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What is blepharitis and its Symptoms

Blepharitis is an inflammation of the free edge of the eyelid (the pinkish rim located at the level of the eyelashes). This inflammation can spread to the skin (eyelid), the inner side of the eyelid, located against the eye, or even the eye itself. It can cause a fall of eyelashes called madarosis.

Symptoms of Blepharitis

Blepharitis gives a redness of the palpebral margin. There are sometimes crusty deposits at the base of the eyelashes. In highly inflammatory forms, there may be eyelid edema, deformities or ulcerations of the eyelid margins.

It is accompanied by sensations of foreign body, burns, itching, even pain and more rarely a decrease in visual acuity.

Causes of blepharitis

1 / Staphylococcus

Staphylococcal blepharitis is either recent onset and abrupt or complicates blepharitis from other causes by manual contamination.

The inflammation of the free edge of the eyelid is marked, often accompanied by erosions of the ciliary follicle, hard crusts around the root of the eyelashes, desquamation flange around the eyelash, and then the loss of eyelashes (madarose) and an irregular palpebral margin (tylosis)

2 / Demodex

Demodex folliculorum is a cutaneous parasite that lives in the hair follicles of the face. It can give a demodecidosis of the face (redness resembling rosacea but not healing with antibiotics).

In case of blepharitis related proliferation of demodex, we get to see the parasites with the naked eye, which swarm in the form of tubular clear sleeves around the base of the eyelashes.

3 / Rosacea

Rosacea is a pathology that gives rosacea and pimples of the cheeks and nose. This pathology is often accompanied by blepharitis since it is found in 60% of cases of cutaneous rosacea. It is even indicative of rosacea while there are still no signs of skin in 20% of cases.

The blepharitis of rosacea is accompanied by a posterior involvement that is to say concerning the mucosal side of the eyelid with involvement of the Meibomian glands, glands located on the conjunctiva, which are dilated, make oily liquid flow if we press on it and make the tear film greasy. Sometimes these glands are clogged with an oily plug and ignite (meibomite)

The conjunctiva is red, with dilated vessels, swollen areas, and may even have atrophic scars in advanced stages.

4 / Seborrheic dermatitis

Seborrheic dermatitis causes redness to predominate in the seborrheic areas of the face (edges of the nose, nasolabial folds, around the eyes …). It can be accompanied by a low inflammatory blepharitis, with eyelid involvement by dermatitis, with oily squames

5 / Rare causes

Other causes of blepharitis are psoriasis (appearance similar to seborrheic dermatitis), contact or atopic eczema (giving then eczema of the eyelids), cicatricial pemphigoid, toxidermias, chronic lupus, dermatomyositis and body phthiriasis (“Crabs” that can colonize eyebrows and eyelashes in addition to public involvement).

Medical treatment of blepharitis

1 / Staphylococcus

The doctor uses eye drops or ointments containing mercury (twice a day for 7 days: Ophtergine, yellow mercuric oxide 1% Chauvin), bacitracin (Bacitracin Martinet), chloramphenicol (Chloramphenicol) Faure single-dose, one drop 3 to 6 times a day), aminoglycosides (Gentalline eye drops or ointment, Tobrex eye drops or ointment, 3 applications / day)

The ointment can be used in addition to eye drops and will be applied in the evening. It allows the softening of crusts.

There are antibiotic eye drops containing fluoroquinolones, which are more expensive and rarely used. Cyclins are also rarely used because of the resistance of many strains of staphylococci.

The simultaneous use of corticosteroids and an antibiotic (Gentasone ointment) is controversial, but it allows a faster improvement in functional symptoms than the antibiotic alone: ​​local corticosteroids must be used with great care, once the Diagnosis of infectious keratitis (herpes …) was formally eliminated by an ophthalmologist.

2 / Demodex

The treatment involves the application of a 1% mercury oxide ointment. 100 (Ophtergine, 1% Chauvin Yellow Mercuric Oxide), Boric Acid Solutions (Dacryoserum Unidose, Dacudoses), and the mechanical removal of ciliary cuffs from the forceps.

3 / Rosacea

Elimination of oily secretions from Meibomian glands

The doctor advises to do a double-eyelid massage of the eyelids, in order to evacuate the oily secretions of the Meibomian glands. This massage can be preceded by the application of compresses soaked with hot water that soften secretions.

Fight against dry eye

Use of artificial tears without preservatives (Gel-Larmes single dose, 2 to 4 times a day, Lacryvisc single dose, ophthalmic gel).

Treatment of rosacea

The dermatologist uses antibiotics (cyclines: Tolexine, 100 mg / day for 12 weeks) orally that have a good impact not only on the cutaneous rosacea but also on blepharitis.

Local cyclins such as oxytetracycline (Tetranase) do not have a marketing authorization for this indication, but they can also be effective.

Metronidazole gel at 0.75 p. 100 (Rozex gel) can be applied once daily to the cutaneous side of the eyelids and their free edge for 12 weeks.

4 / Seborrheic dermatitis

Hygiene care is important again, in order to eliminate oily crusts and scales that are a source of bacterial overgrowth and irritation by using an eyelid cleanser (Blephagel, Lid-Care…).

Blepharitis associated with seborrheic dermatitis is often contaminated by staphylococci; it then requires management similar to staphylococcal blepharitis.

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