Inflammation of the Eyelids
(Blepharitis)
Description of the Disease and Clinical Picture
Blepharitis can be focal (hordeolum and granulomatous blepharitis), where there is inflammation of one or more Meibomian glands, but it can also develop as a diffuse problem causing inflammation of the entire margin of the eyelids. It can occur as a primary problem, but also as one of the manifestations of a generalized skin disease. Accordingly, the causes of blepharitis are the same as the causes of dermatitis. They can be infectious in nature, caused by parasites (Demodex, Sarcoptes, Cuterebra larvae, Hypoderma larvae), bacteria (Staphylococcus spp., Streptococcus spp., and others), fungi (Microsporum canis, Microsporum gypseum, Trichophyton mentagrophytes, and Malassezia pachydermatis), as well as some protozoa (Leishmania infantum). Causes are often immunological, ranging from allergies to autoimmune diseases, as well as vascular and nutritional. Individual causes of blepharitis will be described in detail in the following sections.
The symptoms vary depending on the cause and the duration of the disease. The most common symptoms are pronounced swelling and erythema of the eyelids, blepharospasm, and tearing. Blepharitis is often accompanied by conjunctivitis (blepharoconjunctivitis). The clinical picture may also include periocular alopecia, erosions, flakes, crusts, exudation, and scars.
Therapy
To be successful, the therapy must determine the exact cause of the disease. If bacterial or fungal blepharitis is suspected, cytological and microbiological examinations are performed. Demodex is diagnosed by skin scraping, and Leishmania by serological or PCR tests. Atopic dermatitis is confirmed by intradermal skin tests, and autoimmune diseases by histopathological examination of tissue samples taken by biopsy. Each cause has its own specific drug therapy, which can be local and/or systemic. The length of the therapy depends on the cause and can last for months, or even for a lifetime (autoimmune diseases).
 
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