Blepharitis

What it is

Blepharitis is inflammation of the lid margins.

The two types

There are two main types, and the scale tells them apart:

• Staphylococcal, caused by S. aureus: ulcerative, with dry scales
• Seborrheic: no ulcers, with greasy scales

How it presents

There is itching, tearing and a foreign body sensation. The lid margins are thickened and red, with crusting, and discharge appears with pressure on the lids, which is the toothpaste sign.

The company it keeps: ocular rosacea

Blepharitis is one of the features of ocular rosacea, which is the associated condition asked about in rosacea: ocular rosacea means blepharitis, conjunctivitis and dry gritty eyes.

Rosacea itself is erythematous facial flushing with papules and pustules on the cheeks, nose and chin, sparing the nasolabial folds. Its triggers are alcohol, spicy food, stress and sunlight. There are no comedones, which is what differentiates it from acne vulgaris, and the other differential is SLE, a malar rash with systemic symptoms. Rhinophyma, a bulbous nose, is a late complication in men. Its two lines of treatment are topical metronidazole or azelaic acid, and oral doxycycline for moderate to severe cases.