Editing Blepharitis

{{Short description|Inflammation of the eyelid}}
{{Infobox medical condition (new)
| name            = Blepharitis
| image           = Infant with blepharitis on the right side.jpg
| caption         = An infant with mild blepharitis on his right side
| pronounce       = {{IPAc-en|b|l|ɛ|f|ə|ˈ|r|aɪ|t|ᵻ|s}} {{respell|BLEF|ər|EYE|tis}}
| synonyms        =
| field           = [[Ophthalmology]], [[Optometry]]
| symptoms        = crusty eyelids
| complications   =
| onset           =
| duration        =
| types           =
| causes          =
| risks           =
| diagnosis       =
| differential    =
| prevention      =
| treatment       =
| medication      =
| prognosis       =
| frequency       =
| deaths          =
}}

'''Blepharitis''', sometimes known as '''granulated eyelids''', is one of the most common ocular conditions characterized by [[inflammation]], scaling, [[Erythema|reddening]], and crusting of the [[eyelid]]. This condition may also cause swelling, burning, itching, or a grainy sensation when introducing foreign objects or substances to the eye. Although blepharitis by itself is not sight-threatening, it can lead to permanent alterations of the eyelid margin. The primary cause is bacteria and inflammation from [[Meibomian gland dysfunction|congested meibomian oil glands]] at the base of each eyelash. Other conditions may give rise to blepharitis, whether they be infectious or noninfectious, including, but not limited to, [[bacterial infection]]s or [[allergies]].

Different variations of blepharitis can be classified as seborrheic, [[Staphylococcal infection|staphylococcal]], mixed, posterior or meibomitis, or [[Parasitic disease|parasitic]].<ref name="vaughan2">{{cite book|title=Vaughan & Asbury's general ophthalmology.| vauthors = Cunningham ET, Riordan-Eva P |publisher=McGraw-Hill Medical|isbn=978-0071634205|edition=18th|date=2011-05-17}}</ref> In a survey of US ophthalmologists and optometrists, 37% to 47% of patients seen by those surveyed had signs of blepharitis, which can affect all ages and ethnic groups.<ref name=":0">{{Cite web |url=http://eyewiki.aao.org/Blepharitis |title=Blepharitis |vauthors=Singh Tonk R, Hossain K |work=EyeWiki |publisher=American Academy of Ophthalmology |date=4 September 2023 |access-date=29 October 2023 |archive-date=3 February 2022 |archive-url=https://web.archive.org/web/20220203054539/https://eyewiki.aao.org/Blepharitis |url-status=live }}</ref> One single-center study of 90 patients with chronic blepharitis found that the average age of patients was 50 years old.<ref name=":0" /> The word is {{ety|el|''βλέφαρον'' (blepharon)|eyelid||-itis|inflammation of}}.

==Signs and symptoms==
Blepharitis is characterized by chronic [[inflammation]] of the [[eyelid]], usually at the base of the [[eyelash]]es.<ref name="autogenerated42">{{cite web | url = http://www.mayoclinic.org/diseases-conditions/blepharitis/basics/definition/con-20024605 | title = Blepharitis Definition - Diseases and Conditions | work = Mayo Clinic | access-date = 29 October 2023 | archive-date = 1 October 2017 | archive-url = https://web.archive.org/web/20171001010219/http://www.mayoclinic.org/diseases-conditions/blepharitis/basics/definition/con-20024605 | url-status = live }}</ref><ref name="autogenerated22">{{cite web | url = http://www.webmd.com/eye-health/blepharitis | title = Blepharitis: Symptoms, Treatment, and Prevention | publisher = WebMD, LLC | access-date = 29 October 2023 | archive-date = 29 January 2022 | archive-url = https://web.archive.org/web/20220129225037/https://www.webmd.com/eye-health/blepharitis | url-status = live }}</ref><ref name="Lowry_2019">{{cite web | vauthors = Lowery RS | date = 3 January 2019 | veditors = Law SK, Rapuano CJ | title = Adult Blepharitis | url = http://emedicine.medscape.com/article/1211763-clinical | work = Medscape | access-date = 29 October 2023 | archive-date = 11 July 2021 | archive-url = https://web.archive.org/web/20210711211614/https://emedicine.medscape.com/article/1211763-clinical | url-status = live }}</ref> Symptoms include inflammation, irritation, itchiness, a burning sensation, excessive tearing, and crusting and sticking of eyelids.<ref name="autogenerated42" /><ref name="autogenerated22" /> Additional symptoms may include visual impairment such as [[photophobia]] and [[blurred vision]]. Symptoms are generally worse in the mornings and patients may experience exacerbation and several remissions if left untreated.<ref name=":0" /> It is typically caused by bacterial infection or blockage of the meibomian oil glands.<ref name="autogenerated22" /> Diseases and conditions that may lead to blepharitis include [[rosacea]], [[herpes simplex]] [[dermatitis]], [[varicella-zoster]] dermatitis, [[molluscum contagiosum]], allergic dermatitis, [[contact dermatitis]], [[seborrheic dermatitis]], [[staphylococcal]] dermatitis, [[demodicosis]] and [[phthiriasis palpebrarum]].<ref name=":0" /><ref name="autogenerated42" /><ref name="Lowry_2019" />

