Blepharitis

Definition/diagnostic criteria Blepharitis is a common, chronic bilateral inflammatory condition of the eyelid margins. It is characterised by eyelid-margin erythema, telangiectasia and accumulation of debris along the lashes. The condition can be categorised as anterior blepharitis (involving the base of the eyelashes) and posterior blepharitis (affecting the meibomian glands).

Epidemiology Blepharitis is a common condition, although its exact prevalence in the UK is not precisely known due to variations in its definition and diagnosis. It is recognised as one of the most common ocular conditions encountered by both GPs and ophthalmologists. Blepharitis can affect all ages but is more frequent in older adults.

Diagnosis
Clinical features: Patients typically present with symptoms including burning sensation, grittiness, itching and redness of the eyelids. They may also complain of crusting or scaling at the base of the eyelashes. In anterior blepharitis, crusts and scales are visible around the eyelashes, while in posterior blepharitis, there is often meibomian gland dysfunction, leading to abnormal secretions.

Investigations: Diagnosis is primarily clinical. Biomicroscopy can be used to examine the eyelid margins, meibomian glands, and quality of the tear film. In cases of suspected secondary infection, bacterial culture from the eyelid margin may be considered.

Treatment Initial management includes eyelid hygiene measures such as warm compresses and lid margin cleaning with diluted baby shampoo or commercially available lid-cleaning solutions. For more persistent or severe cases, topical antibiotics such as chloramphenicol or fusidic acid may be prescribed. In cases of posterior blepharitis associated with meibomian gland dysfunction, oral tetracyclines (e.g., doxycycline) can be effective.

Patients with blepharitis also often benefit from artificial tears to alleviate symptoms of dry eyes.

Prognosis Blepharitis is a chronic condition with a relapsing course. While it is generally not sight threatening, it can significantly affect quality of life. Good control can often be achieved with ongoing lid hygiene and appropriate treatment. However, patients should be counselled about the chronic nature of the disease and the need for long-term management.

Further reading

Published: 31st July 2022 Updated: 15th February 2024

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Nursing in Practice Reference is based on the best-selling book Symptom Sorter. The experts behind Nursing in Practice Reference are Marilyn Eveleigh who is Nursing in Practice’s editorial advisor and a primary care nurse in East Sussex, Dr Keith Hopcroft who is the co-author of Symptom Sorter, a GP in Essex and Pulse editorial advisor and Dr Poppy Freeman, a GP in Camden and also a clinical advisor to Pulse.