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Blepharitis

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What is blepharitis?
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Blepharitis is chronic inflammation of the margins of the eyelids. It can involve the eyelids, eyelashes, conjunctiva (whites of the eye) and the meibomian glands (those that lubricate the eye).

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What are the symptoms and signs?
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Generally there is a persistent and unsightly redness and scaliness of the skin on and around the eyelid margins. Other problems may include:

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  • persistent soreness of the eyelids or eyes

  • greasy appearance of the eyelid margins

  • flakes of skin, like dandruff

  • eyelashes that fall out

  • small ulcers on the eyelid

  • crusting and bleeding (if severe)

  • irritation of the eye (from flakes)

  • sensation of ‘something in the eye’

  • grittiness, burning, itching and dryness

  • discharge from the lids, causing lashes to glue together during sleep

  • sensitivity to light

  • swelling of the eyelids and conjunctiva.

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What are the three main causes or types?
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  • Seborrhoeic blepharitis: associated with seborrhoeic dermatitis

  • Rosacea blepharitis: associated with rosacea of face

  • Staphylococcus blepharitis: due to infection with the bacterium Staphylococcus aureus

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What are the complications of blepharitis?
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Apart from infection with Staphylococcus any of the following can occur:

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  • styes (infection of an eyelash)

  • meibomian cyst infection

  • conjunctivitis

  • ulceration of the conjunctiva (white of eye) or cornea (clear covering of eye)

  • loss of eyelashes

  • scarring of eyelids

  • misdirected eyelash growth (e.g. inwards).

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What is the expected outcome?
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Blepharitis is a chronic inflammation that is stubbornly resistant to treatment. It can be controlled and sometimes cured in about 6 to 12 months but tends to recur.

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What is the treatment?
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  • Eyelid hygiene is the key to successful treatment. The crusts and other debris on the eyelids should be gently cleaned with a cotton bud dipped in clean, warm water, a weak solution of sodium bicarbonate (baking soda) or a 1 in 10 dilution of baby shampoo. This should be done once or twice daily depending on the severity. An alternative is to apply a warm water or saline soak with gauze for 20 minutes followed by a rest for 60 minutes before bathing the eyelids again.

  • Control scalp seborrhoea with antidandruff shampoo (e.g. Head & Shoulders shampoo).

  • Eye lubricants such as artificial tear preparation will relieve the symptoms of dry eyes.

  • Avoid wearing eye makeup while inflammation is present.

  • Discontinue wearing contact lenses until the condition has cleared.

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  • Short-term use of a cortisone eye ointment applied to the margins after washing will give relief.

  • Antibiotic ointment should be smeared on the lid margin regularly if infection is present.

  • Your doctor may prescribe a combined cortisone ...

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