Blepharitis

Blepharitis is a common inflammatory condition of the eyelid margins. It often affects the anterior lid margin where the eyelashes meet the lid, or the posterior margin where the meibomian glands open. The condition can be chronic with periods of flare and is more common in adults, though it can occur at any age.

Signs and symptoms include redness and swelling of the eyelids, burning or stinging, itching, a gritty or foreign-body sensation, tearing, and crusting or scaling along the lash line. Patients may wake with sticky lids, and recurrent styes can occur. On examination, there may be lid-margin irregularities, telangiectasia, lash loss, and problems with meibomian gland secretions.

Causes and risk factors commonly involve Staphylococcus aureus colonization, seborrheic dermatitis, rosacea, and meibomian gland dysfunction. Contributing factors include chronic eyelid inflammation, poor lid hygiene, and contact dermatitis. Blepharitis is often a long-standing condition with episodic exacerbations and is not primarily an infection, though bacteria can contribute to symptoms.

Diagnosis is usually clinical, based on history and slit-lamp examination of the lid margins, meibomian glands, tear film, and ocular surface. It is important to rule out conjunctivitis, styes, chalazia, and other eyelid or ocular surface diseases, and to assess for underlying skin conditions such as rosacea.

Management focuses on eyelid hygiene: regular warm compresses and lid cleansing with dilute cleansers or commercial lid scrubs. For anterior blepharitis, topical antibiotics may be used briefly. For posterior blepharitis or meibomian gland dysfunction, oral antibiotics such as doxycycline or minocycline are commonly prescribed for several weeks. Lubricating eye drops or gels can help, and treatment of associated skin conditions may reduce recurrence. Prognosis varies with adherence to hygiene and control of underlying factors.