Blepharitis Complications

The inflammation of the rims/edges of the eyelids due to obstruction of the oil glands is called blepharitis. This is a common eye disorder, and patients with blepharitis experience discomfort, itchiness, and irritation in the eyes. Blepharitis can be easily diagnosed and treated and, if untreated, may lead to complications. Fortunately, serious complications are uncommon.

Blepharitis inflammation. Image Credit: donikz / Shutterstock

Complications Caused by Staphylococcal Blepharitis

The below are identified as the complications caused by Staphylococcal blepharitis (S. blepharitis):

• Madarosis
• Entropion
• Ectropion
• Trichiasis
• Chalazion
• Styes
• Bacterial conjunctivitis

The inflammation of the eyelid margin and folliculitis due to the S. blepharitis results in madarosis, which is characterized by the lack of eyebrows or eyelashes.

Blepharitis can lead to a condition called entropion, in which the eyelid margins turn inward, resulting in malposition of the eyelid. Congenital entropion can also lead to ectropion, in which there is sagging of the lower eyelid and the eyelid is turned outward.

Chronic blepharitis patients may suffer from Trichiasis, an abnormality in the eyelid where the eyelashes are turned inward and grow toward the eye. This ingrowth of eyelashes rubs the cornea, the conjunctiva, and the eyelids (inner surface) and results in eye irritation. The difference between entropian and trichiasis is that, in the former there is a malposition with the eyelid margin, whereas in the latter, there is a malposition in the growth of the eyelash.

In conditions such as posterior blepharitis, the openings to the meibomian glands are totally blocked and the oil that is produced forms cysts in the eyelid. This leads to a condition called Chalazion or meibomian cyst.

Styes or hordeolum results when infections are caused at the roots of the eyelashes. A painful boil-like swelling can be seen on the outer eyelid, which is usually filled with pus.

Bacterial conjunctivitis occurs when the bacteria present in the eyelids cause infections. Although children are more prone, adults can also develop pink eye-conjunctivitis, where there is a thick, yellow-green secretion. The bacterial type is highly contagious and spreads when individuals establish direct or indirect contact with secretions of the infected individual.

Complications Caused by Demodex Blepharitis

When the cause of blepharitis is due to the species Demodex folliculorum (D.folliculorum) and Demodex brevis (D. brevis), it can create other complications as well.

D. folliculorum is found in the eyelash follicle and D. brevis is seen in the sebaceous and meibomian glands. In search of sebum, its main source of food, D. brevis goes deep into the glands, feeds on the epithelial cells, and damages the eyelid margin directly. The life span of adult mites is limited and the infestation of Demodex mites is dependent on mating. In untreated blepharitis, complications arise as mating is not prevented and this allows direct transmission of the mites.

A greater number of mites will lead to greater damage. In general, Demodex mites are found in larger numbers in patients with a condition called Rosacea. These mites can also act as a vector for bacteria. Bacillus oleronius, detected in Demodex mites, have an effect on patients with Rosacea. Blepharitis can lead to Ocular rosacea, an inflammation of the eye that causes an itching and burning sensation. However, sometimes ocular rosacea may develop first, before showing facial symptoms of Rosacea.
Epithelial hyperplasia can be caused due to micro-abrasions inflicted by the mites. Cylindrical dandruff is formed around the eyelash base. Demodex mites are the likely causes of recurrence of chalazia.

Other than eyelash misalignment, the debris of the mites release bacterial antigens that could trigger inflammatory responses.

Corneal Complications

Patients suffering from long-time blepharitis face the risk of eyelid scarring. D. brevis is connected to corneal manifestations. Corneal infections and ulcers pose a threat to the vision. Chronic conditions of blepharitis can give rise to infections in the cornea. Swelling and redness of the eye can harm the cornea and result in Keratitis–damage to the transparent eye layer. The Demodex species can influence marginal infiltration, nodular scar, superficial opacity, and corneal vascularization.

Complications Due to Tear Film Deficiency

Conditions such as Seborrheic Blepharitis, Meibomian Seborrheic Blepharitis, and Angular Blepharitis lead to instability of the tear film and make the eyelids dry, scaly, or emit a white foamy discharge. Lubrication in the eye is affected and patients may find it difficult to wear contact lenses.

Dry Eye Syndrome

When tears are not produced properly or if the consistency of the tear is such that it evaporates quickly, dry eye may occur. The meibomian glands present in the eyelids produce oily fluids that form the outer layer of the tear film. However, complications arising from blepharitis may lead to dry eye as dysfunction of the meibomian gland (Meibomian blepharitis) will create an imbalance in the tear component.

Chronic blepharitis, combined with conjunctivitis results in Blepharoconjunctivitis, causing inflammation and irritation in the eyelids.

Regular eyelid hygiene, intake of omega-3 fatty acid supplements, and proper treatment of blepharitis can avert complications and help to maintain good vision.