Will Ayliffe Ph.D, FRCS.
Consultant Ophthalmic Surgeon
St Anthony’s Hospital, London UK
To survey the types and treatments of blepharitis
Literature search and case studies
Blepharitis is a poorly understood, mostly chronic inflammatory condition of the eyelids.
It has been variously classified over the years and this has led to confusion in diagnosis and management. Simplification more recently has broadly differentiated the inflammation into anterior blepharitis mainly involving the skin and lashes or posterior blepharitis affecting the meibomian glands and conjunctiva.
Anterior inflammation has been associated with folliculitis caused by staphylococcal or even mite infestation.
Posterior blepharitis is mainly due to the composition and qualities of the meibomian oil, but secondary causes my lead to anatomical changes in the position of the orifices and failure to deliver oil to the optimal site and subsequent blepharitis.
The heterogenous causes have understandably led to a wide variety of treatments.
Unfortunately robust evidence for any is lacking. A recent analysis of 34 studies (2,169 patients)1.
AAO Preferred Practice Pattern Guidelines (AAO 2008) assessed the strength of evidence to support lid hygiene, topical antibiotics, topical corticosteroids, and oral tetracyclines as treatment for blepharitis only as level III2.
In patients with anterior blepharitis, topical antibiotics reduced symptoms and unsurprisingly reduced bacterial load from the eyelid margin.
In posterior blepharitis, lid hygiene reduced symptoms in many patients.
The effectiveness of other treatments, including topical steroids and oral antibiotics, was inconclusive.
The available evidence fails to show any strong effect for any intervention.
In patients with anterior blepharitis, topical antibiotics may help but the role of short-term systemic antibiotics for posterior blepharitis remains controversial.
Lindley et al. Interventions for chronic blepharitis. Cochrane Database Syst Rev. ; 5: CD005556. doi:10.1002/14651858.CD005556.pub2.
A consensus opinion in the absence of substantial controlled evidence
Diopsys plc helped with travel expenses.