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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
  • Prognosis
    • good to excellent
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
Complications
  • Corneal infection

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