Blepharitis overview: Difference between revisions

Jump to navigation Jump to search
No edit summary
m (Bot: Removing from Primary care)
 
(32 intermediate revisions by 3 users not shown)
Line 5: Line 5:
==Overview==
==Overview==
'''Blepharitis''' is characterized by [[inflammation]] of the [[eyelid]] margins.
'''Blepharitis''' is characterized by [[inflammation]] of the [[eyelid]] margins.
Blepharitis may be classified according to the anatomic location of the disease into 2 subtypes [[anterior]] and [[posterior]]. Additionally, blepharitis may be classified based on the duration of [[symptoms]] into [[acute]] or [[chronic]].<ref name="pmid11153404">{{cite journal| author=Cheung J, Sharma S| title=Ophthaproblem. Blepharitis. | journal=Can Fam Physician | year= 2000 | volume= 46 | issue=  | pages= 2393, 2400 | pmid=11153404 | doi= | pmc=2145002 | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=11153404  }} </ref>
Blepharitis may be classified according to the anatomic location of the disease into 2 subtypes: [[anterior]] and [[posterior]]. Additionally, blepharitis may be classified based on the duration of [[symptoms]] into either [[acute]] or [[chronic]].<ref name="pmid11153404">{{cite journal| author=Cheung J, Sharma S| title=Ophthaproblem. Blepharitis. | journal=Can Fam Physician | year= 2000 | volume= 46 | issue=  | pages= 2393, 2400 | pmid=11153404 | doi= | pmc=2145002 | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=11153404  }} </ref>
The exact [[pathogenesis]] of blepharitis is not fully understood.  
The exact [[pathogenesis]] of blepharitis is not fully understood.  
It is thought that blepharitis is caused by either bacterial colonization (''[[Staphylococcus aureus]]'' or ''[[Staphylococcus epidermidis]]'') in the eyelids or [[Meibomian gland]] dysfunction. Both may occur at the same time.
It is thought that blepharitis is caused by either bacterial colonization (''[[Staphylococcus aureus]]'' or ''[[Staphylococcus epidermidis]]'') in the eyelids or [[meibomian gland]] dysfunction. Blepharitis may also caused by [[allergens]] and [[mite]]s that affect the eyelashes.<ref name="pmid24055901">{{cite journal| author=Bunya VY, Brainard DH, Daniel E, Massaro-Giordano M, Nyberg W, Windsor EA et al.| title=Assessment of signs of anterior blepharitis using standardized color photographs. | journal=Cornea | year= 2013 | volume= 32 | issue= 11 | pages= 1475-82 | pmid=24055901 | doi=10.1097/ICO.0b013e3182a02e0e | pmc=3947496 | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=24055901  }} </ref>
[[Allergies]] and [[lice]] that affects the [[eyelashe]]s may also cause blepharitis, although these causes are less common.<ref name="pmid24055901">{{cite journal| author=Bunya VY, Brainard DH, Daniel E, Massaro-Giordano M, Nyberg W, Windsor EA et al.| title=Assessment of signs of anterior blepharitis using standardized color photographs. | journal=Cornea | year= 2013 | volume= 32 | issue= 11 | pages= 1475-82 | pmid=24055901 | doi=10.1097/ICO.0b013e3182a02e0e | pmc=3947496 | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=24055901  }} </ref>
Blepharitis must be differentiated from [[conjunctivitis]], [[trichiasis]], [[dry eye syndrome]], [[keratitis]], [[hordeolum]], and [[chalazion]].<ref name="pmid19383269">{{cite journal| author=Lemp MA, Nichols KK| title=Blepharitis in the United States 2009: a survey-based perspective on prevalence and treatment. | journal=Ocul Surf | year= 2009 | volume= 7 | issue= 2 Suppl | pages= S1-S14 | pmid=19383269 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=19383269  }} </ref>
Blepharitis is often confused with [[conjunctivitis]], [[trichiasis]], [[dry eye syndrome]], [[keratitis]], [[hordeolum]], and [[chalazion]].<ref name="pmid19383269">{{cite journal| author=Lemp MA, Nichols KK| title=Blepharitis in the United States 2009: a survey-based perspective on prevalence and treatment. | journal=Ocul Surf | year= 2009 | volume= 7 | issue= 2 Suppl | pages= S1-S14 | pmid=19383269 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=19383269  }} </ref>
Blepharitis is usually [[asymptomatic]] until the disease progresses. As it progresses, the patient begins to notice a foreign body sensation, [[itching]], [[irritation]], and crusting of the eyelids. Blepharitis can frequently be improved but is rarely eliminated. If left untreated, severe blepharitis may cause loss of eyelashes, [[scarring]] of the eyelids, [[corneal]] involvement, and ultimately [[blindness]]. Common complications of blepharitis include loss of eyelashes, [[hordeolum]], [[chalazion]], [[corneal ulcer]], and [[conjunctivitis]].
Blepharitis is usually [[asymptomatic]] until the disease progresses. As it progresses, the patient begins to notice a foreign body sensation, [[itching]] and [[irritation]] of the eyelids, and eyelid crusting. Blepharitis can frequently be improved but are rarely eliminated. If left untreated, severe blepharitis may cause alterations in the [[eyelid|eyelid margin]], loss of eyelashes, [[scarring]] of the eyelids, [[corneal]] involvement, and ultimately [[blindness]]. Common [[complications]] of blepharitis include loss of eyelashes, [[hordeolum]], chalazia, [[corneal ulcer]], and [[conjunctivitis]].
Blepharitis is associated with a favorable long-term prognosis.<ref name="pmid21276617">{{cite journal| author=Nemet AY, Vinker S, Kaiserman I| title=Associated morbidity of blepharitis. | journal=Ophthalmology | year= 2011 | volume= 118 | issue= 6 | pages= 1062-8 | pmid=21276617 | doi=10.1016/j.ophtha.2010.10.015 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=21276617  }} </ref>
Blepharitis is associated with a favorable long-term [[prognosis]].<ref name="pmid21276617">{{cite journal| author=Nemet AY, Vinker S, Kaiserman I| title=Associated morbidity of blepharitis. | journal=Ophthalmology | year= 2011 | volume= 118 | issue= 6 | pages= 1062-8 | pmid=21276617 | doi=10.1016/j.ophtha.2010.10.015 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=21276617  }} </ref>
Physical examination of patients with blepharitis is usually remarkable for irritated eyelid edges, crusting of the lashes, [[entropion]], [[ectropion]], [[poliosis]], and diffuse [[conjunctival injection]].<ref name="pmid18347619">{{cite journal| author=Jackson WB| title=Blepharitis: current strategies for diagnosis and management. | journal=Can J Ophthalmol | year= 2008 | volume= 43 | issue= 2 | pages= 170-9 | pmid=18347619 | doi=10.1139/i08-016 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=18347619  }} </ref>
Physical examination of patients with blepharitis is usually remarkable for [[irritated]] eyelid edges, hard crusting of the lashes or greasy appearing flake, [[entropion]], [[ectropion]], [[poliosis]], and diffuse [[conjunctival injection]].<ref name="pmid18347619">{{cite journal| author=Jackson WB| title=Blepharitis: current strategies for diagnosis and management. | journal=Can J Ophthalmol | year= 2008 | volume= 43 | issue= 2 | pages= 170-9 | pmid=18347619 | doi=10.1139/i08-016 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=18347619  }} </ref>
In general, blepharitis is diagnosed based on clinical features alone.
Laboratory tests are not often required in patients with blepharitis. In general, blepharitis is diagnosed based on clinical features alone.
There are no diagnostic lab findings associated with blepharitis. Blepharitis is diagnosed based on clinical features alone.<ref name="pmid18347619">{{cite journal| author=Jackson WB| title=Blepharitis: current strategies for diagnosis and management. | journal=Can J Ophthalmol | year= 2008 | volume= 43 | issue= 2 | pages= 170-9 | pmid=18347619 | doi=10.1139/i08-016 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=18347619  }} </ref><ref name="pmid11009317">{{cite journal| author=McCulley JP, Shine WE| title=Changing concepts in the diagnosis and management of blepharitis. | journal=Cornea | year= 2000 | volume= 19 | issue= 5 | pages= 650-8 | pmid=11009317 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=11009317  }} </ref>
However, cultures of the eyelid margins and eyelid [[biopsy]] may be indicated for patients who have recurrent anterior blepharitis with severe [[inflammation]], as well as for patients who are not responding to [[therapy]].<ref name="pmid18347619">{{cite journal| author=Jackson WB| title=Blepharitis: current strategies for diagnosis and management. | journal=Can J Ophthalmol | year= 2008 | volume= 43 | issue= 2 | pages= 170-9 | pmid=18347619 | doi=10.1139/i08-016 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=18347619  }} </ref><ref name="pmid11009317">{{cite journal| author=McCulley JP, Shine WE| title=Changing concepts in the diagnosis and management of blepharitis. | journal=Cornea | year= 2000 | volume= 19 | issue= 5 | pages= 650-8 | pmid=11009317 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=11009317  }} </ref>
Eyelid hygiene and regular cleaning are the mainstay of therapy for blepharitis.  
Eyelid hygiene and regular cleaning are the mainstay of therapy for blepharitis.  
[[Antimicrobial]] topical therapy may be indicated in some cases depending on the causative [[pathogen]] and the underlying cause.<ref name="pmid21450919">{{cite journal| author=Geerling G, Tauber J, Baudouin C, Goto E, Matsumoto Y, O'Brien T et al.| title=The international workshop on meibomian gland dysfunction: report of the subcommittee on management and treatment of meibomian gland dysfunction. | journal=Invest Ophthalmol Vis Sci | year= 2011 | volume= 52 | issue= 4 | pages= 2050-64 | pmid=21450919 | doi=10.1167/iovs.10-6997g | pmc=3072163 | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=21450919  }} </ref><ref>{{cite web | url = http://www.aao.org/preferred-practice-pattern/blepharitis-ppp--2013 | title = Blepharitis PPP 2013}}</ref>
[[Antimicrobial]] topical therapy may be indicated in some cases depending on the causative pathogen and the underlying cause.<ref name="pmid21450919">{{cite journal| author=Geerling G, Tauber J, Baudouin C, Goto E, Matsumoto Y, O'Brien T et al.| title=The international workshop on meibomian gland dysfunction: report of the subcommittee on management and treatment of meibomian gland dysfunction. | journal=Invest Ophthalmol Vis Sci | year= 2011 | volume= 52 | issue= 4 | pages= 2050-64 | pmid=21450919 | doi=10.1167/iovs.10-6997g | pmc=3072163 | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=21450919  }} </ref><ref name=Blepharitis PPP 2013> Blepharitis. American Academy of Ophthalmology. (2013). http://www.aao.org/preferred-practice-pattern/blepharitis-ppp--2013 </ref>


