What are the common causes of eyelid inflammation. How can you distinguish between styes and chalazia. What are the most effective treatments for blepharitis. When should you seek medical attention for eyelid problems.

Understanding Blepharitis: Types of Eyelid Inflammation

Blepharitis is a general term for inflammation of the eyelid. Two common types of eyelid inflammation are styes and chalazia. While both conditions affect the eyelids, they have distinct characteristics and causes.

Styes: Acute Bacterial Infections

Styes, also known as hordeola, are acute bacterial infections that typically develop rapidly. They are characterized by:

• Painful, red swelling on the eyelid
• Formation of a pus-filled lump
• Typically caused by staphylococcus bacteria
• Usually resolve within a week

Chalazia: Chronic Oil Gland Blockages

Chalazia, also called meibomian cysts, are non-bacterial inflammations that develop more slowly. Key features include:

• Painless swelling on the eyelid
• No pus formation
• Caused by long-term blockage of oil glands
• May take weeks or months to resolve

Anatomy of the Eyelid: Glands and Their Functions

To understand eyelid inflammations, it’s crucial to know the anatomy of the eyelid. The eyelid contains several types of glands that play vital roles in maintaining eye health:

1. Sweat glands: Produce moisture to keep the eye surface lubricated
2. Oil glands (sebaceous glands): Produce oils that mix with tear fluid to prevent evaporation
3. Meibomian glands: Special oil glands located on the inner part of the eyelid

When these glands become blocked or infected, it can lead to various forms of eyelid inflammation.

Risk Factors for Developing Eyelid Inflammations

Several factors can increase the likelihood of developing styes or chalazia:

Common Risk Factors for Styes

• Poor hand hygiene, especially when handling contact lenses
• Blockage of oil or sweat glands
• Diabetes or other conditions that weaken the immune system
• Hormonal fluctuations
• Stress
• Skin conditions like rosacea

Risk Factors for Chalazia

• Chronic blockage of oil glands
• Chronic skin conditions, particularly rosacea
• Long-term inflammation of eyelid tissues

Recognizing Symptoms: When to Suspect Eyelid Inflammation

Identifying the symptoms of eyelid inflammation can help in seeking appropriate treatment. Common signs include:

Symptoms of Styes

• Rapid onset of redness and swelling
• Pain and tenderness in the affected area
• Visible pus-filled lump, often yellow in color
• Discomfort when blinking

Symptoms of Chalazia

• Gradual development of a painless lump
• Swelling without visible pus
• Possible discomfort or pressure sensation
• May interfere with vision if large enough

Diagnostic Approaches for Eyelid Inflammations

Diagnosing eyelid inflammations typically involves a combination of visual examination and patient history. Here’s what you can expect during a diagnostic evaluation:

Visual Examination

• Assessment of the eyelid appearance
• Checking for pain upon palpation
• Use of a slit lamp for detailed examination

Additional Tests

In most cases, extensive testing is not necessary. However, in certain situations, a doctor may recommend:

• Swab tests to identify specific bacteria (rare)
• Blood tests to check for underlying conditions
• Tissue examination to rule out more serious conditions

Is it possible to differentiate between a stye and a chalazion without medical expertise? While a definitive diagnosis should be made by a healthcare professional, there are some key differences that can help you distinguish between the two:

• Pain: Styes are typically painful, while chalazia are usually painless
• Development speed: Styes develop rapidly, chalazia form more slowly
• Appearance: Styes often have a visible pus point, chalazia do not

Treatment Options for Eyelid Inflammations

While many cases of eyelid inflammation resolve on their own, various treatment options can help manage symptoms and speed up recovery:

Home Remedies and Self-Care

• Warm compresses to promote drainage and healing
• Gentle cleansing of the eyelid area
• Avoiding makeup and contact lenses during the healing process
• Over-the-counter pain relievers for discomfort

Medical Treatments

For persistent or severe cases, a healthcare provider may recommend:

• Topical or oral antibiotics for bacterial infections
• Steroid injections to reduce inflammation in chalazia
• Minor surgical procedures to drain or remove persistent lesions

How effective are warm compresses in treating eyelid inflammations? Warm compresses are generally considered beneficial for both styes and chalazia. They can:

1. Increase blood circulation to the affected area
2. Promote drainage of blocked glands
3. Provide pain relief
4. Accelerate the healing process

However, it’s important to use clean, warm (not hot) compresses and apply them for 10-15 minutes several times a day for best results.

