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Overview
Blepharitis is a noncontagious inflammation of the
eyelids that usually affects the lower part of the
lid and eyelashes. It is usually characterized by
excess oil production in the meibomian glands near
the eyelid, which creates a favorable environment
for bacterial growth. Repeated occurrences of
styes or hordeolum (inflammation of the eyelid’s
sebaceous gland) and chalazia (swelling that
results from a blockage of the meibomian glands)
are also associated with blepharitis.
Blepharitis does not usually affect vision or
damage the eye. It is a chronic, manageable
condition in most cases. If left untreated, it can
lead to a more serious condition called
ulcerative blepharitis. This is usually caused
by a bacterial infection and can cause loss of
eyelashes, eyelid scarring, and inflammation of
the cornea.
Incidence and Prevalence
Blepharitis is a common eye disorder throughout
the world. It affects people of all ages, but
blepharitis caused by seborrhea is seen more
frequently in older patients.
Risk Factors
Chronic blepharitis is often linked to occupations
in which the hands are dirty for much of the day.
Poor hygiene is also a risk factor. Seborrheic
dermatitis of the face or scalp is also a common
risk factor. Dermatitis caused by herpes simplex,
varicella-zoster virus, allergies, and
staphylococcus may also cause blepharitis. It has
also been associated with rosacea.
Drugs and allergens can cause acute blepharitis.
Chronic cases can be aggravated by environmental
irritants such as exposure to chemical fumes,
smoke, and smog.
Causes
Blepharitis is usually caused by
seborrheic dermatitis
(a skin disorder that causes itching, flaking, and
inflammation) or a bacterial infection. Infections
are usually caused by staphylococcus bacteria,
which live on human skin and usually cause no
harm. When this bacteria causes blepharitis, the
normal cycle of the bacterial colonies has usually
been altered by excess oil production. Blepharitis
can also be caused by allergies or lice
infestation in the eyelashes.
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Signs and Symptoms
Symptoms include itching, burning, and redness
around the edge of the eyelids in both eyes,
excessive tearing, and a loss of eyelashes.
Blepharitis associated with seborrhea often causes
greasy, easily removable scales (“dandruff”) on
the eyelid, close to the lash line. Other symptoms
of seborrheic blepharitis are feeling that a
foreign object is in the eye or a sandy or gritty
sensation.
With ulcerative blepharitis, small pustules that
eventually crust and bleed develop in the
follicles of the eyelashes. Lashes are often stuck
together by dried secretions upon awakening. In
some cases, it can also cause dry eyes, resulting
from an imbalance in the quantity and/or quality
of the tears.
Diagnosis
Routine examination of the eyelids and eyelashes
is usually sufficient to diagnose blepharitis. A
slit lamp microscope is used for more
detailed inspection. This is a microscope with an
attached light that allows the doctor to examine
the eye under high magnification and is used for
examination of the cornea, iris, and lens.
Treatment
Carefully cleaning the eyelids is usually all that
is needed to control symptoms and prevent
complications.
The edges of the eyelids can be gently scrubbed
with tearless shampoo using a cotton-tipped
applicator or lint-free washcloth wrapped around
the index finger. The eyelids may need to be
cleaned several times a day until symptoms clear
up. Warm compresses applied to the eyelids can
loosen crusted secretions.
Sometimes the doctor prescribes a specially
formulated eyelid cleanser to clear the lash area
of crusts and scaling. For severe cases,
especially those associated with bacterial
infection, a topical antibiotic ointment may be
prescribed. Corticosteroid ointments provide
short-term relief. In stubborn cases, oral
antibiotics might be prescribed. Antibiotic and
steroid drops may be used to treat inflammation
that has spread to the cornea.
If lice are the cause, petroleum jelly can be
applied along the base of the eyelashes to
eliminate them.
Prevention
Keeping the eyelids, scalp, and face clean is the
most effective way to prevent blepharitis and its
recurrence. Avoiding exposure to smoke and
chemical fumes and obtaining treatment for skin
disorders like rosacea and seborrhea also helps
prevent blepharitis. |
