Vol. 2, #06  •   Thursday, April 22, 2021


Review's Chief Clinical Editor
Paul M. Karpecki, OD, FAAO

Provides you with cutting-edge clinical strategies for optimal management of ocular surface disease and beyond.


Differential Diagnosis of Blepharitis

Determining the type of blepharitis your patient has plays a key role in successful management. What works for one type may not work for the other. Let’s look at the two most common causes of blepharitis.

Case 1: A patient presents to you with complaints of itchy eyes and says the problem “has gone on for years.” Previous doctors have prescribed allergy drops and lid hygiene, but nothing has helped long-term. You are the fourth doctor to see this patient. How do you proceed?

A key pearl when you hear the complaint of itching is to ask the patient: “Where do you feel the itching?” If it’s the canthal region, for example, it’s likely to be allergic conjunctivitis. In this presentation, the patient would clearly demonstrate the itching is on her lid margin/lash area.

The eyelids are the most important structure to evaluate when it comes to dry eye and ocular surface disease management. When looking at the eyelashes, have the patient look down so you can scan the lashes and lid margin with your slit lamp.

In the image above, you will quickly notice that most of the findings are at the base of the lashes. These are best described as collarettes and are pathognomonic for demodex blepharitis.

Case 2. Unlike demodex blepharitis, patients with staphylococcal blepharitis typically complain about mattering and discharge. The mattering can be found throughout the lashes, similar to this image (left).

The examination will reveal yellowish discharge throughout the lashes. Although staphylococcal blepharitis may appear to be the primary diagnosis, the presence of a few collarettes could suggest a mixed presentation.

Next week we’ll discuss treatment and management approaches of the various types of blepharitis.

KEY TAKEAWAY: It is important to not only diagnose blepharitis when present but to differentiate the type of blepharitis and remember that itching doesn’t always mean allergy.

Supported by an independent medical grant from Kala Pharmaceuticals

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