Blepharitis

Overview

•Bilateral chronic grittiness, soreness, burning of eyelid margins

•Sticky eyes in the morning - secretions and crusts accumulate overnight

•Red eyelid margins - redness localised to lid edge, not the conjunctiva

•Dry eye symptoms - paradoxical watering from reflex tearing

•Vision is not affected - any visual acuity change should prompt urgent alternative diagnosis

•Associated conditions: hypothyroidism (meibomian gland dysfunction), rosacea, seborrhoeic dermatitis

🎯

Chronicity (months to years, bilateral) distinguishes blepharitis from acute conjunctivitis. Itch is less prominent than in allergic conjunctivitis.

Investigations

•Clinical diagnosis - history and examination of lid margins (crusting, redness, blocked meibomian orifices)

•Visual acuity - to exclude corneal or intraocular pathology

Management

🥇 First-line

•warm compresses - clean flannel on closed eyelids for 5-10 minutes, twice daily; softens inspissated meibomian secretions

•lid scrubs - immediately after compress; cotton bud with diluted baby shampoo or proprietary wipe to remove biofilm and crusts

🥈 Second-line

•lubricating eye drops (artificial tears) - add only if symptomatic dry eye is present

•topical chloramphenicol ointment - only if secondary bacterial conjunctivitis develops; not for routine blepharitis

🥉 Third-line

•oral doxycycline (or oxytetracycline in younger patients) - moderate-to-severe posterior blepharitis or rosacea-associated disease; low dose for 6-12 weeks

🎯

Warm compresses are first-line - not artificial tears and not topical antibiotics. Artificial tears are added only if dry eye is a feature. Topical chloramphenicol is reserved for secondary conjunctivitis.

📌

Counsel patients that blepharitis is chronic and cannot be cured, only controlled. Stopping lid hygiene typically leads to recurrence.