Prevention Strategies for Eyelid Health

Preventing eyelid inflammations involves maintaining good eye hygiene and overall health. Here are some effective prevention strategies:

Hygiene Practices

• Wash hands thoroughly before touching eyes or contact lenses
• Remove eye makeup completely before sleeping
• Clean eyelids regularly with gentle, eye-safe cleansers
• Replace eye makeup every 3-6 months to prevent bacterial growth

Lifestyle and Health Considerations

• Manage stress through relaxation techniques or exercise
• Control underlying conditions like diabetes or rosacea
• Stay hydrated to promote overall eye health
• Consume a balanced diet rich in omega-3 fatty acids and vitamins A and E

Can regular eyelid massages help prevent chalazia? Gentle eyelid massages may help prevent chalazia by:

1. Promoting proper drainage of oil glands
2. Preventing blockages that can lead to inflammation
3. Improving overall eyelid health

However, it’s crucial to perform these massages with clean hands and to be gentle to avoid irritating the delicate eye area.

When to Seek Medical Attention for Eyelid Problems

While many eyelid inflammations resolve on their own, certain situations warrant professional medical attention:

Warning Signs

Seek medical care if you experience:

• Severe pain or redness
• Vision changes or blurriness
• Fever or chills
• Swelling that extends beyond the eyelid
• No improvement after a week of home treatment
• Recurrent styes or chalazia

Potential Complications

Although rare, untreated eyelid inflammations can lead to:

• Spread of infection to surrounding tissues
• Cellulitis of the eye socket
• Chronic eyelid problems
• Scarring of eyelid tissues

How can you differentiate between a common stye and a more serious eye condition? While styes are usually benign, certain signs may indicate a more serious condition:

1. Rapid spread of redness and swelling beyond the eyelid
2. Fever and systemic symptoms
3. Severe pain that doesn’t respond to over-the-counter pain relievers
4. Any changes in vision

If you experience these symptoms, it’s crucial to seek immediate medical attention to rule out more severe conditions like orbital cellulitis or preseptal cellulitis.

Long-term Management and Recurrence Prevention

For individuals prone to recurrent eyelid inflammations, long-term management strategies can be beneficial:

Daily Eyelid Hygiene Routine

• Use of specialized eyelid cleansers or baby shampoo diluted with warm water
• Regular use of warm compresses, even when not experiencing active inflammation
• Gentle massage of eyelids to promote oil gland drainage

Lifestyle Modifications

• Avoiding touching or rubbing eyes frequently
• Using hypoallergenic makeup and skincare products
• Managing underlying health conditions effectively
• Staying hydrated and maintaining a balanced diet

Are there any supplements that can help prevent recurrent eyelid inflammations? While more research is needed, some studies suggest that certain supplements may support overall eye health and potentially reduce the risk of recurrent inflammations:

1. Omega-3 fatty acids: May help improve oil gland function
2. Vitamin D: Could support immune function and reduce inflammation
3. Probiotics: Might help balance the microbiome, including around the eyes

However, it’s important to consult with a healthcare provider before starting any new supplement regimen, as individual needs may vary.

Impact of Eyelid Inflammations on Quality of Life

While often considered minor ailments, eyelid inflammations can significantly impact an individual’s quality of life:

Physical Discomfort and Appearance

• Pain and irritation affecting daily activities
• Cosmetic concerns, especially with visible swelling
• Potential interference with vision, particularly for large chalazia

Psychological and Social Effects

• Anxiety about recurrence or complications
• Self-consciousness in social situations
• Stress related to managing symptoms and treatments

How can individuals cope with the psychological impact of recurrent eyelid inflammations? Coping strategies may include:

1. Educating oneself about the condition to reduce anxiety
2. Joining support groups or online communities for shared experiences
3. Practicing stress-reduction techniques like mindfulness or meditation
4. Focusing on overall health and well-being to boost confidence

It’s important to remember that while eyelid inflammations can be frustrating, they are generally treatable and manageable with proper care and attention.

