Blepharitis

Blepharitis is an inflammatory eyelid condition caused by chronic staphylococcal infection and malfunction of the meibomian (lipid) glands. It can cause secondary conjunctivitis and dry eye and occasionally small corneal ulcers.

Symptoms

A gradual onset or chronic history of:

  • Gritty / sore eye
  • Crusting on lashes 
  • Red eyes

Signs

  • Red rimmed, thickened lid margins +/- mild to severe crusting on the eyelashes  
  • Blocked or oozing meibomian glands  
  • Red conjunctiva in some
  • Eye examination
  • Observe lid margins, conjunctiva and cornea with white light
  • Instil 1 drop of proxymetacaine 0.5% with fluorescein 0.25%
  • Observe for corneal staining (preferably using a blue light source)

Treatment

  • Give patient blepharitis information leaflet
  • Eyelid hygiene (explain to patient how to perform this)
  • If severe blepharitis, prescribe chloramphenicol ointment 1% bd for one week, to be applied to eye lid margins after cleaning
  • Ensure patient is informed it is a chronic condition and the need for them to clean their lids twice a day once current inflammation has settled
  • Review as appropriate

Lid massage and hygiene

  1. Warm compress: apply a warm compress (flannel under hot water, wrung out and applied to lid for 1 minute) where time permits
  2. Lid massage: using a finger or a cotton bud firmly stroke the skin of the lids towards the lashes, i.e. downwards for the top lid and upwards for the bottom lid, massaging the whole width of the eyelids – this helps unblock the meibomian glands and expresses the oils
  3. Lid hygiene: pull the eyelid away from the eye with a finger and use a moist cotton bud to clean the posterior lid margins gently but firmly, then clean the root of the lashes more firmly with the bud; for the top lid, this is often best done with the eye closed