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
- For excellent patient education resources, visit eMedicine's Eye and Vision Center. Also, see eMedicine's patient education article Eyelid Inflammation (Blepharitis).
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