Future Directions in Eyelid Inflammation Research and Treatment

As medical understanding of eyelid inflammations continues to evolve, several areas of research show promise for improved diagnosis and treatment:

Advanced Diagnostic Techniques

• Development of more precise imaging technologies for early detection
• Genetic testing to identify predispositions to recurrent inflammations
• Biomarker identification for tailored treatment approaches

Innovative Treatment Modalities

• Exploration of novel antibiotics for resistant bacterial strains
• Investigation of anti-inflammatory compounds derived from natural sources
• Development of targeted therapies for specific types of eyelid inflammations

What potential breakthroughs in eyelid inflammation treatment are on the horizon? While research is ongoing, some promising areas include:

1. Nanotechnology-based drug delivery systems for more effective topical treatments
2. Personalized medicine approaches based on individual microbiome profiles
3. Gene therapy techniques to address underlying genetic factors in chronic cases
4. Advanced laser therapies for non-invasive treatment of persistent chalazia

These potential advancements could lead to more effective, targeted treatments with fewer side effects and improved outcomes for patients with eyelid inflammations.

Styes and chalazia (inflammation of the eyelid): Overview – InformedHealth.org

Created: December 5, 2019; Next update: 2022.

Introduction

Eyelid inflammations can occur if a gland along the edge of the eyelid becomes inflamed. This leads to swelling. If it’s caused by bacteria, this can happen very quickly and hurt. It is then known as a stye (hordeolum) – a pus-filled swelling on the eyelid, caused by an infection.

There’s another kind of eyelid inflammation called a chalazion (also known as a meibomian cyst). This develops more slowly and usually doesn’t hurt. It occurs after an oil gland (sebaceous gland) has been inflamed for quite a long time. It is not caused by bacteria.

The eyelid has various glands in it that keep the eyes from becoming too dry: a lot of small sweat glands and oil glands near to the eyelashes along the edge of the eyelid, and oil glands on the inner part of the eyelid. The oil that is made there mixes with the tear fluid covering the eye, keeping the eye moist. If a gland at the edge of the eyelid becomes blocked or infected with bacteria, the tear fluid is affected, causing the eyelid to become inflamed.

Symptoms

If you have an eyelid inflammation, your upper or lower eyelid is red and swollen – usually at the edge of the eyelid, close to the eyelashes. The swelling can grow to about the size of a pea.

Styes are painful. Pus collects in the middle of the swelling, and can often be seen as a yellow lump.

Stye on the lower eyelid

Chalazia don’t have pus in them and usually aren’t painful either. But many people find them bothersome. They often occur on the inner part of the eyelid.

Both styes and chalazia can develop on the lower or upper eyelids.

Chalazion on the upper eyelid

Causes and risk factors

Styes occur if bacteria infect a gland in the eyelid. These are usually staphylococcus bacteria. You’re more likely to get styes if, for instance, you don’t clean your hands properly before putting contact lenses in or taking them out. The risk is also greater if the oil or sweat made in glands can’t flow out properly. This might happen if the glands are blocked by dried-up secretions or by make-up that hasn’t been removed. Styes are also more common in people who have diabetes or another disease that weakens the immune system. Further risk factors include hormonal fluctuations, stress and skin conditions like rosacea.

Chalazia usually develop because an oil gland has become blocked and is then inflamed for a long time: The oil (sebum) builds up, and more and more of the tissue becomes inflamed and hard. This type of tissue is known as granulation tissue. The inflammation isn’t caused by bacteria, so there’s no pus. You’re more likely to develop a chalazion if you have a chronic skin condition like rosacea.

Prevalence and outlook

Inflammations of the eyelid, such as styes and chalazia, are common and can occur at any age.

Styes develop very quickly, but usually go away again soon after: The pus normally leaves the stye on its own after about a week, and the inflammation goes down.

The swelling associated with chalazia develops more slowly. It usually goes down on its own, but also more slowly than the swelling associated with styes. It can take weeks or months for chalazia to go away completely. But they sometimes don’t go away on their own.

Effects

If a stye doesn’t go away completely, it might develop into a chalazion. Or a new stye might develop in the same place.

The inflammation caused by styes might spread, for instance to the eye socket. But these complications are very rare, particularly in people who are otherwise healthy. It’s important to avoid touching the inflamed area and to pay particular attention to good hygiene – for example, by not sharing towels with other people.

Diagnosis

It’s easy to diagnose styes and chalazia based on what they look like and the symptoms they cause: If the inflamed area doesn’t hurt, even when you push against it, it’s probably a chalazion.

