A Survey of Blepharitis in Pre-operative Cataract Patients

Abstract

Objective: To diagnose and categorize blepharitis and associated skin diseases in preoperative cataract patients and to correlate blepharitis with the development of post-operative ocular inflammation. Design: A prospective single blind study. Setting: An ophthalmic ward in a district general hospital. Patients: One hundred consecutive patients undergoing routine cataract extraction and lens implantation. Main Outcome Measures: 1. The proportion of patients showing blepharitis of the four main clinical types - staphylococcal, seborrhoeic, demodectic and meibomian gland dysfunction. 2. The prevalence of rosacea and seborrhoeic dermatitis, skin diseases associated with blepharitis. 3. The relationship of blepharitis to the development of post-operative ocular inflammation. RESULTS: Four patients had staphylococcal blepharitis. Four patients had seborrhoeic blepharitis, one with associated seborrhoeic dermatitis. Fifty-three patients showed varying degrees of demodectic cuffing; none had demodectic blepharitis. Forty-three (43%) had evidence of meibomian gland dysfunction; 18 of these had blockage of the meibomian duct orifices, lid notching and conjunctival concretions; the remaining 25 had notching and concretions only. Three patients had seborrhoeic dermatitis. No patient had frank papulopustular rosacea. Two patients had erythema, telangiectasia and a history of flushing, suggestive of early rosacea. Three patients developed abnormal post-operative ocular inflammation. Of these, one had seborrhoeic blepharitis and two had moderate demodectic cuffing. The four patients with staphylococcal blepharitis and the remaining three with seborrhoeic blepharitis developed no post-operative ocular inflammation. Conclusions: The results indicate that hitherto undetected blepharitis occurs in patients presenting for cataract operation. The prevalence of rosacea and seborrhoeic dermatitis in the population studied was 2% and 3%, respectively. Patients being listed for cataract surgery should be screened for blepharitis and associated skin conditions, and treated well in advance of operation.