Blepharitis

Signs/Symptoms

  • Presenting complaining of dry irritating eyes
  • Red lid margins
  • Crusting of lid margins/flakes visible on eyelashes particularly towards the roots
  • Recurrent styes/ chalazion
  • Watery eyes
  • Burning/itchy sensation
  • Constant foreign body sensation
  • Complaint of eyelids stuck together in the mornings

Causes

Blepharitis is an extremely common condition and regularly seen in practice. It affects patients of all ages but more common in patients over the age of 60 years. Often patients will present with symptoms of dry, irritable eyes

There are different types of blepharitis – staphylococcal, seborrheic and posterior and the condition is often linked to Meibomian gland dysfunction hence the dry eye symptoms.

This picture shows mildly inflamed lid margins with visible “crusting” of the eye lashes indicated by the blue arrow. The yellow arrow points to a blocked Meibomian gland.

Treatment:

  • Good lid hygiene- regular washing of the eyelids at least twice daily
  • Over the counter lid wipes are very effective
  • Hot compresses/heat bags can help to unblock glands to ease dry eye symptoms and when combined with lid wipes are effective treatment
  • Cleaning with baby shampoo was a previous common recommendation but has been superseded by the advice above.
  • If the above haven’t worked after six weeks or the symptoms worsen then routine referral to GP for antibiotic treatment may be appropriate. The GP may prescribe chloramphenicol 1% ointment to reduce the bacterial load on the eyelids which should be combined with lid hygiene.
  • Dry eye symptoms can be relived with over-the-counter lubricating drops and ointments.

Red Flags

  • Increasing eye pain
  • Reduced vision
  • Photophobia
  • Possible ulcer caused by infection
  • Increasing red eye

When one or more of these red flags is raised, a conversation with another registrant in practice should take place following which appropriate referral or management should be actioned and noted. If there are no other registrants in practice then contact should be made with colleagues elsewhere or contact should be made for advice to the local Hospital Eye Service (HES).