Can Blepharitis Present Acutely?
Blepharitis is fundamentally a chronic condition with periods of exacerbation and remission, not an acute disease entity. 1
Natural Course and Temporal Pattern
Blepharitis follows a chronic relapsing-remitting pattern rather than presenting as an acute condition:
- The disease is characterized by chronic inflammation with periodic flares rather than acute onset episodes 1
- Onset typically occurs in middle-aged adults, though it can begin in childhood, and persists throughout life 1
- Patients with seborrheic blepharitis and meibomian gland dysfunction generally have a long history of ocular symptoms ranging from 6.5 to 11.6 years 1
- The condition requires long-term management of underlying causes rather than acute treatment 2
What May Appear "Acute" to Patients
While the underlying disease is chronic, patients may experience what feels like acute presentations:
- Exacerbations of chronic blepharitis can cause sudden worsening of symptoms (redness, irritation, burning, tearing, itching, crusting) that may prompt acute presentation to clinicians 1
- Morning symptoms are typically worse in blepharitis, which may create the impression of acute episodes 1
- Recurrent hordeola (styes) and chalazia represent acute inflammatory events superimposed on chronic blepharitis 1
Critical Distinction from Truly Acute Conditions
When evaluating apparent "acute blepharitis," consider alternative diagnoses:
- Recent exposure to infected individuals (such as pediculosis palpebrarum from Phthirus pubis) can cause acute eyelid inflammation that mimics blepharitis but represents a different entity 1
- Medication-induced blepharitis from isotretinoin or dupilumab may present more acutely but still represents a chronic process once established 1
- Local trauma (mechanical, thermal, chemical, or radiation injury) can cause acute eyelid inflammation distinct from chronic blepharitis 1
Clinical Implications
The chronic nature of blepharitis has important management implications:
- A cure is not possible in most cases, and treatment focuses on controlling symptoms and preventing complications 3
- Long-term daily eyelid hygiene routines are the mainstay of management, not short-term acute interventions 3, 4, 5
- Subjective symptoms may persist even when clinical signs improve, reflecting the chronic inflammatory nature 3
Common Pitfall
The most important clinical error is treating blepharitis as an acute, self-limited condition rather than establishing long-term management strategies. 2, 3 Patients who receive only short-term treatment will inevitably experience recurrence, as the underlying chronic inflammatory process persists without ongoing management 1