Blepharitis

What is Blepharitis?

Blepharitis refers to inflammation of the eyelids  causing red, irritated eyelids and the formation of dandruff-like scales on the eyelashes. Oils and other products normally secreted by the eye and eyelids build up on the lid surface and eyelashes resulting in eye irritation and often redness. It's a common disorder and occurs in two forms:

  • Anterior Blepharitis - this is when the inflammation affects the outside front edge of your eyelids, where your eyelashes are connected. Two possible causes are bacterial infection - (Staph) and Seborrhoeic
  • Posterior Blepharitis - this is when the inflammation affects the inside front edge of your eyelids, where they come into contact with your eye. This is caused when something affects the glands that are found at the rim of your eyelids, for example skin conditions such as seborrhoeic dermatitis or acne rosacea.Reoccurrence is common and may lead to Trichiasis

How Common is it ?

  • 8% of Population suffer from Blepharitis on a chronic basis
  • 60% of patients with Dry Eye, also have Blepharitis
  • MGD - is perhaps more prevelent

Causes

  • Allergies
  • Seborrheic (Dandruff)
  • Bacterial infections (Staph Infection)
  • Demodex mites- these are intradermal parasites, which thrive in follicles and sebaceous glands of humans and animals and is spread by direct contact and probably by dust containing eggs. Currently, it is thought that pathological changes in the course of demodicosis of the eyelids can cause:
    • blockage of follicles and leading out tubules of sebaceous glands by the mites and by reactive hyperkeratinization and epithelial hyperplasia;
    • a mechanical vector role of bacteria;
    • host's inflammatory reaction to the presence of parasite's chitine as a foreign body; and
    • stimulation of the host's humoral responses and cell-mediated immunological reactions under the influence of the mites and their waste products.

It has been established that an Infection of Demodex often occurs in the course of chronic Blepharitis

M.G.D.

Meibomian gland dysfunction (MGD) is a chronic, diffuse abnormality of the meibomian glands, commonly characterized by terminal duct obstruction and/or qualitative/ quantitative changes in the glandular secretion. It may result in alteration of the tear film, symptoms of eye irritation, clinically apparent inflammation, and ocular surface disease.

Although the etiology of MGD may differ from that of aqueous deficient dry eye disease (which is due to insufficient lacrimal gland production), the two conditions share many clinical features, including symptoms of ocular surface irritation and visual fluctuation, altered tear film stability, and potential ocular surface compromise. When the severity of MGD is of a sufficient degree, it may give rise to the second major subtype of dry eye disease, evaporative dry eye. These subtypes are not mutually exclusive.

Diagnosis

  • Blepharitis can be usually diagnosed by an Eye Specialist based on the history as given by the patient and physical examination.
  • The history should include a discussion of symptoms that the patient is experiencing and the presence of any general health problems that may be contributing to the eye problem.
  • The physical examination should place special emphasis on evaluation of the eyelids, lid margins, base of the lashes, oil gland openings, tear quantity and quality, and front surface of the eyeball using a slit lamp, which allows a magnified view with sufficient illumination.
  • A differentiation among the various types of blepharitis can often be made based on this examination, and appropriate treatment can be suggested.
  • Occasionally, cultures are taken - swabbing the discharge and sending this to the laboratory to look for specific organisms. In some cases, an allergy evaluation may be required.

Blepharitis