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Eyelid Diseases

Blepharitis


What is Blepharitis?

Blepharitis is a diffuse inflammation of the sebaceous glands (posterior blepharitis) or lash follicles (anterior blepharitis) of the eyelids. It is often caused by abnormal oil production in the meibomian glands (posterior blepharitis) or skin organisms such as Staphylococcus aureus (anterior blephartitis).

How does it present?

The patient complains of a gritty, burning sensation and mattering, especially upon awakening.

The eyelid margins look red and thickened. A magnified view shows flaky debris in the lashes. The conjunctiva is mildly and diffusely hyperemic. Sometimes the corneal margin develops a yellow-white infiltrate.

Individuals who have rosacea or seborrheic dermatitis of the scalp and face are especially prone to blepharitis.

What to do?

If you can make the diagnosis, tell the patient to perform warm compresses and lid-margin scrubs twice a day as follows:

  1. Place a warm washcloth over the closed lid for 5 minutes to soften the crust.
  2. Moisten a cotton-tipped applicator in a solution of 3 ounces of water and 3 drops of baby shampoo, and use it to scrub the closed lid.
  3. Rinse the solution from the lids with clean water.
  4. Brush off lid margin debris with a clean, dry applicator.

If several weeks of this treatment fails, prescribe nightly application of bacitracin, erythromycin, Maxitrol, or Tobradex ointment or Azasite gel to the eyelid margins. If topical medication does not work, try oral tetracycline 0.5 to 1 gm/day in four doses or doxycycline 50 to 100 mg once or twice daily (except in pregnant patients and children aged 12 years or less).

In addition, omega-3 supplementation, i.e. fish oil, krill oil or flaxseed oil, has been shown to be helpful for patients with posterior blepharitis.