GPAtlas🧭 When to suspect
Blepharitis is chronic inflammation of the eyelid margins and one of the commonest reasons a patient brings an irritable eye to primary care – it accounts for at least 5% of eye presentations.
Suspect it in an adult (onset is typically in the fourth or fifth decade) with:
• Bilateral, persistent sore, gritty, itchy or burning eyes that are characteristically worse on waking
• Eyelids that stick together
• Crusting or flakes at the lash base
Symptoms relapse and remit, and are often disproportionate to the modest signs found on examination.
Raise suspicion particularly where there is a background of:
• Seborrhoeic dermatitis
• Acne rosacea
• Eczema
• Psoriasis
• Dry eye disease
Two anatomical patterns exist and frequently overlap:
• Anterior blepharitis affects the lash base and is either staphylococcal or seborrhoeic
• Posterior blepharitis reflects meibomian gland dysfunction (MGD) and is the commonest form
The clinical skill in primary care is to:
• Recognise the pattern
• Treat the right way (lid hygiene first, antibiotics only where they add value)
• Never dismiss truly unilateral or treatment-resistant lid disease, which can hide a tumour
| Type | Site | Typical features |
|---|---|---|
| Anterior – staphylococcal | Base of the lashes | • Hard scales and collarettes at the lash base, lid-margin telangiectasia • Lash distortion or loss • More common in women |
| Anterior – seborrhoeic | Base of the lashes | • Greasy, soft scales with lashes stuck together • Less inflammation • Signs of seborrhoeic dermatitis on scalp/brows |
| Posterior (MGD) – commonest | Meibomian gland orifices | • Capped, oily or foamy gland orifices, frothy/unstable tear film, lid-margin telangiectasia • Strongly linked to rosacea |
Source: College of Optometrists · DermNet
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