Blepharitis, sometimes known as granulated eyelids, is one of the most common ocular conditions characterized by inflammation, scaling, reddening, and crusting of the eyelid. This condition may also cause swelling, burning, itching, or a grainy sensation when introducing foreign objects or substances to the eye. Although blepharitis by itself is not sight-threatening, it can lead to permanent alterations of the eyelid margin. The primary cause is bacteria and inflammation from congested meibomian oil glands at the base of each eyelash. Other conditions may give rise to blepharitis, whether they be infectious or noninfectious, including, but not limited to, bacterial infections or allergies.

Different variations of blepharitis can be classified as seborrheic, staphylococcal, mixed, posterior or meibomitis, or parasitic. In a survey of US ophthalmologists and optometrists, 37% to 47% of patients seen by those surveyed had signs of blepharitis, which can affect all ages and ethnic groups. One single-center study of 90 patients with chronic blepharitis found that the average age of patients was 50 years old. Symptoms include inflammation, irritation, itchiness, a burning sensation, excessive tearing, and crusting and sticking of eyelids.

thumb|Scaling and bacterial debris at the base of the eyelashes

Associated symptoms

  • Watery eyes – due to excessive tearing.
  • Red eyes – due to dilated blood vessels on the sclera. Long-term untreated blepharitis can lead to eyelid scarring, excess tearing, difficulty wearing contact lenses, development of a stye (an infection near the base of the eyelashes, resulting in a painful lump on the edge of the eyelid) or a chalazion (a blockage/bacteria infection in a small oil gland at the margin of the eyelid, just behind the eyelashes, leading to a red, swollen eyelid), chronic pink eye (conjunctivitis), keratitis, and corneal ulcer or irritation. The condition can sometimes lead to a chalazion or a stye. Chronic bacterial blepharitis may also lead to ectropion. Posterior blepharitis or rosacea-associated blepharitis is manifested by a broad spectrum of symptoms involving the lids including inflammation and plugging of the meibomian orifices and production of abnormal secretion upon pressure over the glands. It is commonly recurrent and it requires special medical care. The prevalence of S. aureus in the conjunctival sac and on the lid margin varies among countries, likely due to differences in climate and environment. Seborrheic blepharitis is characterized by less inflammation than Staphylococcal blepharitis; however, it causes more excess oil or greasy scaling. Meibomian gland dysfunction is a result of abnormalities of the meibomian glands and altered secretion of meibum, which plays an imperative role in lagging the evaporation of tear films and smoothing of the tear film to produce an even optical surface. Posterior blepharitis is an inflammation of the eyelids, secondary to dysfunction of the meibomian glands. Like anterior blepharitis, it is a bilateral chronic condition and may be associated with skin rosacea.

Diagnosis

thumb|Blepharitis: swollen and reddened eyelid

Diagnosis of the condition is done via a physical examination under a slit lamp. Cultures of debris are occasionally collected for bacterial or fungal testing. Microscopic evaluation of epilated eyelashes may reveal mites, which have been evident in cases of chronic blepharoconjunctivitis. A biopsy of the eyelid can also determine the exclusion of carcinoma, therapy resistance, or unifocal recurrent chalazia.

{| class="wikitable"

!Condition

!Entity

|-

|Bacterial infections

|Erysipelas (due to Streptococcus pyogenes)

Impetigo (due to Staphylococcus aureus)

|-

|Viral infections

|Herpes simplex virus

Molluscum contagiosum

Varicella zoster virus

Papillomavirus

Vaccinia

|-

|Parasitic infection

|Pediculosis palperbrarum

|-

|Immunologic conditions

|Atopic dermatitis

Contact dermatitis

Erythema multiforme

Crohn's disease

|-

|Dermatoses

|Psoriasis

Erythroderma

|-

|Benign eyelid tumors

|Actinic keratosis

Pyogenic granuloma

|-

|Malignant eyelid tumors

|Melanoma

Mycosis fungoides

Basal cell carcinoma

|-

|Trauma

|Chemical

Radiation

Surgical

Thermal

|-

|Toxic conditions

|Medicamentosa

|}

Prevention

Blepharitis is a result of bacteria and inflammation from congested meibomian oil glands at the base of each eyelash. Routine washing of the eyelids helps subdue symptoms and prevent blepharitis. Washing each eyelid for 30 seconds, twice a day, with a single drop of hypoallergenic soap (e.g. baby shampoo) and ample water can help. The most effective treatment is over the counter lid scrubs used twice a day. Some doctors may recommend using a hypochlorous acid treatment depending on the severity. Topical steroids provided some symptomatic relief, but they were ineffective in clearing bacteria from the eyelids. to treat blepharitis.

Lotilaner (Xdemvy) was approved for medical use in the United States in July 2023, for the treatment of Demodex blepharitis.

Prognosis

Blepharitis is a chronic condition that has periods of exacerbation and remission. Patients should be informed that symptoms can frequently improve but are rarely eliminated. Infrequently, severe blepharitis can result in permanent alterations in the eyelid margin or vision loss from superficial keratopathy, corneal neovascularization, and ulceration. Patients with an inflammatory eyelid lesion that appears suspicious of malignancy should be referred to an appropriate specialist.

Research

A study conducted in November 2017 detected a correlation between blepharitis and early-onset metabolic syndrome (MetS). To investigate the relationship between blepharitis and MetS, researchers used the Longitudinal Health Insurance Database in Taiwan. Results indicated that hyperlipidaemia and coronary artery disease were significantly correlated with the prior development of blepharitis. Therefore, blepharitis was shown to be significantly related to MetS and can serve as an early indication of the condition.

In another study, the presence of Demodex mites was shown to be a common cause of blepharitis. However, the pathogenesis of demodicosis is still unclear. In this study, researchers provided a diagnosis of the disease and proposed diagnostic criteria for Demodex blepharitis.

There is inadequate evidence to draw conclusions about the use of oral doxycycline in the treatment of blepharitis. According to very low certainty data, oral doxycycline may help with symptoms like itchiness, burning, or watery eyes, but may induce more side effects.

A review of treatments showed that the anti-mite drug ivermectin can be an effective treatment for reducing symptoms.

Eye drops or ointments containing corticosteroids are frequently used in conjunction with antibiotics and can reduce eyelid inflammation.

The supplement n-acetylcysteine may be effective for blepharitis.

References

  • Blepharitis Resource Guide from the National Eye Institute (NEI).