Adult Blepharitis

Updated: Dec 15, 2016
  • Author: R Scott Lowery, MD; Chief Editor: Andrew A Dahl, MD, FACS  more...
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Overview

Background

Blepharitis refers to a family of inflammatory disease processes of the eyelid(s).

Blepharitis can be divided anatomically into anterior and posterior blepharitis. Anterior blepharitis refers to inflammation mainly centered around the skin, eyelashes, and lash follicles, while the posterior variant involves the meibomian gland orifices, meibomian glands, tarsal plate, and blepharo-conjunctival junction. Anterior blepharitis usually is subdivided further into staphylococcal and seborrheic variants.

Frequently, a considerable overlap exists in these processes in individual patients. Blepharitis often is associated with systemic diseases, such as rosacea, atopy, and seborrheic dermatitis, as well as ocular diseases, such as dry eye syndromes, chalazion, trichiasis, ectropion and entropion, infectious or other inflammatory conjunctivitis, and keratitis.

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Pathophysiology

The pathophysiology of blepharitis frequently involves bacterial colonization of the eyelids. This results in direct microbial invasion of tissues, immune system–mediated damage, or damage caused by the production of bacterial toxins, waste products, and enzymes. Colonization of the lid margin is increased in the presence of seborrheic dermatitis or meibomian gland dysfunction. 

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Epidemiology

Frequency

United States

Blepharitis is a common eye disorder in the United States and throughout the world. Based on Lemp et al’s estimate that 86% of all patients with dry eyes have concomitant blepharitis, more than 25 million Americans suffer from blepharitis. [1]

Mortality/Morbidity

The exact association between blepharitis and mortality is not known, but diseases with known mortality, such as systemic lupus erythematosus, may have blepharitis as part of their constellation of findings. Associated morbidity includes loss of visual function, well-being, and ability to carry out daily life activities. The disease process can result in damage to the lids with trichiasis, notching entropion, and ectropion. Corneal damage can result in inflammation, scarring, loss of surface smoothness, irregular astigmatism, and loss of optical clarity. If severe inflammation develops, corneal perforation can occur. 

Race

No known studies demonstrate racial differences in the incidence of blepharitis. Rosacea may be more common in fair-skinned individuals, although this finding may be only because it is more easily and frequently diagnosed in these individuals.

Sex

No well-designed studies of differences in the incidence and clinical features of blepharitis between the sexes have been found.

Age

Seborrheic blepharitis is more common in an older age group. The apparent mean age is 50 years.

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