• Simple squamous blepharitis is often called seborrheic blepharitis. It tends to occur in the older child who has other signs and symptoms of seborrhea. It has a predilection for areas with increased sebaceous gland activity.
• Ulcerative blepharitis is often called staphylococcal blepharitis. It is usually due to a secondary infection with Staphylococcus aureus or S. epidermidis. Purulent inflammation of the glands of the lid margin results in ulcerations.

• Thirty meibomian glands are located in each tarsal plate. Pilosebacious glands of Zeis and apocrine glands of Moll are located anterior to the meibomian glands within the distal eyelid margin.
• Bacteria and meibomian gland secretions play an integral role in the development of blepharitis.
• Occlusion of the glands of the eye will cause an accumulation of secretions.

• Blepharitis is the most common cause of chronic conjunctivitis in children.
• Children who rub their eyes frequently are at risk for developing blepharitis.
• It is associated with contact lens use, as well as use of cosmetics.

• Chalazion: the most common complication, which results from the spread of infection to the meibomian gland and obstruction of the orifices
• Hordeolum (or stye): obstruction of the glands of Zeis
• Partial loss of eyelashes (madarosis) from recurrent rubbing and pulling on the lashes
• Secondary blepharoconjunctivitis
• Thickening of the lid margins (tylosis ciliaris)

• Frequently recurrent or chronic

• Atopic dermatitis (accounts for 90% of eyelid dermatitis)
• Contact dermatitis
• Trauma may primarily appear as an inflamed eyelid or may exacerbate an already inflamed eyelid.
• Psoriasis may rarely affect the eyelids.
• Chalazion
• Stye
• Rosacea: chronic hyperemic disease that often involves the eyelids. Look for persistent erythema, telangiectasias, and episodes of papulopustule formation.
• Systemic lupus erythematosus may cause dermatitis of the eyelid.
• Drugs
• Photosensitive dermatitis
• Infections, such as cellulitis or impetigo
• Acute conjunctivitis (bacterial or viral)
• Lice can cause an inflammatory reaction of the eyelid, with marked pruritus.

• Chronology and development of the inflammation; often recurrent
• Change in size or appearance
• Chemicals or medications used on or near the eyes
• Scratching or rubbing of the eyes
• Handwashing practices
• Eyelid hygiene
• Allergic or atopic history in the patient or the family
• Crusting pattern; symptoms often worse in the morning
• Contact lens use
• Makeup use

• Evaluate eyelid margins for thickening, crusting, erythema, and ulcerations; commonly bilateral.
• Usually, an associated papillary conjunctivitis is present.
• Loss of eyelashes
• Edema around the lid develops because of redundancy of eyelid skin and loose connection to underlying tissue; however, it remains localized because the surrounding skin is tightly adherent.
• Grouped vesicle on the eyelid suggests herpes simplex virus.
• Evidence of nits or adult lice suggests pubic lice.
• Evaluate for seborrhea in the scalp.
• Examine the skin for signs of atopic dermatitis.
• Hypertrophy and desquamation of the epidermis near the lid margin, with erythema and scaling near the lid border, are seen with seborrheic blepharitis.

• Ulcerative blepharitis can be a manifestation of herpes simplex infection (grouped vesicles).
• Pubic lice can reside in the eyelashes and cause blepharitis. Itching is the predominant complaint.

• Giemsa stain of conjunctival scrapings: helps confirm the diagnosis. Neutrophils are present in blepharitis.
• Bacterial and viral culture of the lid margins

• A combination of antimicrobials and eyelid hygiene (e.g., soap, dilute baby shampoo, or lid scrub) provides the best results.
• Most patients prefer a commercial preparation of lid scrub for the convenience and ease of use.
• Warm compresses for 15 minutes, twice a day (use caution to avoid causing a first-degree burn)
• Tarsal massage
• Removal of the scales and crust with a moist cotton swab
• Topical anti-staphylococcal antibiotic, two to three times a day (ophthalmic ointment is more soothing than solution, but ointment will cause blurring of vision)
• Oral medications may be required in severe cases.
• Continue treatment for several weeks, until blepharitis is completely resolved.
• Treat underlying seborrhea of the scalp and eyebrows with selenium sulfide shampoo.
• Use hypoallergenic makeup.

• As needed to assure compliance with prescribed regimen
• Improvement may be seen in as short a time as a few days.
• Any child with recurrent chalazions or a chronic stye should be evaluated for blepharitis.

• Avoidance of eye rubbing
• Maintenance of good eye hygiene
• Isolation of hospitalized patient: standard universal precautions
• Control measures: frequent handwashing in children who rub their eyes

Q: How did my child get blepharitis?
A: The pathophysiology of blepharitis is unclear at present. There may be an interaction of host mechanisms, such as composition of tears, with colonizing bacteria.

Q: Will it go away?
A: Blepharitis is usually a chronic condition. With good eyelid hygiene, it can be controlled. The eyelid hygiene will need to be continued for life.

Q: Is it contagious?
A: No. Children and other family members will not get blepharitis from the patient. However, it is recommended that they wash their hands frequently to prevent spread of bacteria.

Q: What is the difference between a chalazion and a stye?
A: Both chalazions and styes are accumulations of secretions from the glands of the eyelid. A chalazion is found on the inner surface of the eyelid and is due to blocked meibomian glands. Chalazions often appear as a subcutaneous nodule within the eyelid. If the chalazion gets large enough, it can distort vision by producing astigmatism from pressure exerted on the globe. Surgical removal of a chalazion is recommended if it distorts vision or is considered a cosmetic blemish. It may resolve spontaneously. A stye is an accumulation of secretions from the gland of Zeis and is found on the outer surface of the eyelid. The treatment for both lesions is application of warm compresses twice daily.

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