| Blepharitis is a chronic inflammation of the upper and lower eyelids that develops as a result of bacterial infection, inflammation, skin conditions, or allergic reactions. Usually both eyes are affected. Over-production by the glands of the eyelids (meibomian blepharitis) may attract bacteria that irritate lid edges (margins), creating redness and scaling of skin. Secretions may cause the eyelids to become crusted or "glued" together.
Blepharitis is often associated with other facial skin disorders, such as rosacea and seborrhea. It is aggravated by exposure to dust, smoke, irritating chemicals, and eye makeup and by poor facial hygiene.
Anterior blepharitis affects the outer or front portion of the eyelids. An ulcerative form of anterior blepharitis can be caused by staphylococcal infection in the eyelash roots or follicles. Nonulcerative anterior blepharitis resembles dandruff and is frequently accompanied by scaling of the scalp, eyebrows, and ears (seborrhea).
Posterior blepharitis occurs when glands found in the inner portion of the eyelid (meibomian or tarsal glands) are inflamed or blocked, resulting in irregular production of the oily coating that normally helps protect the eye. Thicker-than-normal secretions or infection may obstruct the glands, causing inflammation and a painful burning sensation in the eyes.
Blepharitis tends to occur in both eyes (bilateral). If only one eye seems to be involved, an underlying cancer (sebaceous cell carcinoma) or infection of the tear sac (dacryocystitis) should be ruled out.
Blepharitis is usually a chronic, recurrent condition. This can be frustrating to patients, who must take extra measures to keep the lids clean and avoid makeup and must see a doctor for antibiotics when infections occur.
Susceptibility to blepharitis may be inherited. Although it can be uncomfortable, blepharitis does not directly affect eyesight. However, over time the effects of scarring and infection can affect other eye structures and endanger vision.Risk: Blepharitis occurs equally in individuals of all races and both genders. It affects people of all ages but is more common among older individuals, with a mean apparent age of 50 years (Lowery). Incidence and Prevalence: Since many cases of blepharitis go unreported, the true incidence is unknown. However, blepharitis is a common eye disorder, both in the US and worldwide. |
Source: Medical Disability Advisor
| History: Individuals may report irritation, itching, and burning at the edge of the eyelids, or the sensation of a foreign body in the eyes. Individuals may see scales or "granulations" clinging to both upper and lower eyelids and may awaken in the morning with their eyes "glued" shut. Individuals who have ulcerative blepharitis may report dry scales, red eyelids, and tiny ulcerations along the edge of the lids. Lashes also tend to fall out. Nonulcerative blepharitis produces greasy scales. In this form of the condition, individuals may only have slightly red eyelids. In a mixed infection, which is common, both dry and greasy scales are present. Eyelid edges are red and may be ulcerated. With posterior blepharitis, a history of repeated stye infections (hordeolum) or inflammation of the meibomian (tarsal) glands (chalazia) may be reported. In advanced cases, blurring of vision may be reported. Physical exam: The eyelid margins will be red and swollen and may have dry and/or greasy scales. A slit-lamp examination may show missing or encrusted eyelashes. The mucous membrane that lines the eyelids will be irritated and inflamed; the mucous membrane covering the anterior surface of the eyeball (conjunctiva) may also be inflamed (conjunctivitis). In posterior blepharitis, meibomian glands at the edges of the lids may be sore and swollen and produce an abnormal soft, cheesy substance when pressure is applied. Examination of the eyelashes may reveal lice infestation, and examination of the scalp may reveal dandruff (seborrheic dermatitis). Tests: Normally, a comprehensive eye examination is able to diagnose blepharitis; no diagnostic tests are needed. However, a culture of eye secretions may be done to rule out infection or to identify the causative bacteria, especially if the individual has not responded to treatment. An individual who fails to respond to treatment may be tested for allergies. |
Source: Medical Disability Advisor
