Blepharitis
Overview
Blepharitis describes a group of disorders characterised by inflammation of the eyelid margin. It can be acute or chronic and is usually bilateral.
Classification
Anterior blepharitis – affects the lashes:
- Staphylococcal blepharitis
- Seborrhoeic blepharitis
Posterior blepharitis – affects the meibomian glands:
- Usually due to meibomian gland dysfunction which can be due to:
- Seborrhoeic dermatitis
- Rosacea
The meibomian glands secrete sebum onto the eye surface to prevent evaporation of the tear film. Dysfunction of the meibomian glands can lead to eye dryness and irritation.
Presentation
Patients usually have episodes of remission interspersed with relapses in symptoms:
- Usually bilateral symptoms
- Eye grittiness/discomfort
- Patients often feel like there is something in their eye
- Eye itching
- Eye burning
- Sticky eyelids – patients often wake up with eyelids stuck together upon waking
- Eyelid margins may be red
Investigations
- Clinical diagnosis
- If there is diagnostic doubt, a slit-lamp examination can be carried out
Management
- 1st-line: warm compresses twice a day + eyelid hygiene measures
- Warm compresses soften and melt meibomian gland secretions allowing drainage
- Eyelid hygiene measures involve using cotton wool buds soaked in a mixture of cooled boiled water and dilute baby shampoo
- Consider artificial tears (e.g. carmellose) if dry eyes are problematic
- 2nd-line: consider antibiotics if eyelid measures are ineffective:
- Anterior blepharitis: topical chloramphenicol rubbed into the lid margin
- Posterior blepharitis with meibomian glad dysfunction and rosacea: consider oral doxycycline or tetracycline (avoid in pregnancy)
Patient Advice
- Patients should maintain eyelid hygiene measures indefinitely to prevent relapses in symptoms
Chalazion
Overview
Also known as a meibomian cyst, a chalazion is a firm and painless non-infectious lump on the eyelid due to the blockage of a meibomian gland, with the gland continuing to release sebum. A chalazion is usually drained or absorbed spontaneously over 2-8 weeks.
Presentation
The lump appears slowly in a chalazion. There is a gradually enlarging firm lump in the upper or lower eyelid. There may be tenderness initially due to inflammation but this settles.
Investigations
- Clinical diagnosis
- Perform biopsy if lesions recur at the same site – to rule out malignancy
Management
- 1st-line: warm compresses at least twice daily
- Clean the lid margins with cotton buds dipped in cooled and diluted baby shampoo if there is associated blepharitis
- Incision and drainage may need to be considered
Patient Advice
- A chalazion is usually drained or absorbed spontaneously over 2-8 weeks.
Stye
Overview
Also known as a hordeolum, a style is a tender lump due to the formation of a localised abscess in the upper or lower eyelid. It is most commonly due to Staphylococcus aureus, followed by Staphylococcus epidermidis.
Styes can be classified into:
- External hordeola – due to the infection of the glands of Zeis or glands of Moll
- Internal hordeola – infection of the meibomian glands
- This can leave behind a chalazion
Presentation
The main presenting complaint is a painful lump in the eyelid. Patients may have excess eye-watering and symptoms can be unilateral or bilateral:
- External hordeola:
- Swelling is at the eyelid margin
- Swelling is usually around an eyelash follicle
- A small, yellow, pus-filled spot may be seen
- Internal hordeola:
- Swelling is localised on the internal eyelid
- Swelling is usually further away from the lid margin
- Everting the eyelid shows localised swelling within the eyelid
Investigations
- Clinical diagnosis
- Perform biopsy if lesions recur at the same site – to rule out malignancy
Management
- 1st-line: hot compresses at least twice daily + analgesia
- Clean the lid margins with cotton buds dipped in cooled and diluted baby shampoo if there is associated blepharitis
- If associated conjunctivitis: prescribe antibiotics – see Infective Conjunctivitis
Patient Advice
- Most styes resolve with warm compresses and do not need antibiotics
- Patients should maintain eyelid hygiene measures to prevent recurrence
Ectropion
Overview
Ectropion is the eversion of the eyelid margin. This can cause problems with the conjunctiva and cornea due to their increased exposure. In severe cases, there may be scarring of the cornea.
Presentation
Most patients are asymptomatic with an everted eyelid, but there can be features of irritation:
- Excessive tearing
- Itching – eye rubbing makes the ectropion worse
- Grittiness
- Red eye
Management
- 1st-line: lubricants and artificial tears
- Definitive management: surgery
Entropion
Overview
Entropion is the inversion of the eyelid margin. This can cause problems with the conjunctive and cornea due to their increased exposure. In severe cases, there may be scarring of the cornea.
Presentation
Most patients are asymptomatic with an inverted eyelid, but there can be features of irritation:
- Excessive tearing
- Itching
- Grittiness
- Red eye
Management
- 1st-line: lubricants and artificial tears
- Definitive management: surgery
