Blepharitis

Clinical Features

• sore/itchy
• inflammation of lid margin with ocular irritation, matted lashes
• Distinguish anterior from posterior blepharitis using slit lamp
  • Posterior - swelling and pluggin of meibomian gland openings
  • Anterior - on external exam, material such as greasy flakes (seborrheic) or hard crust (staph) surrounds eyelashes

Differential Diagnosis

Periorbital swelling

Proptosis

• Normal IOP
  • Orbital cellulitis
  • Orbital pseudotumor
  • Orbital tumor
• Increased IOP
  • Retrobulbar abscess
  • Retrobulbar emphysema
  • Retrobulbar hemorrhage
  • Orbital tumor

No proptosis

• Periorbital cellulitis/erysipelas
• Dacryocystitis (lacrimal duct)
• Dacryocele/Dacryocystocele
• Dacryostenosis
• Dacryoadenitis (lacrimal gland)
• Allergic reaction
• Nephrotic Syndrome (pediatrics)

Lid Complications

• Blepharitis (crusts)
• Chalazion (meibomian gland)
• Stye (hordeolum) (eyelash folicle)

Other

• Subperiosteal abscess
• Orbital abscess
• Cavernous sinus thrombosis
• Conjunctivitis
• Contact dermatitis
• Herpes zoster
• Herpes simplex
• Sarcoidosis
• Granulomatosis with polyangiitis

Evaluation

• Clinical diagnosis

Management

• Lid hygiene most important for both anterior and posterior blepharitis
• Warm compresses 15min 4x/day
• Scrub with mild shampoo BID
• Consider topical erythromycin or bacitracin directly onto lid margin
• No conclusive evidence for oral antibiotics or topical steroids

Disposition

• Outpatient optho - chronic condition without definitive cure

See Also

• Red Eye (Bilateral)

References

Authors

Kevin Lu, Ross Donaldson, Claire, Daniel Ostermayer, Neil Young