Seborrheic blepharitis may occur alone or in combination with staphylococcal blepharitis, MGD, or seborrheic dermatitis. Inflammation occurs primarily at the anterior eyelid margin; a variable amount of scaling or scurf (Fig 3-17), typically of an oily or greasy consistency, may be found on the eyelids, eyelashes, eyebrows, and scalp. Patients with seborrheic blepharitis often have increased meibomian gland secretions that appear turbid when expressed. Additional signs and symptoms include chronic eyelid redness, burning, and, occasionally, foreign-body sensation. In a small percentage of patients (approximately 15%), an associated keratitis or conjunctivitis develops. The keratitis is characterized by punctate epithelial erosions distributed over the inferior one-third of the cornea. Approximately one-third of patients with seborrheic blepharitis have evaporative dry eye. See Table 3-11 for additional information on seborrheic and other types of blepharitis.
Eyelid hygiene (discussed elsewhere in this chapter) is the primary treatment for seborrheic blepharitis as well as the associated MGD or staphylococcal blepharitis. Concurrent treatment of the scalp disease with selenium sulfide shampoos is recommended.
Demodicosis should be considered in patients who do not improve with traditional blepharitis treatments. Eyelash sleeves are typically seen (Fig 3-18A; also see Fig 3-17). In a recent small case series, improvement in symptoms and signs was seen when weekly 50% tea tree oil eyelid scrubs and daily tea tree oil shampoo scrubs were used for a minimum of 6 weeks in a group of patients who had not improved with eyelid hygiene and concurrent scalp treatment. Oral ivermectin has also been reported to be of benefit in some cases of recalcitrant Demodex blepharitis.
Excerpted from BCSC 2020-2021 series: Section 10 - Glaucoma. For more information and to purchase the entire series, please visit https://www.aao.org/bcsc.