Blepharitis

Inflammation of the eyelids/lashes.glands and associated structures with minimal ocular involvement

• Can cause styes, chalazia, conjunctival or corneal ulcers
• Usually bilateral

Risks 

• seborrheic dermatitis, acne, rosacea

Types

• Anterior blepharitis anterior eyelid margin shows crusting, scaling and redness of the eyelid margin
• Posterior blepharitis is caused by dysfunction of the meibomian glands, which are sebaceous glands at the rim of the eyelid

Clinical

• Anterior Blepharitis:
  • Symptoms: Burning and grittiness in both eyes.
  • Examination Findings: Crusting, scaling, and redness of the eyelid margin.
• Posterior Blepharitis:
  • Cause: Dysfunction of the meibomian glands.
  • Common Association: Rosacea.
  • Signs: Redness of the eyelid margin, blocked meibomian glands, and frothy discharge along the eyelid margins; possible associated chalazia.

Management of Blepharitis(eTG)

Eyelid Hygiene:

• Warm compresses: Applied to the eyelids (with eyes closed) daily for 2 to 5 minutes to soften crusts.
• Gentle scrubbing: Lashes with either:
  • Sodium bicarbonate solution (1 teaspoon in 500 mL freshly boiled and cooled water).
  • Baby shampoo solution (5 drops in 100 mL freshly boiled and cooled water).
  • Proprietary eyelid solutions or wipes.

Topical Antibiotics for Anterior Blepharitis:

• Chloramphenicol 1% eye ointment: Applied to the eyelid margin of both eyes, twice daily for 1 to 2 weeks.

Systemic Antibiotics for Posterior Blepharitis:

• Doxycycline:
  • Adults: 100 mg orally daily, reduced to 50 mg orally daily after clinical improvement (usually after 2 to 4 weeks), for a minimum of 8 weeks.
  • Children 8 years or older:
    • Less than 26 kg: 50 mg orally daily, reduced to 25 mg orally daily after clinical improvement (usually after 2 to 4 weeks), for a minimum of 8 weeks.
    • 26 to 35 kg: 75 mg orally daily, reduced to 50 mg orally daily after clinical improvement (usually after 2 to 4 weeks), for a minimum of 8 weeks.
    • More than 35 kg: 100 mg orally daily, reduced to 50 mg orally daily after clinical improvement (usually after 2 to 4 weeks), for a minimum of 8 weeks.
• Erythromycin (for pregnant or breastfeeding women):
  • Erythromycin base: 500 mg orally daily for a minimum of 8 weeks. If not tolerated, reduce to 250 mg.
  • Erythromycin ethyl succinate: 800 mg orally daily for a minimum of 8 weeks. If not tolerated, reduce to 400 mg.
• Erythromycin (for children younger than 8 years):
  • Erythromycin ethyl succinate (child 1 month or older): 20 mg/kg up to 800 mg orally daily as a single dose, or in two divided doses to improve tolerability, for a minimum of 8 weeks. If not tolerated, reduce to 10 mg/kg up to 400 mg daily.

Review:

• Review after 8 weeks.
• Maintenance therapy may be required to control symptoms.

Special Considerations:

• In children with posterior blepharitis, cutaneous symptoms of rosacea are often absent.
• Seek expert advice from an ophthalmologist because corneal complications can occur even in the absence of acute symptoms.

Complications from blepharitis include:

• Stye (hordeolum) – a red tender lump caused by an infection of an oil gland of the eyelid.
• Chalazion – a painless firm lump caused by inflammation of the oil gland of the eyelid. Chalazion can be painful and red if it becomes infected.
• Abnormal or decreased oil secretion resulting in excess tearing or eye dryness.
• Corneal infections due to abnormal or decreased oil secretion.