Blepharitis overview
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Sara Mehrsefat, M.D. [2]
Overview
Blepharitis is characterized by inflammation of the eyelid margins. Blepharitis may be classified according to the anatomic location of the disease into 2 subtypes: anterior and posterior. Additionally, blepharitis may be classified based on the duration of symptoms into either acute or chronic.[1] The exact pathogenesis of blepharitis is not fully understood. It is thought that blepharitis is caused by either bacterial colonization (Staphylococcus aureus or Staphylococcus epidermidis) in the eyelids or meibomian gland dysfunction. Blepharitis may also caused by allergens and mites that affect the eyelashes.[2] Blepharitis must be differentiated from conjunctivitis, trichiasis, dry eye syndrome, keratitis, hordeolum, and chalazion.[3] Blepharitis is usually asymptomatic until the disease progresses. As it progresses, the patient begins to notice a foreign body sensation, itching, irritation, and crusting of the eyelids. Blepharitis can frequently be improved but is rarely eliminated. If left untreated, severe blepharitis may cause loss of eyelashes, scarring of the eyelids, corneal involvement, and ultimately blindness. Common complications of blepharitis include loss of eyelashes, hordeolum, chalazion, corneal ulcer, and conjunctivitis. Blepharitis is associated with a favorable long-term prognosis.[4] Physical examination of patients with blepharitis is usually remarkable for irritated eyelid edges, crusting of the lashes, entropion, ectropion, poliosis, and diffuse conjunctival injection.[5] In general, blepharitis is diagnosed based on clinical features alone. There are no diagnostic lab findings associated with blepharitis. Blepharitis is diagnosed based on clinical features alone.[5][6] Eyelid hygiene and regular cleaning are the mainstay of therapy for blepharitis. Antimicrobial topical therapy may be indicated in some cases depending on the causative pathogen and the underlying cause.[7]
Historical Perspective
Blepharitis was first described in the late 19th century as "conjunctivitis meibomianae" in a patient with accumulated sebaceous-like material in the meibomian glands.[3]
Classification
Blepharitis may be classified according to the anatomic location of the disease into 2 subtypes: anterior and posterior. Additionally, blepharitis may be classified based on the duration of symptoms into either acute or chronic.[1]
Pathophysiology
The exact pathogenesis of blepharitis is not fully understood. It is thought that blepharitis is caused by either bacterial colonization (Staphylococcus aureus or Staphylococcus epidermidis) in the eyelids or meibomian gland dysfunction. Blepharitis may also caused by allergens and lice that affect the eyelashes.[2][8]
Causes
Common causes of blepharitis include bacterial infections, dysfunctional meibomian glands, allergies (less common), and Demodex folliculorum (small parasitic mites).[3]
Differentiating Blepharitis from other Diseases
Blepharitis must be differentiated from allergic contact dermatitis, conjunctivitis, trichiasis, dry eye syndrome, keratitis, hordeolum, chalazion, rosacea, and sebaceous carcinoma.[9]
Epidemiology and Demographics
Blepharitis is one of the most common ocular disorders encountered in clinical practice. Up to 20,000 per 100,000 adults over the age of 45 report some discomfort from blepharitis and meibomian gland dysfunction (MGD).[10]
Risk Factors
Common risk factors in the development of blepharitis are dry eye syndrome, dermatologic conditions (acne rosacea, seborrheic dermatitis), demodicosis (chronic blepharitis), lice, and allergies.[11][12][13]
Screening
Screening for blepharitis is not recommended.[14]
Natural History, Complications and Prognosis