The parasite ''[[Demodex folliculorum]]'' (''D. folliculorum'') causes blepharitis when the parasite is present in excessive numbers within the [[dermis]] of the eyelids. These parasites can live for approximately 15 days. The parasites (both adult and eggs) live on the hair follicle, inhabiting the sebaceous and [[apocrine gland]] of the human lid. Direct contact allows this pathogen to spread. Factors that allow this pathogen to multiply include hypervascular tissue, poor hygienic conditions, and immune deficiency. In treating blepharitis caused by ''D. folliculorum'', mechanical cleaning and proper hygiene are important towards decreasing the parasite's numbers.&nbsp;<ref name="pmid19367544">{{cite journal | vauthors = Inceboz T, Yaman A, Over L, Ozturk AT, Akisu C | title = Diagnosis and treatment of demodectic blepharitis | journal = Turkiye Parazitolojii Dergisi | volume = 33 | issue = 1 | pages = 32–36 | date = 2009 | pmid = 19367544 }}</ref>
[[File:Anterior Blepharitis.jpg|thumb|Scaling and bacterial debris at the base of the eyelashes]]

===Associated symptoms===
* Watery eyes – due to excessive tearing.<ref name="autogenerated12">{{cite web | url = http://www.mayoclinic.org/diseases-conditions/blepharitis/basics/symptoms/con-20024605 | title = Blepharitis Symptoms - Diseases and Conditions | work = Mayo Clinic | access-date = 2015-01-03 | archive-date = 2017-09-22 | archive-url = https://web.archive.org/web/20170922055825/http://www.mayoclinic.org/diseases-conditions/blepharitis/basics/symptoms/con-20024605 | url-status = live }}</ref>
* Red eyes – due to dilated blood vessels on the sclera.<ref name="autogenerated12" />
* Swollen eyelids – due to inflammation.<ref name="autogenerated12" />
* Crusting at the eyelid margins/base of the eyelashes/[[Anatomical terms of location#Medial and lateral|medial]] [[canthus]], generally worse on waking – due to excessive bacterial buildup along the lid margins.<ref name="autogenerated22" /><ref name="Lowry_2019" /><ref name="autogenerated12" />
* Eyelid sticking – due to crusting along the eyelid margin.<ref name="autogenerated12" />
* Eyelid itching – due to the irritation from inflammation and epidermis scaling of the eyelid.<ref name="autogenerated12" />
* Flaking of skin on eyelids – due to tear film suppressed by clogged meibomian glands.<ref name="autogenerated12" />
* Gritty/burning sensation in the eye, or foreign-body sensation – due to crusting from bacteria and clogged oil glands<ref name="autogenerated12" />
* Frequent blinking – due to impaired tear film from clogged oil glands unable to keep tears from evaporating.<ref name="autogenerated12" />
* Light sensitivity/[[photophobia]]<ref name="Lowry_2019" /><ref name="autogenerated12" />
* Misdirected eyelashes that grow abnormally – due to permanent damage to the eyelid margin<ref name="autogenerated12" />
* Eyelash loss – due to excessive buildup of bacteria along the base of the eyelashes.<ref name="autogenerated12" />
* Infection of the eyelash follicle/sebaceous gland ([[hordeolum]])
* Debris in the [[tear film]], seen under magnification (improved contrast with use of [[fluorescein]] drops)
[[File:Internal hordeolum.jpg|thumb|Chalazion]]
