Blepharitis

Unit Kornea, Infeksi & Immunologi

Rumah Sakit Mata Cicendo
Fakultas Kedokteran
Universitas Padjadjaran Bandung
 Inflammation of eyelid margin is called blepharitis
One of the most common causes of external ocular
irritation
Infectious or Inflammatory etiology
Most common causes are Staphylococcus aureus species

Introduction
 Classification of Blepharitis

1. Anterior
Staphylococal
Seborrhoeic
Mixed

2. Posterior
Meibomian seborrhoea
Meibomianitis
3. Mixed Anterior and Posterior
1. Anterior Blepharitis
Long Standing
. Staphylococcal Staphylococcal Blepharitis
Staphylococcal Blepharitis
. Seborrhoeic
. Mixed

Hyperemia, telangiectasia,
Symptoms
hypertrophy, scarring lid
Burning, grittiness, mild
margin, andcrusting,
photophobia, madarosis in
rednessLong
of lidStanding
margin
Staphylococcal Blepharitis
Worse in the morning
Sign
Hyperemia, telangiectasia
Hard scales around bases of
eyelashes
1. Anterior Blepharitis
. Staphylococcal
. Seborrhoeic
. Mixed

Trichiasis, Madarosis,
Complication of External hordeolum
Poliosis
Staphylococcal
Blepharitis

Marginal Keratitis Tear Film Instability

1. Anterior Blepharitis
. Staphylococcal
Seborrhoeic Blepharitis
. Seborrhoeic
. Mixed

Sign
Hyperemic and greasy
anterior lid margin,
eyelashes are sticking
together
Soft scales
Assoc. with seborrhoeic
dermatitis
 2. Posterior Blepharitis
Meibomian Meibomian Seborrhoea
Meibomianitis
seborrhoea (excessive meibomian
(Inflammation gland
and Obstruction
. Meibomianitis secretion)
of Meibomian Glands)

Inflamed and blocked Toothpaste-like Meibomian cyst

meibomian gland plaques formation (small
from
orifice gland orifices meibomian
Meibomian glands chalazia)
are capped by oil globules Tear film is oily and foamy
1. Dry eye
Similar symptoms with blepharitis
Ocular symptoms developed later in the day than in the
morning
2. Infltrating lid tumors (sebaceous gland carcinoma)
Suspected in pts with apparently asymmetrical or unilateral
chonic blepharitis, assoc. with madarosis

Differential Diagnosis
1. Lid hygiene
To remove crust and toxic product
Using cotton bud and 25% solution of baby shampoo
2. Warm compress
To melt solidified sebum and mechanical expression of meibomian gland
3. Antibiotic ointment
Chloramphenicol or sodium fusidat (Fucidin) to treat acute foliculitis
4. Weak topical steroid
For secondary papillary conjunctivitis and marginal keratitis
5. Tear Substitutes
For tear film instability
6. Systemic antibiotics
For posterior blepharitis
Tetracycline (4x250 mg), doxycycline (2x100 mg), Minocycline (1x100 mg)
Erithromycin or Azithromycine if contraindicated

Treatment
 Kanski JJ. Cilinical Ophthalmology A Systematic Approach. Butterworth Heinemann.
Philadelphia PA: Elsevier Science Limited. 2003

American Academy of Ophthalmology. The Eye MD Association. External Eye Disease

and Cornea. Basic and Clinical Science Course. Section 8. 2010-2011. Singapore:
American Academy of Ophthalmology: 2010

Ehlers JP, Shah CP. The Wills Eye Manual. Office and Emergency Room, Diagnosis
and Treatment of Eye Disease. 5th Ed. Philadelphia PA 19106 USA: Lippincott
Williams & Wilkins. 2008

References
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