• 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



  • 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.”

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