Blepharitis
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- Localization. Eyes and appendages
- Erythematous lesion? Erythematous lesion
- Evolution time. Acute: less than 2 weeks, Chronic: more than 2 weeks
- Skin lesion. Flat: macule or spot
- Surface texture. Crust/ulceration/excoriation
- Edges Poorly defined
- Color.
- Distribution of lesions. Injury with symmetrical pattern, Confluent/coalescent lesions
- Associated symptoms. Itching
- Additional information.
Brief information
- Chronic ophthalmological condition characterized by inflammation of the eyelid margin associated with eye irritation. There are two variants of this condition based on the location of the inflammation:
- anterior blepharitis: affects the outer eyelid (eyelash base region, eyelash follicles and eyelid skin)
- posterior blepharitis: affects the inner eyelid (due to Meibomius gland dysfunction)
- Etiology is diverse and differs according to the type of blepharitis.
- Causes of anterior blepharitis include:
- staphylococcal infection;
- seborrheic dermatitis (users often present seborrheic dermatitis in other places such as the face and/or scalp);
ocular rosacea; - Causes of posterior blepharitis include:
- meibomian gland dysfunction in the inner eyelid (excessive secretion of an oily substance that causes obstruction of the gland and consequent engorgement)
- Demodex mite infestation (demodicosis) can occur for both types of blepharitis.
- It generally manifests itself with itching, a burning sensation and the formation of crusts on the eyelids. They may also experience tearing, blurred vision and a foreign body sensation.
- Causes of anterior blepharitis include:
- In general, symptoms tend to worsen in the morning, with crusts on the eyelashes being more prominent upon waking.
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- Symptoms tend to affect both eyes and may be intermittent.
- More common after 50 years of age. No gender preference.
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- The diagnosis is clinical and based on characteristic findings of redness and edema of the eyelid margin associated with crusting or flaking on the eyelashes or eyelid margins.
- The slit lamp allows for a more detailed examination of the meibomian glands, which can help distinguish between posterior and anterior blepharitis. However, it is generally not necessary to make the distinction.
Differential diagnosis
- Conjunctivitis
- Hordeolum
- Chalazion
- Eyelid malignancy
Treatment
Blepharitis is a chronic condition that requires long-term treatment. Good eyelid hygiene should be maintained and potential triggers or exacerbators (allergens, tobacco smoke, contact lenses) should be eliminated or limited.
- Mild or moderate symptoms:
- apply hot compresses to the eyelids for 3 minutes, two to four times a day to soften the crust and adherent scales and/or warm the meibomian secretions;
- gently massage the edge of the eyelid in gentle circular movements and wash the eyelids to remove residue build-up on the eyelashes (avoid vigorous washing);
- gently clean the eyelid with a cotton swab dipped in a mixture of water and children’s shampoo;
- applying artificial tears to alleviate associated dryness may be beneficial;
- consider topical antibiotic therapy if symptoms do not respond to previous measures. Options include:
- Bacitracin (or erythromycin) applied directly to the eyelid margin once a day at bedtime for 2 to 8 weeks (until symptoms resolve). As soon as symptoms improve, treatment can be stopped, but hygiene measures must be continued.
- Azithromycin 1% (1 drop every 12 hours, for 10 to 14 days) is an alternative option, especially for patients with posterior blepharitis.
- Moderate or severe symptoms (for example associated with rosacea), or unresponsive to topical antibiotic therapy:
- Doxycycline 50-100 mg once a day for 8-12 weeks.
- Alternative regimen: azithromycin 500 mg once a day for 1 day, then 250 mg per day for another 4 days.
- Application of short cycles (2 weeks maximum) of topical corticosteroids to the eyelid margins may be indicated if there is associated inflammation and lack of response to other therapeutic strategies.
- The minimally effective dose and shortest duration of use should be administered in order to reduce the risk of increased intraocular pressure and cataract formation. Choosing a topical corticosteroid with less ocular penetration, such as fluorometholone, can minimize these adverse effects.
- Refer to ophthalmology if: hyperemia or severe eye pain, photosensitivity, vision changes, corneal abnormalities (erosions, ulcers, scars), uncertain diagnosis, suspected malignancy or Demodex infection.