Blepharitis | Omicron Clinic Quebec
Types of blepharitis
The classification of blepharitis guides management, with each form having its own mechanisms and preferred treatments:
| Type | Location | Main mechanism | Associated factors |
|---|---|---|---|
| Staphylococcal anterior blepharitis | Eyelash base, eyelid skin | Colonization by Staphylococcus aureus or epidermidis; production of irritating toxins | Acne, rosacea, dry skin, immunosuppression |
| Seborrheic anterior blepharitis | Lash base, anterior palpebral margin | Dysregulation of sebum production; frequent association with seborrheic dermatitis of the scalp and face | Seborrheic dermatitis, dandruff, oily skin |
| Posterior blepharitis (Meibomius gland dysfunction) | Posterior palpebral rim, Meibomian glands | Obstruction and alteration of lipid secretion from the Meibomian glands, destabilizing the tear film | Ocular rosacea, acne, omega-3 deficiency, age |
| Parasitic blepharitis (Demodex) | Ciliary follicles | Excessive proliferation of Demodex folliculorum and brevis mites in eyelash follicles | Advanced age, rosacea, immunosuppression, poor palpebral hygiene |
Causes and risk factors
Several factors contribute to the onset or aggravation of blepharitis:
- Seborrheic dermatitis of the scalp, face or eyebrows
- Rosacea of the skin or eyes
- Chronic bacterial colonization of the palpebral margin (staphylococci)
- Infestation by Demodex folliculorum mites (common after age 50)
- Prolonged contact lens wear
- Eye make-up not completely removed in the evening
- Allergy to cosmetics or preservative eye drops
- Dry, ventilated or polluted environment (air conditioning, forced heating)
- Pre-existing dry eye syndrome
- Diet low in omega-3 fatty acids
Symptoms
Blepharitis generally manifests itself as bilateral symptoms, often more marked in the morning on waking. Their intensity fluctuates over time, with periods of improvement and exacerbation:
- Redness and swelling of the eyelid margins, sometimes on both sides
- Yellowish crusts or oily scales at the base of the eyelashes, sticking to the eyelids on waking.
- Itching, burning or gritty sensation in the eyes
- Excessive tearing or, conversely, marked dry eyes
- Increased sensitivity to light (mild to moderate photophobia)
- Slightly blurred vision, improving after blinking
- Loss of eyelashes (madarosis) in severe chronic forms
- Recurrent styes or chalazion
- Feeling of heavy or tired eyelids at the end of the day
Diagnosis
Diagnosis is primarily clinical, based on slit-lamp examination of the eyelids by a physician or ophthalmologist. There is no specific blood test to confirm blepharitis.
- Visual inspection of the palpebral border: appearance of eyelashes, presence of crusts, redness, telangiectasias
- Slit-lamp examination: assessment of the meibomian glands, their secretion and the quality of the tear film
- Testing for Demodex: removal of an eyelash and microscopic examination if suspected
- Assessment of tear film: Schirmer test, tear film break-up time (BUT)
- Bacteriological sampling of the palpebral margin in cases of suspected resistant bacterial infection
- Additional dermatological examination for rosacea or associated seborrheic dermatitis
Treatments
Management of blepharitis is largely based on daily hygiene measures, supplemented by medication depending on the form and severity of the condition.
| Treatment | Terms and conditions | Main indications |
|---|---|---|
| Daily palpebral hygiene | Warm compresses 5 to 10 min, then clean eyelid margins with wipes or specialized solution | All forms of blepharitis; essential basic treatment |
| Palpebral massage | Gentle massage of the eyelids after warm compresses to release secretions from the Meibomius glands | Meibomian gland dysfunction |
| Artificial tears | Preservative-free lubricating eye drops, several times a day as needed | Associated dry eyes, dry eye syndrome |
| Topical antibiotics | Erythromycin or bacitracin ophthalmic ointment, applied to the palpebral margin | Staphylococcal blepharitis, bacterial superinfection |
| Oral antibiotics | Doxycycline or azithromycin extended course (4 to 12 weeks) | Severe posterior blepharitis, associated ocular rosacea, refractory form |
| Topical corticosteroids | Low-concentration eye drops or ointments for short courses of treatment | Marked inflammatory flare-ups; use limited in time due to ocular side effects |
| Anti-Demodex treatment | Tea tree oil (TTO) products at 50 %, topical or oral ivermectin | Confirmed or suspected Demodex blepharitis |
| Omega-3 supplementation | Oral EPA/DHA fatty acids | Meibomian gland dysfunction; improved quality of lipid secretions |
Possible complications
When poorly controlled or neglected over the long term, blepharitis can lead to a variety of complications:
| Complication | Description |
|---|---|
| Recurrent stye | Acute infection of a ciliary or sebaceous gland of the palpebral margin, favored by chronic bacterial colonization |
| Chalazion | Chronic inflammatory cyst resulting from obstruction of a Meibomian gland; may require surgical incision |
| Superficial keratitis | Inflammation or erosion of the cornea by contact with inflammatory secretions or bacterial toxins |
| Chronic conjunctivitis | Persistent conjunctival irritation associated with palpebral inflammation |
| Trichiasis | Deviation of eyelashes towards the cornea, causing persistent mechanical irritation |
| Madarose | Partial or total loss of eyelashes due to chronic inflammation of hair follicles |
| Severe dry eye syndrome | Progressive degradation of tear film quality and stability, affecting daily visual comfort |
Prevention and long-term maintenance
Since blepharitis is a chronic condition, the prevention of relapses relies on daily habits that are maintained over time:
- Maintain a daily palpebral hygiene routine, even in periods of calm
- Remove all eye make-up every evening, paying particular attention to the edges of the eyelids.
- Avoid irritating or out-of-date cosmetics (mascara, eyeliner).
- Replace contact lenses regularly and follow care instructions
- Parallel treatment of seborrheic dermatitis or associated rosacea
- Humidify work environment in dry or air-conditioned conditions
- Consult rapidly if symptoms reappear to adjust treatment.
Consult at Clinique Omicron
Clinique Omicron manages common eye conditions, including blepharitis, at several locations in Quebec. A physician or specialized nurse practitioner (SNP) can assess your symptoms, identify the form of blepharitis involved and refer you to an ophthalmologist if necessary. In-person and telemedicine consultations are available depending on your situation. To book an appointment at one of our points of service in Montreal, on the South Shore or elsewhere in Quebec, visit cliniqueomicron.ca.
The content of this page is provided for informational purposes only and is not intended to replace the advice of a qualified healthcare professional. Consult a physician for any symptoms, questions or decisions you may have regarding your health.
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