One of the most common eyelid problems is blepharitis, or inflammation of the eyelid margin. Patients typically experience itching, burning, mild foreign-body sensation, tearing and crusting around the eyes on awakening. On examination, the eyelid margins are erythematous, and thickened with crusts and debris within the lashes
Conjunctival injection or a mild mucus discharge may be present. Blepharitis occurs with chronic bacterial lid infection, meibomian gland dysfunction, seborrhea and acne rosacea that affects the eye, known as ocular rosacea.1 The diagnosis of rosacea is supported by the presence of dilated telangiectatic blood vessels on the lid margins, cheeks, nose and chin.
Treatment of blepharitis consists initially of warm compresses, eyelid scrubs and application of antibiotic ointment. Warm compresses should be applied for 15 minutes twice a day. This step loosens irritating crusts in the eyelashes and melts the oil produced by the meibomian glands, which can occlude the gland orifices. The eyelids should be scrubbed after the warm compress is removed. Baby shampoo mixed with water produces a soapy solution. With the eyelids closed, the eyelid margin region should be gently scrubbed with this solution, using a cotton-tipped applicator, wash cloth or finger. Erythromycin or another antibiotic ointment should then be applied to the lid margin. The ointment should be applied only at bedtime, because it may temporarily blur vision. If an obvious infection is present, antibiotic eye-drops may also be used.
If the condition is unresponsive to treatment, eyelid cultures should be obtained to rule out the possibility of resistant organisms. Oral antibiotics may be used in such cases, or in patients with the diagnosis of ocular rosacea. If severe, blepharitis may result in corneal infiltrates or ulcers. Rarely, sebaceous cell carcinoma may masquerade as unilateral or bilateral intractable blepharitis.
Patients must be cautioned that blepharitis is a chronic disease and that eyelid hygiene may need to be continued indefinitely. When the process is brought under better control, once-daily eyelid scrubs may be sufficient to keep the problem in check.