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==Overview==
==Overview==
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 [[acute]] or [[chronic]].<ref name="pmid11153404">{{cite journal| author=Cheung J, Sharma S| title=Ophthaproblem. Blepharitis. | journal=Can Fam Physician | year= 2000 | volume= 46 | issue=  | pages= 2393, 2400 | pmid=11153404 | doi= | pmc=2145002 | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=11153404  }} </ref><ref name="pmid13274422">{{cite journal| author=THYGESON P, VAUGHAN DG| title=Seborrheic blepharitis. | journal=Trans Am Ophthalmol Soc | year= 1954 | volume= 52 | issue=  | pages= 173-88 | pmid=13274422 | doi= | pmc=1312591 | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=13274422  }} </ref><ref name="pmid19383269">{{cite journal| author=Lemp MA, Nichols KK| title=Blepharitis in the United States 2009: a survey-based perspective on prevalence and treatment. | journal=Ocul Surf | year= 2009 | volume= 7 | issue= 2 Suppl | pages= S1-S14 | pmid=19383269 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=19383269  }} </ref>
Blepharitis may be classified according to the affected lid structure delineated by the gray line (the muscle of Riolan) into anterior and posterior blepharitis. Blepharitis may be acute or chronic, depending on the acuity of onset and time course of clinical presentation. Alternatively, blepharitis can be classified based on [[meibomian gland]] morphology, tear [[osmolarity]], and [[Schirmer test]] result into (1) seborrheic, (2) obstructive, (3) obstructive with sicca, and (4) sicca.


==Classification==
==Classification==
Based on the anatomic location, blepharitis may be classified into:


'''Anterior blepharitis''' affects the front of the [[eyelids]] near the base of the [[eyelashes]], eyelid skin, and the eyelash follicles. Anterior blepharitis may be classified into:<ref name="pmid11153404">{{cite journal| author=Cheung J, Sharma S| title=Ophthaproblem. Blepharitis. | journal=Can Fam Physician | year= 2000 | volume= 46 | issue=  | pages= 2393, 2400 | pmid=11153404 | doi= | pmc=2145002 | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=11153404  }} </ref><ref name="pmid13274422">{{cite journal| author=THYGESON P, VAUGHAN DG| title=Seborrheic blepharitis. | journal=Trans Am Ophthalmol Soc | year= 1954 | volume= 52 | issue=  | pages= 173-88 | pmid=13274422 | doi= | pmc=1312591 | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=13274422  }} </ref>
===Classification by anatomic location===
*[[Staphylococcal]] blepharitis
A clinically useful approach is to classify blepharitis based on the affected location of the lid margin delineated by the gray line (the muscle of Riolan), which divides the area into the anterior lamella ([[skin]], [[muscle]], [[eyelash]] [[follicle]]s, and [[glands of Zeis]]) and posterior lamella ([[tarsus]], [[conjunctiva]], and [[meibomian glands]]). According to the affected lid structure and the location of the predominant inflammation, marginal blepharitis can be divided into:<ref>Wilhelmus, K. R. "Inflammatory disorders of the eyelid margins and eyelashes." Ophthalmol Clin North Am 5.2 (1992): 187.</ref><ref>Keith, C. G. "Seborrhoeic blepharo-kerato-conjunctivitis." Transactions of the ophthalmological societies of the United Kingdom 87 (1966): 85-103.</ref><ref>Gutgesell, Vicki J., George A. Stern, and C. Ian Hood. "Histopathology of meibomian gland dysfunction." American journal of ophthalmology 94.3 (1982): 383-387.</ref><ref>Foulks, Gary N., and Anthony J. Bron. "Meibomian gland dysfunction: a clinical scheme for description, diagnosis, classification, and grading." The ocular surface 1.3 (2003): 107-126.</ref>
*Seborrheic blepharitis
* '''Anterior blepharitis'''
'''Posterior blepharitis''' affects the back of the eyelids. It involves [[tarsal plate]], [[meibomian glands]], and [[gland orifices]].
:* Anterior blepharitis describes an [[inflammation]] of the lid margin anterior to the gray line and concentrated around the lashes. It may be accompanied by squamous debris or collarettes around the lashes, and [[inflammation]] may spill onto the posterior lid margin.
* '''Posterior blepharitis'''
:* Posterior blepharitis describes an [[inflammation]] of the posterior lid margin, which may have different causes, including [[meibomian gland dysfunction]], conjunctival [[inflammation]] (allergic or infective), and/or other conditions, such as [[acne rosacea]].