Chronic blepharitis may result in damage of varying severity and, in the worst cases,  may have a negative effect on vision. This can be resolved with a proper [[eyeglass prescription]].<ref name="emedicinehealth2">{{Cite web|url=http://www.emedicinehealth.com/eyelid_inflammation_blepharitis/page3_em.htm#Eyelid%20Inflammation%20Symptoms|title=Eyelid Inflammation Symptoms|vauthors=Weinstock FJ|publisher=emedicinehealth.com|access-date=21 December 2012|archive-date=18 October 2012|archive-url=https://web.archive.org/web/20121018121718/http://www.emedicinehealth.com/eyelid_inflammation_blepharitis/page3_em.htm#Eyelid%20Inflammation%20Symptoms|url-status=live}}</ref> Long-term untreated blepharitis can lead to eyelid scarring, excess tearing, difficulty wearing contact lenses, development of a [[stye]] (an infection near the base of the eyelashes, resulting in a painful lump on the edge of the eyelid) or a [[chalazion]] (a blockage/bacteria infection in a small oil gland at the margin of the eyelid, just behind the eyelashes, leading to a red, swollen eyelid), chronic [[pink eye]] ([[conjunctivitis]]), [[keratitis]], and [[corneal ulcer]] or irritation.<ref name="autogenerated22" /><ref>{{cite web | url = http://www.mayoclinic.org/diseases-conditions/blepharitis/basics/complications/con-20024605 | title = Blepharitis - Diseases and Conditions | work = Mayo Clinic | access-date = 31 October 2023 | archive-date = 10 September 2017 | archive-url = https://web.archive.org/web/20170910122444/http://www.mayoclinic.org/diseases-conditions/blepharitis/basics/complications/con-20024605 | url-status = live }}</ref><ref name="Lowry_2019" /> The lids may become red and may have ulcerate, non-healing areas that may lead to bleeding.<ref name="emedicinehealth2" /> Blepharitis can also cause [[blurred vision]] due to a poor tear film.<ref name="autogenerated22" /> [[Tears]] may be frothy or bubbly, which can contribute to mild scarring along the eyelids. Symptoms and signs of blepharitis are often erroneously ascribed by the patient to "recurrent conjunctivitis".<ref name="Dahl"/>

=== Subtype symptoms ===

General symptoms include a foreign body sensation, matting of the lashes, and burning. [[Iris (anatomy)#Collarette|Collarette]] around eyelashes, a ring-like formation around the lash shaft, can be observed.<ref name="Lowry_2019" /> Other symptoms include loss of eyelashes or broken eyelashes.<ref name="Blepharitis: Eyelid and Lacrimal Disorders: Merck Manual Professional2">{{cite web|url=http://www.merckmanuals.com/professional/eye_disorders/eyelid_and_lacrimal_disorders/blepharitis.html?qt=&sc=&alt=|title=Blepharitis|vauthors=Garrity J|date=August 2012|publisher=The Merck Manual|access-date=21 December 2012|archive-date=6 June 2012|archive-url=https://web.archive.org/web/20120606131054/http://www.merckmanuals.com/professional/eye_disorders/eyelid_and_lacrimal_disorders/blepharitis.html?qt=&sc=&alt=|url-status=live}}</ref>  The condition can sometimes lead to a [[chalazion]] or a [[stye]].<ref name="Blepharitis, Syte and Chalazion2">{{cite web |url=http://chicago.medicine.uic.edu/cms/One.aspx?portalId=506244&pageId=15356063 |title=Blepharitis, Stye and Chalazion |publisher=University of Illinois College of Medicine |access-date=21 December 2012 |archive-url=https://web.archive.org/web/20140419234143/http://chicago.medicine.uic.edu/cms/One.aspx?portalId=506244&pageId=15356063|archive-date=19 April 2014|url-status=dead}}</ref> Chronic bacterial blepharitis may also lead to [[ectropion]].<ref>{{Cite web | vauthors = Heiting G | date = January 2019 | work = All About Vision | url = http://www.allaboutvision.com/conditions/blepharitis.htm | title = How to Get Rid of Sore, Red Eyelids (Blepharitis) | access-date = 31 October 2023 | archive-date = 30 November 2021 | archive-url = https://web.archive.org/web/20211130082027/https://www.allaboutvision.com/conditions/blepharitis.htm | url-status = live }}</ref> Posterior blepharitis or ''rosacea-associated'' blepharitis is manifested by a broad spectrum of symptoms involving the lids including inflammation and plugging of the meibomian orifices and production of abnormal secretion upon pressure over the glands.<ref name="vaughan2" />

