Professional Documents
Culture Documents
Adult Blepharitis
Updated: Dec 15, 2016
Author: R Scott Lowery, MD; Chief Editor: Andrew A Dahl, MD, FACS more...
OVERVIEW
Background
Blepharitis refers to a family of inflammatory disease processes of the eyelid(s).
Blepharitis can be divided anatomically into anterior and posterior blepharitis. Anterior blepharitis
refers to inflammation mainly centered around the skin, eyelashes, and lash follicles, while the
posterior variant involves the meibomian gland orifices, meibomian glands, tarsal plate, and
blepharo-conjunctival junction. Anterior blepharitis usually is subdivided further into staphylococcal
and seborrheic variants.
Frequently, a considerable overlap exists in these processes in individual patients. Blepharitis often
is associated with systemic diseases, such as rosacea, atopy, and seborrheic dermatitis, as well as
ocular diseases, such as dry eye syndromes, chalazion, trichiasis, ectropion and entropion,
infectious or other inflammatory conjunctivitis, and keratitis.
Pathophysiology
The pathophysiology of blepharitis frequently involves bacterial colonization of the eyelids. This
results in direct microbial invasion of tissues, immune system–mediated damage, or damage
caused by the production of bacterial toxins, waste products, and enzymes. Colonization of the lid
margin is increased in the presence of seborrheic dermatitis or meibomian gland dysfunction.
Epidemiology
Frequency
United States
Blepharitis is a common eye disorder in the United States and throughout the world. Based on
Lemp et al’s estimate that 86% of all patients with dry eyes have concomitant blepharitis, more
than 25 million Americans suffer from blepharitis. [1]
Mortality/Morbidity
The exact association between blepharitis and mortality is not known, but diseases with known
mortality, such as systemic lupus erythematosus, may have blepharitis as part of their constellation
of findings. Associated morbidity includes loss of visual function, well-being, and ability to carry out
daily life activities. The disease process can result in damage to the lids with trichiasis, notching
entropion, and ectropion. Corneal damage can result in inflammation, scarring, loss of surface
smoothness, irregular astigmatism, and loss of optical clarity. If severe inflammation develops,
corneal perforation can occur.
http://emedicine.medscape.com/article/1211763-overview 1/4
17/07/2017 Adult Blepharitis: Background, Pathophysiology, Epidemiology
Race
No known studies demonstrate racial differences in the incidence of blepharitis. Rosacea may be
more common in fair-skinned individuals, although this finding may be only because it is more
easily and frequently diagnosed in these individuals.
Sex
No well-designed studies of differences in the incidence and clinical features of blepharitis between
the sexes have been found.
Age
Seborrheic blepharitis is more common in an older age group. The apparent mean age is 50 years.
Clinical Presentation
References
1. Lemp MA, Crews LA, Bron AJ, Foulks GN, Sullivan BD. Distribution of aqueous-deficient and
evaporative dry eye in a clinic-based patient cohort: a retrospective study. Cornea. 2012 May.
31 (5):472-8. [Medline].
2. Pinckney J 2nd, Cole P, Vadapalli SP, Rosen T. Phthiriasis palpebrarum: a common culprit
with uncommon presentation. Dermatol Online J. 2008 Apr 15. 14(4):7. [Medline].
5. Jackson WB. Blepharitis: current strategies for diagnosis and management. Can J
Ophthalmol. 2008 Apr. 43(2):170-9. [Medline].
7. Holzchuh FG, Hida RY, Moscovici BK, Villa Albers MB, Santo RM, Kara-José N, et al. Clinical
Treatment of Ocular Demodex folliculorum by Systemic Ivermectin. Am J Ophthalmol. 2011
Jun. 151(6):1030-1034.e1. [Medline].
8. Arky R. Acromycin V tetracycline HCl. Physicians' Desk Reference. 53rd ed. 1999. 1514-
1515. [Full Text].
9. Cohen EJ. Cornea and external disease in the new millennium. Arch Ophthalmol. 2000 Jul.
118(7):979-81. [Medline].
10. Diaz-Valle D, Benitez del Castillo JM, Fernandez Acenero MJ. Bilateral lid margin ulcers as
the initial manifestation of Crohn disease. Am J Ophthalmol. 2004 Aug. 138(2):292-4.
[Medline].
11. Fraunfelder FT, Roy FH, Steinemann TL. Current Ocular Therapy. 5th ed. 2000. 72, 374,
378, 450.
13. Held KS. Blepharitis. Decision Making in Ophthalmology. 2nd ed. 2000. 50-51.
16. Sullivan JH. Lids and lacrimal apparatus. General Ophthalmology. 14th ed. 1995. 78-81.
17. Weisbecker CA, Fraunfelder FT, Rhee D. Physicians' Desk Reference for Ophthalmology.
28th ed. 2000.
18. Yanoff M, Fine BS. Inflammation. Ocular Pathology. 4th ed. 1996. 166-168.
19. Tighe S, Gao YY, Tseng SC. Terpinen-4-ol is the Most Active Ingredient of Tea Tree Oil to Kill
Demodex Mites. Transl Vis Sci Technol. 2013 Nov. 2 (7):2. [Medline].
20. Hart PH, Brand C, Carson CF, Riley TV, Prager RH, Finlay-Jones JJ. Terpinen-4-ol, the main
component of the essential oil of Melaleuca alternifolia (tea tree oil), suppresses inflammatory
mediator production by activated human monocytes. Inflamm Res. 2000 Nov. 49 (11):619-26.
[Medline].
21. Carson CF, Hammer KA, Riley TV. Melaleuca alternifolia (Tea Tree) oil: a review of
antimicrobial and other medicinal properties. Clin Microbiol Rev. 2006 Jan. 19 (1):50-62.
[Medline].
Media Gallery
of 0
Tables
Back to List
Author
Simon K Law, MD, PharmD Clinical Professor of Health Sciences, Department of Ophthalmology,
Jules Stein Eye Institute, University of California, Los Angeles, David Geffen School of Medicine
Simon K Law, MD, PharmD is a member of the following medical societies: American Academy of
Ophthalmology, Association for Research in Vision and Ophthalmology, American Glaucoma
Society
http://emedicine.medscape.com/article/1211763-overview 3/4
17/07/2017 Adult Blepharitis: Background, Pathophysiology, Epidemiology
Disclosure: Serve(d) as a director, officer, partner, employee, advisor, consultant or trustee for:
Cornea Society, AAO, OMIC, Aerie, Bausch & Lomb, Bio-Tissue, Shire, TearLab<br/>Serve(d) as a
speaker or a member of a speakers bureau for: Allergan, Bausch & Lomb, Bio-Tissue.
Chief Editor
Andrew A Dahl, MD, FACS Assistant Professor of Surgery (Ophthalmology), New York College of
Medicine (NYCOM); Director of Residency Ophthalmology Training, The Institute for Family Health
and Mid-Hudson Family Practice Residency Program; Staff Ophthalmologist, Telluride Medical
Center
Andrew A Dahl, MD, FACS is a member of the following medical societies: American Academy of
Ophthalmology, American College of Surgeons, American Intraocular Lens Society, American
Medical Association, American Society of Cataract and Refractive Surgery, Contact Lens
Association of Ophthalmologists, Medical Society of the State of New York, New York State
Ophthalmological Society, Outpatient Ophthalmic Surgery Society
Additional Contributors
http://emedicine.medscape.com/article/1211763-overview 4/4