Blepharitis & MGD
At a glance
Lid-margin inflammation and meibomian gland dysfunction frequently overlap with dry eye.
CAVE
- Persistent unilateral disease, lash loss or a recurrent lesion at the same site requires assessment for malignancy.
Clinical presentation
- Crusting, irritation, recurrent chalazia, plugged gland openings and altered meibum.
Diagnosis & investigations
- Examine lash bases, lid architecture, collarettes, scales, telangiectasia and meibomian orifices. Express selected glands gently to assess secretion quality and expressibility; look for rosacea, recurrent chalazia, conjunctival inflammation and corneal staining/infiltrates.
- Unilateral persistent disease, lash loss, ulceration, focal thickening or a recurrent “chalazion” in the same site warrants tumour exclusion and possible biopsy. Consider culture for severe, recurrent or treatment-resistant anterior disease rather than routine swabs in every case.
Differential diagnosis
- Allergic or contact dermatitis, Demodex-associated disease, infection and eyelid tumour.
Treatment
- Explain the chronic relapsing course and demonstrate the technique, not just “lid hygiene”. Choose anterior, MGD and Demodex measures according to the actual findings; mixed disease is common.
- Reserve a short topical steroid course for selected significant inflammation after excluding infection; define an end point and an IOP check. Persistent corneal infiltrates or epithelial defects require corneal assessment rather than repeatedly renewing an antibiotic-steroid combination.
| Finding | Action | Timing / detail |
|---|---|---|
| Anterior crusting/scales at the lash base | Daily gentle lid-margin cleaning; remove loosened debris without abrading the cornea | Consider a short topical antibiotic course for significant bacterial anterior disease, not indefinite routine antibiotics |
| MGD: plugged orifices, altered meibum, telangiectasia | Warm compress for about 5–10 minutes, comfortably warm rather than hot, then gentle lid massage; lubricate as needed | Consistency matters; avoid squeezing an acutely inflamed focal lesion |
| Collarettes strongly suggest Demodex | Examine lash bases systematically and use targeted treatment available in the jurisdiction | Avoid concentrated tea-tree oil or irritating home mixtures on the ocular surface |
| Refractory inflammatory MGD/rosacea | Consider a selected oral tetracycline or macrolide course after assessing contraindications and interactions | Doxycycline: pregnancy/age restrictions, photosensitivity and oesophageal irritation; do not prescribe automatically for simple crusting |
Follow-up
- Reassess technique, symptoms, lid findings and corneal staining after about 4–6 weeks in uncomplicated disease. Review earlier for steroid use, corneal involvement or deteriorating vision. If response is poor, reconsider Demodex, contact allergy, rosacea and masquerade disease before extending systemic treatment.
Risk factors & context
- Separate anterior lid-margin disease from obstructive MGD.
- Look for rosacea and cylindrical collarettes suggesting Demodex involvement.
Complications
- Recurrent chalazia, tear-film instability and corneal involvement.
- Monitor IOP if topical corticosteroids are prescribed.
When to refer
- Urgent review for corneal ulceration; specialist referral for suspicious focal lesions.
References 1
- AAO · Blepharitis Preferred Practice Pattern ↗2024 · Care process; differential diagnosis; management
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