Snapshot A 54-year-old man presents to his primary care physician with eyelid itching. His symptom is associated with a "burning" sensation along with eyelid swelling. Physical examination is notable for redness and irritation of the eyelid margin and with crusting on the lid margin. He is recommended to apply warm compresses, lid massage, and lid washing. Introduction Overview inflammation of the eyelid margin Pathophysiology Posterior blepharitis inflammation of the inner eyelid at the level of the meibomian glands hyperkeratinization of the meibomian gland duct leads to altered lipid composition of the gland secretion favors bacterial growth, leading to an inflammatory response in the posterior eyelid Anterior blepharitis inflammation at the bases of the eyelashes can be due to Staphylococcus aureus or coagulase-negative staphylococci mechanism is unclear Presentation Symptoms transient blurred vision that improves with blinking red, swollen, or pruritic eyes gritty or burning sensation crusting of the eyelashes Physical exam pink or irritated eyelids eyelid swelling crusting/flakes of the lashes conjunctival injection (common) Differential Conjunctivitis differentiating factors erythema of the eye rather than the eyelids Hordeolum differentiating factors infectious nodule/bump in the eyelid note that hordeolum can be associated with blepharitis Treatment Lifestyle eyelid hygiene indication mainstay of treatment Medical topical antibiotics indication cases refractory to conservative therapy oral antibiotics indication cases refractory to topical antibiotics Prognosis Good to excellent