From the Guidelines
Anterior blepharitis affects the front of the eyelid where eyelashes grow, while posterior blepharitis involves the inner eyelid that touches the eye, with the most recent and highest quality study 1 providing the basis for understanding these conditions.
Key Differences
- Anterior blepharitis is typically caused by bacterial infection (often Staphylococcus) or seborrheic dermatitis, resulting in crusty debris at the base of eyelashes, redness, and irritation.
- Posterior blepharitis, also called meibomian gland dysfunction, occurs when oil glands in the eyelids become clogged, leading to thickened secretions, eye dryness, and a greasy appearance to the lid margin.
Treatment Approaches
- Treatment for anterior blepharitis includes warm compresses and gentle eyelid cleaning with diluted baby shampoo or commercial eyelid cleansers, along with antibiotic ointments like erythromycin or bacitracin if bacterial infection is present, as supported by 1.
- Posterior blepharitis treatment focuses on warm compresses to melt thickened oils, lid massage to express the glands, artificial tears for dryness, and sometimes oral antibiotics like doxycycline (50-100mg daily for 1-3 months) for their anti-inflammatory properties, with 1 highlighting the importance of tailored treatment plans.
Chronic Nature and Management
- Both conditions are chronic and require ongoing lid hygiene, but posterior blepharitis tends to be more persistent and may contribute more significantly to dry eye symptoms, as noted in 1.
- The management of blepharitis involves a combination of eyelid hygiene, topical treatments, and in some cases, oral antibiotics, with the goal of reducing symptoms and preventing complications, as discussed in 1.
From the Research
Definition and Classification of Blepharitis
- Blepharitis is a common ophthalmic condition with multiple etiologies and no definitive, universal treatment 2.
- It can be categorized based on the anatomical location of the disease: anterior (involving the anterior lid margin and eyelashes) and posterior (characterized by dysfunction of the meibomian glands) 3, 4, 5.
Anterior Blepharitis
- Anterior blepharitis involves the front of the eye and can be further classified into types such as staphylococcal and seborrheic blepharitis 3.
- Management options for anterior blepharitis include eyelid hygiene with warm compresses, eyelid scrubs, baby shampoo, and over-the-counter eyelid cleansers, as well as topical antibiotics and antibiotic-steroid combination drops/ointments 2.
- Topical antibiotics have been shown to provide some symptomatic relief and are effective in eradicating bacteria from the eyelid margin for anterior blepharitis 3.
Posterior Blepharitis
- Posterior blepharitis, also known as meibomian gland dysfunction (MGD), involves the back of the eye and is characterized by dysfunction of the meibomian glands 2, 3, 5.
- Treatment for posterior blepharitis/MGD includes at-home warm compress or in-office administration of heat therapy/thermal pulsation treatment to clear obstruction in the meibomian glands and restore meibum secretions to maintain a healthy tear film 2.
- Lid hygiene may also provide symptomatic relief for posterior blepharitis 3.
Comparison of Anterior and Posterior Blepharitis
- Both anterior and posterior blepharitis can cause significant ocular symptoms such as burning sensation, irritation, tearing, and red eyes, as well as visual problems such as photophobia and blurred vision 3, 6.
- While there are different treatment approaches for anterior and posterior blepharitis, long-term management of the underlying causes of the condition remains the best clinical approach 6, 5.