Eye doctors usually test your eyesight too, and take a closer look at your eyes and eyelids with the help of a special magnifying lamp (a slit lamp).

Because styes are normally caused by staphylococcus bacteria, there’s usually no need to do a swab test to find out what’s causing the infection. Other tests, such as blood tests or tissue examinations, are only needed if the doctor thinks it could be cancer or if you have a weakened immune system. Some of the tests involve quite a bit of time and effort.

Treatment

Styes and chalazia usually go away on their own. Various things are thought to speed up the process. But there’s generally a lack of good research on how well they actually work. If a stye or chalazion doesn’t go away, it might be possible to remove it during a minor surgical procedure.

Sources

• Berufsverband der Augenärzte Deutschlands (BVA), Deutsche Ophthalmologische Gesellschaft (DOG). Leitlinie Nr. 10: Hordeolum / Chalazion. August 2011. [PubMed: 31932952]

• Burk A, Burk R. Checkliste Augenheilkunde. Stuttgart: Thieme; 2017.

• Cheng K, Law A, Guo M, Wieland LS, Shen X, Lao L. Acupuncture for acute hordeolum. Cochrane Database Syst Rev 2017; (2): CD011075. [PMC free article: PMC5378315] [PubMed: 28181687]

• Lindsley K, Nichols JJ, Dickersin K. Non-surgical interventions for acute internal hordeolum. Cochrane Database Syst Rev 2017; (1): CD007742. [PMC free article: PMC5370090] [PubMed: 28068454]

• Pschyrembel. Klinisches Wörterbuch. Berlin: De Gruyter; 2017.

• IQWiG health information is written with the aim of helping
  people understand the advantages and disadvantages of the main treatment options and health
  care services.

  Because IQWiG is a German institute, some of the information provided here is specific to the
  German health care system. The suitability of any of the described options in an individual
  case can be determined by talking to a doctor. We do not offer individual consultations.

  Our information is based on the results of good-quality studies. It is written by a
  team of
  health care professionals, scientists and editors, and reviewed by external experts. You can
  find a detailed description of how our health information is produced and updated in
  our methods.

Styes and chalazia (inflammation of the eyelid): Overview – InformedHealth.org

Created: December 5, 2019; Next update: 2022.

Introduction

Eyelid inflammations can occur if a gland along the edge of the eyelid becomes inflamed. This leads to swelling. If it’s caused by bacteria, this can happen very quickly and hurt. It is then known as a stye (hordeolum) – a pus-filled swelling on the eyelid, caused by an infection.

There’s another kind of eyelid inflammation called a chalazion (also known as a meibomian cyst). This develops more slowly and usually doesn’t hurt. It occurs after an oil gland (sebaceous gland) has been inflamed for quite a long time. It is not caused by bacteria.

The eyelid has various glands in it that keep the eyes from becoming too dry: a lot of small sweat glands and oil glands near to the eyelashes along the edge of the eyelid, and oil glands on the inner part of the eyelid. The oil that is made there mixes with the tear fluid covering the eye, keeping the eye moist. If a gland at the edge of the eyelid becomes blocked or infected with bacteria, the tear fluid is affected, causing the eyelid to become inflamed.

Symptoms

If you have an eyelid inflammation, your upper or lower eyelid is red and swollen – usually at the edge of the eyelid, close to the eyelashes. The swelling can grow to about the size of a pea.

Styes are painful. Pus collects in the middle of the swelling, and can often be seen as a yellow lump.

Stye on the lower eyelid

Chalazia don’t have pus in them and usually aren’t painful either. But many people find them bothersome. They often occur on the inner part of the eyelid.

Both styes and chalazia can develop on the lower or upper eyelids.

Chalazion on the upper eyelid

Causes and risk factors

Styes occur if bacteria infect a gland in the eyelid. These are usually staphylococcus bacteria. You’re more likely to get styes if, for instance, you don’t clean your hands properly before putting contact lenses in or taking them out. The risk is also greater if the oil or sweat made in glands can’t flow out properly. This might happen if the glands are blocked by dried-up secretions or by make-up that hasn’t been removed. Styes are also more common in people who have diabetes or another disease that weakens the immune system. Further risk factors include hormonal fluctuations, stress and skin conditions like rosacea.

