Blepharitis is a common cause of chronic conjunctivitis in children. The signs and symptoms of blepharitis in children are similar to those in adults and include ocular irritation, conjunctival hyperemia, morning eyelid crusting, eyelid margin erythema, and meibomian gland obstruction (Fig 20-6). Intermittent blurred vision may occur because of tear film instability. Inferior keratitis may develop in more severe cases, leading to epithelial disruption and fluorescein staining, corneal scarring, and permanent vision loss (Figs 20-7, 20-8).
Recurrent chalazia in children may indicate underlying blepharitis. Acne rosacea in children may be manifested by chronic blepharitis and facial telangiectasias, papules, and pustules. Demodex (human mites that inhabit the hair follicles) may play a role in the pathogenesis of blepharitis and should be considered when blepharitis does not respond to treatment. Patients with demodicosis typically present with a waxy, sleevelike buildup at the base of eyelashes. Demodicosis may respond to dilute tea tree oil applied to lash bases.
Figure 20-6 Blepharitis with meibomian gland dysfunction, scurf, and telangiectasias.
(Courtesy of Steven Safran, MD.)
A, Inferior keratitis secondary to severe blepharitis. B, Fluorescein staining of keratitis (same patient as in part A).
(Courtesy of Robert W. Hered, MD.)
Figure 20-8 Severe corneal scarring secondary to keratitis caused by blepharitis.
(Courtesy of Erin Stahl, MD.)
Initial treatment of blepharitis includes warm compresses, eyelid scrubs with baby shampoo, and erythromycin or bacitracin ophthalmic ointment or azithromycin ophthalmic solution, 1%. Severe cases may benefit from oral antibiotic use. Tetracyclines (tetracycline, doxycycline, minocycline) and macrolides (erythromycin, azithromycin) may be helpful. Macrolides are most commonly used in children younger than 8 years to avoid the potential dental staining associated with use of tetracyclines. Judicious use of topical corticosteroids may be indicated in patients with corneal disease. Dietary supplementation with omega-3 fatty acids may benefit some patients.
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.