==Historical Perspective==
==Historical Perspective==
In 19th century, blepharitis was first described as a conjunctivitis meibominae and meibomian seborrhea.<ref name="pmid19383269">{{cite journal| author=Lemp MA, Nichols KK| title=Blepharitis in the United States 2009: a survey-based perspective on prevalence and treatment. | journal=Ocul Surf | year= 2009 | volume= 7 | issue= 2 Suppl | pages= S1-S14 | pmid=19383269 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=19383269  }} </ref>
Blepharitis was first described in the late 19th century as "conjunctivitis meibomianae" in a patient with accumulated sebaceous-like material in the meibomian glands.<ref name="pmid19383269">{{cite journal| author=Lemp MA, Nichols KK| title=Blepharitis in the United States 2009: a survey-based perspective on prevalence and treatment. | journal=Ocul Surf | year= 2009 | volume= 7 | issue= 2 Suppl | pages= S1-S14 | pmid=19383269 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=19383269  }} </ref>


==Classification==
==Classification==
Blepharitis may be classified according to the anatomic location of the disease into 2 subtypes [[anterior]] and [[posterior]]. Additionally, blepharitis may be classified based on the duration of [[symptoms]] into [[acute]] or [[chronic]].<ref name="pmid11153404">{{cite journal| author=Cheung J, Sharma S| title=Ophthaproblem. Blepharitis. | journal=Can Fam Physician | year= 2000 | volume= 46 | issue=  | pages= 2393, 2400 | pmid=11153404 | doi= | pmc=2145002 | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=11153404  }} </ref>
Blepharitis may be classified according to the anatomic location of the disease into 2 subtypes: [[anterior]] and [[posterior]]. Additionally, blepharitis may be classified based on the duration of [[symptoms]] into either [[acute]] or [[chronic]].<ref name="pmid11153404">{{cite journal| author=Cheung J, Sharma S| title=Ophthaproblem. Blepharitis. | journal=Can Fam Physician | year= 2000 | volume= 46 | issue=  | pages= 2393, 2400 | pmid=11153404 | doi= | pmc=2145002 | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=11153404  }} </ref>


