History and exam
Key diagnostic factors
common
burning sensation
Usually bilateral.
itching sensation
Usually bilateral.
foreign body sensation
Usually bilateral.
crusting of eyelids
Usually bilateral.
dry eye
Blepharitis is commonly associated with dry eye syndrome.
lid erythema, telangiectasias
Usually bilateral. Seen on slit lamp exam.
collarettes around lashes
Seen on slit lamp exam.
capped meibomian glands
Seen on slit lamp exam. Thickened and turbid secretions may be expressed from the meibomian glands.
conjunctival hyperemia
Seen on slit lamp exam.
unstable tear film with rapid tear break-up time
Seen on slit lamp exam.
Other diagnostic factors
common
chalazion
Chalazions are caused by inflammation of blocked meibomian gland. If recurrent, lid biopsy may be required to exclude other disorders, particularly malignancies.
scalp changes
With associated seborrheic dermatitis, flaking and greasy skin on the scalp, retroauricular area, glabella, and nasolabial folds is typical.
contact lens intolerance
Symptoms of dry eye disease can lead to intolerance with contact lens wear.
uncommon
photophobia
Usually bilateral.
facial telangiectasias, erythema, pustules, papules
Seen only with associated acne rosacea.
depigmentation of lashes
Usually occurs only in chronic blepharitis.
Lid biopsy may be required to exclude other disorders, particularly malignancies.
trichiasis
Turning-in of lashes usually occurs only in chronic blepharitis.
madarosis
Loss of lashes usually occurs only in chronic blepharitis.
Lid biopsy may be required to exclude other disorders, particularly malignancies.
lid margin thickening, notching, and ulceration
Usually occurs in chronic blepharitis. Lid biopsy may be required to exclude other disorders, particularly malignancies.
corneal changes
Corneal punctate epithelial erosion, vascularization, scarring, phlyctenule, ulceration, and perforation may occur rarely, leading to decreased vision.
decreased vision
Corneal changes may cause decreased vision.
Risk factors
weak
Demodex infection
age ≥50 years
Although the mean age of patients with blepharitis is generally 50 years, in practice, blepharitis can affect people at any age.
female
Staphylococcal blepharitis is thought to affect women predominantly.[32] However, in practice, blepharitis is seen commonly in both men and women.
dermatologic disease
Dermatologic conditions such as rosacea, seborrheic dermatitis, and eczema are associated with blepharitis.[1]
intraocular or lid surgery/injury
Prior intraocular and lid surgeries or injury can increase the risk of blepharitis.[1]
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