THERAPY OF INFECTIOUS BLEPHARITIS

Abstract

Blepharitis refers to inflammation of the eyelid margin, which includes the eyelashes and associated apocrine and sebaceous 01+654 glands. Although many classifications of blepharitis have been proposed, 16,20,21,24 a simple distinction can be made between disease of the anterior and posterior eyelid margins. Anterior blepharitis includes staphylococcal blepharitis, seborrheic blepharitis, and mixed staphylococcal/seborrheic blepharitis. Staphylococcal blepharitis is characterized by collarettes, inflamed lids, and a waxing and waning pattern of infection in association with colonization of the anterior lid margin with bacteria, whereas seborrheic blepharitis results from an overproduction of sebum. Posterior blepharitis most frequently results from meibomian gland dysfunction and may not have a significant infectious component. In the past, it was thought that an overgrowth of Staphylococcus aureus on the eyelid margins was to blame for infectious blepharitis. S. aureus is a transient colonizer of the skin, nares, axillae, perineum, and gastrointestinal tract; at any given time about 30% of the population are colonized in one of these locations. More recent studies, however, have shown that other bacterial species may have an equally important role in causing blepharitis. 8,13,21 In a study by Groden et al, 13 the most common organisms cultured from the eyelid margins of patients with chronic blepharitis were Staphylococcus epidermidis (96%), Propionibacterium acnes (93%), Corynebacterium sp. (77%), Acinetobacter sp. (11%) and Staphylococcus aureus (10%). S. aureus were not found significantly more often in blepharitis patients, nor were they cultured in significantly greater numbers compared with controls. Conversely, S. epidermidis and P. acnes were present in a significantly higher proportion of blepharitis patients ( P P P P P. acnes may act as an adjuvant in promoting hypersensitivity to S. epidermidis , thereby leading to blepharitis. Although the cause of anterior blepharitis has not been completely resolved, it is clear that not all cases are associated with staphylococcal species.