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Blepharitis

Definition

Blepharitis is inflammation of the eyelid. It is a very common eye disease that affects the edge of the eyelids and eyelash hair follicles. There are three main types of blepharitis:
  • Seborrheic blepharitis—Skin cells shed more rapidly than normal due to a sebaceous gland that is not functioning properly. The sebaceous gland secretes oil to the skin. The presence of excess oil and skin cells help bacteria grow.
  • Infectious blepharitis—Bacteria, in particular, staphylococcus, cause an infection in the glands along the eyelid.
  • Contact dermatitis blepharitis—Something coming in contact with the eyelid leads to local inflammation. For example, mascara may produce such an allergic reaction.
Blepharitis
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Causes

The primary types of blepharitis are caused by either a skin condition or a bacterial infection. Blepharitis often occurs along with seborrheic dermatitis and acne rosacea.

Risk Factors

A risk factor is something that increases your chance of getting a disease or condition. Risk factors for blepharitis include:
  • Seborrheic dermatitis
  • Acne rosacea
  • Contact allergies
  • Diabetes
  • Chemical irritants
  • Poor hygiene
  • Cosmetic makeup
  • Advanced age

Symptoms

Symptoms depend on the cause of the blepharitis. They are usually worse in the morning and involve both eyes.
Symptoms may include:
  • Redness, flaky skin, and oily secretions along the edge of the eyelid
  • Crusty material clinging to the eyelashes
  • Eyelids “glued together” in the morning
  • Dry scales or dandruff-type material on the scalp and eyebrows
  • Itching or burning sensation
  • Tearing
  • Light sensitivity
  • Sensation of a foreign object in the eye
  • Ulcers or sores at the base of the eyelashes (in severe cases)
  • Scant, broken eyelashes
  • Chalazion (nonpainful bumps in the eyelid), which may become infected (called a stye)
  • Conjunctivitis (occasionally)

Diagnosis

The doctor will ask about your symptoms and medical history, and perform a physical exam. Initially you may not have any special tests. If the inflammation looks unusual for blepharitis or fails to respond to treatment, the doctor may do a culture by passing a swab across the edge of the lid. The swab is sent to a lab to see if bacteria grow, and, if so, what kind. Your ophthalmologist may also decide to perform a biopsy by removing a tiny piece of the eyelid margin for microscopic examination to be certain that there is no sign of cancer (rarely, some cancers can mimic chronic blepharitis).

Treatment

Blepharitis is a chronic condition that often requires long-term management. Treatment depends on the cause of the condition. Your doctor may advise you not to wear contact lenses until the blepharitis has resolved.

Hygiene

In mild cases, careful, daily eyelid hygiene may bring the inflammation under control:
  • Thoroughly wash your hands before performing any eye care.
  • Run a washcloth under warm water.
  • Place the warm washcloth on your eyelids for 5-15 minutes. This warm compress helps to loosen crust.
  • With your eyes closed, wash the eyelids with a special eyelid cleanser or diluted baby shampoo. Use a clean cotton ball for each eye.
  • Rinse with cool water.

Medication

If an infection is causing the blepharitis, you will be given antibiotic eye ointment.
  • If your doctor advises, wash your eyelids as described above and apply the ointment with a cotton-tipped applicator.
  • For a mild case, you may only need ointment at bedtime.
  • If the infection is more severe, you may need to apply the ointment up to four times daily.
  • Once resolved, your doctor may advise you to apply the ointment nightly to prevent another episode.
  • If blepharitis returns after topical treatment, you may be given oral antibiotics, though this is rarely necessary.
  • If oral antibiotics are necessary, they will need to be taken for an extended period, up to six weeks.
Topical corticosteroids may be needed for severe inflammation and complications.
Oral antibiotics are used for more serious infections.
If you are diagnosed with blepharitis, follow your doctor's instructions .
Topical corticosteroids may be needed for severe inflammation and complications.
Oral antibiotics are used for more serious infections.
If you are diagnosed with blepharitis, follow your doctor's instructions .

Prevention

If you are susceptible to blepharitis, conscientious eyelid hygiene can help prevent a recurrence:
  • Always wash your hands before touching your eyelids.
  • Wash your hair and face daily.
  • Wash your eyelids nightly as described above.
  • Try to avoid using cosmetic makeup.

RESOURCES

American Academy of Family Physicians http://www.aafp.org/online/en/home.html

The American Optometric Association http://www.aoa.org

CANADIAN RESOURCES

Canadian Family Physician http://www.cfp.ca

Canadian Ophthalmological Society http://www.cos-sco.ca/

References

American Academy of Ophthalmology website. Available at: http://www.aao.org .

Carter SR. Eyelid disorders: Diagnosis and Management. American Family Physician website. Available at: http://www.aafp.org/afp/1998/0601/p2695.html . Published June 1998. Accessed June 30, 2009.

Cecil RL, Goldman L, Bennett J. Cecil Textbook of Medicine. 21st ed. Philadelphia, PA: WB Saunders Company; 2000.

Dambro MR. Griffith's 5-Minute Clinical Consult . 2001 ed. Philadelphia, PA: Lippincott Williams & Wilkins; 2001.

Goroll AH, Mulley AG. Goroll: Primary Care Medicine . 4th ed. Philadelphia, PA: Lippincott Williams & Wilkins; 2000.

Mandell GL, Douglas RG, Bennett JE, Dolin R. Mandell, Douglas, and Bennett's Principles and Practice of Infectious Diseases . 5th ed. Philadelphia, PA:Churchill Livingstone, Inc.; 2000.

Revision Information

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