Pathophysiology
Blepharitis refers to inflammation of the eyelids and the associated structures such as skin, lashes and glands. It is most commonly seen bilaterally and is usually chronic with exacerbations intermittently.
The glands that are involved are the Meibomian glands which are responsible for oil secretion onto the eye surface, this prevents rapid evaporation of the aqueous layer and keeps them moist
The causes can be:
- Meibomian gland dysfunction
- Seborrheic dermatitis
- Staphylococcal infection - Staph. epidermidis almost always.
- It is also associated with patients that have rosacea.
😷 Presentation
Symptoms are generally bilateral.
As the meibomian glands are dysfunctional we get dry eyes → irritation and inflammation.
- Painful eyelid margins.
- Gritty feeling especially around the margins of the eye that’s looks crusty in appearance.
- Sticky eyes in the morning.
- Redness of the eyelid margins.
It very rarely causes any change to eyesight.
- Styes - more common with blepharitis. It is essentially a pimple on the eyelid and looks like a boil that is painful.
- Chalazion - also more common in blepharitis. It is a blocked oil gland. The difference between a stye and chalazion is that a chalazion is a hard lump that is not painful.
🔍 Investigations
Clinical diagnosis is usually made based on history and examination, revealing eye crusting and bilateral symptoms.
A slit lamp may be used to confirm diagnosis. It may show crusting, lid erythema.
🧰 Management
- Softening of the eyelid margins using heat compression.
- Lid hygiene - using a sterile swab and baby shampoo is often good.
- Eye drops may relieve symptoms:
- Hypromellose - least viscous and only lasts around 10 minutes.
- 🥇 Polyvinyl alcohol - intermediate viscosity. Usually first line.
- 🏆 Carbomer - most viscous and lasts up to 1 hour, but can be more expensive.