Chalazia usually develop because an oil gland has become blocked and is then inflamed for a long time: The oil (sebum) builds up, and more and more of the tissue becomes inflamed and hard. This type of tissue is known as granulation tissue. The inflammation isn’t caused by bacteria, so there’s no pus. You’re more likely to develop a chalazion if you have a chronic skin condition like rosacea.

Prevalence and outlook

Inflammations of the eyelid, such as styes and chalazia, are common and can occur at any age.

Styes develop very quickly, but usually go away again soon after: The pus normally leaves the stye on its own after about a week, and the inflammation goes down.

The swelling associated with chalazia develops more slowly. It usually goes down on its own, but also more slowly than the swelling associated with styes. It can take weeks or months for chalazia to go away completely. But they sometimes don’t go away on their own.

Effects

If a stye doesn’t go away completely, it might develop into a chalazion. Or a new stye might develop in the same place.

The inflammation caused by styes might spread, for instance to the eye socket. But these complications are very rare, particularly in people who are otherwise healthy. It’s important to avoid touching the inflamed area and to pay particular attention to good hygiene – for example, by not sharing towels with other people.

Diagnosis

It’s easy to diagnose styes and chalazia based on what they look like and the symptoms they cause: If the inflamed area doesn’t hurt, even when you push against it, it’s probably a chalazion.

Eye doctors usually test your eyesight too, and take a closer look at your eyes and eyelids with the help of a special magnifying lamp (a slit lamp).

Because styes are normally caused by staphylococcus bacteria, there’s usually no need to do a swab test to find out what’s causing the infection. Other tests, such as blood tests or tissue examinations, are only needed if the doctor thinks it could be cancer or if you have a weakened immune system. Some of the tests involve quite a bit of time and effort.

Treatment

Styes and chalazia usually go away on their own. Various things are thought to speed up the process. But there’s generally a lack of good research on how well they actually work. If a stye or chalazion doesn’t go away, it might be possible to remove it during a minor surgical procedure.

Sources

• Berufsverband der Augenärzte Deutschlands (BVA), Deutsche Ophthalmologische Gesellschaft (DOG). Leitlinie Nr. 10: Hordeolum / Chalazion. August 2011. [PubMed: 31932952]

• Burk A, Burk R. Checkliste Augenheilkunde. Stuttgart: Thieme; 2017.

• Cheng K, Law A, Guo M, Wieland LS, Shen X, Lao L. Acupuncture for acute hordeolum. Cochrane Database Syst Rev 2017; (2): CD011075. [PMC free article: PMC5378315] [PubMed: 28181687]

• Lindsley K, Nichols JJ, Dickersin K. Non-surgical interventions for acute internal hordeolum. Cochrane Database Syst Rev 2017; (1): CD007742. [PMC free article: PMC5370090] [PubMed: 28068454]

• Pschyrembel. Klinisches Wörterbuch. Berlin: De Gruyter; 2017.

• IQWiG health information is written with the aim of helping
  people understand the advantages and disadvantages of the main treatment options and health
  care services.

  Because IQWiG is a German institute, some of the information provided here is specific to the
  German health care system. The suitability of any of the described options in an individual
  case can be determined by talking to a doctor. We do not offer individual consultations.

  Our information is based on the results of good-quality studies. It is written by a
  team of
  health care professionals, scientists and editors, and reviewed by external experts. You can
  find a detailed description of how our health information is produced and updated in
  our methods.

What is blepharitis? | Théa

Definition

What is blepharitis?

Identification of blepharitis

Blepharitis is an inflammation of the outer edge of the eyelid, or the entire area of ​​the eyelids. With blepharitis, the eyelids turn red and swell, and small scales can form on the skin of the eyelids and at the base of the eyelashes. Most often, both eyes are affected at the same time, and soreness and itching characteristic of this disease are felt in the eyelids. Also, with blepharitis, redness of the eyes, a feeling of a foreign body or “sand” in the eyes, burning and itching in the eyes, and discharge from the eyes often occur.

Symptoms

What are the symptoms of blepharitis?

The inflammatory process can affect only the skin of the eyelids and eyelashes (anterior blepharitis), or it can cover the inner edge of the eyelid in contact with the surface of the eye, including the glands located in the eyelids (posterior blepharitis).

In some cases, blepharitis occurs against the background of chalazion, stye or dry eye syndrome ¹ .

