eMedicine Specialties > Ophthalmology > Lid

Blepharitis, Adult: Follow-up

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

Follow-up

Further Outpatient Care

  • Patients with blepharitis usually are started on treatment, and they are seen in 2-6 weeks for a follow-up examination. During this visit, an assessment of the clinical response to therapy is made. The physician should again emphasize the necessity for a prolonged and dedicated course of treatment to the patient. Encouragement and support is critical in helping them to become committed to the course of treatment and to follow it. Additionally, the clinician is able to keep the focus on rigorous intervention by the patient, rather than accepting blame for not curing the condition.
  • Patients are seen based on progress. If little improvement has been made after 1-2 months of treatment, intervention should be stepped up by prescribing antibiotic-corticosteroid ointments or oral antibiotics or by treating tear film dysfunction with such measures as punctal closure. Fluorescein staining is recommended on each examination.

Deterrence/Prevention

  • Maintenance of a long-term regimen of lid hygiene helps prevent outbreaks of more symptomatic disease.

Complications

  • Conjunctivitis and keratitis can result as a complication of blepharitis and require additional treatment besides eyelid margin therapy. Antibiotic-corticosteroid solutions can greatly reduce inflammation and symptoms of conjunctivitis. Corneal infiltrates also can be treated with antibiotic-corticosteroid drops. Small marginal ulcers can be treated empirically, but larger, paracentral, or atypical ulcers should be scraped and specimens sent for diagnostic slides and for culture and sensitivity testing.
  • Recurrent bouts of inflammation and scarring from blepharitis can promote eyelid positional disease. Trichiasis and lid notching can result in keratitis and severe symptoms. These conditions often are very refractory to simple management steps. Trichiasis is treated with epilation, destruction of the follicles via electric current, laser, or cryotherapy, or with surgical excision. Entropion or ectropion can develop and complicate the clinical situation.

Prognosis

  • Overall, the prognosis for patients with blepharitis is good to excellent. Blepharitis only causes significant morbidity in an extremely small subset of patients. For most, it remains more of a symptomatic affliction than a true threat to their health and function. Patients experience a considerable amount of discomfort and misery that can greatly reduce their well-being and ability to carry out the daily activities of life and work. Recognition of the waxing and waning course of the disease, and of management through a prolonged program rather than via an instant cure, helps them to approach the disease in a successful manner.

Patient Education

Miscellaneous

Medicolegal Pitfalls

  • Patients with unilateral or very asymmetric blepharitis may have sebaceous cell carcinoma. An oculoplastics consult may be required for a lid biopsy.
  • Certain systemic diseases, such as Sjogren syndrome or systemic lupus erythematosus, may present as blepharitis. Patients should be encouraged to have a complete physical examination with their primary care physician, and long-term follow-up care is indicated.
 


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

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

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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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