== Mechanism ==
The mechanism by which the bacteria causes symptoms of blepharitis is not fully understood and may include direct irritation of bacterial toxins and/or enhanced cell-mediated immunity to ''[[Staphylococcus aureus|S. aureus]]''.

Staphylococcal blepharitis is caused by an infection of the anterior portion of the eyelid by [[Staphylococcus|Staphylococcal bacteria]].<ref name=smolin/> In a study of ocular flora, 46% to 51% of those diagnosed with staphylococcal blepharitis had cultures positive for Staphylococcus aureus in comparison to 8% of normal patients.<ref name=":0" /> Staphylococcal blepharitis may start in childhood and continue into adulthood.<ref>{{cite web|url=http://www.avclinic.com/blepharitis.htm|title=Blepharitis|publisher=Angeles Vision Clinic|archive-url=https://web.archive.org/web/20120504114556/http://www.avclinic.com/blepharitis.htm|archive-date=4 May 2012|url-status=dead|access-date=21 December 2012}}</ref> It is commonly recurrent and it requires special medical care. The prevalence of ''S. aureus'' in the conjunctival sac and on the lid margin varies among countries, likely due to differences in climate and environment.<ref name="smolin">{{cite journal | vauthors = Smolin G, Okumoto M | title = Staphylococcal blepharitis | journal = Archives of Ophthalmology | volume = 95 | issue = 5 | pages = 812–816 | date = May 1977 | pmid = 324453 | doi = 10.1001/archopht.1977.04450050090009 }}</ref> Seborrheic blepharitis is characterized by less inflammation than Staphylococcal blepharitis; however, it causes more excess oil or greasy scaling. [[Meibomian gland|Meibomian gland dysfunction]] is a result of abnormalities of the meibomian glands and altered secretion of [[meibum]], which plays an imperative role in lagging the evaporation of tear films and smoothing of the tear film to produce an even optical surface. Posterior blepharitis is an inflammation of the eyelids, secondary to dysfunction of the [[meibomian gland]]s. Like anterior blepharitis, it is a bilateral chronic condition and may be associated with skin [[rosacea]].<ref name="vaughan2" />  There is growing evidence that, in some cases, it is caused by [[demodex]] [[mite]]s.<ref>{{cite journal | vauthors = Liu J, Sheha H, Tseng SC | title = Pathogenic role of Demodex mites in blepharitis | journal = Current Opinion in Allergy and Clinical Immunology | volume = 10 | issue = 5 | pages = 505–510 | date = October 2010 | pmid = 20689407 | pmc = 2946818 | doi = 10.1097/aci.0b013e32833df9f4 }}</ref>

==Diagnosis==
[[File:Blepharitis.JPG|thumb|Blepharitis: swollen and reddened eyelid]]
Diagnosis of the condition is done via a physical examination under a [[slit lamp]]. Cultures of debris are occasionally collected for bacterial or fungal testing.<ref>{{cite web | url = http://www.mayoclinic.org/diseases-conditions/blepharitis/basics/tests-diagnosis/con-20024605 | title = Blepharitis Tests and diagnosis - Diseases and Conditions | work = Mayo Clinic | access-date = 31 October 2023 | archive-date = 6 September 2017 | archive-url = https://web.archive.org/web/20170906191640/http://www.mayoclinic.org/diseases-conditions/blepharitis/basics/tests-diagnosis/con-20024605 | url-status = live }}</ref><ref name="Lowry_2019" />

=== Examination ===
In all forms of blepharitis, optometrists or ophthalmologists examine the tear film, which is the most efficient method in determining instability. The most frequently used method is to measure tear production via [[tear break-up time]] (TBUT), which calculates the duration interval between complete blinks. This serves as a primary indication of regional dryness in the pre-corneal tear film after fluorescein injections. If TBUT is shorter than 10 seconds, then this suggests instability.<ref name=":0" />

