Blepharitis is an inflammation of the eyelid, usually localised on the inner part around the Meibomian glands (posterior blepharitis) or at the base of the eyelashes (anterior blepharitis). Meibomian glands (modified sebaceous glands) secrete the oily layer in the tear film which is essential for eye lubrication. Inflammation may be associated with changes in keratinisation in the glands, causing them to produce lipids with altered composition, resulting in toxic effects on the eye surface, a unstable tear film and an environment facilitating bacterial growth. In anterior blepharitis, Staphylococci and Demodex seem to play a role. Chronic skin diseases such as rosacea, seborrhoeic dermatitis, eczema and psoriasis may predispose one to blepharitis. (Contact) allergens and cigarette smoking may trigger or exacerbate it. Blepharitis occurs mostly bilaterally, sometimes asymmetrical. It is a clinical diagnosis. Blepharitis tends to recur.
Symptoms are red or pink swollen eyelids with a scaling of the skin and crusts around the eyelashes. Burning or itchy sensations and excessive tearing may occur. Eyelid hygiene is the most important aspect in the treatment of blepharitis. Irritants and allergens (e.g. cosmetics and contact lenses) should be avoided. Artificial tear eye drops are often needed for associated symptoms of dry eyes. Topical antibiotics are advised when initial treatment fails after a few weeks. Referral to an ophthalmologist is needed only in severe cases.
Blepharitis should be distinguished from conjunctivitis, in which there is erythema of the eye instead of the eyelid. However, the two conditions can occur together.
Hordeolum and chalazion are unilateral nodular lesions of the eyelid. Both are diagnosed based on the typical clinical picture.
A hordeolum (stye) is an acute inflammation of a gland in the internal or external surface of the upper or lower eyelid, often caused by bacteria (mostly Staphylococcus aureus). It presents as a tender, swollen, erythematous nodulus, which may be purulent. Often spontaneous improvement occurs within two weeks but warm compresses may help to accelerate perforation, resulting in pain relief. (Topical) antibiotics are usually not necessary but preseptal (preorbital) cellulitis is a relatively rare but serious infection and requires oral antibiotics.
A chalazion is a sterile lipogranuloma caused by an obstructed Meibomian gland. It presents as a subcutaneous swelling in the eyelid, most commonly the upper eyelid. The swelling is painless, firm and often small in size. Typically, spontaneous improvement occurs after several months. Warm compresses and massage can facilitate drainage of the obstructed gland. Therapeutic options for chalazia that do not improve spontaneously are intralesional corticosteroid injection or surgical removal. These can be performed by a GP with sufficient expertise or by the ophthalmologist after referral.