Blepharitis (Blefarite)

Blepharitis is a noncontagious inflammation of the eyelids that usually affects the lower part of the lid and eyelashes. It is usually characterized by excess oil production in the meibomian glands near the eyelid, which creates a favorable environment for bacterial growth. Repeated occurrences of styes or hordeolum (inflammation of the eyelid's sebaceous gland) and chalazia (swelling that results from a blockage of the meibomian glands) are also associated with blepharitis.
Blepharitis does not usually affect vision or damage the eye. It is a chronic, manageable condition in most cases. If left untreated, it can lead to a more serious condition called ulcerative blepharitis. This is usually caused by a bacterial infection and can cause loss of eyelashes, eyelid scarring, and inflammation of the cornea.
Incidence and Prevalence Blepharitis is a common eye disorder throughout the world. It affects people of all ages, but blepharitis caused by seborrhea is seen more frequently in older patients.
Risk Factors
Chronic blepharitis is often linked to occupations in which the hands are dirty for much of the day. Poor hygiene is also a risk factor. Seborrheic dermatitis of the face or scalp is also a common risk factor. Dermatitis caused by herpes simplex, varicella-zoster virus, allergies, and staphylococcus may also cause blepharitis. It has also been associated with rosacea.
Drugs and allergens can cause acute blepharitis. Chronic cases can be aggravated by environmental irritants such as exposure to chemical fumes, smoke, and smog.
Causes
Blepharitis is usually caused by seborrheic dermatitis (a skin disorder that causes itching, flaking, and inflammation) or a bacterial infection. Infections are usually caused by staphylococcus bacteria, which live on human skin and usually cause no harm. When this bacteria causes blepharitis, the normal cycle of the bacterial colonies has usually been altered by excess oil production. Blepharitis can also be caused by allergies or lice infestation in the eyelashes.
Signs and Symptoms:
Symptoms include itching, burning, and redness around the edge of the eyelids in both eyes, excessive tearing, and a loss of eyelashes. Blepharitis associated with seborrhea often causes greasy, easily removable scales ("dandruff") on the eyelid, close to the lash line. Other symptoms of seborrheic blepharitis are feeling that a foreign object is in the eye or a sandy or gritty sensation.
With ulcerative blepharitis, small pustules that eventually crust and bleed develop in the follicles of the eyelashes. Lashes are often stuck together by dried secretions upon awakening. In some cases, it can also cause dry eyes, resulting from an imbalance in the quantity and/or quality of the tears.
Diagnosis:
Routine examination of the eyelids and eyelashes is usually sufficient to diagnose blepharitis. A slit lamp microscope is used for more detailed inspection. This is a microscope with an attached light that allows the doctor to examine the eye under high magnification and is used for examination of the cornea, iris, and lens.
Treatment:
Carefully cleaning the eyelids is usually all that is needed to control symptoms and prevent complications.
The edges of the eyelids can be gently scrubbed with tearless shampoo using a cotton-tipped applicator or lint-free washcloth wrapped around the index finger. The eyelids may need to be cleaned several times a day until symptoms clear up. Warm compresses applied to the eyelids can loosen crusted secretions.
Sometimes the doctor prescribes a specially formulated eyelid cleanser to clear the lash area of crusts and scaling. For severe cases, especially those associated with bacterial infection, a topical antibiotic ointment may be prescribed. Corticosteroid ointments provide short-term relief. In stubborn cases, oral antibiotics might be prescribed. Antibiotic and steroid drops may be used to treat inflammation that has spread to the cornea.
If lice are the cause, petroleum jelly can be applied along the base of the eyelashes to eliminate them.
Prevention:
Keeping the eyelids, scalp, and face clean is the most effective way to prevent blepharitis and its recurrence. Avoiding exposure to smoke and chemical fumes and obtaining treatment for skin disorders like rosacea and seborrhea also helps prevent blepharitis.