Staphylococcal blepharitis is diagnosed by examining erythema and edema of the eyelid margin. Patients may exhibit [[alopecia areata]] of eyelashes and/or growth misdirection, [[trichiasis]]. Other signs may include [[telangiectasia]] on the anterior eyelid, collarettes encircling the lash base, and corneal changes.<ref name=":0" /> Seborrheic blepharitis is distinguished by less [[erythema]], [[edema]], and telangiectasia of the eyelid margins. Posterior blepharitis and Meibomian gland dysfunction are frequently associated with rosacea and can be seen during an ocular examination of the posterior eyelid margin. The Meibomian glands may appear caked with oil or visibly obstructed.<ref name=":0" />

=== Procedures ===
Cultures of the eyelid margins can be a clear indicator for patients who have recurrent anterior blepharitis with severe inflammation, in addition to patients who are not responding to therapy.<ref name=":0" /> Measurements of tear osmolarity may be beneficial in diagnosing concurrent [[dry eye syndrome]] (DES), which may be responsible for overlapping symptoms and would allow the physician to decipher between conditions and move forward with the most beneficial protocol for the patient. Consequently, the measurement of tear osmolarity has various limitations in differentiating between aqueous deficiencies and evaporative dry eye.<ref name="pmid19668387">{{cite journal | vauthors = Savini G, Prabhawasat P, Kojima T, Grueterich M, Espana E, Goto E | title = The challenge of dry eye diagnosis | journal = Clinical Ophthalmology | volume = 2 | issue = 1 | pages = 31–55 | date = March 2008 | pmid = 19668387 | pmc = 2698717 | doi = 10.2147/opth.s1496 | doi-access = free }}</ref> Microscopic evaluation of [[Epilation|epilated]] eyelashes may reveal mites, which have been evident in cases of chronic [[blepharoconjunctivitis]]. A [[biopsy]] of the eyelid can also determine the exclusion of carcinoma, therapy resistance, or unifocal recurrent [[Chalazion|chalazia]].<ref>{{cite journal | vauthors = Nemoto Y, Arita R, Mizota A, Sasajima Y | title = Differentiation between chalazion and sebaceous carcinoma by noninvasive meibography | journal = Clinical Ophthalmology | volume = 8 | pages = 1869–1875 | date = September 2014 | pmid = 25258508 | pmc = 4172083 | doi = 10.2147/OPTH.S69804 | doi-access = free }}</ref>

=== Related conditions ===
{| class="wikitable"
!Condition
!Entity
|-
|Bacterial infections
|[[Erysipelas]] (due to Streptococcus pyogenes)
[[Impetigo]] (due to Staphylococcus aureus)
|-
|Viral infections
|[[Herpes simplex virus]]
[[Molluscum contagiosum]]

[[Varicella zoster virus]]

[[Papillomaviridae|Papillomavirus]]

[[Vaccinia]]
|-
|Parasitic infection
|Pediculosis palperbrarum
|-
|Immunologic conditions
|[[Atopic dermatitis]]
[[Contact dermatitis]]

[[Erythema multiforme]]

[[Crohn's disease]]
|-
|Dermatoses
|[[Psoriasis]]
[[Erythroderma]]
|-
|Benign eyelid tumors
|[[Actinic keratosis]]
[[Pyogenic granuloma]]
|-
|Malignant eyelid tumors
|[[Melanoma]]
[[Mycosis fungoides]]

[[Basal-cell carcinoma|Basal cell carcinoma]]
|-
|Trauma
|[[Chemical substance|Chemical]]
[[Radiation]]

[[Surgery|Surgical]]

Thermal
|-
|Toxic conditions
|Medicamentosa
|}

== Prevention ==
Blepharitis is a result of bacteria and inflammation from congested [[Meibomian gland|meibomian]] oil glands at the base of each eyelash. Routine washing of the eyelids helps subdue symptoms and prevent blepharitis.  Washing each eyelid for 30 seconds, twice a day, with a single drop of [[hypoallergenic]] soap (e.g. baby shampoo) and ample water can help. The most effective treatment is over the counter lid scrubs used twice a day. Some doctors may recommend using a hypochlorous acid treatment depending on the severity.<ref name=":0" />

