Blepharitis PPP 2023

By the American Academy of Ophthalmology Preferred Practice Pattern Cornea/External Disease Committee: Amy Lin, MD,¹ Sumayya Ahmad, MD, Methodologist,² Guillermo Amescua, MD,³ Albert Y. Cheung, MD,⁴ Daniel S. Choi, MD,⁵ Vishal Jhanji, MD, FRCS, FRCOphth,⁶ Shahzad I. Mian, MD,⁷ Michelle K. Rhee, MD,⁸ Elizabeth T. Viriya, MD,⁹ Francis S. Mah, MD, Co-Chair,¹⁰ Divya M. Varu, MD, Co-Chair¹¹

As of November 2015, the PPPs are initially published online only in the Ophthalmology journal and may be freely downloaded in their entirety by all visitors. Open the PDF for this entire PPP or click here to access the PPP on the journal's site. Click here to access the journal's PPP collection page.

¹John A. Moran Eye center, University of Utah, Salt Lake City, Utah
²Department of Ophthalmology, New York Eye and Ear Infirmary of Mount Sinai, New York, New York
³Department of Ophthalmology, Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, Florida
⁴Virginia Eye Consultants, Norfolk, Virginia, Assistant Professor, Department of Ophthalmology, Eastern Virginia Medical School
⁵Cataract and Vision Center of Hawaii, Honolulu, Hawaii
⁶Department of Ophthalmology, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
⁷Department of Ophthalmology and Visual Sciences, University of Michigan, Ann Arbor, Michigan
⁸Department of Ophthalmology, Icahn School of Medicine at Mount Sinai, Elmhurst Hospital, Mount Sinai Services, Elmhurst, New York
⁹Department of Ophthalmology, Lincoln Hospital/NYC Health+ Hospitals, Bronx, New York
¹⁰Departments of Cornea and External Diseases, Scripps Clinic Torrey Pines, La Jolla, California
¹¹Dell Laser Consultants, Austin, Texas

Highlighted Findings and Recommendations for Care

In the management of ocular surface disease, it is helpful to distinguish anterior and posterior (meibomian gland dysfunction [MGD]) blepharitis from aqueous deficient dry eye. Anterior blepharitis affects the lash line and includes posterior blepharitis, which is defined as meibomian gland involvement. Worsening of symptoms in the morning is typical of blepharitis, whereas worsening of the symptoms later in the day are typical of aqueous deficient dry eye.

---

Blepharitis is typically a chronic condition that cannot be permanently cured. It is important for patients to understand that successful management depends on their compliance with a treatment regimen.

---

Topical antibiotic drops or ointments with or without corticosteroids and/or oral antibiotics can be effective in the treatment of blepharitis. Although azithromycin is used as a treatment for blepharitis, it may produce cardiac arrhythmias when used orally in patients with cardiovascular problems.

---

In-office procedures targeting the meibomian glands have shown efficacy in some studies, but there is a lack of independent, randomized controlled studies demonstrating superiority of any one of these treatments over another.

---

In patients with blepharitis who do not respond to therapy, the possibility of carcinoma or immune-mediated diseases should be considered, particularly if the blepharitis is associated with loss of eyelashes and/or conjunctival cicatricial changes. Early diagnosis and appropriate treatment can prevent vision loss and disfigurement, and it may be lifesaving.

Literature Search

Blepharitis PPP - 2023 - Literature Search