Blepharitis

Types

• Anterior Blepharitis:

  • Inflammation at the eyelid margins and eyelashes (outer edge)

  • Can be staphylococcal (crusting, scales at lash base) or seborrhoeic (greasy scales)

  • Often presents with redness, irritation, and possible lash debris

• Posterior Blepharitis:

  • Involves the meibomian glands (inner lid margin)

  • Gland dysfunction leads to blocked orifices and foamy tears

  • Commonly associated with rosacea or seborrhoeic dermatitis

Associations

• Staphylococcal infection (commonly S. aureus)

• Seborrhoea (e.g. scalp dandruff)

• Rosacea (facial redness, telangiectasia, papulopustular lesions)

• Allergy (chronic inflammatory response)

Treatment

General Measures

• Warm Compresses: 2–4 times daily, 5–10 minutes each, helps soften crusts and improve meibomian gland flow

• Eyelid Hygiene:

  • Use proprietary eyelid cleansers specifically formulated for blepharitis (e.g. lid scrubs)

  • Avoid baby shampoo (can irritate eyes and disrupt tear film)

• Lubricating Eye Drops: Alleviate dryness and irritation

Anterior Blepharitis

• Topical Antibiotic Ointment:

  • e.g. Chloramphenicol 1% ointment once daily (HS) or BD if staphylococcal involvement is suspected

  • Apply to the lid margin, not just the conjunctival sac

• Ensure concurrent lid hygiene to remove crusting

Posterior Blepharitis

• Oral Doxycycline:

  • 100 mg once daily for 4–8 weeks, then consider reducing to 50 mg daily

  • Monitor for GI side effects, consider sun protection due to photosensitivity

• Topical Azithromycin (off-label or specialist recommended) if severe or doxycycline contraindicated

• Firm Eyelid Massage: Gently express meibomian glands to improve lipid flow

• Address underlying rosacea or seborrhoea (e.g. with topical metronidazole for facial rosacea, anti-seborrhoeic shampoos)

Complications

• Keratitis: Corneal involvement can cause vision changes

• Chalazion: Blocked meibomian gland cyst

• Dry Eye Syndrome: Reduced tear film quality

• Recurrent Infections: If poor lid hygiene persists

Notes

• Blepharitis tends to be chronic and recurrent. Consistent lid hygiene is key to preventing flare-ups.

• In rosacea-related blepharitis, controlling facial rosacea (topical or systemic therapies) helps reduce eyelid inflammation.

• If severe pain, visual disturbance, or atypical presentation occurs, consider ophthalmology referral.