Blepharitis
Basics
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)
- Anterior blepharitis (inflammation at the base of the eyelashes):
- 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
- Contact dermatitis/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.”
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Citation
Domino, Frank J., et al., editors. "Blepharitis." 5-Minute Clinical Consult, 33rd ed., Wolters Kluwer, 2025. Medicine Central, im.unboundmedicine.com/medicine/view/5-Minute-Clinical-Consult/116079/all/Blepharitis.
Blepharitis. In: Domino FJF, Baldor RAR, Golding JJ, et al, eds. 5-Minute Clinical Consult. Wolters Kluwer; 2025. https://im.unboundmedicine.com/medicine/view/5-Minute-Clinical-Consult/116079/all/Blepharitis. Accessed December 9, 2024.
Blepharitis. (2025). In Domino, F. J., Baldor, R. A., Golding, J., & Stephens, M. B. (Eds.), 5-Minute Clinical Consult (33rd ed.). Wolters Kluwer. https://im.unboundmedicine.com/medicine/view/5-Minute-Clinical-Consult/116079/all/Blepharitis
Blepharitis [Internet]. In: Domino FJF, Baldor RAR, Golding JJ, Stephens MBM, editors. 5-Minute Clinical Consult. Wolters Kluwer; 2025. [cited 2024 December 09]. Available from: https://im.unboundmedicine.com/medicine/view/5-Minute-Clinical-Consult/116079/all/Blepharitis.
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