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Blepharitis

Author
Roni M Shtein, MD
Section Editor
Jonathan Trobe, MD
Deputy Editor
Howard Libman, MD, FACP

INTRODUCTION

Blepharitis is a common chronic ophthalmologic condition characterized by inflammation of the eyelid margin associated with eye irritation. Other related eyelid conditions are discussed separately, as is dry eye disease, which is a frequent complication of blepharitis. (See "Eyelid lesions" and "Dry eyes".)

ETIOLOGY AND PATHOPHYSIOLOGY

The etiology and pathophysiology of blepharitis differ somewhat based on the type (posterior versus anterior). However, there is considerable overlap between these categories (table 1) [1].

Posterior blepharitis – Posterior blepharitis, the more common type, is characterized by inflammation of the inner portion of the eyelid at the level of the Meibomian glands (picture 1) [2]. Meibomian glands are modified sebaceous glands located within the tarsal plates of the eyelids responsible for secretion of the oily layer of the tear film. This oily layer prevents tear evaporation, reduces the surface tension of the tear layer, and facilitates the spread of tears [3]. It is critical for normal eye lubrication.

Hyperkeratinization of the meibomian gland ductal epithelium is an early finding in patients with posterior blepharitis [4]. Altered lipid composition in gland secretions leads to instability of the tear film [5-11]. The abnormal secretions also have a direct toxic effect on the ocular surface [8,12]. Additionally, the altered lipid composition provides an environment that promotes bacterial growth, which perpetuates the Meibomian gland abnormalities. Long-term inflammation leads to gland dysfunction and fibrosis as well as damage to the eyelid and ocular surface.

Chronic inflammatory skin conditions such as rosacea and seborrheic dermatitis may cause posterior blepharitis, but it also commonly occurs in their absence [3,13,14]. Blepharitis in patients with underlying chronic dermatoses tends to be more severe. (See "Seborrheic dermatitis in adolescents and adults".)

                          
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Literature review current through: Sep 2017. | This topic last updated: Jul 21, 2017.
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