Blepharitis diagnosis

In case of inflammation of the eyes or eyelids, one cannot do without consulting an ophthalmologist who will be able to determine the cause of the inflammation using clinical, instrumental and laboratory research methods and prescribe the most optimal treatment, which will depend on the cause of the disease.

Different types of blepharitis

Blepharitis comes in different types depending on the affected area. With anterior blepharitis, the outer part of the eyelid is affected: the skin and eyelashes. The eyelid looks reddened and swollen, with small scales often forming at the base of the eyelashes.

With posterior blepharitis, the inflammatory process affects the inner edge of the eyelid adjacent to the eyeball, and the meibomian glands located in the eyelids – in this case, tiny white nodules, barley, or chalazion may appear on the inner edge of the eyelids.

Blepharitis can be mixed when the inflammation affects both the ciliary edge of the eyelids, the inner edge of the eyelids adjacent to the eyeball, and the meibomian glands.

Causes

Causes of blepharitis

The most common cause of blepharitis is infection (eg staph infection). Allergic blepharitis often occurs, affecting the skin of the eyelid and the eyelash growth zone, in which case it is possible to detect areas of a skin rash on the eyes and face. An allergic reaction develops as a result of applying cosmetic products (decorative cosmetics, creams) to the eyelid or due to the content of air pollution: impurities, pollen. In this case, the eye itself is often also affected. If you suspect an allergy, you should immediately contact an allergist to identify the allergen that caused the reaction, and in the future to exclude contact with this allergen.

Some skin conditions, such as psoriasis or eczema, can cause damage to the eyelids.

Posterior blepharitis most often develops as a result of dysfunction of the meibomian glands ² _. These glands, invisible to the eye, are located in the region of the edge of the eyelids and it is they who secrete a lipid (fatty) secret, which mixes with the lacrimal fluid and lubricates the surface of the eye. These glands can become inflamed if:

• too thick secretion of the meibomian glands clogs their excretory ducts, as a result of which small white nodules form on the inner edge of the eyelid.

• in certain diseases that affect both the skin of the face and the skin of the eyelids, such as rosacea, seborrheic dermatitis – an excessive amount of sebum is produced on the face, as well as an excessive amount of secretions from the meibomian glands. Pustules can occur on the skin of the face or scalp, as well as in the eyelids.

Treatment

Prevention of blepharitis, treatment, eyelid care

Necessary preventive measures

Blepharitis is characterized by relapses. Therefore, patients suffering from blepharitis should pay special attention to daily hygiene of the eyelids in order to prevent the growth and reproduction of pathogens, as well as to improve the functioning of the meibomian glands.

Eyelid hygiene should be performed daily with 1-2 minutes of self-massage and cleansing of the edges of the eyelids and eyelashes using gentle products designed specifically for the eyes and delicate skin of the eyelids: Blefaclean 9 Wet Cleansing Wipes0029 ® , or Teagel ^® sterile hypoallergenic gel .

If the secretion of the meibomian glands is too dense, the doctor will recommend physiotherapy, or an independent technique of self-massage of the eyelids, which can be done at home. To do this, warm compresses are applied to the closed eyelid in the form of cotton pads or gauze swabs soaked in warm water (1-2 minutes). After warm compresses, the softened secretion of the meibomian glands is easily removed with a 1-2-minute eyelid massage with Teagel ³ .

What to do if blepharitis occurs?

If blepharitis is suspected, an ophthalmologist should be consulted immediately to determine the cause and treat it.

With a doctor-confirmed diagnosis of Meibomian gland dysfunction, it is important to allocate 3-5 minutes daily in the morning and evening for self-massage of the eyelids with the gel. To perform eyelid massage correctly, ask your doctor to demonstrate the technique of its implementation. Regular self-massage will ensure timely cleansing of the ducts of the meibomian glands, alleviate symptoms and prevent inflammation ³ .

Blepharitis and dry eye syndrome can often develop simultaneously: in this case, it is important to protect the surface of the eyes with moisturizing and lubricating eye drops without preservatives, such as Thealose ^® eye drops (medical device).

Which doctor should I contact if I have blepharitis?

In case of inflammation of the eyes or eyelids, it is necessary to consult an ophthalmologist who will conduct the necessary examinations and select a treatment.

