November 30, 2015
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Blepharitis (cont.)

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What causes blepharitis?

Blepharitis involves the eyelid margins, where the eyelashes grow and the openings of the tiny oil glands are located. There may be involvement of the skin adjacent to the outer edges of the eyelid margins and/or the inner edge of the eyelid that comes into contact with the eyeball secondary to the underlying disorder of the lid margins.

Most cases of blepharitis are posterior blepharitis, due to inflammation of the meibomian glands of the lids. There are about 40 of these glands in each of the upper and lower lids. The eyelid margins can become inflamed, irritated, and itchy when these glands produce abnormal secretions. Blepharitis is often seen in patients with acne rosacea, a generalized illness of oil glands.

Anterior blepharitis is due to inflammation of the lid margin around the lashes. Seborrheic blepharitis is similar to dandruff of the scalp.

Allergies due to reactions from mascara, contact lens solutions, sprays, exposure to animals, environmental chemicals, or airborne allergens can also cause blepharitis.

Less commonly, inflammation of the lids can be caused by a primary infection of the eye lids by bacteria such as Staphylococci or infestation of the lashes by tiny mites (Demodex) or head lice.

What are the symptoms and signs of blepharitis?

Signs and symptoms of blepharitis are usually present in both eyes, affecting the upper and lower lids. They can appear at any age. Symptoms (what one feels in the eyes or eyelids) include:

  • itchy or irritated eyelids,
  • mild tearing,
  • dryness of the eyes,
  • burning sensation,
  • gritty or sandy sensation,
  • foreign-body sensation (the feeling that something may be in the eye),
  • crusting of the eyelids,
  • decreased comfort while wearing contact lenses, and
  • sensitivity to light.

Signs (observations that one makes) of blepharitis include:

  • red eyelid margins,
  • swollen eyelids,
  • increased shedding of skin cells near the eyelids, causing flaking of the skin around the eyes,
  • matting of the lashes or eyes "glued together" in the morning,
  • eyelids that appear greasy and crusted with scales that cling to the lashes,
  • crusted eyelashes upon awakening,
  • tears that are frothy or bubbly in nature,
  • eyelashes that grow abnormally,
  • loss of eyelashes,
  • mild scarring of the eyelid margins,
  • mild ulceration of the lid margins,
  • dry and flaky patches of skin on the lid, and
  • dandruff of the lashes and eyebrows.

The symptoms and signs of blepharitis are often erroneously ascribed by the patient as being due to "recurrent conjunctivitis." They are also often mistakenly attributed to "dry eye" by patients due to the gritty sensation that may occur. Lubricating drops, however, do little to improve the condition.

How is blepharitis diagnosed?

Blepharitis can be usually diagnosed by a physician based on the history as given by the patient and the physical examination. Taking a history includes a discussion of symptoms that the patient is experiencing and a review of any general health problems that may be contributing to the eye problem.

The physical examination concentrates on an evaluation of the eyelids, lid margins, base of the lashes, oil gland openings, tear quantity and quality, and the front surface of the eyeball using a slit lamp, which allows a magnified view with sufficient illumination. The type of blepharitis is determined based on this examination and appropriate treatment recommended. Occasionally, cultures are taken by swabbing the discharge and sending this to the laboratory. In some cases, an allergy evaluation may be required.

What are complications of blepharitis?

It is unusual for blepharitis to cause serious problems. However; blepharitis can lead to a number of other conditions.

  • Sty: A sty (sometimes spelled stye) or hordeolum is a bacterial infection in one of the oil glands whose opening is clogged. The result is a painful lump on the edge or inside of the eyelid.
  • Chalazion: A chalazion or conjunctival granuloma occurs when blockage in the oil glands causes them to become enlarged and scarred.
  • Chronic pink eye: Blepharitis can lead to recurrent bouts of pink eye (conjunctivitis).
  • Ulceration of the cornea: Constant irritation from inflamed eyelids or misdirected eyelashes may cause a sore (ulcer) to develop on the cornea.

Blepharitis does not affect vision generally, although disturbances of the tear film may intermittently blur vision, causing varying amounts of fluctuating vision during the day.

Call the ophthalmologist if these symptoms develop, which are not due to blepharitis:

  • Significant changes in vision
  • A sore on the eyelid that persists or increases in size, especially if it is red, bleeding, and not healing
  • Significant pain in either or both eyes
  • Symptoms that become worse or last for longer than 2 weeks
Medically Reviewed by a Doctor on 9/18/2015


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