| disease | Blepharitis |
| alias | Blepharitis |
Inflammation of the eyelid margin is a chronic condition of the eyelid. Blepharitis can be caused by bacteria, seborrheic dermatitis, or local allergic reactions, and these factors often coexist. It leads to subacute or chronic inflammation of the eyelid margin surface, eyelashes, hair follicles, and their glandular tissues. Based on different clinical features, blepharitis can be classified into three types: squamous blepharitis, ulcerative blepharitis, and angular blepharitis.
bubble_chart Etiology
Squamous blepharitis: It is caused by excessive secretion of the sebaceous glands and meibomian glands of the eyelids, leading to seborrhea and resulting in a grade I infection. Squamous blepharitis (squamous blepharitis) is the pathogenic cause. Various physical and chemical irritants (wind, dust, smoke, heat, etc.), reduced systemic resistance, malnutrition, lack of sleep, refractive errors, and visual fatigue, along with poor eye hygiene, are all contributing disease factors.
Ulcerative blepharitis: Ulcerative blepharitis (ulcerative blepharitis) is often caused by a Staphylococcus aureus infection, leading to acute or suppurative inflammation of the eyelash follicles, Zeis glands, and Moll glands.
Angular blepharitis: Angular blepharitis (angular blepharitis) is caused by infection with Morax-Axenfeld diplobacillus. It often affects both eyes and is limited to the canthal region, with the outer canthus being the most commonly affected. It is often associated with poor constitution or anemia, subcutaneous nodules, or may result from a deficiency of riboflavin.
bubble_chart Clinical Manifestations
Scaly Blepharitis:
1. Subjective symptoms: stinging pain, dryness, intense itching.
2. Signs: Congestion of the eyelid margin, scales of epithelial cells adhering to the eyelashes and eyelid margin surface. There may be punctate sebum secretion on the eyelid margin surface, with sebum accumulating at the roots of the eyelashes, forming yellow waxy secretions that dry and crust. After removing the scales and crusts, a congested eyelid margin surface is exposed, but there are no ulcers or pustules. Eyelashes easily fall out but can regrow. If the inflammation persists for a long time, it may lead to thickening of the eyelid margin, with the posterior lip becoming blunt and rounded, preventing close contact with the eyeball. If accompanied by conjunctivitis, swelling and eversion of the lacrimal punctum may occur, leading to epiphora. Epiphora can cause eczema of the lower eyelid, forcing the patient to frequently wipe tears and resulting in ectropion of the lower eyelid, exacerbating the epiphora.Ulcerative Blepharitis:
There is excessive secretion of sebum from the eyelid margin glands, which dries and forms crusts, binding the eyelashes into clusters. After removing the crusts, hemorrhagic ulcers and small pustules can be seen at the roots of the eyelashes. Because the lesions extend deep into the sebaceous glands and hair follicles, the follicles are destroyed, causing eyelashes to fall out easily and regrow with difficulty, leading to madarosis. Even if they regrow, the position may be abnormal. Scar contraction nearby can result in trichiasis or misaligned eyelashes, irritating the cornea. Prolonged disease progression can cause thickening and deformation of the eyelid margin. Associated conditions include chronic conjunctivitis, epiphora, eczema of the surrounding skin, and even ectropion of the lower eyelid, worsening the epiphora. The tears, in turn, exacerbate the ectropion and chronic conjunctivitis.
The eyelid margin and nearby skin show significant congestion and erosion, with subjective symptoms of dryness, stinging, itching, and a foreign body sensation. It is often combined with chronic conjunctivitis, referred to as angular blepharoconjunctivitis.
bubble_chart Treatment Measures
scale blepharitis:
1. First, remove the disease cause, avoid all irritating factors, correct refractive errors, pay attention to nutrition, exercise, and treat other systemic chronic sexually transmitted diseases to improve overall physical condition.
2. Locally, use a cotton swab dipped in 3–4% sodium bicarbonate solution or warm saline to remove crusts and ensure the smooth excretion of excess secretions from the eyelid sebaceous glands and tarsal glands. Then apply antibiotic ointment to the eyelid margin, or use 1:5000 mercuric oxycyanide ointment on the eyelid margin 2–3 times daily. Continue medication for two weeks after recovery to prevent recurrence. If allergic to mercury or severe local irritation occurs, switch to antibiotics or 5% sulfonamide eye medicinal paste. If accompanied by conjunctivitis, antibiotic eye drops should be used.
ulcerative blepharitis: This is more difficult to treat. Daily removal of crusts and plucking of affected eyelashes is necessary, followed by application of various antibiotic or sulfonamide eye ointments. Treatment must be thorough and uninterrupted. For recurrent or long-term unhealed cases, bacterial culture and drug sensitivity tests should be performed to select effective medications. Severe ulcerative blepharitis can be treated with 1% silver nitrate application, followed by saline rinse once daily, which may lead to recovery within a few days.
Frequent application of 0.25%–0.5% zinc sulfate solution or antibiotic eye ointment has special therapeutic effects. Zinc sulfate iontophoresis can also be used, and application of 1% ammoniated mercury ointment is also effective.
Systemically, riboflavin can be taken orally.
Chinese medicine refers to blepharitis as "wind-string erosion" or "rotten-string wind." When the lesion is localized to the canthus, it is called "canthal redness and erosion." It is caused by the accumulation of damp-heat in the spleen and stomach combined with external contraction of wind pathogens. Treatment focuses on dispelling wind, clearing heat, and dispelling dampness.
