Skip to main content
SpringerLink
Log in

Chronic Blepharitis: Diagnosis, Pathogenesis, and New Treatment Options

  • Chapter
Cornea and External Eye Disease

Part of the book series: Essentials in Ophthalmology ((ESSENTIALS))

  • 1440 Accesses

Abstract

■ Chronic blepharitis can cause severe corneal changes, but is surprisingly often not diagnosed

■ Pathogenesis often includes skin diseases, but also bacterial involvement, meibomian gland dysfunction with altered meibomian gland lipids, hormonal imbalance

■ Important sequelae of chronic blepharitis are dry eye syndrome, corneal involvement like keratitis, phlyctenules, pannus, vascularization, corneal ulcers, and lid changes like trichiasis and madarosis

■ The treatment includes mechanical measures, preservative-free artificial tears, steroids, antibiotics, immunomodulatory eye drops (e.g., steroids, cyclosporin) or ointment (e.g., FK506, Pimecrolimus), and occasionally surgical treatment

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

Log in via an institution
Chapter
USD 29.95
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
eBook
USD 149.00
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
Softcover Book
USD 199.99
Price excludes VAT (USA)
  • Compact, lightweight edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info
Hardcover Book
USD 199.99
Price excludes VAT (USA)
  • Durable hardcover edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Institutional subscriptions

Preview

Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.

References

  1. Akpek EK, Dart JK, Watson S, Christen W, Dursun D, Yoo S, O’Brien TP, Schein OD, Gottsch JD (2004) A randomized trial of topical cyclosporin 0.05% in topical steroid-resistant atopic keratoconjunctivitis. Ophthalmology 111:476–482

    Article  PubMed  Google Scholar 

  2. Auw-Haedrich C, Feltgen N (2003) Oestrogen receptor expression in Meibomian glands and its correlation with age and dry-eye parameter. Graefes Arch Clin Exp Ophthalmol 241:705–709

    Article  PubMed  CAS  Google Scholar 

  3. Avisar R, Savir H, Deutsch D, Teller J (1991) Effect of I-Scrub on signs and symptoms of chronic blepharitis. DICP 25:359–360

    PubMed  CAS  Google Scholar 

  4. Barnhorst DA Jr, Foster JA, Chern KC, Meisler DM (1996) The efficacy of topical metronidazole in the treatment of ocular rosacea. Ophthalmology 103:1880–1883

    PubMed  Google Scholar 

  5. Baudouin C (2001) The pathology of dry eye. Surv Ophthalmol 45 [Suppl 2]:S211–S220

    Google Scholar 

  6. Baum JL, Bull MJ (1974) Ocular manifestations of the ectrodactyly, ectodermal dysplasia, cleft lip-palate syndrome. Am J Ophthalmol 78:211–216

    PubMed  CAS  Google Scholar 

  7. Ben Simon GJ, Huang L, Nakra T, Schwarcz RM, McCann JD, Goldberg RA (2005) Intralesional triamcinolone acetonide injection for primary and recurrent chalazia: is it really effective? Ophthalmology 112:913–917

    Article  PubMed  Google Scholar 

  8. Borrie P (1953) Rosacea with special reference to its ocular manifestations. Br J Dermatol 65:458–463

    Article  PubMed  CAS  Google Scholar 

  9. Bowman RW, Dougherty JM, McCulley JP (1987) Chronic blepharitis and dry eyes. Int Ophthalmol Clin 27:27–35

    Article  PubMed  CAS  Google Scholar 

  10. Bron AJ, Benjamin L, Snibson GR (1991) Meibomian gland disease. Classification and grading of lid changes. Eye 5(4):395–411

    PubMed  Google Scholar 

  11. De Leener H, Maudgal PC (1993) Chronic blepharitis, meibomitis and corneal lesions. Bull Soc Belge Ophtalmol 249:101–106

    PubMed  Google Scholar 

  12. Dougherty JM, McCulley JP (1984) Comparative bacteriology of chronic blepharitis. Br J Ophthalmol 68:524–528

    Article  PubMed  CAS  Google Scholar 

  13. Dougherty JM, McCulley JP (1986) Bacterial lipases and chronic blepharitis. Invest Ophthalmol Vis Sci 27:486–491

    PubMed  CAS  Google Scholar 

  14. Dougherty JM, McCulley JP, Silvany RE, Meyer DR (1991) The role of tetracycline in chronic blepharitis. Inhibition of lipase production in staphylococci. Invest Ophthalmol Vis Sci 32:2970–2975

