Blepharitis Management: A Clinical Approach

PATHoGEnEsis Anterior blepharitis is oft en associated with excessive bacterial growth on the lid margins. Th e microbes involved are typically the same species that normally reside there, including Staphylococcus epidermidis and Staphylococcus aureus.2 While questions remain about the role(s) of bacteria in blepharitis, it appears that toxic exoenzymes produced by the colonizing species—particularly S. epidermidis—irritate the eyelids and ocular surface, causing the release of infl ammatory mediators.1 In some cases, altered meibomian gland secretions may be an initiating factor, off ering a supportive environment for bacterial proliferation.3 But bacteria can Blepharitis is a catchall term encompassing the many, oft en overlapping, infl ammatory and infectious conditions of the eyelids. Without a single, etiology-based defi nition, it has not been possible to gain a good idea of the prevalence of blepharitis. But the conditions that comprise blepharitis are among the most common encountered in a comprehensive ophthalmology practice.1 Indeed, nearly a third of the patients I see—from young adults to seniors—present with signs and/or symptoms of blepharitis. It is oft en useful to distinguish types of blepharitis based on anatomical location. Th us, we have anterior blepharitis, which aff ects the area around the lashes and follicles, and posterior blepharitis, which aff ects the meibomian glands and proximate tissues. In either form, multiple causative factors and disease processes may be involved; and anterior and posterior blepharitis oft en coexist. Comorbidities, including chalazion and hordeolum, conjunctivitis, keratopathy (from superfi cial punctate keratitis to peripheral ulceration), and dry eye disease may be present with blepharitis.2 Blepharitis aff ects a broad swath of our patients: we see it in younger patients, who may have associated seborrheic dermatitis or acne rosacea; we see it in contact lens wearers, and in candidates for refractive, cataract, or other ocular surgeries; and we see it in patients who Blepharitis Management: A Clinical Approach