¹ 2007 Report of the International Dry Eye WorkShop (DEWS). The Ocular Surface 2007; 5(2)/ http://www.tearfilm.org/dewsreport/pdfs/TOS-0502-DEWS-noAds.pdf

² Kelly K. Nichols; Gary N. Folks; Anthony J. Bron; Ben J. Glasgow; Murat Dogru; Kazuo Tsubota; Michael A. Lemp; David A. Sullivan. The International Workshop on Meibomian Gland Dysfunction: Executive Summary. Investigative Ophthalmology & Visual Science March 2011, Vol. 52, 1922-1929. doi:10.1167/iovs.10-6997a

³ Algorithm for therapeutic eyelid hygiene in ocular surface pathology: textbook / comp. Trubilin V. N., Kurenkov V. V., Polunina E. G., Kapkova S. G., Markova E. Yu. – Moscow: FMBA, 2017 – 32 p.

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Blepharitis: causes, symptoms, diagnosis and treatment.

Definition

Blepharitis is a bilateral inflammation of the margins of the eyelids, which almost always has a chronic course and is one of the most common eye diseases.

Causes of blepharitis

Eyelid irritation caused by mechanical trauma, thermal or chemical damage can be the cause of blepharitis.

Inflammation of the eyelids often develops as one of the manifestations of an allergic reaction. Ingredients of cosmetics, plant pollen, animal dander, and drugs can act as allergens.

Blepharitis can be inflammatory or infectious in nature.

The most common cause of blepharitis is considered to be a staphylococcal infection (mainly S. aureus , to a lesser extent – S. epidermidis ). In addition, Streptococcus pneumoniae , Haemophilus influenzae , Moraxella lacunata , herpes simplex viruses (types I and II, herpes virus type III Varicella – Herpes zoster ), molluscum contagiosum cipoxvirus , pathogenic fungi (Pityrosporum orbiculare, P. ovale), mites Demodex folliculorum hominis , D. brevis ; lice Phthirus pubis.

The development of infectious blepharitis is based on immune reactions to pathogen antigens. Non-infectious blepharitis is diagnosed with seborrhea, rosacea, eczema, immunodeficiency of various etiologies.

Posterior (marginal) blepharitis is associated with impaired secretion production by the meibomian glands.

Classification of the disease

According to the localization of inflammation, there are:

• marginal blepharitis, which affects only the ciliary edge of the eyelid;
• posterior blepharitis, when the lesion is localized in the region of the meibomian glands;
• Angular blepharitis, when inflammation develops in the corners of the eyes.

By duration:

• acute blepharitis,
• subacute blepharitis,
• chronic blepharitis.

According to clinical forms, blepharitis is subdivided:

• into simple blepharitis,
• scaly (seborrheic),
• ulcerative (staphylococcal),
• demodectic,
• allergic,
• acne,
• mixed.

Symptoms of blepharitis

Common symptoms that are characteristic of different types of blepharitis include:

• reddening of the edges of the eyelids with pronounced or slight swelling;
• burning sensation in the eyelids and eyes;
• itching that causes severe discomfort;
• crusts that accumulate in the skin folds of the periorbital region;
• glued eyelashes, as well as their loss or dysplasia;
• tearing;
• eye fatigue even after slight exertion.

Symptoms of scaly blepharitis

This form of pathology is characterized not only by redness, but also by thickening of the eyelids. In the interciliary space, yellow scales, resembling dandruff, appear tightly attached to the skin. Often inflammation affects the conjunctiva, resulting in the development of blepharoconjunctivitis. The disease can also be accompanied by seborrheic dermatitis of the scalp. If scaly blepharitis becomes chronic, then an ectropion (eversion) of the eyelid may form.

Symptoms of ulcerative blepharitis

The ulcerative form is also called purulent blepharitis, since this pathology is characterized by the presence of purulent contents of the hair follicles. Purulent blepharitis almost inevitably causes eyelash loss (in severe forms, there is a risk of losing eyelashes completely). Scar tissue that forms as a result of inflammatory processes in the hair follicles can lead to deformity of the eyelids.

Main symptom of demodectic blepharitis is unbearable itching and redness. A discharge appears, which glues the eyelashes. The edges of the eyelids thicken and look swollen. At the base of the eyelashes, an accumulation of sebaceous secretion and keratinocytes is formed, which resembles a collar or muff in shape.

