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, with eyelids that stick together and crusting or flakes at the lash base. Symptoms relapse and remit, and are often disproportionate to the modest signs found on examination.
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), and never dismiss truly unilateral or treatment-resistant lid disease, which can hide a tumour. Raise suspicion particularly where there is a background of seborrhoeic dermatitis, acne rosacea, eczema, psoriasis or dry eye disease.
| 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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