blepharitis / dry eyes

see also:

• dermatology
• ophthalmology
• Sjögren's syndrome (SS)
• facial rashes

• blepharitis is inflammation of the eyelids which is the main cause of dry eyes accounting for over 80% of cases
• anterior blepharitis involves the skin, eyelashes and lash follicles
• posterior blepharitis involves meibomian glands and orifices, tarsal plate, and blepharo-conjunctival junction
• it may be due to auto-immune conditions, but mostly it appears to be due to colonisation with bacteria which is more likely when there is dermatologic conditions such as dermatitis
• chronic inflammation may result in:
  • trichiasis
  • notching entropion
  • ectropion
  • keratitis with secondary corneal scarring, astigmatism, impaired vision, and if severe, can result in corneal perforation

• acne rosacea
  • involves meibomian glands in 90% of ocular cases, and if untreated, may result in chalazia, keratitis, episcleritis or anterior uveitis
  • most common in 40-80yr olds but can arise in younger patients
  • 10% of population develop rosacea and of these, 60% develop ocular rosacea
• atopic_dermatitis
• seborrhoeic dermatitis - especially in those over 50yrs
• dry eye syndromes such as:
  • Sjögren's syndrome (SS) / keratoconjunctivitis Sicca
  • systemic lupus erythematosus (SLE)
• chalazion
• trichiasis
• ectropion
• entropion
• conjunctivitis
• keratitis

• as blepharitis is a chronic condition, treatment needs to be long term and continued even when there is improvement
• patients with dry eyes may benefit from use of artificial tears
• graded Rx starting with:
  • eyelid hygiene
    • twice daily warm compresses placed over closed eyes for 5-10 minutes (esp. if posterior)
    • eyelid cleansing and massage after their evening warm compress - massage with no-tears baby shampoo or eyelid wipes
  • consider 2 week bd trial of topical antibiotics if anterior symptoms, either:
    • erythromycin ointment
    • azithromycin solution
  • consider oral antibiotics if posterior symptoms or ocular rosacea
    • oral azithromycin 1 g each week for 3 weeks every 3-4 months
  • consider omega 3 acids
    • two 1g tablets tds appears to improve symptoms
  • consider topical tea tree oil scrubs
  • severe cases may need topical steroids / cyclosporine as per ophthalmologist opinion