==Pathophysiology==
==Pathophysiology==
The exact [[pathogenesis]] of blepharitis is not fully understood.  
The exact [[pathogenesis]] of blepharitis is not fully understood.  
It is thought that blepharitis is caused by either bacterial colonization (''[[Staphylococcus aureus]]'' or ''[[Staphylococcus epidermidis]]'') in the eyelids or [[Meibomian gland]] dysfunction. Both may occur at the same time.
It is thought that blepharitis is caused by either bacterial colonization (''[[Staphylococcus aureus]]'' or ''[[Staphylococcus epidermidis]]'') in the eyelids or [[meibomian gland]] dysfunction.
[[Allergies]] and [[lice]] that affects the [[eyelashe]]s may also cause blepharitis, although these causes are less common.
Blepharitis may also caused by [[allergens]] and [[lice]] that affect the eyelashes.<ref name="pmid24055901">{{cite journal| author=Bunya VY, Brainard DH, Daniel E, Massaro-Giordano M, Nyberg W, Windsor EA et al.| title=Assessment of signs of anterior blepharitis using standardized color photographs. | journal=Cornea | year= 2013 | volume= 32 | issue= 11 | pages= 1475-82 | pmid=24055901 | doi=10.1097/ICO.0b013e3182a02e0e | pmc=3947496 | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=24055901  }} </ref><ref name="pmid3957566">{{cite journal| author=Dougherty JM, McCulley JP| title=Bacterial lipases and chronic blepharitis. | journal=Invest Ophthalmol Vis Sci | year= 1986 | volume= 27 | issue= 4 | pages= 486-91 | pmid=3957566 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=3957566  }} </ref>
People who have blepharitis have too much oil being produced by the glands near the eyelid. This allows [[bacteria]] normally found on the skin to overgrow.<ref name="pmid24055901">{{cite journal| author=Bunya VY, Brainard DH, Daniel E, Massaro-Giordano M, Nyberg W, Windsor EA et al.| title=Assessment of signs of anterior blepharitis using standardized color photographs. | journal=Cornea | year= 2013 | volume= 32 | issue= 11 | pages= 1475-82 | pmid=24055901 | doi=10.1097/ICO.0b013e3182a02e0e | pmc=3947496 | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=24055901  }} </ref><ref name="pmid3957566">{{cite journal| author=Dougherty JM, McCulley JP| title=Bacterial lipases and chronic blepharitis. | journal=Invest Ophthalmol Vis Sci | year= 1986 | volume= 27 | issue= 4 | pages= 486-91 | pmid=3957566 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=3957566  }} </ref>


==Causes==
==Causes==
Line 34: Line 32:


==Differentiating Blepharitis from other Diseases==
==Differentiating Blepharitis from other Diseases==
Blepharitis must be differentiated from [[allergic contact dermatitis]], [[conjunctivitis]], [[trichiasis]], [[dry eye syndrome]], [[keratitis]], [[hordeolum]], [[chalazion]], [[rosacea]], and sebaceous [[carcinoma]].<ref name="pmid15534133">{{cite journal| author=Mathers WD, Choi D| title=Cluster analysis of patients with ocular surface disease, blepharitis, and dry eye. | journal=Arch Ophthalmol | year= 2004 | volume= 122 | issue= 11 | pages= 1700-4 | pmid=15534133 | doi=10.1001/archopht.122.11.1700 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=15534133  }} </ref>
Blepharitis must be differentiated from [[allergic contact dermatitis]], [[conjunctivitis]], [[trichiasis]], [[dry eye syndrome]], [[keratitis]], [[hordeolum]], [[chalazion]], [[rosacea]], and [[sebaceous gland carcinoma|sebaceous carcinoma]].<ref name="pmid15534133">{{cite journal| author=Mathers WD, Choi D| title=Cluster analysis of patients with ocular surface disease, blepharitis, and dry eye. | journal=Arch Ophthalmol | year= 2004 | volume= 122 | issue= 11 | pages= 1700-4 | pmid=15534133 | doi=10.1001/archopht.122.11.1700 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=15534133  }} </ref>


==Epidemiology and Demographics==
==Epidemiology and Demographics==
Line 47: Line 45:


==Natural History, Complications and Prognosis==  
==Natural History, Complications and Prognosis==  
Blepharitis is usually [[asymptomatic]] until the disease progresses. A As it progresses, the patient begins to notice a foreign body sensation, [[itching]] and [[irritation]] of the [[eyelids]], and eyelid crusting. Blepharitis can frequently be improved but are rarely eliminated. If left untreated, sever blepharitis may cause alterations in the [[eyelid]] margin, loss of eyelashes, [[scarring]] of the [[eyelid]]s, [[conjunctivitis]], corneal involvement, superficial [[keratopathy]], and ultimately [[blindness]]. Common [[complications]] of blepharitis include loss of eyelashes, [[hordeolum]], chalazia, [[corneal ulcer]], and [[conjunctivitis]].
Blepharitis is usually [[asymptomatic]] until the disease progresses. As it progresses, the patient begins to notice a foreign body sensation, [[itching]], [[irritation]], and crusting of the [[eyelids]]. Blepharitis can frequently be improved but are rarely eliminated. If left untreated, severe blepharitis may cause alterations in the eyelid margin, loss of eyelashes, [[scarring]] of the eyelids, [[conjunctivitis]], corneal involvement, superficial [[keratopathy]], and ultimately [[blindness]]. Common [[complications]] of blepharitis include loss of eyelashes, [[hordeolum]], [[chalazion]], [[corneal ulcer]], and [[conjunctivitis]].
Blepharitis is associated with a favorable long-term [[prognosis]]. Severe blepharitis is rarely associated with permanent alterations in the eyelid margin or [[vision loss]] from superficial [[keratopathy]], therefore these patients have a poor long term prognosis.<ref name="pmid21276617">{{cite journal| author=Nemet AY, Vinker S, Kaiserman I| title=Associated morbidity of blepharitis. | journal=Ophthalmology | year= 2011 | volume= 118 | issue= 6 | pages= 1062-8 | pmid=21276617 | doi=10.1016/j.ophtha.2010.10.015 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=21276617  }} </ref>
In general, blepharitis is associated with a favorable long-term prognosis. Severe blepharitis is rarely associated with permanent alterations in the eyelid margin or vision loss from superficial keratopathy. Therefore, severe blepharitis ​is associated with a poor p​rognosis​.<ref name="pmid21276617">{{cite journal| author=Nemet AY, Vinker S, Kaiserman I| title=Associated morbidity of blepharitis. | journal=Ophthalmology | year= 2011 | volume= 118 | issue= 6 | pages= 1062-8 | pmid=21276617 | doi=10.1016/j.ophtha.2010.10.015 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=21276617  }} </ref>


