Blepharitis, Stye, and Chalazion
Blepharitis, or chronic inflammation of the eyelid,
is the most common ocular disease known. The symptoms of blepharitis
include redness of the eyes and eyelids, itching, burning and a
feeling that something is in the eyes. Some patients complain that
their eyelids form crusts and stick together in the morning. Blepharitis
always involves the eyelid margin (edge), but in some cases it may
also affect the conjunctiva (inner lining of the eye), cornea (clear
outer layer of the eye) and eyelid skin.
Who can get blepharitis?
Adults are affected more often than children.
The condition may occur at an increased frequency within certain
families and in children with Down's syndrome.
What are the types of blepharitis?
To better understand this condition, think of
the eyelid as being composed of two layers, one in front of the
other. Each of these layers contains unique structures whose function
may be affected by blepharitis.
Anterior blepharitis is related to
inflammation of the front layer of the eyelid. The symptoms usually
are limited to ocular itching, burning and irritation. Although
there are many possible causes of anterior blepharitis, it is most
often related to bacterial infection or seborrheic dermatitis, a
chronic inflammatory skin condition.
Seborrheic dermatitis is a common problem affecting the scalp,
eyebrows, face and eyelids in two-thirds of anterior blepharitis
patients. It is the most common cause of blepharitis. This condition
leads to oily secretions, eyelid swelling, scaling and flaking produce
ocular itching and burning that can be severe. Both layers of the
eyelid may be affected.
Posterior blepharitis occurs when
the small (meibomian) glands in the inner layer of the eyelid either
become inflamed or secrete an excessive quantity of their normal
product. These glands produce an oily substance, an important part
of the normal tear film that bathes the surface of the eye. Overproduction
of this substance can produce a bothersome burning sensation of
the eyes, although the eyelids may remain normal in appearance.
In contrast, patients suffering from gland inflammation may also
complain of a burning sensation as well as tearing, itching, irritation,
sensitivity to light and crusting upon awakening in the morning.
In these patients, the eyelid margin may appear red and swollen.
The cause of gland inflammation is unknown, but bacterial infection
or plugging of the glands by abnormally thick secretions is thought
to play a role.
Treatment of blepharitis
Blepharitis is a chronic condition. Treatment involves thorough
eyelid cleansing aimed at keeping the eyelid margin free from crusts
and secretions. Both anterior and posterior blepharitis are treated
with warm compresses (warm, moist wash cloth applied to the eyelid)
followed by lid cleansing (using a moist cotton swab to gently clean
the eyelid margin) two to three times each day. For posterior blepharitis
with significant meibomian gland dysfunction, some physicians may
recommend treatment with oral antibiotics. Blepharitis is a difficult
disease to treat and a complete cure is not easily achieved. Effective
treatment requires a long-term commitment from both patient and
Complications concerning blepharitis
Complications may occur in patients with anterior or posterior blepharitis.
In the presence of bacterial blepharitis, an abscess (a collection
of pus surrounded by inflamed tissue) may form in the sweat glands
or hair follicles normally present in the anterior layer of the
eyelid, producing a stye. A stye develops
rapidly, producing an elevated, painful, red, swollen area on the
eyelid. Styes rarely occur in seborrheic dermatitis, but may occur
in up to one-third of patients with posterior blepharitis. Treatment
consists of frequent warm compresses and, in select cases, antibiotics.
A chalazion is a firm nodule that
may form following either anterior or posterior blepharitis. Secretions
from meibomian glands normally present in the posterior layer of
the eyelids may leak into the surrounding tissues, causing inflammation.
Chalasia may occur suddenly or may appear gradually over time. They
may be painful, red, and swollen, or may simply produce a firm mass.
Conservative treatment with frequent warm compresses is often successful,
but steroid injections into the chalazion or surgical removal are
sometimes necessary. In rare cases, cancerous tumors of the eyelid
can appear like a stye or chalazion.