What is Blepharoconjunctivitis?
Blepharoconjunctivitis is an eye condition that combines blepharitis and conjunctivitis. It is characterized by inflammation of the eyelid (blepharitis) and conjunctiva (conjunctivitis). If blepharitis is not treated it can progress to affect the conjunctiva. Blepharoconjunctivitis is common and if not properly managed can affect one’s vision. A study of U.S. ophthalmologists and optometrists found 37% to 47% of patients had signs of blepharitis.
- Blepharoconjunctivitis is an inflammatory condition of the eyelid and conjunctiva.
- Blepharoconjunctivitis may be caused by bacteria, parasites, or skin conditions.
- Treatment for blepharoconjunctivitis may include lid hygiene, topical steroids, and antibiotics.
Blepharoconjunctivitis may be caused by several factors including a combination of chronic low-grade bacterial infections of the ocular surface, inflammatory skin conditions (atopy, seborrhea), and parasitic infestations (Demodex mites).
The condition is often categorized based on location, anterior vs posterior. Meibomian gland dysfunction (MGD) often affects the posterior part of the lid. An anterior lid infection may be caused by Staphylococcus or a seborrheic process.
Blepharoconjunctivitis has been divided into 6 subgroups including:
- Mixed seborrheic/staphylococcal
- Seborrheic with meibomian seborrhea
- Seborrheic with secondary meibomianitis
- Meibomian keratoconjunctivitis.
What is Angular Blepharoconjunctivitis?
Angular blepharoconjunctivitis is blepharoconjunctivitis involving the lateral canthal angle of the eye (the lateral aspect of where the eyelids meet closest to the temples). Redness, skin scaling, and irritation will be present in the canthus area of the eye. Angular blepharoconjunctivitis may be caused by Moraxella or Staphylococcus.
Risk Factors for Blepharoconjunctivitis
The risk factors for blepharoconjunctivitis are the same as blepharitis. It affects people of all ages, ethnicities, and genders. It is more common in individuals older than 50. Studies demonstrate staphylococcal may be more common in females with the age of onset being 42. With seborrheic blepharitis, no significant difference was noted between sexes and average age of onset was around 50 years.
Blepharoconjunctivitis symptoms typically affect both eyes and are worse in the morning.
- Eye irritation
- Foreign body sensation
- Crusting of the eyelids
- Red eyes
- Scaly, dry skin
- Gritty eyes
- Blurry vision
- Missing or misdirected eyelashes
- Corneal irritation
Blepharoconjunctivitis is diagnosed based upon patient history, clinical ocular signs, and patient symptoms. A doctor makes the diagnosis by closely examining the lids, lashes, tear film, and other structures of the eye. Dry eye testing like tear break-up time (TBUT) and fluorescein staining can help make the diagnosis and determine if treatment is effective.
If one has blepharoconjunctivitis, their eyelid margins may appear swollen, red, and small blood vessels (telangiectasia) may be visible. If chronic, there may be changes in the eyelashes such as poliosis (depigmentation), trichiasis (change in direction), or madarosis (reduction in the number of eyelashes). The eyelid may look different, and possibly turn in or out. The small glands at the base of the eyelashes called meibomian glands may appear capped with a thick oil or clogged.
Doctors are able to determine the type depending on clinical signs.
Staphylococcal blepharitis patients may have sticky eyelids, thickened lid margins, and missing and misdirected eyelashes. Seborrheic blepharitis patients often have greasy flakes or scales around the base of their eyelashes and the lids may be red. Ulcerative blepharitis patients have matted, hard crusts around the eyelashes. Removing the crusts may be difficult and leave small sores that ooze and bleed. These patients often experience eyelash loss, distortion of the front edges of the eyelids and chronic tearing. The cornea may also become inflamed. Meibomian blepharitis patients have oil glands (meibomian) blockage, poor quality of tears, and redness of the lining inside of the eyelids.
Blepharoconjunctivitis treatment is primarily eyelid hygiene. Eyelid hygiene includes warm compresses and lid scrubs. The use of warm eye compress for 5 to 10 minutes helps soften the oil within the meibomian glands. Lid massage can help express the oil, and an eyelash scrub removes debris. Eyelid hygiene should be used prophylactically because blepharoconjunctivitis is often a chronic condition. It is important that patients are educated on the symptoms and the importance of daily hygiene therapy. Blepharoconjunctivitis treatment may include the addition of artificial tears to balance the tear film and improve dry eye symptoms. For more information on eyelid hygiene, click here.
Topical steroids can be used in the acute phase to reduce inflammation from blepharoconjunctivitis. Both topical and oral antibiotics may be necessary if eyelid hygiene is not effective. Currently, no guidelines exist regarding the use of oral antibiotics, including antibiotic type, dosage, and treatment duration, for chronic blepharitis although tetracyclines are commonly used. In addition, omega-3 and omega-6 fatty acids supplementation may aid in improving dry eye symptoms.