A review of the diagnosis and management of this common irritant eye condition.


Blepharitis refers to the inflammation of the eyelids,1 most frequently affecting the edges. It can either be acute or chronic but typically manifests as a chronic condition. It does not usually cause serious problems, but can be very uncomfortable and irritating for the patient.2

Blepharitis can be either classified as anterior or posterior according to the specific area of eye anatomy affected. Anterior blepharitis is inflammation around the eyelashes and follicles, while the posterior variant involves the meibomian gland orifices or in simpler terms the inner eyelid.2


Many inflammatory and infectious conditions can cause blepharitis. Inflammatory pathologies include seborrheic dermatitis, acne rosacea, atopic and allergic dermatitis. Infectious causes include bacteria such as staphylococcal aureus and epidermis, viruses such as molluscum contagiousum, herpes simplex and varicella-zoster dermatitis.3,4

Staphylococcal and seborrheic dermatitis usually cause anterior blepharitis.5 Posterior blepharitis is caused by meibomian gland dysfunction; these glands are responsible for producing the oily fluid that forms the tear film that lubricates the front of the eye hence their dysfunction can lead to dry eyes. These three causes (staphylococcal, seborrheic and meibomian blepharitis) commonly co-exist.5

Long-term exposure to fumes such as smoke can also cause a chronic blepharitis.2

Clinical presentation

When taking a history, the following symptoms point towards blepharitis:3,5

  • The main symptoms are that the eyes may feel sore, itchy and gritty. Some people describe a burning or a foreign body sensation.
  • Red eyes and sometimes mild photophobia.
  • Watering of the eyes.

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