==Diagnosis==
==Diagnosis==
===History and Symptoms===
===History and Symptoms===
A detailed and thorough history from the patient is necessary. Specific areas of focus when obtaining a history from the patient include history of smoking, use of [[retinoids]], and prior history of [[rosacea]] or [[Seborrheic dermatitis]]. Common symptoms of blepharitis include red eye, red [[swollen eyelids]], Itchy eyelids, burning sensation, crusting or matting of eyelashes in the morning, light sensitivity, blurred vision, and oily skin.<ref name="pmid26525679">{{cite journal| author=Pelletier JS, Stewart KP, Capriotti K, Capriotti JA| title=Rosacea Blepharoconjunctivitis Treated with a Novel Preparation of Dilute Povidone Iodine and Dimethylsulfoxide: a Case Report and Review of the Literature. | journal=Ophthalmol Ther | year= 2015 | volume= 4 | issue= 2 | pages= 143-50 | pmid=26525679 | doi=10.1007/s40123-015-0040-4 | pmc=4675729 | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=26525679  }} </ref><ref name=Blepharitis> PubMed Health (2009) http://www.ncbi.nlm.nih.gov/pubmedhealth/PMHT0023008/ Accessed on July 13, 2016 </ref>
A detailed and thorough history from the patient is necessary. Specific areas of focus when obtaining a history from the patient include history of smoking, use of retinoids, prior history of acne rosacea, and history of seborrheic dermatitis. Common symptoms of blepharitis include red, swollen,and itchy eyelids, burning sensation, crusting or matting of eyelashes in the morning, light sensitivity, blurred vision, and oily skin.<ref name="pmid26525679">{{cite journal| author=Pelletier JS, Stewart KP, Capriotti K, Capriotti JA| title=Rosacea Blepharoconjunctivitis Treated with a Novel Preparation of Dilute Povidone Iodine and Dimethylsulfoxide: a Case Report and Review of the Literature. | journal=Ophthalmol Ther | year= 2015 | volume= 4 | issue= 2 | pages= 143-50 | pmid=26525679 | doi=10.1007/s40123-015-0040-4 | pmc=4675729 | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=26525679  }} </ref><ref name=Blepharitis> PubMed Health (2009) http://www.ncbi.nlm.nih.gov/pubmedhealth/PMHT0023008/ Accessed on July 13, 2016 </ref>
===Physical Examination===
===Physical Examination===
Physical examination of patients with blepharitis is usually remarkable for irritated eyelid edges, hard crusting of the lashes or greasy appearing flake, [[entropion]], [[ectropion]], [[poliosis]], and diffuse [[conjunctival injection]].<ref name="pmid18347619">{{cite journal| author=Jackson WB| title=Blepharitis: current strategies for diagnosis and management. | journal=Can J Ophthalmol | year= 2008 | volume= 43 | issue= 2 | pages= 170-9 | pmid=18347619 | doi=10.1139/i08-016 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=18347619  }} </ref>
Physical examination of patients with blepharitis is usually remarkable for irritated eyelid edges, hard crusting of the lashes, [[entropion]], [[ectropion]], [[poliosis]], and diffuse [[conjunctival injection]].<ref name="pmid18347619">{{cite journal| author=Jackson WB| title=Blepharitis: current strategies for diagnosis and management. | journal=Can J Ophthalmol | year= 2008 | volume= 43 | issue= 2 | pages= 170-9 | pmid=18347619 | doi=10.1139/i08-016 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=18347619  }} </ref>
===Laboratory Findings===
===Laboratory Findings===
Laboratory tests are not often required in patients with blepharitis. In general, blepharitis is diagnosed based on clinical features alone.
There are no diagnostic lab findings associated with blepharitis. Blepharitis is diagnosed based on clinical features alone. Culture of eyelid margins may be indicated for some patients with blepharitis who have recurrent anterior blepharitis with severe inflammation, as well as patients who are not responding to therapy.<ref name="pmid18347619">{{cite journal| author=Jackson WB| title=Blepharitis: current strategies for diagnosis and management. | journal=Can J Ophthalmol | year= 2008 | volume= 43 | issue= 2 | pages= 170-9 | pmid=18347619 | doi=10.1139/i08-016 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=18347619  }} </ref><ref name="pmid11009317">{{cite journal| author=McCulley JP, Shine WE| title=Changing concepts in the diagnosis and management of blepharitis. | journal=Cornea | year= 2000 | volume= 19 | issue= 5 | pages= 650-8 | pmid=11009317 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=11009317  }} </ref>
However, cultures of the eyelid margins and eyelid [[biopsy]] may be indicated for patients who have recurrent anterior blepharitis with severe [[inflammation]], as well as for patients who are not responding to therapy.<ref name="pmid18347619">{{cite journal| author=Jackson WB| title=Blepharitis: current strategies for diagnosis and management. | journal=Can J Ophthalmol | year= 2008 | volume= 43 | issue= 2 | pages= 170-9 | pmid=18347619 | doi=10.1139/i08-016 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=18347619  }} </ref><ref name="pmid11009317">{{cite journal| author=McCulley JP, Shine WE| title=Changing concepts in the diagnosis and management of blepharitis. | journal=Cornea | year= 2000 | volume= 19 | issue= 5 | pages= 650-8 | pmid=11009317 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=11009317  }} </ref>
===Other imaging findings===
===Other imaging findings===
Posterior blepharitis overlaps with [[meibomian gland]] dysfunction (MGD). Dynamic meibomian imaging (DMI) can be used to obtain a distinct picture of the entire everted inferior [[tarsal plate]] in a patient with blepharitis.<ref name="pmid21450917">{{cite journal| author=Schaumberg DA, Nichols JJ, Papas EB, Tong L, Uchino M, Nichols KK| title=The international workshop on meibomian gland dysfunction: report of the subcommittee on the epidemiology of, and associated risk factors for, MGD. | journal=Invest Ophthalmol Vis Sci | year= 2011 | volume= 52 | issue= 4 | pages= 1994-2005 | pmid=21450917 | doi=10.1167/iovs.10-6997e | pmc=3072161 | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=21450917  }} </ref><ref name="pmid8779082">{{cite journal| author=Driver PJ, Lemp MA| title=Meibomian gland dysfunction. | journal=Surv Ophthalmol | year= 1996 | volume= 40 | issue= 5 | pages= 343-67 | pmid=8779082 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=8779082  }} </ref>
Posterior blepharitis overlaps with meibomian gland dysfunction (MGD). Dynamic meibomian imaging (DMI) can be used to obtain a distinct picture of the entire everted inferior [[tarsal plate]] in a patient with blepharitis.<ref name="pmid21450917">{{cite journal| author=Schaumberg DA, Nichols JJ, Papas EB, Tong L, Uchino M, Nichols KK| title=The international workshop on meibomian gland dysfunction: report of the subcommittee on the epidemiology of, and associated risk factors for, MGD. | journal=Invest Ophthalmol Vis Sci | year= 2011 | volume= 52 | issue= 4 | pages= 1994-2005 | pmid=21450917 | doi=10.1167/iovs.10-6997e | pmc=3072161 | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=21450917  }} </ref><ref name="pmid8779082">{{cite journal| author=Driver PJ, Lemp MA| title=Meibomian gland dysfunction. | journal=Surv Ophthalmol | year= 1996 | volume= 40 | issue= 5 | pages= 343-67 | pmid=8779082 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=8779082  }} </ref>
There are no [[blepharitis electrocardiogram|electrocardiogram]], [[blepharitis X ray|X ray]], [[blepharitis CT scan|CT scan]], [[blepharitis MRI|MRI]], and [[blepharitis ultrasound|ultrasound]] findings associated with blepharitis.
There are no electrocardiogram, X ray, CT scan, MRI, and ultrasound findings associated with blepharitis.
===Other diagnostic studies===
===Other diagnostic studies===