Blepharitis is usually asymptomatic until the disease progresses. As it progresses, the patient begins to notice a foreign body sensation, itching, irritation, and crusting of the eyelids. Blepharitis can frequently be improved but are rarely eliminated. If left untreated, severe blepharitis may cause alterations in the eyelid margin, loss of eyelashes, scarring of the eyelids, conjunctivitis, corneal involvement, superficial keratopathy, and ultimately blindness. Common complications of blepharitis include loss of eyelashes, hordeolum, chalazion, corneal ulcer, and conjunctivitis. In general, blepharitis is associated with a favorable long-term prognosis. Severe blepharitis is rarely associated with permanent alterations in the eyelid margin or vision loss from superficial keratopathy. Therefore, severe blepharitis is associated with a poor prognosis.[4]
Diagnosis
History and Symptoms
A detailed and thorough history from the patient is necessary. Specific areas of focus when obtaining a history from the patient include history of smoking, use of retinoids, prior history of acne rosacea, and history of seborrheic dermatitis. Common symptoms of blepharitis include red, swollen,and itchy eyelids, burning sensation, crusting or matting of eyelashes in the morning, light sensitivity, blurred vision, and oily skin.[15][16]
Physical Examination
Physical examination of patients with blepharitis is usually remarkable for irritated eyelid edges, hard crusting of the lashes, entropion, ectropion, poliosis, and diffuse conjunctival injection.[5]
Laboratory Findings
There are no diagnostic lab findings associated with blepharitis. Blepharitis is diagnosed based on clinical features alone. Culture of eyelid margins may be indicated for some patients with blepharitis who have recurrent anterior blepharitis with severe inflammation, as well as patients who are not responding to therapy.[5][6]
Other imaging findings
Posterior blepharitis overlaps with meibomian gland dysfunction (MGD). Dynamic meibomian imaging (DMI) can be used to obtain a distinct picture of the entire everted inferior tarsal plate in a patient with blepharitis.[17][18] There are no electrocardiogram, X ray, CT scan, MRI, and ultrasound findings associated with blepharitis.
Other diagnostic studies
Other diagnostic studies for blepharitis include Slit lamp examination, tear break up time (TBUT), and measurement of tear osmolarity.[18][19][20]
Treatment
Medical Therapy
Eyelid hygiene and regular cleaning are the mainstay of therapy for blepharitis. Antimicrobial topical therapy may be indicated in some cases depending on the causative pathogen and the underlying cause.[7]
Surgery
Surgery is not the firstline treatment option for patients with blepharitis. Surgery is usually reserved for patients with complications, such as chalazion, entropion, ectropion, or horizontal eyelid laxity.[7][21]
Primary Prevention
Effective measures for the primary prevention of blepharitis include good self-hygiene and anti-dandruff shampoo.[22] [23]
Secondary Prevention
Secondary prevention strategies following blepharitis include good self-hygiene, anti-dandruff shampoo, removing eye makeup before bedtime, and avoiding eyeliner.[24]
References
- ↑ 1.0 1.1 Cheung J, Sharma S (2000). "Ophthaproblem. Blepharitis". Can Fam Physician. 46: 2393, 2400. PMC 2145002. PMID 11153404.
- ↑ 2.0 2.1 Bunya VY, Brainard DH, Daniel E, Massaro-Giordano M, Nyberg W, Windsor EA; et al. (2013). "Assessment of signs of anterior blepharitis using standardized color photographs". Cornea. 32 (11): 1475–82. doi:10.1097/ICO.0b013e3182a02e0e. PMC 3947496. PMID 24055901.
- ↑ 3.0 3.1 3.2 Lemp MA, Nichols KK (2009). "Blepharitis in the United States 2009: a survey-based perspective on prevalence and treatment". Ocul Surf. 7 (2 Suppl): S1–S14. PMID 19383269.
- ↑ 4.0 4.1 Nemet AY, Vinker S, Kaiserman I (2011). "Associated morbidity of blepharitis". Ophthalmology. 118 (6): 1062–8. doi:10.1016/j.ophtha.2010.10.015. PMID 21276617.
- ↑ 5.0 5.1 5.2 5.3 Jackson WB (2008). "Blepharitis: current strategies for diagnosis and management". Can J Ophthalmol. 43 (2): 170–9. doi:10.1139/i08-016. PMID 18347619.
- ↑ 6.0 6.1 McCulley JP, Shine WE (2000). "Changing concepts in the diagnosis and management of blepharitis". Cornea. 19 (5): 650–8. PMID 11009317.
- ↑ 7.0 7.1 7.2 Geerling G, Tauber J, Baudouin C, Goto E, Matsumoto Y, O'Brien T; et al. (2011). "The international workshop on meibomian gland dysfunction: report of the subcommittee on management and treatment of meibomian gland dysfunction". Invest Ophthalmol Vis Sci. 52 (4): 2050–64. doi:10.1167/iovs.10-6997g. PMC 3072163. PMID 21450919.
