Introduction
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 eyelashes and follicles, while the posterior variant involves the meibomian gland orifices. 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 and seborrheic dermatitis, as well as ocular diseases, such as dry eye syndromes, chalazion, trichiasis, conjunctivitis, and keratitis.
Pathophysiology
The pathophysiology of blepharitis usually 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.
Frequency
United States
Blepharitis is a common eye disorder in the United States and throughout the world.
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, 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.
Clinical
History
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.
Physical
- 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.
Causes
- 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
- 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.
More on Blepharitis, Adult |
 Overview: Blepharitis, Adult |
| Differential Diagnoses & Workup: Blepharitis, Adult |
| Treatment & Medication: Blepharitis, Adult |
| Follow-up: Blepharitis, Adult |
| References |
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References
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Further Reading
Keywords
adult blepharitis, seborrheic blepharitis, eyelid inflammation, inflammation of the eyelid, bacterial colonization of the eyelid, bacterial infection, anterior blepharitis, posterior blepharitis
