Blepharitis is inflammation of the eyelid margins that may be acute or chronic. Symptoms and signs include itching and burning of the eyelid margins with redness and edema. Diagnosis is by history and examination. Acute ulcerative blepharitis is usually treated with topical antibiotics or systemic antivirals. Acute nonulcerative blepharitis is occasionally treated with topical corticosteroids. Chronic disease is treated with tear supplements, warm compresses, and occasionally oral antibiotics (eg, a tetracycline) for meibomian gland dysfunction or with eyelid hygiene and tear supplements for seborrheic blepharitis.

Blepharitis may be acute (ulcerative or nonulcerative) or chronic (meibomian gland dysfunction, seborrheic blepharitis).

In acute ulcerative blepharitis, small pustules may develop in eyelash follicles and eventually break down to form shallow marginal ulcers. Tenacious adherent crusts leave a bleeding surface when removed. During sleep, eyelids can become glued together by dried secretions. Recurrent ulcerative blepharitis can cause eyelid scars and loss or misdirection (trichiasis) of eyelashes.

In acute nonulcerative blepharitis, eyelid margins become edematous and erythematous; eyelashes may become crusted with dried serous fluid.

In meibomian gland dysfunction, examination reveals dilated, inspissated gland orifices that, when pressed, exude a waxy, thick, yellowish secretion. In seborrheic blepharitis, greasy, easily removable scales develop on eyelid margins. Most patients with seborrheic blepharitis and meibomian gland dysfunction have symptoms of keratoconjunctivitis sicca, such as foreign body sensation, grittiness, eye strain and fatigue, and blurring with prolonged visual effort.

Diagnosis is usually by slit-lamp examination. Chronic blepharitis that does not respond to treatment may require biopsy to exclude eyelid tumors that can simulate the condition.

Acute blepharitis most often responds to treatment but may recur, develop into chronic blepharitis, or both. Chronic blepharitis is indolent, recurrent, and resistant to treatment. Exacerbations are inconvenient, uncomfortable, and cosmetically unappealing but do not usually result in corneal scarring or vision loss.

Antimicrobials for acute ulcerative blepharitis; warm compresses and sometimes topical corticosteroids for acute nonulcerative blepharitis

For chronic blepharitis, treatment of keratoconjunctivitis sicca, warm compresses, cleansing of eyelids, and sometimes topical or systemic antibiotics as clinically indicated.

Common forms of blepharitis include acute ulcerative (often secondary to staphylococcal or herpes virus infection), acute nonulcerative (usually allergic), and chronic (often with meibomian gland dysfunction or seborrheic dermatitis).

Secondary keratoconjunctivitis sicca usually accompanies chronic blepharitis.

Common symptoms include itching and burning of the eyelid margins and conjunctival irritation with lacrimation, photosensitivity, and foreign body sensation.

Diagnosis is usually by slit-lamp examination.

Supportive treatments are indicated (eg, warm compresses, eyelid cleansing, and treatment of keratoconjunctivitis sicca as needed).

Specific treatments can include antimicrobials for acute ulcerative blepharitis and sometimes chronic blepharitis and topical corticosteroids for persistent acute nonulcerative blepharitis.

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