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==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==
There are two types of Blepharitis:
# Anterior blepharitis affects the front of the eyelids near the eyelashes. The causes are [[seborrheic dermatitis]] (similar to[[dandruff]]) and occasional infection by [[Staphylococcus]] bacteria.
# Posterior blepharitis affects the back of the eyelids, the part that makes contact with the eyes. This is caused by the oil glands present in this region. It is by far, the most common type of blepharitis.
===Staphylococcal Blepharitis===
''Staphlycoccal blepharitis'' is a type of external eye inflammation.
As with dandruff, it is usually asymptomatic until the disease progresses.
As it progresses, the sufferer begins to notice a [[foreign body]] sensation, matting of the lashes, and burning.
Usually, the [[primary care]] [[physician]] will prescribe topical antibiotics for staphylococcal blepharitis. Unfortunately this is not an effective treatment.


This ailment can sometimes lead to a [[chalazion]] or a [[stye]].<ref name="Blepharitis, Syte and Chalazion">[http://www.uic.edu/com/eye/LearningAboutVision/EyeFacts/BlepharitisStyeChalazion.shtml]</ref>
===Classification by anatomic location===
===Seborrheic 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>
* '''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'''
:* 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]].


''Seborrheic blepharitis'', the most common type of blepharitis, is usually one part of the spectrum of seborrheic dermatitis[[seborrheic dermatitis|seborrhea]] which involves the [[scalp]], lashes, [[eyebrow]]s, nasolabial folds and [[ear]]s.
===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.


Treatment is best accomplished by a dermatologist.
===Classification by meibomian gland morphology, tear osmolarity, and Schirmer test result===
===Posterior Blepharitis or Rosacea Associated Blepharitis===
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>
The most common type of blepharitis is often found in people with a rosacea skin type. The oil glands in the lid (meibomian glands) secrete a modified oil which leads to inflammation at the gland openings which are found at the edge of the lid.
* '''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}}


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[[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.
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