    PubMed  CAS  Google Scholar 

  15. Dougherty JM, Osgood JK, McCulley JP (1991) The role of wax and sterol ester fatty acids in chronic blepharitis. Invest Ophthalmol Vis Sci 32:1932–1937

    PubMed  CAS  Google Scholar 

  16. Driver PJ, Lemp MA (1996) Meibomian gland dysfunction. Surv Ophthalmol 40:343–367

    Article  PubMed  CAS  Google Scholar 

  17. Esmaeli B, Harvey JT, Hewlett B (2000) Immunohistochemical evidence for estrogen receptors in meibomian glands. Ophthalmology 107:180–184

    Article  PubMed  CAS  Google Scholar 

  18. Farpour B, McClellan KA (2001) Diagnosis and management of chronic blepharokeratoconjunctivitis in children. J Pediatr Ophthalmol Strabismus 38:207–212

    PubMed  CAS  Google Scholar 

  19. Gutgesell VJ, Stern GA, Hood CI (1982) Histopathology of meibomian gland dysfunction. Am J Ophthalmol 94:383–387

    PubMed  CAS  Google Scholar 

  20. Hammersmith KM, Cohen EJ, Blake TD, Laibson PR, Rapuano CJ (2005) Blepharokeratoconjunctivitis in children. Arch Ophthalmol 123:1667–1670

    Article  PubMed  Google Scholar 

  21. Heiligenhaus A, Koch JM, Kemper D, Kruse FE, Waubke TN (1994) [Therapy of dry eye disorders]. Klin Monatsbl Augenheilkd 204:162–168

    PubMed  CAS  Google Scholar 

  22. Heiligenhaus A, Koch JM, Kruse FE, Schwarz C, Waubke TN (1995) [Diagnosis and differentiation of dry eye disorders]. Ophthalmologe 92:6–11

    PubMed  CAS  Google Scholar 

  23. Henriquez AS, Korb DR (1981) Meibomian glands and contact lens wear. Br J Ophthalmol 65:108–111

    Article  PubMed  CAS  Google Scholar 

  24. Holly FJ, Lemp MA (1977) Tear physiology and dry eyes. Surv Ophthalmol 22:69–87

    Article  PubMed  CAS  Google Scholar 

  25. Huber-Spitzy V (2005) [Blepharitis]. Klin Monatsbl Augenheilkd 222:R55–R67; quiz R68–R72

    Article  Google Scholar 

  26. Hykin PG, Bron AJ (1992) Age-related morphological changes in lid margin and meibomian gland anatomy. Cornea 11:334–342

    Article  PubMed  CAS  Google Scholar 

  27. Jester JV, Nicolaides N, Smith RE (1981) Meibomian gland studies: histologic and ultrastructural investigations. Invest Ophthalmol Vis Sci 20:537–547

    PubMed  CAS  Google Scholar 

  28. Joseph MA, Kaufman HE, Insler M (2005) Topical tacrolimus ointment for treatment of refractory anterior segment inflammatory disorders. Cornea 24:417–420

    Article  PubMed  Google Scholar 

  29. Kaercher T, Brewitt H (2004) [Blepharitis]. Ophthalmologe 101:1135–1147; quiz 1148

    Article  PubMed  CAS  Google Scholar 

  30. Keith CG (1967) Seborrhoeic blepharo-kerato-conjunctivitis. Trans Ophthalmol Soc UK 87:85–103

    PubMed  CAS  Google Scholar 

  31. Kersten RC, Kleiner FP, Kulwin DR (1992) Tarsotomy for the treatment of cicatricial entropion with trichiasis. Arch Ophthalmol 110:714–717

    PubMed  CAS  Google Scholar 

  32. Key JE (1996) A comparative study of eyelid cleaning regimens in chronic blepharitis. CLAO J 22:209–212

    PubMed  CAS  Google Scholar 

  33. Kock A, Schwarz T, Kirnbauer R, Urbanski A, Perry P, Ansel JC, Luger TA (1990) Human keratinocytes are a source for tumor necrosis factor alpha: evidence for synthesis and release upon stimulation with endotoxin or ultraviolet light. J Exp Med 172:1609–1614

    Article  PubMed  CAS  Google Scholar 

  34. Lee SH, Tseng SC (1997) Rose bengal staining and cytologic characteristics associated with lipid tear deficiency. Am J Ophthalmol 124:736–750

