Bacterial Blepharitis : Inflammation of eyelid

Bacterial Blepharitis

Bacterial blepharitis, also known as chronic anterior blepharitis, or staphylococcal blepharitis or ulcerative blepharitis, is a chronic infection of the anterior part of the lid margin. The disorder usually starts in childhood and may continue throughout life. It is an inflammation of the eyelids in which they become red, irritated and itchy with dandruff-like scales that form on the eyelashes. It is a common eye disorder caused by either bacteria or a skin condition, such as dandruff of the scalp or rosacea.

Etiology

Causative organisms, most commonly involved are coagulase positive Staphylococci. Rarely, Streptococci, Propionibacterium acnes, and Moraxella may be involved.
Predisposing factors, usually none, may rarely include chronic conjunctivitis and dacryocystitis.

Clinical features

Symptoms include chronic irritation, itching, mild lacrimation, gluing of cilia, and mild photophobia. The symptoms are characteristically worse in the morning. Remissions and exacerbations in symptoms are quite common. Signs are as below:

Yellow crusts are seen at the root of cilia which glue them together.
Small ulcers, which bleed easily, are seen on removing the crusts.
Red, thickened lid margins are seen with dilated blood vessels (rosettes).
Mild papillary conjunctivitis and conjunctival hyperemia are common associations.

Complications and sequelae of long standing bacterial blepharitis include:

Lash abnormalities such as madarosis (sparseness or absence of cilia), trichiasis (misdirected cilia), and poliosis (graying of lashes).
Tylosis, i.e., thickening and scarring of lid margin. . Eversion of punctum leading to epiphora.
Eczema of skin and ectropion may develop due to prolonged watering.
Recurrent styes (external hordeola) are a common complication. Marginal keratitis, and occasionally phlyctenulosis may develop.
Tear film instability, and dry eye may result.
Secondary inflammatory and mechanical changes in the conjunctiva and cornea are common because of intimate relationship between the lid margins and ocular surface.

Treatment

Bacterial blepharitis should be treated promptly, as below, to avoid complications and sequelae:

Lid hygiene is essential at least twice daily which includes:
- Warm compresses for 5-10 minutes to soften the crusts,
- Crust removal and lid margin cleaning with the help of cotton buds dipped in the dilute baby shampoo or solution of 3% sodium bicarbonate.
- Avoid rubbing of the eyes or fingering of the lids.
Antibiotic should be used as below:
- Applying eye ointment at the lid margin, immediately after removal of the crusts.
- Using antibiotic eye drops 3-4 times a day.
- Oral antibiotics such as erythromycin or doxycycline may be useful in unresponsive patients and those complicated by external hordeola and abscess of lash follicle.
Topial steroids (weak) such as fluoromethalon may be required in patients with papillary conjunctivitis, marginal keratitis and phlyctenulosis.
Ocular lubricants, i.e., artificial tear drops, are required for associated tear film instability and dry eye.