Other diagnostic studies for blepharitis include [[Slit lamp|Slit lamp examination]], tear break up time (TBUT), and measurement of tear osmolarity.<ref name="pmid8779082">{{cite journal| author=Driver PJ, Lemp MA| title=Meibomian gland dysfunction. | journal=Surv Ophthalmol | year= 1996 | volume= 40 | issue= 5 | pages= 343-67 | pmid=8779082 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=8779082  }} </ref><ref name="pmid21450918">{{cite journal| author=Tomlinson A, Bron AJ, Korb DR, Amano S, Paugh JR, Pearce EI et al.| title=The international workshop on meibomian gland dysfunction: report of the diagnosis subcommittee. | journal=Invest Ophthalmol Vis Sci | year= 2011 | volume= 52 | issue= 4 | pages= 2006-49 | pmid=21450918 | doi=10.1167/iovs.10-6997f | pmc=3072162 | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=21450918  }} </ref><ref name="pmid23799315">{{cite journal| author=Bachmeyer C, Bégon E| title=Chronic blepharitis. | journal=Neth J Med | year= 2013 | volume= 71 | issue= 5 | pages= 259-63 | pmid=23799315 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=23799315  }} </ref>
Other diagnostic studies for blepharitis include [[Slit lamp|Slit lamp examination]], tear break up time (TBUT), and measurement of tear osmolarity.<ref name="pmid8779082">{{cite journal| author=Driver PJ, Lemp MA| title=Meibomian gland dysfunction. | journal=Surv Ophthalmol | year= 1996 | volume= 40 | issue= 5 | pages= 343-67 | pmid=8779082 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=8779082  }} </ref><ref name="pmid21450918">{{cite journal| author=Tomlinson A, Bron AJ, Korb DR, Amano S, Paugh JR, Pearce EI et al.| title=The international workshop on meibomian gland dysfunction: report of the diagnosis subcommittee. | journal=Invest Ophthalmol Vis Sci | year= 2011 | volume= 52 | issue= 4 | pages= 2006-49 | pmid=21450918 | doi=10.1167/iovs.10-6997f | pmc=3072162 | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=21450918  }} </ref><ref name="pmid23799315">{{cite journal| author=Bachmeyer C, Bégon E| title=Chronic blepharitis. | journal=Neth J Med | year= 2013 | volume= 71 | issue= 5 | pages= 259-63 | pmid=23799315 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=23799315  }} </ref>
Line 67: Line 64:
===Medical Therapy===
===Medical Therapy===
Eyelid hygiene and regular cleaning are the mainstay of therapy for blepharitis.  
Eyelid hygiene and regular cleaning are the mainstay of therapy for blepharitis.  
[[Antimicrobial|Antimicrobial topical therapy]] may be indicated in some cases depending on the causative [[pathogen]] and the underlying cause.<ref name="pmid21450919">{{cite journal| author=Geerling G, Tauber J, Baudouin C, Goto E, Matsumoto Y, O'Brien T et al.| title=The international workshop on meibomian gland dysfunction: report of the subcommittee on management and treatment of meibomian gland dysfunction. | journal=Invest Ophthalmol Vis Sci | year= 2011 | volume= 52 | issue= 4 | pages= 2050-64 | pmid=21450919 | doi=10.1167/iovs.10-6997g | pmc=3072163 | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=21450919  }} </ref> <ref>{{cite web | url = http://www.aao.org/preferred-practice-pattern/blepharitis-ppp--2013 | title = Blepharitis PPP 2013}}</ref>
Antimicrobial topical therapy may be indicated in some cases depending on the causative [[pathogen]] and the underlying cause.<ref name="pmid21450919">{{cite journal| author=Geerling G, Tauber J, Baudouin C, Goto E, Matsumoto Y, O'Brien T et al.| title=The international workshop on meibomian gland dysfunction: report of the subcommittee on management and treatment of meibomian gland dysfunction. | journal=Invest Ophthalmol Vis Sci | year= 2011 | volume= 52 | issue= 4 | pages= 2050-64 | pmid=21450919 | doi=10.1167/iovs.10-6997g | pmc=3072163 | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=21450919  }} </ref>
===Surgery===
===Surgery===
[[Surgical|Surgical intervention]] is not the first-line treatment option for patients with blepharitis.<ref name="pmid21450919">{{cite journal| author=Geerling G, Tauber J, Baudouin C, Goto E, Matsumoto Y, O'Brien T et al.| title=The international workshop on meibomian gland dysfunction: report of the subcommittee on management and treatment of meibomian gland dysfunction. | journal=Invest Ophthalmol Vis Sci | year= 2011 | volume= 52 | issue= 4 | pages= 2050-64 | pmid=21450919 | doi=10.1167/iovs.10-6997g | pmc=3072163 | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=21450919  }} </ref><ref name="pmid24043929">{{cite journal| author=Qiao J, Yan X| title=Emerging treatment options for meibomian gland dysfunction. | journal=Clin Ophthalmol | year= 2013 | volume= 7 | issue=  | pages= 1797-803 | pmid=24043929 | doi=10.2147/OPTH.S33182 | pmc=3772773 | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=24043929  }} </ref>
Surgery is not the first­line treatment option for patients with blepharitis. Surgery is usually reserved for patients with complications, such as [[chalazion]], [[entropion]], [[ectropion]], or horizontal eyelid laxity.<ref name="pmid21450919">{{cite journal| author=Geerling G, Tauber J, Baudouin C, Goto E, Matsumoto Y, O'Brien T et al.| title=The international workshop on meibomian gland dysfunction: report of the subcommittee on management and treatment of meibomian gland dysfunction. | journal=Invest Ophthalmol Vis Sci | year= 2011 | volume= 52 | issue= 4 | pages= 2050-64 | pmid=21450919 | doi=10.1167/iovs.10-6997g | pmc=3072163 | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=21450919  }} </ref><ref name="pmid24043929">{{cite journal| author=Qiao J, Yan X| title=Emerging treatment options for meibomian gland dysfunction. | journal=Clin Ophthalmol | year= 2013 | volume= 7 | issue=  | pages= 1797-803 | pmid=24043929 | doi=10.2147/OPTH.S33182 | pmc=3772773 | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=24043929  }} </ref>
===Primary Prevention===
===Primary Prevention===
There are no established method for [[primary prevention]] of blepharitis. However, good self-hygiene and anti-dandruff shampoo may help to prevent blepharitis.<ref name="pmid23118519">{{cite journal| author=Benitez-Del-Castillo JM| title=How to promote and preserve eyelid health. | journal=Clin Ophthalmol | year= 2012 | volume= 6 | issue=  | pages= 1689-98 | pmid=23118519 | doi=10.2147/OPTH.S33133 | pmc=3484726 | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=23118519  }} </ref>
Effective measures for the primary prevention of blepharitis include good [[hygiene|self-hygiene]] and [[dandruff|anti-dandruff shampoo]].<ref name="pmid23118519">{{cite journal| author=Benitez-Del-Castillo JM| title=How to promote and preserve eyelid health. | journal=Clin Ophthalmol | year= 2012 | volume= 6 | issue=  | pages= 1689-98 | pmid=23118519 | doi=10.2147/OPTH.S33133 | pmc=3484726 | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=23118519  }} </ref>
<ref name="pmid22890229">{{cite journal| author=Guillon M, Maissa C, Wong S| title=Eyelid margin modification associated with eyelid hygiene in anterior blepharitis and meibomian gland dysfunction. | journal=Eye Contact Lens | year= 2012 | volume= 38 | issue= 5 | pages= 319-25 | pmid=22890229 | doi=10.1097/ICL.0b013e318268305a | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=22890229  }} </ref>
<ref name="pmid22890229">{{cite journal| author=Guillon M, Maissa C, Wong S| title=Eyelid margin modification associated with eyelid hygiene in anterior blepharitis and meibomian gland dysfunction. | journal=Eye Contact Lens | year= 2012 | volume= 38 | issue= 5 | pages= 319-25 | pmid=22890229 | doi=10.1097/ICL.0b013e318268305a | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=22890229  }} </ref>
===Secondary Prevention===
===Secondary Prevention===
[[Secondary prevention]] strategies following blepharitis include good self-hygiene, using anti-dandruff shampoo, removing eye makeup before bedtime, and avoiding eyeliner.<ref name="pmid4236660">{{cite journal| author=Beare JM| title=Blepharitis and related conditions. | journal=Proc R Soc Med | year= 1969 | volume= 62 | issue= 1 | pages= 5-7 | pmid=4236660 | doi= | pmc=2279072 | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=4236660  }} </ref>
Secondary prevention strategies following blepharitis include good [[hygiene|self-hygiene]], [[dandruff|anti-dandruff shampoo]], removing eye makeup before bedtime, and avoiding eyeliner.<ref name="pmid4236660">{{cite journal| author=Beare JM| title=Blepharitis and related conditions. | journal=Proc R Soc Med | year= 1969 | volume= 62 | issue= 1 | pages= 5-7 | pmid=4236660 | doi= | pmc=2279072 | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=4236660  }} </ref>