== Treatment ==
[[File:Warm compress.jpg|thumb|right|Microwavable warm compresses for daily loop treatment]]

Blepharitis is a chronic condition causing frequent exacerbation, thus requiring routine eyelid hygiene. Hygienic practices include warm compresses, eyelid massages, and eyelid scrubs.<ref name=":0" /> A [[Cochrane Collaboration|Cochrane Systematic Review]] found topical antibiotics to be effective in providing symptomatic relief and clearing bacteria for individuals with anterior blepharitis.<ref name="Lindsley2">{{cite journal | vauthors = Lindsley K, Matsumura S, Hatef E, Akpek EK | title = Interventions for chronic blepharitis | journal = The Cochrane Database of Systematic Reviews | volume = 2012 | issue = 5 | pages = CD005556 | date = May 2012 | pmid = 22592706 | pmc = 4270370 | doi = 10.1002/14651858.CD005556.pub2 }}</ref> Topical steroids provided some symptomatic relief, but they were ineffective in clearing bacteria from the eyelids.<ref name="Lindsley2" /> Lid hygiene measures such as [[warm compresses]] and lid scrubs were found to be effective in providing symptomatic relief for participants with anterior and posterior blepharitis.<ref name="Lindsley2" /> [[BlephEx]] is a handheld medical device used by a doctor to exfoliate eyelids<ref name="King5.com">{{cite web |last1=Enersen |first1=Jean |title=New treatment for 'gritty eyes' |url=http://www.king5.com/story/news/health/body/2014/10/06/blepharitis-gritty-eyes-blephex/16832759/ |accessdate=8 April 2015 |website=King5.com |publisher=Gannett}}</ref> to treat blepharitis.<ref name="Ophthalmology">{{cite web |last1=Stevenson |first1=Sheryl |title=BlephEx introduces medical device for blepharitis |url=http://ophthalmologytimes.modernmedicine.com/ophthalmologytimes/news/blephex-introduces-medical-device-blepharitis?page=full |url-status=dead |archive-url=https://web.archive.org/web/20150427162108/http://ophthalmologytimes.modernmedicine.com/ophthalmologytimes/news/blephex-introduces-medical-device-blepharitis?page=full |archive-date=27 April 2015 |accessdate=8 April 2015 |website=Ophthalmology Times |publisher=Modern Medicine}}</ref>

[[Lotilaner]] (Xdemvy) was approved for medical use in the United States in July 2023, for the treatment of ''Demodex'' blepharitis.<ref>{{cite press release | title=FDA Approves Xdemvy (lotilaner ophthalmic solution) 0.25% for the treatment of Demodex blepharitis | publisher=Tarsus Pharmaceuticals | via=GlobeNewswire | date=25 July 2023 | url=https://www.globenewswire.com/en/news-release/2023/07/25/2710273/0/en/FDA-Approves-XDEMVY-lotilaner-ophthalmic-solution-0-25-for-the-treatment-of-Demodex-blepharitis.html | access-date=5 August 2023}}</ref>

== Prognosis ==
Blepharitis is a chronic condition that has periods of exacerbation and remission. Patients should be informed that symptoms can frequently improve but are rarely eliminated. Infrequently, severe blepharitis can result in permanent alterations in the eyelid margin or vision loss from superficial [[Thygeson's superficial punctate keratopathy|keratopathy]], [[corneal neovascularization]], and [[ulceration]]. Patients with an inflammatory eyelid lesion that appears suspicious of malignancy should be referred to an appropriate specialist.<ref name=":0" /><ref name="Dahl">{{Cite web |url=https://www.medicinenet.com/blepharitis/article.htm |title=Blepharitis |vauthors=Dahl AA |website=MedicineNet |access-date=31 October 2023 |archive-date=10 August 2017 |archive-url=https://web.archive.org/web/20170810041537/http://www.medicinenet.com/blepharitis/page2.htm |url-status=live }}</ref>

