Blepharitis

Key clinical points

• Blepharitis is chronic and typically managed rather than cured.
• Anterior blepharitis is often staphylococcal or seborrheic; Demodex is an underrecognized cause.
• Posterior blepharitis overlaps with meibomian gland dysfunction and evaporative dry eye.
• Lid hygiene—warm compresses and lid cleansing—is the cornerstone of therapy.
• Refractory disease may benefit from topical or oral anti-inflammatory and antibiotic therapy.

Types and contributors

Anterior blepharitis affects the skin and lashes at the front of the lid margin and is commonly associated with staphylococcal colonization, seborrheic dermatitis, or Demodex mite infestation, which produces characteristic cylindrical dandruff at the lash base. Posterior blepharitis involves the meibomian glands and is closely linked to meibomian gland dysfunction and rosacea.

The two forms frequently coexist and both destabilize the tear film, driving chronic irritation, burning, crusting, and fluctuating vision.

Diagnosis

Slit-lamp examination of the lid margin identifies collarettes, crusting, telangiectasia, meibomian gland capping, and abnormal meibum. Assessment of the tear film and ocular surface establishes the associated dry eye component, and evaluation for rosacea and Demodex guides targeted therapy.

Management

Daily lid hygiene with warm compresses and gentle lid cleansing is foundational and must be sustained because the condition is chronic. Demodex-related disease may respond to tea tree oil–based cleansers or newer targeted therapies. Staphylococcal disease and inflammation may warrant topical antibiotic-steroid combinations.

For rosacea-associated and refractory posterior disease, oral tetracyclines or topical macrolides reduce inflammation, and treating coexisting meibomian gland dysfunction improves outcomes.