Blepharitis

The signs and symptoms of blepharitis include discomfort and irritation of the bilateral eyelids. Individuals may experience itching, burning, and crusting of the eyelids. Associated symptoms can include light sensitivity, blurred vision, tearing, and foreign body sensation. Generally, symptoms are worse in the morning upon waking due to an accumulation of crust along the eyelid margins. Scaling can be seen at the base of the eyelashes forming "collarettes,” which are waxy buildup and debris wrapping around the lashes. Also, loss of lashes (i.e., madarosis), depigmentation of lashes (i.e., poliosis), and misdirection of lashes (i.e. trichiasis) may be seen. If the meibomian glands are obstructed, thick secretions and scarring of the lid may be seen in the area surrounding the glands. 

Symptoms of blepharitis are often intermittent; however, it can be a chronic, lifelong condition. Blepharitis is rarely sight-threatening, but if left untreated, it can result in complications, including chronic conjunctivitis (i.e., inflammation of the membrane that covers the white of the eye), scarring of the eyelids, keratitis (i.e., inflammation of the cornea), corneal ulcers, and vision loss. 

Blepharitis is a clinical diagnosis made based on exam findings of irritation of the lid margins with crusting and flaking of the lashes. A history, including the individual’s symptoms, medical history, and current medications, can provide a more complete clinical picture. No specific diagnostic testing beyond the history and physical exam is required; however, they can be helpful in confirming the diagnosis. For example, a slit lamp exam of an individual with blepharitis may reveal erythema and edema of the eyelid margin, telangiectasias (i.e., dilated blood vessels) at the outer portions, and the presence of Demodex mites. 

Blepharitis is treated primarily by preventing the condition with eyelid hygiene and eliminating potential triggers, including eye makeup. During acute stages of blepharitis, wet and warm compresses can be applied to the eyes for 5 to 10 minutes to soften the eyelid secretions and dilate the meibomian glands. Following the compress, individuals can gently massage the closed eyelid in small circular patterns to express oils from the meibomian glands, then wash the eyelids with a cotton swab soaked in warm water and baby shampoo. This can be repeated two to four times a day during an acute flare. Since there is no definitive cure, those with chronic, recurrent blepharitis may need to continue their lid hygiene regimen daily even when they are not experiencing an acute flare. Artificial tears may be used to reduce redness, swelling, and dryness.