| The American Optometric Association reports that self-treatment at home is the most important part of controlling blepharitis. Treatment involves three steps. First, warm compresses are repeatedly applied to the eyelids to loosen scaly and crusty material and help open up blocked glands. Next, the eyelid edges are cleansed several times daily with warm water and baby shampoo to remove scales. The scalp and eyebrows must also be kept clean. Medicated antidandruff shampoo may be recommended. Finally, when bacterial infection is suspected as the cause of blepharitis, antibiotic ointment is applied to the edge of the eyelids several times daily. The use of eyedrops, facial makeup, and contact lenses that may have caused nonbacterial blepharitis is discontinued during treatment; suspected or proven allergens should be discontinued indefinitely. The inner eyelids may be treated with systemic antibiotics and topical steroids if meibomian gland dysfunction is present. In some cases, a chronic inflammatory granuloma of the meibomian gland (chalazion) that develops in conjunction with blepharitis may be incised or injected with steroids. |
Source: Medical Disability Advisor
| Individuals rarely lose their vision or sustain permanent eye damage from blepharitis, but the disorder is annoying, sometimes painful, and difficult to cure. It tends to become a chronic condition, improving for a while, then recurring (except in the case of contact blepharitis, which usually resolves once the substance causing irritation is eliminated). Scarring of the eyelids or permanent loss of lashes may occur in prolonged, serious cases. |
Source: Medical Disability Advisor
| Nonulcerative blepharitis frequently causes conjunctivitis, an inflammation of the inner lining of the eye. Ulcerative blepharitis can cause small sores along the lids. Eyelashes may fall out or turn inward, and corneal ulcers may form. Red swollen sores (styes) may form from an abscess. A firm mass of granulomatous tissue (chalazion) in the meibomian gland of either eye may also accompany blepharitis. Corneal scarring, growths, thinning, ulceration, and perforation may occur, though perforation is rare. |
Source: Medical Disability Advisor
| Breaks may be needed several times daily for application of medicated ointment to the eyelids. |
Source: Medical Disability Advisor
| If an individual fails to recover within the expected maximum duration period, the reader may wish to consider the following questions to better understand the specifics of an individual's medical case. Regarding diagnosis:
- Was individual exposed to dust, smoke, or irritating chemicals? Does individual use makeup or eyedrops? Is individual receiving treatment for any chronic facial skin problems?
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What is individual's personal hygiene? Is it good?
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Does individual have irritation, itching, and burning at the edge of the eyelids or the sensation of a foreign body in the eyes?
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Does individual have dry scales, red eyelids, and tiny ulcerations along the edge of the lids?
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Do the eyelashes tend to fall out? Are the eyelashes missing? Are greasy scales present?
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Are the eyelid edges red and ulcerated?
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Are the meibomian glands swollen? Do they produce an abnormal soft, cheesy substance when pressure is applied?
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Does individual have a history of repeated hordeolum or chalazia?
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Is the conjunctiva irritated?
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Was a culture of eye secretions done?
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Was individual tested for allergies?
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Were conditions with similar symptoms ruled out?
Regarding treatment:
- Does individual cleanse the eyelid area several times a day with warm water and baby shampoo? Are the scalp and eyebrows kept clean?
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Is individual compliant with treatment regimen?
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Have a medicated shampoo and antibiotic ointment been prescribed?
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Were eyedrops or makeup that may have caused contact blepharitis discontinued?
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Has underlying meibomian gland dysfunction been treated with systemic antibiotics and topical steroids?
Regarding prognosis:
- Can individual's employer accommodate any necessary restrictions?
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Does individual have any conditions that may affect ability to heal?
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Are any complications present, such as conjunctivitis or corneal ulcers, that may affect recovery?
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Source: Medical Disability Advisor
| Lowery, Scott R., and Roy Hampton. "Blepharitis, Adult." eMedicine. Eds. Fernando H. Murillo-Lopez, et al. 21 Nov. 2006. Medscape. 23 Sep. 2004 <http://emedicine.medscape.com/article/1211763-overview>. |
Source: Medical Disability Advisor
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