- ↑ Dougherty JM, McCulley JP (1986). "Bacterial lipases and chronic blepharitis". Invest Ophthalmol Vis Sci. 27 (4): 486–91. PMID 3957566.
- ↑ Mathers WD, Choi D (2004). "Cluster analysis of patients with ocular surface disease, blepharitis, and dry eye". Arch Ophthalmol. 122 (11): 1700–4. doi:10.1001/archopht.122.11.1700. PMID 15534133.
- ↑ Macsai MS (2008). "The role of omega-3 dietary supplementation in blepharitis and meibomian gland dysfunction (an AOS thesis)". Trans Am Ophthalmol Soc. 106: 336–56. PMC 2646454. PMID 19277245.
- ↑ McCulley JP, Dougherty JM (1985). "Blepharitis associated with acne rosacea and seborrheic dermatitis". Int Ophthalmol Clin. 25 (1): 159–72. PMID 3156100.
- ↑ Bhandari V, Reddy JK (2014). "Blepharitis: always remember demodex". Middle East Afr J Ophthalmol. 21 (4): 317–20. doi:10.4103/0974-9233.142268. PMC 4219223. PMID 25371637.
- ↑ Bowman RW, Dougherty JM, McCulley JP (1987). "Chronic blepharitis and dry eyes". Int Ophthalmol Clin. 27 (1): 27–35. PMID 3818198.
- ↑ American Academy of Ophthalmology/eyewiki (2014) http://eyewiki.org/Blepharitis Accessed on July 14, 2016
- ↑ Pelletier JS, Stewart KP, Capriotti K, Capriotti JA (2015). "Rosacea Blepharoconjunctivitis Treated with a Novel Preparation of Dilute Povidone Iodine and Dimethylsulfoxide: a Case Report and Review of the Literature". Ophthalmol Ther. 4 (2): 143–50. doi:10.1007/s40123-015-0040-4. PMC 4675729. PMID 26525679.
- ↑ PubMed Health (2009) http://www.ncbi.nlm.nih.gov/pubmedhealth/PMHT0023008/ Accessed on July 13, 2016
- ↑ Schaumberg DA, Nichols JJ, Papas EB, Tong L, Uchino M, Nichols KK (2011). "The international workshop on meibomian gland dysfunction: report of the subcommittee on the epidemiology of, and associated risk factors for, MGD". Invest Ophthalmol Vis Sci. 52 (4): 1994–2005. doi:10.1167/iovs.10-6997e. PMC 3072161. PMID 21450917.
- ↑ 18.0 18.1 Driver PJ, Lemp MA (1996). "Meibomian gland dysfunction". Surv Ophthalmol. 40 (5): 343–67. PMID 8779082.
- ↑ Tomlinson A, Bron AJ, Korb DR, Amano S, Paugh JR, Pearce EI; et al. (2011). "The international workshop on meibomian gland dysfunction: report of the diagnosis subcommittee". Invest Ophthalmol Vis Sci. 52 (4): 2006–49. doi:10.1167/iovs.10-6997f. PMC 3072162. PMID 21450918.
- ↑ Bachmeyer C, Bégon E (2013). "Chronic blepharitis". Neth J Med. 71 (5): 259–63. PMID 23799315.
- ↑ Qiao J, Yan X (2013). "Emerging treatment options for meibomian gland dysfunction". Clin Ophthalmol. 7: 1797–803. doi:10.2147/OPTH.S33182. PMC 3772773. PMID 24043929.
- ↑ Benitez-Del-Castillo JM (2012). "How to promote and preserve eyelid health". Clin Ophthalmol. 6: 1689–98. doi:10.2147/OPTH.S33133. PMC 3484726. PMID 23118519.
- ↑ Guillon M, Maissa C, Wong S (2012). "Eyelid margin modification associated with eyelid hygiene in anterior blepharitis and meibomian gland dysfunction". Eye Contact Lens. 38 (5): 319–25. doi:10.1097/ICL.0b013e318268305a. PMID 22890229.
- ↑ Beare JM (1969). "Blepharitis and related conditions". Proc R Soc Med. 62 (1): 5–7. PMC 2279072. PMID 4236660.