clinical features
Last edited 05/2022 and last reviewed 05/2022
The condition usually affects both eyes. Symptoms are worse in the morning; there may be several exacerbations and remissions (1).
- If contact dermatitis is the cause there is generally a history of atopy or there may be other areas of the dermatitis due to the application of the cosmetics.
Symptoms include:
- anterior blepharitis
- may be asymptomatic
- ocular discomfort, soreness, burning, itching, mild photophobia
- symptoms of dry eyes - blurred vision, poor tolerance of contact lenses
- posterior blepharitis
- may be asymptomatic
- ocular discomfort, soreness, burning, stinging
- symptoms of dry eyes - blurred vision, poor tolerance of contact lenses
Signs include:
- staphylococcal blepharitis (anterior blepharitis)
- erythema, oedema and telangiectasiae of the lid margin
- crusting of anterior lid margin (scales at bases of lashes) which may form collarettes which encircle the lashes
- recurrent styes and chalazia (rarely)
- aqueous tear deficiency
- conjunctival hyperaemia
- in severe and long standing disease there can be
- trichiasis - misdirection of eyelashes towards the eye
- poliosis - depigmentation of the eyelashes
- madarosis - loss of eyelashes
- eyelid ulceration and eyelid and corneal scarring may occur
- seborrhoeic blepharitis (anterior blepharitis)
- erythema, edema, and telangiectasia of the lid margins (changes are less marked than in staphylococcal blepharitis)
- oily scale and greasy crusting on the lashes
- conjunctival hyperaemia
- aqueous tear deficiency
- Demodex folliculorum mite infestation (anterior blepharitis)
- lid margin erythema
- “cylindrical dandruff” - characteristic clear sleeve (collarette) covers base of lash, extending further up the lash than flat staphylococcal rosettes
- misalignment, trichiasis or madarosis could occur due to persistent infestation of the lash follicles
- MGD (posterior blepharitis)
- thick and/or opaque secretion at Meibomian gland orifices (which is difficult or impossible to express by finger pressure)
- dilated gland and formation of microliths and chalazia - due to plugging of the ducts
- telangiectasias and lid scarring may be present
- excess lipid, foamy discharge (1)
- conjunctival hyperaemia
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