==References==
==References==
{{reflist|2}}
{{reflist|2}}
{{WH}}
{{WS}}


[[Category:Disease]]
[[Category:Up-To-Date]]
[[Category:Ophthalmology]]
[[Category:Ophthalmology]]
[[Category:Immunology]]
[[Category:Infectious disease]]
[[Category:Primary care]]
{{WH}}
{{WS}}

Latest revision as of 20:38, 29 July 2020

Blepharitis Microchapters

Home

Patient Information

Overview

Historical Perspective

Classification

Pathophysiology

Causes

Differentiating Blepharitis from other Diseases

Epidemiology and Demographics

Risk Factors

Screening

Natural History, Complications and Prognosis

Diagnosis

History and Symptoms

Physical Examination

Laboratory Findings

X Ray

CT

MRI

Ultrasound

Other Imaging Findings

Other Diagnostic Studies

Treatment

Medical Therapy

Surgery

Primary Prevention

Secondary Prevention

Cost-Effectiveness of Therapy

Future or Investigational Therapies

Case Studies

Case #1

Blepharitis overview On the Web

recent articles

Most cited articles

Review articles

CME Programs

Powerpoint slides

Images

American Roentgen Ray Society Images of Blepharitis overview

All Images
X-rays
Echo & Ultrasound
CT Images
MRI

Ongoing Trials at Clinical Trials.gov

National Guidelines Clearinghouse

NICE Guidance

FDA on Blepharitis overview

CDC on Blepharitis overview

Blepharitis overview in the news

Blogs on Blepharitis overview

Directions to Hospitals Treating Blepharitis

Risk calculators and risk factors for Blepharitis overview

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Sara Mehrsefat, M.D. [2]

