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17/07/2017 Adult Blepharitis: Background, Pathophysiology, Epidemiology

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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.

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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

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blepharitis. Adv Ther. 2008 Sep. 25(9):858-70. [Medline].

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13. Held KS. Blepharitis. Decision Making in Ophthalmology. 2nd ed. 2000. 50-51.

14. Kanski JJ. Marginal blepharitis. Clinical Ophthalmology. 1984. 1.2-1.4.

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Contributor Information and Disclosures

Author

R Scott Lowery, MD Associate Professor of Ophthalmology, Department of Pediatric


Ophthalmology and Strabismus, University of Arkansas for Medical Sciences College of Medicine,
Arkansas Children's Hospital

R Scott Lowery, MD is a member of the following medical societies: American Academy of


Ophthalmology, American Association for Pediatric Ophthalmology and Strabismus, Arkansas
Medical Society

Disclosure: Nothing to disclose.

Specialty Editor Board

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: Nothing to disclose.

Christopher J Rapuano, MD Professor, Department of Ophthalmology, Jefferson Medical College


of Thomas Jefferson University; Director of the Cornea Service, Co-Director of Refractive Surgery
Department, Wills Eye Hospital

Christopher J Rapuano, MD is a member of the following medical societies: American Academy of


Ophthalmology, American Ophthalmological Society, American Society of Cataract and Refractive
Surgery, Cornea Society, Contact Lens Association of Ophthalmologists, Eye Bank Association of
America, International Society of Refractive Surgery

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

Disclosure: Nothing to disclose.

Additional Contributors

Fernando H Murillo-Lopez, MD Senior Surgeon, Unidad Privada de Oftalmologia CEMES

Fernando H Murillo-Lopez, MD is a member of the following medical societies: American Academy


of Ophthalmology

Disclosure: Nothing to disclose.

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