Blepharitis

Disease Description (Causes and Symptoms)

• Definition summary: An inflammatory condition occurring in the eyelid skin and around the eyelashes. Infection and inflammation of the Meibomian glands and areas around the eyelashes are the main pathophysiological mechanisms.
• Main causes
  • Anterior blepharitis: Inflammation at the base of the eyelashes caused by Staphylococcus infection, seborrheic dermatitis (seborrheic changes of the scalp and face), etc.
  • Posterior blepharitis: Imbalance of the lipid layer and inflammation caused by obstruction or dysfunction of the Meibomian gland openings (Meibomian gland dysfunction, MGD).
  • Associated with skin diseases (acneiform rosacea, seborrheic dermatitis), hygiene status, and dry eye syndrome.
• Pathophysiology summary: Meibomian gland secretion dysfunction or inflammation caused by bacteria or dermatitis → continuous eyelid irritation and possible damage to the ocular surface (conjunctiva and cornea) → structural changes when chronic (eyelash loss, trichiasis, etc.).
• Main symptoms
  • Redness and swelling of the eyelid margins, eye discharge (oily or crusted), eyelash loss/deformity (inward turning of the eyelashes), itching, foreign-body sensation, irritation, burning, and bloodshot eyes
  • Pus/pustules and ulcers (in ulcerative blepharitis); in severe cases, chalazion (lipogranuloma), external hordeolum, or internal hordeolum may occur
  • Dry eye symptoms and visual discomfort due to tear-film instability when chronic

Treatment Methods

• Conservative/first-line treatment
  • Apply warm compresses (with a warm wet towel for at least 5 minutes) to soften the oil in the Meibomian glands and help it drain. Perform once or twice a day, and daily at first.
  • Eyelid hygiene (lid scrub): Remove crusts and secretions from the base of the eyelashes using a dedicated eyelid cleanser or diluted shampoo (if recommended by a doctor).
  • Use preservative-free artificial tears to moisturize the ocular surface and relieve irritation.
• Medication treatment
  • Topical antibiotics (ointments): Erythromycin ointment, bacitracin, etc. (especially for anterior blepharitis or localized infection).
  • Topical antibiotic eye drops or antimicrobial agents (as directed by a doctor).
  • Oral antibiotics: Short-term administration of doxycycline or azithromycin may be helpful for chronic posterior blepharitis (MGD) or cases with abundant inflammatory secretions, particularly because of their anti-inflammatory and oil-regulating effects.
  • Short-term topical steroid eye drops/ointments: Used to relieve symptoms during acute exacerbations, but long-term use carries risks of corneal damage and increased intraocular pressure, so they should be used only short term under a doctor’s direction.
• Procedures/systemic treatment
  • Meibomian gland expression (office expression), mechanical removal, thermal pulsation (e.g., LipiFlow), or IPL (deep heat treatment) may help improve Meibomian gland function.
  • Surgical correction may be necessary for severe structural problems (severe abnormal eyelash direction or recurrent tumor-like lesions).
• Lifestyle management and precautions
  • Use eye drops and ointments as prescribed, and do not use steroid medications long term without a doctor’s direction.
  • Visit a medical institution immediately if symptoms worsen (decreased vision, severe pain, spreading redness around the eye, high fever, etc.).
  • It is recommended to stop wearing contact lenses until symptoms improve. Avoid using makeup (eyeliner and mascara), and do not share personal towels or pillows.
• Prognosis
  • There is a tendency for chronic recurrence. Symptoms can be relieved with appropriate hygiene and treatment, but ongoing management is necessary. Additional treatment is needed if complications (chalazion, internal hordeolum, keratitis, etc.) occur.

Checklist Before an Outpatient Visit (Including Preparation Items and Example Questions)

• Items to prepare/bring
  • A list of all medications currently being taken (including eye drops) and a history of allergies
  • Previous ophthalmology medical records and test results (if available)
  • A record of when symptoms began and how they have changed (taking photographs in advance may be useful)
  • Whether contact lenses are used and usage habits, and whether cosmetics are used
  • A history of skin diseases (seborrheic dermatitis, rosacea, etc.) and systemic diseases (diabetes, etc.)
• Things to show the doctor at the outpatient visit
  • Photographs of the eyelids (redness, crusts, discharge, etc.) and a symptom diary (when symptoms become worse)
• Items to check for yourself at the outpatient visit (including example questions)
  • Frequency of symptoms and aggravating factors (When are they worse?)
  • Frequency of and response to existing self-care (warm compresses and cleansing)
  • Eye-related products currently being used (lenses, makeup, ointments, etc.)

Examples of General Questions to Ask the Doctor

• What are the possible side effects of this medication (the prescribed antibiotic/steroid)?
• How many weeks does it usually take for symptoms to improve after starting treatment? How often should I manage the condition to prevent recurrence?
• When can I start wearing contact lenses or using cosmetics again?
• How likely is it that blepharitis will affect the cornea (vision)?
• What lifestyle habits should I maintain for long-term prevention?

Examples of Disease-Specific Questions

• In my case, does Meibomian gland dysfunction appear to be the main cause? Do I need to take an oral antibiotic (e.g., doxycycline)?
• Are procedures such as IPL (intense pulsed light therapy) or LipiFlow suitable for me? What are the expected effects, costs, and side effects?