Eyes & Vision

Blepharitis

Blepharitis is chronic inflammation of the eyelid margins: anterior disease affects the lash line, while posterior disease is usually meibomian gland dysfunction. It causes sore, gritty, crusted lids and evaporative dry-eye symptoms; long-term lid hygiene is the foundation, while pain, visual change or a very red eye needs urgent assessment for another ocular diagnosis.

In a nutshell

Blepharitis is chronic, relapsing lid-margin inflammation: anterior disease affects the lash line and posterior disease is usually meibomian gland dysfunction, often associated with rosacea. Long-term lid hygiene is first-line; add prescribed topical treatment only if hygiene is insufficient, and consider oral antibiotics only for selected persistent/severe posterior disease. Pain, photophobia, visual change or a very red eye needs urgent assessment for another diagnosis.

Classic presentation

A patient with recurrent bilateral sore, gritty, crusted or itchy eyelid margins, worse on waking, with dry-eye symptoms and possibly rosacea, seborrhoeic dermatitis, recurrent styes or chalazia.

Key points

Anterior blepharitis affects the lash line; posterior blepharitis is usually MGD and the two can coexist.
MGD reduces the tear-film lipid layer and causes evaporative dry-eye symptoms.
First-line treatment is ongoing lid hygiene: warm compress, gentle massage and lid-margin cleaning; it is maintenance, not a one-off cure.
Persistent or severe disease may need prescribed topical treatment; oral antibiotics are reserved for selected posterior/MGD or rosacea-associated disease after contraindication and interaction checks.
A unilateral destructive lesion, recurrent same-site lesion or lash loss needs ophthalmic assessment for malignancy.
Pain, photophobia, blurred/lost vision or a very red eye is not typical uncomplicated blepharitis and needs urgent review.

First-line investigation

Clinical examination of both lid margins, lashes, meibomian orifices, ocular surface and associated skin disease; slit-lamp examination where available. Routine laboratory testing is not needed in a typical case.

Management

Exclude a painful red-eye emergency

Pain, photophobia, blurred/lost vision, a very red eye, corneal opacity/infiltrate or a painful contact-lens-associated red eye needs urgent GP/111 or eye-emergency assessment.^3,1

Use regular lid hygiene

Twice daily, use a comfortably warm compress for 5–10 minutes, gently massage the lids for about 30 seconds, then clean the lid margins; continue a maintenance routine after symptoms settle.^3,2

Treat tear-film and skin associations

Use ocular lubricants for associated dry-eye symptoms and address rosacea or seborrhoeic dermatitis; avoid contact lenses and eye make-up while symptomatic.^3,2

Reserve medication and refer selected cases

If regular hygiene is insufficient, arrange clinical review for a prescribed topical antibiotic; consider oral antibiotic treatment only for selected persistent/severe posterior or rosacea-associated disease with BNF/BNFc safety checks. Refer corneal involvement, suspected malignancy, severe/atypical disease or treatment failure.^3,1,2,4,5

Exam traps

Blepharitis is chronic and relapsing; stopping lid hygiene when symptoms settle commonly leads to recurrence.
Do not assume all red or gritty eyes are blepharitis: pain, photophobia, visual change or marked redness raises concern for a sight-threatening diagnosis.
Do not use topical steroid eye drops without appropriate ophthalmic supervision.
Do not make topical or oral antibiotics routine; reserve them for selected persistent, severe or associated disease after clinical review.
A persistent unilateral lesion with lash loss is a malignancy warning sign, not simply resistant blepharitis.

Illustrations

Anterior blepharitis with lash-margin crustingA photograph of an inflamed anterior lid margin with crusting and collarettes around the lash bases. Label it as an illustrative clinical image, not a diagnostic substitute.Imrankabirhossain, Wikimedia Commons · CC-BY-SA-4.0

Key sources

This page is exam revision material, not medical advice, and must not be used for patient care. Always check drug doses against the BNF and current guidance. Full disclaimer.