Etiology and risk factors
The development of blepharitis is associated with infectious or allergic agents. The primary causative agent is Staphylococcus, but the process can also be triggered by Streptococci, Haemophilus influenzae, Moraxella, viruses, fungi, and mites of the genus Demodex.
Predisposing factors include:
- Local changes: seborrhea, eczema, uncorrected refractive errors (hyperopia, astigmatism), dry eye syndrome, chronic conjunctivitis.
- Foci of chronic infection: caries, tonsillitis, adenoids, paranasal sinus pathology.
- Systemic disorders: diabetes mellitus, gastrointestinal diseases, hypovitaminosis, anemia, helminthic infestations, and overall immunosuppression.
Classification
According to the classification by E.A. Egorov (2013), blepharitis is divided according to several criteria:
By etiology:
- Infectious.
- Non-infectious.
By localization:
- Anterior marginal (affecting the musculocutaneous layer of the eyelid).
- Posterior marginal (affecting the tarsoconjunctival plate, the process is associated with meibomian gland dysfunction).
By clinical presentation:
- Squamous (seborrheic).
- Ulcerative (staphylococcal).
- Meibomian (posterior).
- Demodectic.
Clinical presentation of various forms
All patients with blepharitis complain of burning, itching, a feeling of "heaviness" in the eyelids, hypersensitivity to light and dust, and rapid visual fatigue.
- Squamous blepharitis: grayish-white scales (exfoliated epidermis) or yellowish crusts (dried secretion) appear on the eyelid margins. After their removal, hyperemic, thinned skin without ulceration is revealed.
- Ulcerative (staphylococcal) blepharitis: the most severe form, more common in young people. The eyelid margin is thickened, and purulent pustules and ulcers with yellow crusts form at the roots of the eyelashes. Removing the crusts is painful; along with them, the eyelashes fall out, exposing a bleeding surface. This can lead to loss of eyelashes (madarosis), misdirection of growth (trichiasis), and eyelid deformation (tylosis).
- Posterior blepharitis: characterized by telangiectasias at the openings of the meibomian glands and dysfunction thereof. When the eyelid margin is compressed, a foamy secretion is released. May be complicated by chronic conjunctivitis.
Treatment approaches
Therapy is selected individually depending on the form of the disease:
| Morphology | Main treatment directions |
|---|---|
| Allergic | Topical: antihistamines (Visallergol), mast cell stabilizers (Opatanol), glucocorticoids on the eyelid skin (Hydrocortisone-POS). |
| Posterior | Eyelid hygiene, local antibacterial and anti-inflammatory therapy. After inflammation subsides — preservative-free artificial tears. |
| Demodectic | Systemic administration of metronidazole (250 mg twice daily for 2 weeks) and topical application of metronidazole-containing ointments or gels to the eyelid skin (1–1.5 months), massage of the eyelid margins. |
What else to study on this topic
- Technique of eyelid hygiene and massage in posterior blepharitis
- Diagnostic criteria and methods for detecting demodicosis
- Pathogenesis of complications of ulcerative blepharitis: trichiasis, madarosis, tylosis
- Features of the course and complications of external hordeolum
- Rules and media for culturing discharge in purulent-inflammatory eye diseases
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