Blepharoconjunctivitis

Most patients with chronic blepharoconjunctivitis will fall into one of the four seborrheic groups or the primary meibomianitis group. With all of these, there appears to be a predisposition to develop an abnormality in sebaceous glands, as manifested by the fact that such patients have clinically diagnosable seborrheic dermatitis or acne rosacea. These patients tend to develop an abnormality of either the anterior portion of the eyelid with involvement of the gland of Zeis or the posterior portion of the eyelid with involvement of the meibomian glands. Patients in the staphylococcal group are typically younger, a higher percentage are female, and they have a history of symptoms for a relatively shorter period of time. It is only in this latter group that one can hope for a cure with therapy, whereas in the other groups one must aim for control of the disease process. The diagnosis of the various types of blepharoconjunctivitis is important not only because it directs therapy, but also because it gives both the physician and patient an idea about the prognosis. Laboratory evaluation in these patients appears to be of limited value; only in the staphylococcal and mixed seborrheic-staphylococcal group is a pathogen found in the form of S. aureus. The other organism that may contribute directly to disease is S. epidermidis. The antibiotic susceptibility patterns of these two organisms are fairly consistent, and so it is not necessary to culture them to determine antibiotic sensitivities: The majority are sensitive to both bacitracin and erythromycin ointments, as well as the aminoglycosides. Attempts to identify Demodex or to obtain conjunctival scrapings for cytology have not proved helpful. Therefore, the diagnosis is a clinical one and, from a practical standpoint, laboratory evaluation is not required for either diagnosis or management. Therapy for each case of chronic blepharoconjunctivitis must be tailored to the individual and based on the type and severity of blepharoconjunctivitis present. The mainstays in therapy are mechanical and hygienic (i.e., warm compresses and eyelid scrubs ). The use of topical antibiotics must be based on the sensitivities of the likely pathogens (i.e., S. aureus and S. epidermidis). Therefore, while sulfonamides would not appear to be appropriate therapy, bacitracin, erythromycin, or the aminoglycosides are effective antibiotics. The therapy is topical, with the exception of the rare and more severe case of seborrheic blepharoconjunctivitis with secondary meibomianitis and all cases of primary meibomianitis (meibomian keratoconjunctivitis).(ABSTRACT TRUNCATED AT 400 WORDS)