department of Ophthalmology, Jefferson Medical College of Thomas Jefferson University; Co-Chairman of the Cornea Service, Co-Chairman of Refractive Surgery Department, Wills Eye Institute
Christopher J Rapuano, MD is a member of the following medical societies: American Academy of Ophthalmology, American Society of Cataract and Refractive Surgery, Contact Lens Association of Ophthalmologists, Cornea Society, Eye Bank Association of America, International Society of Refractive Surgery, and Pan-American Association of Ophthalmology
Disclosure: Allergan Honoraria Speaking and teaching; Allergan Consulting fee Consulting; Alcon Honoraria Speaking and teaching; Inspire Honoraria Speaking and teaching; RPS Ownership interest Other; Vistakon Honoraria Speaking and teaching

CME Editor

Lance L Brown, OD, MD, Ophthalmologist, Affiliated With Freeman Hospital and St John's Hospital, Regional Eye Center, Joplin, Missouri
Disclosure: Nothing to disclose.

Chief Editor

Hampton Roy Sr, MD, Associate Clinical Professor, Department of Ophthalmology, University of Arkansas for Medical Sciences
Hampton Roy Sr, MD is a member of the following medical societies: American Academy of Ophthalmology, American College of Surgeons, and Pan-American Association of Ophthalmology
Disclosure: Nothing to disclose.

 
 
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