Overview

Blepharitis is characterized by inflammation of the eyelid margins. Blepharitis may be classified according to the anatomic location of the disease into 2 subtypes: anterior and posterior. Additionally, blepharitis may be classified based on the duration of symptoms into either acute or chronic.[1] The exact pathogenesis of blepharitis is not fully understood. It is thought that blepharitis is caused by either bacterial colonization (Staphylococcus aureus or Staphylococcus epidermidis) in the eyelids or meibomian gland dysfunction. Blepharitis may also caused by allergens and mites that affect the eyelashes.[2] Blepharitis must be differentiated from conjunctivitis, trichiasis, dry eye syndrome, keratitis, hordeolum, and chalazion.[3] Blepharitis is usually asymptomatic until the disease progresses. As it progresses, the patient begins to notice a foreign body sensation, itching, irritation, and crusting of the eyelids. Blepharitis can frequently be improved but is rarely eliminated. If left untreated, severe blepharitis may cause loss of eyelashes, scarring of the eyelids, corneal involvement, and ultimately blindness. Common complications of blepharitis include loss of eyelashes, hordeolum, chalazion, corneal ulcer, and conjunctivitis. Blepharitis is associated with a favorable long-term prognosis.[4] Physical examination of patients with blepharitis is usually remarkable for irritated eyelid edges, crusting of the lashes, entropion, ectropion, poliosis, and diffuse conjunctival injection.[5] In general, blepharitis is diagnosed based on clinical features alone. There are no diagnostic lab findings associated with blepharitis. Blepharitis is diagnosed based on clinical features alone.[5][6] Eyelid hygiene and regular cleaning are the mainstay of therapy for blepharitis. Antimicrobial topical therapy may be indicated in some cases depending on the causative pathogen and the underlying cause.[7]

Historical Perspective

Blepharitis was first described in the late 19th century as "conjunctivitis meibomianae" in a patient with accumulated sebaceous-like material in the meibomian glands.[3]

Classification

Blepharitis may be classified according to the anatomic location of the disease into 2 subtypes: anterior and posterior. Additionally, blepharitis may be classified based on the duration of symptoms into either acute or chronic.[1]

Pathophysiology

The exact pathogenesis of blepharitis is not fully understood. It is thought that blepharitis is caused by either bacterial colonization (Staphylococcus aureus or Staphylococcus epidermidis) in the eyelids or meibomian gland dysfunction. Blepharitis may also caused by allergens and lice that affect the eyelashes.[2][8]

Causes

Common causes of blepharitis include bacterial infections, dysfunctional meibomian glands, allergies (less common), and Demodex folliculorum (small parasitic mites).[3]

Differentiating Blepharitis from other Diseases

Blepharitis must be differentiated from allergic contact dermatitis, conjunctivitis, trichiasis, dry eye syndrome, keratitis, hordeolum, chalazion, rosacea, and sebaceous carcinoma.[9]

Epidemiology and Demographics

Blepharitis is one of the most common ocular disorders encountered in clinical practice. Up to 20,000 per 100,000 adults over the age of 45 report some discomfort from blepharitis and meibomian gland dysfunction (MGD).[10]

Risk Factors

Common risk factors in the development of blepharitis are dry eye syndrome, dermatologic conditions (acne rosacea, seborrheic dermatitis), demodicosis (chronic blepharitis), lice, and allergies.[11][12][13]

Screening

Screening for blepharitis is not recommended.[14]

Natural History, Complications and Prognosis

Blepharitis is usually asymptomatic until the disease progresses. As it progresses, the patient begins to notice a foreign body sensation, itching, irritation, and crusting of the eyelids. Blepharitis can frequently be improved but are rarely eliminated. If left untreated, severe blepharitis may cause alterations in the eyelid margin, loss of eyelashes, scarring of the eyelids, conjunctivitis, corneal involvement, superficial keratopathy, and ultimately blindness. Common complications of blepharitis include loss of eyelashes, hordeolum, chalazion, corneal ulcer, and conjunctivitis. In general, blepharitis is associated with a favorable long-term prognosis. Severe blepharitis is rarely associated with permanent alterations in the eyelid margin or vision loss from superficial keratopathy. Therefore, severe blepharitis ​is associated with a poor p​rognosis​.[4]

Diagnosis

History and Symptoms

A detailed and thorough history from the patient is necessary. Specific areas of focus when obtaining a history from the patient include history of smoking, use of retinoids, prior history of acne rosacea, and history of seborrheic dermatitis. Common symptoms of blepharitis include red, swollen,and itchy eyelids, burning sensation, crusting or matting of eyelashes in the morning, light sensitivity, blurred vision, and oily skin.[15][16]

Physical Examination

Physical examination of patients with blepharitis is usually remarkable for irritated eyelid edges, hard crusting of the lashes, entropion, ectropion, poliosis, and diffuse conjunctival injection.[5]

Laboratory Findings

There are no diagnostic lab findings associated with blepharitis. Blepharitis is diagnosed based on clinical features alone. Culture of eyelid margins may be indicated for some patients with blepharitis who have recurrent anterior blepharitis with severe inflammation, as well as patients who are not responding to therapy.[5][6]

Other imaging findings

Posterior blepharitis overlaps with meibomian gland dysfunction (MGD). Dynamic meibomian imaging (DMI) can be used to obtain a distinct picture of the entire everted inferior tarsal plate in a patient with blepharitis.[17][18] There are no electrocardiogram, X ray, CT scan, MRI, and ultrasound findings associated with blepharitis.