    PubMed  CAS  Google Scholar 

  35. Lempert SL, Jenkins MS, Brown SI (1979) Chalazia and rosacea. Arch Ophthalmol 97:1652–1653

    PubMed  CAS  Google Scholar 

  36. Li Y, Ferrante A, Poulos A, Harvey DP (1996) Neutrophil oxygen radical generation. Synergistic responses to tumor necrosis factor and mono/polyunsaturated fatty acids. J Clin Invest 97:1605–1609

    Article  PubMed  CAS  Google Scholar 

  37. Mathers WD (1993) Ocular evaporation in meibomian gland dysfunction and dry eye. Ophthalmology 100:347–351

    PubMed  CAS  Google Scholar 

  38. Mathers WD, Shields WJ, Sachdev MS, Petroll WM, Jester JV (1991) Meibomian gland dysfunction in chronic blepharitis. Cornea 10:277–285

    Article  PubMed  CAS  Google Scholar 

  39. Mayer K, Reinhard T, Reis A, Bohringer D, Sundmacher R (2001) [FK 506 ointment 0.1 % – a new therapeutic option for atopic blepharitis. Clinical trial with 14 patients]. Klin Monatsbl Augenheilkd 218:733–736

    Article  PubMed  CAS  Google Scholar 

  40. McCulley JP, Sciallis GF (1977) Meibomian keratoconjunctivitis. Am J Ophthalmol 84:788–793

    PubMed  CAS  Google Scholar 

  41. McCulley JP, Shine W (1997) A compositional based model for the tear film lipid layer. Trans Am Ophthalmol Soc 95:79–88; discussion 88–93

    PubMed  CAS  Google Scholar 

  42. McCulley JP, Shine WE (2000) Changing concepts in the diagnosis and management of blepharitis. Cornea 19:650–658

    Article  PubMed  CAS  Google Scholar 

  43. McCulley JP, Shine WE (2004) The lipid layer of tears: dependent on meibomian gland function. Exp Eye Res 78:361–365

    Article  PubMed  CAS  Google Scholar 

  44. McCulley JP, Dougherty JM, Deneau DG (1982) Classification of chronic blepharitis. Ophthalmology 89:1173–1180

    PubMed  CAS  Google Scholar 

  45. Meisler DM, Raizman MB, Traboulsi EI (2000) Oral erythromycin treatment for childhood blepharokeratitis. J AAPOS 4:379–380

    PubMed  CAS  Google Scholar 

  46. Mondino BJ, Bath PE, Foos RY, Apt L, Rajacich GM (1984) Absent meibomian glands in the ectrodactyly, ectodermal dysplasia, cleft lip-palate syndrome. Am J Ophthalmol 97:496–500

    PubMed  CAS  Google Scholar 

  47. Nicolaides N, Kaitaranta JK, Rawdah TN, Macy JI, Boswell FM III, Smith RE (1981) Meibomian gland studies: comparison of steer and human lipids. Invest Ophthalmol Vis Sci 20:522–536

    PubMed  CAS  Google Scholar 

  48. Norn MS (1963) Foam at outer palpebral canthus. Acta Ophthalmol (Copenh) 41:531–537

    CAS  Google Scholar 

  49. Perry HD, Doshi-Carnevale S, Donnenfeld ED, Solomon R, Biser SA, Bloom AH (2006) Efficacy of commercially available topical cyclosporine A 0.05% in the treatment of meibomian gland dysfunction. Cornea 25:171–175

    Article  PubMed  Google Scholar 

  50. Rhatigan MC, Ashworth JL, Goodall K, Leatherbarrow B (1997) Correction of blepharoconjunctivitis-related upper eyelid entropion using the anterior lamellar reposition technique. Eye 11 (1):118–120

    Google Scholar 

  51. Rubin M, Rao SN (2006) Efficacy of topical cyclosporin 0.05% in the treatment of posterior blepharitis. J Ocul Pharmacol Ther 22:47–53

    Article  PubMed  CAS  Google Scholar 

  52. Schaur RJ, Dussing G, Kink E, Schauenstein E, Posch W, Kukovetz E, Egger G (1994) The lipid peroxidation product 4-hydroxynonenal is formed by – and is able to attract – rat neutrophils in vivo. Free Radic Res 20:365–373

    PubMed  CAS  Google Scholar 

  53. Shimazaki J, Sakata M, Tsubota K (1995) Ocular surface changes and discomfort in patients with meibomian gland dysfunction. Arch Ophthalmol 113:1266–1270

    PubMed  CAS  Google Scholar 

  54. Shine WE, McCulley JP (1998) Keratoconjunctivitis sicca associated with meibomian secretion polar lipid abnormality. Arch Ophthalmol 116:849–852