== Research ==
A study conducted in November 2017 detected a correlation between blepharitis and early-onset [[metabolic syndrome]] (MetS). To investigate the relationship between blepharitis and MetS, researchers used the Longitudinal Health Insurance Database in Taiwan. Results indicated that [[Hyperlipidemia|hyperlipidaemia]] and [[coronary artery disease]] were significantly correlated with the prior development of blepharitis. Therefore, blepharitis was shown to be significantly related to MetS and can serve as an early indication of the condition.<ref name="pmid29146760">{{cite journal | vauthors = Lee CY, Chen HC, Lin HW, Huang JY, Chao SC, Yeh CB, Lin HY, Yang SF | display-authors = 6 | title = Blepharitis as an early sign of metabolic syndrome: a nationwide population-based study | journal = The British Journal of Ophthalmology | volume = 102 | issue = 9 | pages = 1283–1287 | date = September 2018 | pmid = 29146760 | doi = 10.1136/bjophthalmol-2017-310975 | s2cid = 26261977 }}</ref>

In another study, the presence of ''[[Demodex]]'' mites was shown to be a common cause of blepharitis. However, the pathogenesis of [[demodicosis]] is still unclear. In this study, researchers provided a diagnosis of the disease and proposed diagnostic criteria for ''Demodex'' blepharitis.

There is inadequate evidence to draw conclusions about the use of oral [[doxycycline]] in the treatment of blepharitis. According to very low certainty data, oral [[doxycycline]] may help with symptoms like itchiness, burning, or watery eyes, but may induce more [[side effect]]s.<ref>{{cite journal | vauthors = Onghanseng N, Ng SM, Halim MS, Nguyen QD | title = Oral antibiotics for chronic blepharitis | journal = The Cochrane Database of Systematic Reviews | volume = 2021 | issue = 6 | pages = CD013697 | date = June 2021 | pmid = 34107053 | pmc = 8189606 | doi = 10.1002/14651858.CD013697.pub2 | collaboration = Cochrane Eyes and Vision Group }}</ref>

A review of treatments showed that the anti-mite drug [[ivermectin]] can be an effective treatment for reducing symptoms.<ref>{{cite journal | vauthors = Navel V, Mulliez A, Benoist d'Azy C, Baker JS, Malecaze J, Chiambaretta F, Dutheil F | title = Efficacy of treatments for Demodex blepharitis: A systematic review and meta-analysis | journal = The Ocular Surface | volume = 17 | issue = 4 | pages = 655–669 | date = October 2019 | pmid = 31229586 | doi = 10.1016/j.jtos.2019.06.004 | doi-access = free }}</ref>

Eye drops or ointments containing [[corticosteroid]]s are frequently used in conjunction with antibiotics and can reduce eyelid inflammation.<ref name="autogenerated22" /><ref name="Lowry_2019" /><ref name="autogenerated82">{{cite web | url = http://www.mayoclinic.org/diseases-conditions/blepharitis/basics/treatment/con-20024605 | title = Blepharitis Treatments and drugs - Diseases and Conditions | work = Mayo Clinic | access-date = 31 October 2023 | archive-date = 22 September 2017 | archive-url = https://web.archive.org/web/20170922072451/http://www.mayoclinic.org/diseases-conditions/blepharitis/basics/treatment/con-20024605 | url-status = live }}</ref>

The supplement [[n-acetylcysteine]] may be effective for blepharitis.<ref>[https://journals.lww.com/corneajrnl/Abstract/2002/03000/N_Acetylcysteine_in_Chronic_Blepharitis.7.aspx N-Acetylcysteine in Chronic Blepharitis]
Yalçin, Elvan M.D.; Altin, Feyza M.D.; Cinhüseyinoglue, Feriha M.D.; Arslan, M. Okan M.D., CLINICAL SCIENCES Cornea 21(2):p 164-168, March 2002, accessed 29 October 2023</ref>

== References ==
{{Reflist}}

== External links ==
{{Commons category|Blepharitis}}
* [https://www.nei.nih.gov/learn-about-eye-health/eye-conditions-and-diseases/blepharitis Blepharitis Resource Guide from the National Eye Institute (NEI)].

{{Medical resources
|  DiseasesDB = 1455
|  ICD10 = {{ICD10|H|01|0|h|00}}
|  ICD9 = {{ICD9|373.0}}
|  OMIM =
|  MedlinePlus = 001619
|  ICDO =
|  eMedicineSubj = oph
|  eMedicineTopic = 81
|  MeshID = D001762
}}
{{Eye pathology
}}

[[Category:Disorders of eyelid, lacrimal system and orbit]]
[[Category:Inflammations]]