Other diagnostic studies

Other diagnostic studies for blepharitis include Slit lamp examination, tear break up time (TBUT), and measurement of tear osmolarity.[18][19][20]

Treatment

Medical Therapy

Eyelid hygiene and regular cleaning are the mainstay of therapy for blepharitis. Antimicrobial topical therapy may be indicated in some cases depending on the causative pathogen and the underlying cause.[7]

Surgery

Surgery is not the first­line treatment option for patients with blepharitis. Surgery is usually reserved for patients with complications, such as chalazion, entropion, ectropion, or horizontal eyelid laxity.[7][21]

Primary Prevention

Effective measures for the primary prevention of blepharitis include good self-hygiene and anti-dandruff shampoo.[22] [23]

Secondary Prevention

Secondary prevention strategies following blepharitis include good self-hygiene, anti-dandruff shampoo, removing eye makeup before bedtime, and avoiding eyeliner.[24]

References

  1. 1.0 1.1 Cheung J, Sharma S (2000). "Ophthaproblem. Blepharitis". Can Fam Physician. 46: 2393, 2400. PMC 2145002. PMID 11153404.
  2. 2.0 2.1 Bunya VY, Brainard DH, Daniel E, Massaro-Giordano M, Nyberg W, Windsor EA; et al. (2013). "Assessment of signs of anterior blepharitis using standardized color photographs". Cornea. 32 (11): 1475–82. doi:10.1097/ICO.0b013e3182a02e0e. PMC 3947496. PMID 24055901.
  3. 3.0 3.1 3.2 Lemp MA, Nichols KK (2009). "Blepharitis in the United States 2009: a survey-based perspective on prevalence and treatment". Ocul Surf. 7 (2 Suppl): S1–S14. PMID 19383269.
  4. 4.0 4.1 Nemet AY, Vinker S, Kaiserman I (2011). "Associated morbidity of blepharitis". Ophthalmology. 118 (6): 1062–8. doi:10.1016/j.ophtha.2010.10.015. PMID 21276617.
  5. 5.0 5.1 5.2 5.3 Jackson WB (2008). "Blepharitis: current strategies for diagnosis and management". Can J Ophthalmol. 43 (2): 170–9. doi:10.1139/i08-016. PMID 18347619.
  6. 6.0 6.1 McCulley JP, Shine WE (2000). "Changing concepts in the diagnosis and management of blepharitis". Cornea. 19 (5): 650–8. PMID 11009317.
  7. 7.0 7.1 7.2 Geerling G, Tauber J, Baudouin C, Goto E, Matsumoto Y, O'Brien T; et al. (2011). "The international workshop on meibomian gland dysfunction: report of the subcommittee on management and treatment of meibomian gland dysfunction". Invest Ophthalmol Vis Sci. 52 (4): 2050–64. doi:10.1167/iovs.10-6997g. PMC 3072163. PMID 21450919.
  8. Dougherty JM, McCulley JP (1986). "Bacterial lipases and chronic blepharitis". Invest Ophthalmol Vis Sci. 27 (4): 486–91. PMID 3957566.
  9. Mathers WD, Choi D (2004). "Cluster analysis of patients with ocular surface disease, blepharitis, and dry eye". Arch Ophthalmol. 122 (11): 1700–4. doi:10.1001/archopht.122.11.1700. PMID 15534133.
  10. Macsai MS (2008). "The role of omega-3 dietary supplementation in blepharitis and meibomian gland dysfunction (an AOS thesis)". Trans Am Ophthalmol Soc. 106: 336–56. PMC 2646454. PMID 19277245.
  11. McCulley JP, Dougherty JM (1985). "Blepharitis associated with acne rosacea and seborrheic dermatitis". Int Ophthalmol Clin. 25 (1): 159–72. PMID 3156100.
  12. Bhandari V, Reddy JK (2014). "Blepharitis: always remember demodex". Middle East Afr J Ophthalmol. 21 (4): 317–20. doi:10.4103/0974-9233.142268. PMC 4219223. PMID 25371637.
  13. Bowman RW, Dougherty JM, McCulley JP (1987). "Chronic blepharitis and dry eyes". Int Ophthalmol Clin. 27 (1): 27–35. PMID 3818198.
  14. American Academy of Ophthalmology/eyewiki (2014) http://eyewiki.org/Blepharitis Accessed on July 14, 2016
  15. Pelletier JS, Stewart KP, Capriotti K, Capriotti JA (2015). "Rosacea Blepharoconjunctivitis Treated with a Novel Preparation of Dilute Povidone Iodine and Dimethylsulfoxide: a Case Report and Review of the Literature". Ophthalmol Ther. 4 (2): 143–50. doi:10.1007/s40123-015-0040-4. PMC 4675729. PMID 26525679.
  16. PubMed Health (2009) http://www.ncbi.nlm.nih.gov/pubmedhealth/PMHT0023008/ Accessed on July 13, 2016
  17. Schaumberg DA, Nichols JJ, Papas EB, Tong L, Uchino M, Nichols KK (2011). "The international workshop on meibomian gland dysfunction: report of the subcommittee on the epidemiology of, and associated risk factors for, MGD". Invest Ophthalmol Vis Sci. 52 (4): 1994–2005. doi:10.1167/iovs.10-6997e. PMC 3072161. PMID 21450917.
  18. 18.0 18.1 Driver PJ, Lemp MA (1996). "Meibomian gland dysfunction". Surv Ophthalmol. 40 (5): 343–67. PMID 8779082.
  19. Tomlinson A, Bron AJ, Korb DR, Amano S, Paugh JR, Pearce EI; et al. (2011). "The international workshop on meibomian gland dysfunction: report of the diagnosis subcommittee". Invest Ophthalmol Vis Sci. 52 (4): 2006–49. doi:10.1167/iovs.10-6997f. PMC 3072162. PMID 21450918.
  20. Bachmeyer C, Bégon E (2013). "Chronic blepharitis". Neth J Med. 71 (5): 259–63. PMID 23799315.
  21. Qiao J, Yan X (2013). "Emerging treatment options for meibomian gland dysfunction". Clin Ophthalmol. 7: 1797–803. doi:10.2147/OPTH.S33182. PMC 3772773. PMID 24043929.
  22. Benitez-Del-Castillo JM (2012). "How to promote and preserve eyelid health". Clin Ophthalmol. 6: 1689–98. doi:10.2147/OPTH.S33133. PMC 3484726. PMID 23118519.
  23. Guillon M, Maissa C, Wong S (2012). "Eyelid margin modification associated with eyelid hygiene in anterior blepharitis and meibomian gland dysfunction". Eye Contact Lens. 38 (5): 319–25. doi:10.1097/ICL.0b013e318268305a. PMID 22890229.
  24. Beare JM (1969). "Blepharitis and related conditions". Proc R Soc Med. 62 (1): 5–7. PMC 2279072. PMID 4236660.

Template:WH Template:WS