Anterior Blepharitis

Aka, Eyelash Dandruff

Anterior blepharitis is a common eyelid condition characterised by inflammation of the front portion of the eyelid margin. It typically affects the area where the eyelashes are attached to the eyelid. The condition can be chronic and may cause discomfort, irritation, redness, and itching of the eyelids.

In a 2009 study, 120 ophthalmologists and 84 optometrists were examined to assess the prevalence of blepharitis in their respective practices. The findings revealed that 37% to 47% of their patients were diagnosed with blepharitis.

Types of Anterior Blepharitis

We can determine the type of blepharitis based on the appearance of the eyelid margins. There are two main types of anterior blepharitis:

Staphylococcal blepharitis: This type is caused by an overgrowth of bacteria, particularly Staphylococcus aureus, on the eyelids. These bacteria produce toxins that can irritate the eyelid margins and lead to inflammation.
Seborrheic blepharitis: This type is associated with seborrheic dermatitis, a skin condition characterized by excessive oiliness and scaling of the skin. Seborrheic blepharitis is caused by an overproduction of oil from the sebaceous glands near the eyelashes, leading to inflammation and the accumulation of greasy debris along the eyelid margin.

What are the symptoms of Anterior Blepharitis?

Redness and swelling of the eyelids
Crusty or flaky deposits at the base of the eyelashes
Itching or a burning sensation
Sensitivity to light
Watery or sticky discharge from the eyes
Loss or misdirection of eyelashes
Dry eye symptoms

What causes Anterior Blepharitis?

The intertwining of blepharitis and dry eyes is a common occurrence, giving rise to the dilemma of whether dry eyes trigger blepharitis, or vice versa.

Bacterial infection affecting the eyelids.
Dysfunction of the Meibomian Glands (MGD).
Fungal infection targeting the eyelids.
Presence of parasitic Demodex mites on eyelashes.

Anterior blepharitis is marked by an upsurge of bacteria inhabiting the margins of eyelids and eyelashes, fostering the growth of a biofilm at the lash base. This biofilm, analogous to dental plaque, evolves into a harmful environment. Parasitic Demodex mites thrive on this biofilm, leading to an escalation in eyelid mite population and aggravating eyelid inflammation.

Furthermore, the bacteria within this biofilm generate exotoxins, provoking inflammation within the meibomian glands that secrete oils for tear production. This cascade results in Meibomian Gland Dysfunction (MGD), exacerbating ocular symptoms and contributing to dry eyes.

Blepharitis frequently aligns with other systemic skin conditions, often manifesting in patients with skin afflictions like rosacea, eczema, psoriasis, dandruff, and ocular rosacea. This correlation underscores the interconnected nature of these conditions.

How do we diagnose Anterior Blepharitis?

Blepharitis is diagnosed through a thorough eye examination that places special emphasis on both the eyelids and the anterior surface of the eyeball. This evaluation encompasses the following aspects:

Patient History: This involves identifying any symptoms the patient is currently experiencing, as well as any underlying health conditions that might be contributing to the eye issue.
External Eye Examination: This entails an assessment of various factors, including the structure of the eyelids, the texture of the skin, and the appearance of the eyelashes.
Evaluation of Lid Margins: The examination also covers a meticulous inspection of the lid margins, the base of the eyelashes, and the openings of the meibomian glands. This process is carried out using bright light and magnification to ensure precision.
Tear Quantity and Quality Assessment: The quantity and quality of tears are thoroughly evaluated to detect any potential abnormalities that could be indicative of blepharitis or related conditions.

The picture shows a before (left) and after (right) of what we can see on our microscope during a routine eye test. This is the kind of debris that can lead to future styes and flare-ups, as it usually contains bacteria. Therefore, it is essential to clean it away as soon as you feel or see it.

Complications of Anterior Blepharitis

Stye (hordeolum) – This is characterized by a tender, red lump caused by an infection in an eyelid oil gland.
Chalazion – An inflammation in the eyelid's oil gland that results in a painless, firm lump. If infected, it can become painful and red.
Irregular or reduced oil secretion, which can lead to excessive tearing or dryness of the eyes.
Corneal infections caused by abnormal or reduced oil secretion.
Corneal 'dry spots'.
Corneal abrasions.
Corneal scarring.
Corneal thinning.

Anterior Blepharitis Prevention

Effective hygiene practices often play a crucial role in managing anterior blepharitis. This involves regular cleansing of the scalp and face, employing warm compresses to gently cleanse the eyelids, and delicately scrubbing the eyelids.

In instances where a bacterial infection contributes to or accompanies blepharitis, medical professionals might recommend the use of antibiotics and other relevant medications.

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It's important to consult an eye care professional or a dry eye specialists for a proper diagnosis and guidance on appropriate treatment for anterior blepharitis. They can provide personalized recommendations based on the severity and underlying causes of your condition.