Blepharitis classification
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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
In 1992, Wilhelmus described a clinically useful approach to classify blepharitis based on the affected location of the lid margin delineated by the gray line (the muscle of Riolan).[1] The gray line divides the lid margin into an anterior lamella (skin, muscle, eyelash follicles, and glands of Zeis) and a 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:[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
- 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.
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
- Acute ulcerative blepharitis is usually 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 sensitivity (e.g., dermatoblepharoconjunctivitis).
- Chronic blepharitis
- Chronic blepharitis is the 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 normal tear osmolarity
- Obstructive
- Characterized by low excretion, high gland drop-out and increased tear osmolarity, but normal Schirmer test
- Obstructive with sicca
- Characterized by low excretion, high gland drop-out and increased tear osmolarity, and a low Schirmer test
- Sicca
- Characterized by normal gland morphology, increased tear osmolarity, and low Schirmer test.
References
- ↑ Wilhelmus, K. R. "Inflammatory disorders of the eyelid margins and eyelashes." Ophthalmol Clin North Am 5.2 (1992): 187.
- ↑ Keith, C. G. "Seborrhoeic blepharo-kerato-conjunctivitis." Transactions of the ophthalmological societies of the United Kingdom 87 (1966): 85-103.
- ↑ Gutgesell, Vicki J., George A. Stern, and C. Ian Hood. "Histopathology of meibomian gland dysfunction." American journal of ophthalmology 94.3 (1982): 383-387.
- ↑ 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.
- ↑ Porter, Robert (2011). The Merck manual of diagnosis and therapy. Whitehouse Station, N.J: Merck Sharp & Dohme Corp. ISBN 978-0911910193.
- ↑ Mathers, William D., et al. "Meibomian gland dysfunction in chronic blepharitis." Cornea 10.4 (1991): 277-285.