A distinctive feature of acne blepharitis is red-gray nodules or pustules on the edges of the eyelids, combined with rosacea all over the face.

Diagnosis of blepharitis

Biomicroscopy, a microscopic examination of the eyes under a slit lamp, is used in the diagnosis of blepharitis. Through this device, the edge and the inner side of the eyelid are clearly visible, which makes it possible to assess their condition.

In addition, in the diagnosis of the disease, a number of methods are used to help clarify the cause of blepharitis:

• examination of eyelashes under a microscope in order to identify the Demodex mite;

Demodex mite examination (Demodex folliculorum Demodex brevis), microscopic examination (eyelashes)

There are restrictions on the days of taking samples in medical offices and receiving samples self-collected for this study (feces, urine, etc.).
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Fecal analysis for helminth eggs (helminth eggs)

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Culture of wound discharge and tissues for microflora and determination of sensitivity to antimicrobial drugs

Synonyms:
Wound/tissue Culture. Aerobic Bacteria Identification and Antibiotic Susceptibility testing.
Brief description of the study “Sowing of wound discharge and tissues for microflora and determination of sensi…

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Which doctor to contact

An ophthalmologist conducts the necessary examinations and prescribes the treatment of blepharitis.

In the presence of atopic, seborrheic dermatitis, acne, rosacea, eczema, demodicosis, a consultation with a dermatologist or
allergist.

Blepharitis developing on the background of endocrine pathologies requires consultation
endocrinologist.

Gastroenterological examination should be performed in the presence of concomitant pathology of the gastrointestinal tract.

Treatment of blepharitis

Treatment of chronic blepharitis is of particular difficulty. Hygiene and eyelid massage play a fundamental role in the treatment of this condition. Eyelid hygiene procedures involve mechanical cleaning of the eyelids from crusts and secretions using special wipes, lotions and other products that do not contain irritating substances. With exacerbation of blepharitis, the procedure should be carried out at least 3 times a day until remission occurs. Eyelid massage is required for demodectic and posterior blepharitis.

Local application of antibiotics is necessary if the bacterial nature of the inflammation is established. Systemic drugs are prescribed only in case of ineffectiveness of local remedies.

However, it should be remembered that the abuse of antibacterial drugs can lead to antibiotic resistance, as well as dry eye syndrome.

For the treatment of demodectic blepharitis, acaricidal preparations containing sulfur, metronidazole, are used. They have not only an antiparasitic effect, but also reduce the severity of inflammation.

Therapy of allergic blepharitis requires identification and elimination of the allergen, administration of antihistamines, in some cases corticosteroids are recommended to patients. Symptoms of dry eye syndrome are eliminated with the help of tear substitutes.

Complications

Severe cases of blepharitis and lack of proper treatment can lead to loss of eyelashes or their abnormal growth, decreased visual acuity, scarring at the site of former erosions, degenerative-dystrophic diseases of the cornea.

Prevention of blepharitis

For preventive purposes, it is necessary to treat chronic infections in a timely manner, minimize contact with allergens, observe hygiene (do not touch your eyes with dirty hands, if you wear contact lenses, follow the rules for handling them, do not wipe your face with someone else’s towel) .

Sources:

1. Safonova T.N., Kintyukhina N.P., Sidorov V.V. Treatment of chronic blepharitis // Bulletin of ophthalmology. – 2020;136(1). – p. 97-102.
2. Scientific and practical publication Clinical recommendations. Ophthalmology. Ed. OK. Moshetova, A.P. Nesterova, E.A. Egorova // 2006. 255 p.
3. General practice: national guidelines. Vol. 2 / ed. O.Yu. Kuznetsova, O.M. Lesnyak, E.V. Frolova // 2nd ed., revised. and additional – M.: GEOTAR-Media. – 2020. – 992 p. DOI: 10.33029/9704-5521-0-2VP-2020-1-992.

IMPORTANT!

The information in this section should not be used for self-diagnosis or self-treatment. In case of pain or other exacerbation of the disease, only the attending physician should prescribe diagnostic tests. For diagnosis and proper treatment, you should contact your doctor.
For a correct assessment of the results of your analyzes in dynamics, it is preferable to do studies in the same laboratory, since different laboratories may use different research methods and units of measurement to perform the same analyzes.

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