Vol. 2, #22   •   Thursday, September 16, 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.


Can Blepharitis Be the Culprit in Dry Eye Disease?

Clinical experience reveals that blepharitis and dry eye may not be independent of each other.

DED is multifactorial in nature and I’m convinced, via clinical experience, that bacteria and/or demodex can be a contributor or even the cause. Given this possibility, it’s essential to not only treat DED and the flares associated with it, but also the blepharitis that is often present in evaporative DED.

Look for Signs As Well As Symptoms
Common symptoms of blepharitis include dry, gritty, irritated, itching eyelids, as well as tearing and blurred vision. In addition to multiple similar symptoms, blepharitis and DED can be slowly progressive and chronic with various manifestations, depending on the stage of the disease. Examining the eyelid margins more closely for biofilm formation (often a sheen noted on the eyelid margins), collarettes (sleeves at the base of the lashes), or a volcano sign (debris extruding from the base of the lash as the lash grows out of the follice) are subtle clues pointing to the diagnosis.

Treat Both Conditions
Although it seems obvious to treat every condition that is present, it’s not commonly done. ECPs often select the more significant pathology to manage first. But because one can contribute to the other, both need to be managed simultaneously, Targeted treatments such as microblepharoexfoliation (MBE), lid hygiene, warm compresses, light treatments (e.g., IPL or LLLT), and MeiboClean cleansing brushes, etc., can significantly improve the results in DED patients.

DEBS and Dry Eye Flares
The Dry Eye Blepharitis (DEBS) Theory1 may be on to something for most cases of evaporative DED—making up the majority of DED. Pathogens such as Staphylococcus or demodex can be found in the lash follicles and meibomian glands, and can also contribute to dry eye flares. So it’s imperative to treat the blepharitis, DED, and especially the frequent dry eye flares in these cases. EYSUVIS (0.25% loteprednol) is FDA-approved for the short-term treatment of dry eye signs and symptoms (flares).

KEY TAKEAWAY: In DED cases, look closely for subtle evidence of blepharitis, including collarettes or the volcano sign—especially at the base of the lashes as the patient looks down. Add blepharitis treatments to your dry eye regimen when signs are present, and consider EYSUVIS for the short-term treatment of dry eye signs and symptoms.


1. Rynerson JM, Perry HD. DEBS – a unification theory for dry eye and blepharitis. Clin Ophthalmol. 2016;10:2455-67.

Supported by an independent medical grant from Kala Pharmaceuticals

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