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These dysfunctional secretions lead to a chronic inflammatory state within the lid, and the resultant dysfunctional tear film leads to dry eye symptoms and signs (see “Dry-eye syndrome”). When diagnosing blepharitis, consider the possibility of squamous cell, basal cell or sebaceous cell carcinoma of the eyelid margin (marked eyelid asymmetry may indicate this), dermatitis or infection (e.g. impetigo).17Treatment focuses on improving the Meibomian gland secretions, but is never curative and it should be explained to patients that management needs to be ongoing. As blepharitis is a chronic condition, relapses and exacerbations can be expected.17The following regimen should be initially carried out twice daily, then as symptoms improve, once daily:171. Apply a warm compress to the closed eyelids for five to ten minutes2. Gently massage the eyelid margin with a circular motion3. Clean the eyelid with a wet cloth or cotton bud and rub along the lid margins; use a solution of 1 part baby shampoo to 10 parts water for cleaningThe use of cosmetics around the eye should be avoided, especially eye liner. Artificial tears may assist in relieving symptoms.If the symptoms are particularly severe, topical antibiotics can be considered; chloramphenicol 0.5% eye drops, one to two drops, four times daily, for seven days (or up to six weeks in chronic cases).12, 17 Fusidic acid eye gel 1% is an alternative. In some cases, oral tetracyclines, e.g. low dose doxycycline, may be considered if topical antibiotics have not resulted in an adequate response. Antibiotics are usually prescribed initially for six weeks, but may need to be continued for up to three months, and repeated intermittently.17 Eyelid hygiene should be maintained throughout treatment.Blepharitis does not permanently affect vision, as long as complications are adequately managed.17 People with blepharitis have an increased risk of developing conjunctivitis and keratitis.17 Long-term complications include loss of eyelashes (madarosis), misdirection of lashes towards the eye (trichiasis) and depigmentation of the lashes (poliosis).17ACKNOWLEDGEMENT:
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