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What is it?
Blepharitis is a diffuse inflammation of the sebaceous glands or lash follicles of the eyelids. It is often caused by skin organisms such as Staphylococcus aureus.

How does it present?
The patient complains of a gritty, burning sensation and mattering, especially upon awakening.

The eyelid margins look red and thickened. A magnified view shows flaky debris in the lashes. The conjunctiva is mildly and diffusely hyperemic. Sometimes the corneal margin develops a yellow-white infiltrate.

Individuals who have rosacea or seborrheic dermatitis of the scalp and face are especially prone to blepharitis.

What to do?
If you can make the diagnosis, tell the patient to perform lid-margin scrubs twice a day as follows:
  1. Place a warm washcloth over the closed lid for 5 minutes to soften the crusts.
  2. Moisten a cotton-tipped applicator in a solution of 3 ounces of water and 3 drops of baby shampoo, and use it to scrub the closed lid.
  3. Rinse the solution from the lids with clear water.
  4. Brush off lid margin debris with a clean, dry applicator.

If this treatment fails after several weeks, prescribe nightly application of bacitracin or erythromycin ointment to the eyelid margins. If topical medication does not work, try oral tetracycline 0.5 to 1 gm/day in four doses or doxycycline 50 to 100 mg once or twice daily (except in pregnant patients and children aged 12 years or less).

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