Diagnosis and management of blepharitis: an optometrist's perspective

Blepharitis is a condition characterized by inflammation of the eyelid margin and is a common cause of discomfort and irritation among people of all ages, ethnicity, and sex. In general, blepharitis is not a sight-threatening condition, but if left untreated has the potential to cause keratopathy, corneal neovascularization and ulceration, and permanent alterations in eyelid morphology. Historically, blepharitis has been categorized according to multiple structural classifications, including anatomic location, duration, and etiology. The substantial overlap of symptoms and signs from the differing structural classifications has led to initial misdiagnoses, clinical underreporting, and variability in treatment of blepharitis. The multifactorial nature is still not fully appreciated but infection and inflammation have been identified as the primary contributors. Ongoing clinical research continues the pursuit for a treatment panacea; however, long-term management of the underlying causes of blepharitis remains the best clinical approach. Here, we will attempt to review the existing literature as it pertains to clinical management of blepharitis and address a stepwise approach to diagnosis, treatment, and management.