Blepharitis

  • Diffuse inflammation of lash follicles of lids
  • Usually caused by skin organisms (Staphylococcus aureus)
  • Causes chronic gritty sensation, tenderness and flaky debris on lid margins but rarely causes vision loss
  • Grittiness and mattering of eyes, noted especially on awakening
  • Red and thickened lid margins
  • Flaky debris in lashes
  • Mild conjunctival redness
  • Rosacea-like thickening and reddening of facial skin or seborrheic debris on skin of scalp and face
  • No other condition
  • Instruct patient to perform these lid scrubs twice per day:
    • Place warm washcloth over closed lid for 5 minutes to soften crusts
    • Moisten cotton-tipped applicator in solution of 3 ounces of water and 3 drops of baby shampoo, and use it to scrub closed lid margins
    • Rinse solution from lids with clear water
    • Brush off lid margin debris with clean, dry applicator
  • If 2-week program of lid scrubs fails, prescribe nightly application of bacitracin or erythromycin ointment to lid margins
  • If topical medication does not work, prescribe oral tetracycline 0.5 to 1 gm/day in four doses or doxycycline 50 to 100 mg once or twice daily (except in pregnant patients and children aged 12 years or less)
  • If these treatments do not work after several weeks, refer to ophthalmologist
  • Escalating treatment program of lid scrubs, topical antibiotic ointment, and oral antibiotics usually successful in relieving symptoms