Blepharitis,may be classified based on the duration of symptoms into:<ref name="pmid19383269">{{cite journal| author=Lemp MA, Nichols KK| title=Blepharitis in the United States 2009: a survey-based perspective on prevalence and treatment. | journal=Ocul Surf | year= 2009 | volume= 7 | issue= 2 Suppl | pages= S1-S14 | pmid=19383269 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=19383269  }} </ref>
===Classification by time course===
Blepharitis can also be classified as acute or chronic, depending on the acuity of onset and time course of clinical presentation:<ref>{{cite book | last = Porter | first = Robert | title = The Merck manual of diagnosis and therapy | publisher = Merck Sharp & Dohme Corp | location = Whitehouse Station, N.J | year = 2011 | isbn = 978-0911910193 }}</ref>
* '''Acute blepharitis'''
:* Acute ulcerative blepharitis
::* Acute ulcerative blepharitis is typically caused by [[staphylococcal]] infection. It may also be caused by [[herpes simplex virus]] or [[varicella zoster virus]].
::* Acute nonulcerative blepharitis is usually caused by an [[allergic reaction]] (e.g., atopic blepharodermatitis and seasonal allergic blepharoconjunctivitis) or [[contact hypersensitivity]] (e.g., dermatoblepharoconjunctivitis).
* '''Chronic blepharitis'''
:* Chronic blepharitis refers to non-infectious inflammation of unknown cause.


'''Chronic blepharitis''' (Most often blepharitis is a waxing and waning chronic condition)
===Classification by meibomian gland morphology, tear osmolarity, and Schirmer test result===
 
Alternatively, blepharitis may be classified based on three objective criteria—[[meibomian gland]] morphology, tear [[osmolarity]], and [[Schirmer test]] result:<ref>Mathers, William D., et al. "Meibomian gland dysfunction in chronic blepharitis." Cornea 10.4 (1991): 277-285.</ref>
'''Acute blepharitis''' (usually allergen or irritant exposure)
* '''Seborrheic'''
:* Characterized by hypersecretion, normal gland morphology, and low or normal tear osmolarity
* '''Obstructive'''
:* Characterized by low excretion or high gland dropout on meibography, increased tear osmolarity, and normal Schirmer test result
* '''Obstructive with sicca'''
:* Characterized by low excretion or high gland dropout on meibography, increased tear osmolarity, and low Schirmer test result
* '''Sicca'''
:* Characterized by normal gland morphology, increased tear osmolarity, and low Schirmer test result


==References==
==References==
{{reflist|2}}
{{reflist|2}}


[[Category:Infectious disease]]
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[[Category:Up-To-Date]]
[[Category:Ophthalmology]]
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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 may be classified according to the affected lid structure delineated by the gray line (the muscle of Riolan) into anterior and posterior blepharitis. Blepharitis may be acute or chronic, depending on the acuity of onset and time course of clinical presentation. Alternatively, blepharitis can be classified based on meibomian gland morphology, tear osmolarity, and Schirmer test result into (1) seborrheic, (2) obstructive, (3) obstructive with sicca, and (4) sicca.

Classification

Classification by anatomic location

A clinically useful approach is to classify blepharitis based on the affected location of the lid margin delineated by the gray line (the muscle of Riolan), which divides the area into the anterior lamella (skin, muscle, eyelash follicles, and glands of Zeis) and posterior lamella (tarsus, conjunctiva, and meibomian glands). According to the affected lid structure and the location of the predominant inflammation, marginal blepharitis can be divided into:[1][2][3][4]

  • Anterior blepharitis
  • Anterior blepharitis describes an inflammation of the lid margin anterior to the gray line and concentrated around the lashes. It may be accompanied by squamous debris or collarettes around the lashes, and inflammation may spill onto the posterior lid margin.
  • Posterior blepharitis

Classification by time course

Blepharitis can also be classified as acute or chronic, depending on the acuity of onset and time course of clinical presentation:[5]

  • Acute blepharitis
  • Acute ulcerative blepharitis
  • Chronic blepharitis
  • Chronic blepharitis refers to non-infectious inflammation of unknown cause.

Classification by meibomian gland morphology, tear osmolarity, and Schirmer test result

Alternatively, blepharitis may be classified based on three objective criteria—meibomian gland morphology, tear osmolarity, and Schirmer test result:[6]

  • Seborrheic
  • Characterized by hypersecretion, normal gland morphology, and low or normal tear osmolarity
  • Obstructive
  • Characterized by low excretion or high gland dropout on meibography, increased tear osmolarity, and normal Schirmer test result
  • Obstructive with sicca
  • Characterized by low excretion or high gland dropout on meibography, increased tear osmolarity, and low Schirmer test result
  • Sicca
  • Characterized by normal gland morphology, increased tear osmolarity, and low Schirmer test result

References

  1. Wilhelmus, K. R. "Inflammatory disorders of the eyelid margins and eyelashes." Ophthalmol Clin North Am 5.2 (1992): 187.
  2. Keith, C. G. "Seborrhoeic blepharo-kerato-conjunctivitis." Transactions of the ophthalmological societies of the United Kingdom 87 (1966): 85-103.
  3. Gutgesell, Vicki J., George A. Stern, and C. Ian Hood. "Histopathology of meibomian gland dysfunction." American journal of ophthalmology 94.3 (1982): 383-387.
  4. Foulks, Gary N., and Anthony J. Bron. "Meibomian gland dysfunction: a clinical scheme for description, diagnosis, classification, and grading." The ocular surface 1.3 (2003): 107-126.
  5. Porter, Robert (2011). The Merck manual of diagnosis and therapy. Whitehouse Station, N.J: Merck Sharp & Dohme Corp. ISBN 978-0911910193.
  6. Mathers, William D., et al. "Meibomian gland dysfunction in chronic blepharitis." Cornea 10.4 (1991): 277-285.