Blepharitis

This refers to a chronic inflammation of the lid margins caused by staphylococcal infection. The eyes become red rimmed and there is usually an accumulation of scales giving the appearance of fine dandruff on the lid margins. The condition is often associated with seborrhoea of the scalp. Sometimes it becomes complicated by recurrent styes or chronic infection of the meibomian glands. The eye itself is not usually involved, although there could be a mild superficial punctate keratitis, as evidenced by fine staining of the lower part of the cornea with fluorescein. In more sensitive patients, the unsightly appearance can cause difficulties, but in more severe cases, the discomfort and irritation can interfere with work. Severe recurrent infection can lead to irregular growth of the lashes and trichiasis.

In the management of these patients, it is important to explain the chronic nature of the condition and the fact that certain individuals seem to be prone to it. Attention should be given to keeping the hair, face and hands as clean as possible and to avoid rubbing the eyes. When the scales are copious, they can be gently removed with cotton-wool moistened in sodium bicarbonate lotion twice daily. Dandruff of the scalp should also be treated with a suitable shampoo. A local antibiotic can be applied to the lid margins twice daily with good effect in many, but not all, cases. In severe cases with ulceration of the lid margin, it might be necessary to consider prescribing a systemic antibiotic, preferably after identifying the causative organism by taking a swab from the eyelids. Local steroids when combined with a local antibiotic are very effective treatment, but the prescriber must be aware of the dangers of using steroids on the eye and long-term treatment with steroids should be avoided. Steroids should not be used without monitoring the intraocular pressure.

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