    PubMed  CAS  Google Scholar 

  55. Shine WE, McCulley JP (2000) Association of meibum oleic acid with meibomian seborrhea. Cornea 19:72–74

    Article  PubMed  CAS  Google Scholar 

  56. Shine WE, McCulley JP (2003) Polar lipids in human meibomian gland secretions. Curr Eye Res 26:89–94

    Article  PubMed  Google Scholar 

  57. Shine WE, McCulley JP (2004) Meibomianitis: polar lipid abnormalities. Cornea 23:781–783

    Article  PubMed  Google Scholar 

  58. Shine WE, Silvany R, McCulley JP (1993) Relation of cholesterol-stimulated Staphylococcus aureus growth to chronic blepharitis. Invest Ophthalmol Vis Sci 34:2291–2296

    PubMed  CAS  Google Scholar 

  59. Shine WE, McCulley JP, Pandya AG (2003) Minocycline effect on meibomian gland lipids in meibomianitis patients. Exp Eye Res 76:417–420

    Article  PubMed  CAS  Google Scholar 

  60. Song CH, Choi JS, Kim DK, Kim JC (1999) Enhanced secretory group II PLA2 activity in the tears of chronic blepharitis patients. Invest Ophthalmol Vis Sci 40:2744–2748

    PubMed  CAS  Google Scholar 

  61. Sullivan DA, Sullivan BD, Ullmann MD, Rocha EM, Krenzer KL, Cermak JM, Toda I, Doane MG, Evans JE, Wickham LA (2000) Androgen influence on the Meibomian gland. Invest Ophthalmol Vis Sci 41:3732–3742

    PubMed  CAS  Google Scholar 

  62. Sullivan BD, Evans JE, Cermak JM, Krenzer KL, Dana MR, Sullivan DA (2002) Complete androgen insensitivity syndrome. Effect on human meibomian gland secretions. Arch Ophthalmol 120:1689–1699

    PubMed  CAS  Google Scholar 

  63. Ta CN, Shine WE, McCulley JP, Pandya A, Trattler W, Norbury JW (2003) Effects of minocycline on the ocular flora of patients with acne rosacea or seborrheic blepharitis. Cornea 22:545–548

    Article  PubMed  Google Scholar 

  64. Thygeson P (1946) Etiology and treatment of blepharitis. Arch Ophthalmol 36:445–477

    Google Scholar 

  65. Tiffany JM, Dart JKG (1981) Normal and abnormal functions of meibomian gland secretions. R Soc Med Int Congr Symp Ser 40:1061–1064

    Google Scholar 

  66. Viswalingam M, Rauz S, Morlet N, Dart J K (2005) Blepharokeratoconjunctivitis in children: diagnosis and treatment. Br J Ophthalmol 89:400–403

    Article  PubMed  CAS  Google Scholar 

  67. Weller R, Pattullo S, Smith L, Golden M, Ormerod A, Benjamin N (1996) Nitric oxide is generated on the skin surface by reduction of sweat nitrate. J Invest Dermatol 107:327–331

    Article  PubMed  CAS  Google Scholar 

  68. Zengin N, Tol H, Gunduz K, Okudan S, Balevi S, Endogru H (1995) Meibomian gland dysfunction and tear film abnormalities in rosacea. Cornea 14:144–146

    Article  PubMed  CAS  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Universitäts-Augenklinik, Killianstrasse 5, 79106, Freiburg, Germany

    Claudia Auw-Haedrich & Thomas Reinhard

Authors
  1. Claudia Auw-Haedrich
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Thomas Reinhard
    View author publications

    You can also search for this author in PubMed Google Scholar

Editor information

Thomas Reinhard Frank Larkin

Rights and permissions

Reprints and permissions

Copyright information

© 2008 Springer-Verlag Berlin Heidelberg

About this chapter

Cite this chapter

Auw-Haedrich, C., Reinhard, T. (2008). Chronic Blepharitis: Diagnosis, Pathogenesis, and New Treatment Options. In: Reinhard, T., Larkin, F. (eds) Cornea and External Eye Disease. Essentials in Ophthalmology. Springer, Berlin, Heidelberg. https://doi.org/10.1007/978-3-540-33681-5_10

Download citation

  • DOI: https://doi.org/10.1007/978-3-540-33681-5_10

  • Publisher Name: Springer, Berlin, Heidelberg

  • Print ISBN: 978-3-540-33680-8

  • Online ISBN: 978-3-540-33681-5

  • eBook Packages: MedicineMedicine (R0)

Publish with us

Policies and ethics

Search

Navigation