Description

• Common, usually chronic, inflammatory reaction of the eyelid margin
• Commonly presents as irritation, burning, redness, flaking, crusting of the eyelids worse in morning, contact lens intolerance, and eyelid sticking
• Defined as anterior or posterior blepharitis with considerable overlap
  • Anterior blepharitis (inflammation at the base of the eyelashes):
    • Staphylococcal
    • Seborrheic
  • Posterior blepharitis (inflammation at level of meibomian gland):
    • Meibomian gland dysfunction (MGD)
• Areas affected: cornea, eyelid
• Can be primary or secondary to a systemic disease

Epidemiology

Incidence

• Very common
• All ethnic groups (Asians > Caucasians)
• Predominant age:
  • Nonstaphylococcal (average age: 50 years)
  • Staphylococcal (average age: <42 years)
• Predominant sex:
  • Nonstaphylococcal: male = female
  • Staphylococcal: male < female

Risk Factors

• Seborrheic dermatitis
• Contact dermatitis
• Herpes simplex dermatitis
• Varicella-zoster dermatitis
• Acne rosacea
• Immunocompromised state (e.g., AIDS, chemotherapy)
• Isotretinoin use
• Antihistamine use
• Dry eye syndrome
• Demodex folliculorum infestation
• Giant papillary conjunctivitis

Etiology and Pathophysiology

• Seborrheic
  • Anterior eyelid inflammation secondary to increased and abnormal meibomian gland secretions
  • Eyelid erythema, crusting, and oily appearance
  • Can be associated with keratitis presenting as punctate epithelial erosions
  • Associated with acne rosacea
• Staphylococcal
  • Infection of the glands of the eyelid margin
  • Commonly caused by Staphylococcus aureus and coagulase-negative Staphylococcus, with occasional concomitant Moraxella lacunata infection
  • Crusting (golden) around eyelashes that is worse in the morning, collarette formation around lashes, scaling, crusting, and erythema
  • Severe cases are associated with keratitis and eyelid ulceration.
• MGD: chronic obstruction and inflammation of the meibomian glands; associated with acne rosacea, acne vulgaris, and oral retinoid therapy
• Other types of blepharitis:
  • Contact dermatitis/blepharitis:
    • Develops from type IV hypersensitivity; common causes include ocular medications, topical anesthetics, antivirals, and cosmetics.
    • May occur with secondary Staphylococcus infection
  • Eczematoid blepharitis
    • Caused by type I hypersensitivity reaction to exotoxins and antigens from local flora
    • Strong association with eczema and asthma
    • Staphylococcal infection common
  • Parasitic blepharitis
    • Cylindrical sleeves along lashes
    • Found in 30% of chronic blepharitis
• The exact etiopathogenesis is unknown.
• Suspected to be multifactorial
  • Chronic low-grade infections of the ocular surface with bacteria
  • Infestations with certain parasites such as the mite Demodex
  • Inflammatory skin conditions such as atopy and seborrhea

Commonly Associated Conditions

See “Risk Factors” and “Differential Diagnosis.”