When your pediatric patient presents with irritated, itchy eyelids with reddened lid margins, diagnosing blepharitis may be the easy part of patient care. Implementing a treatment regimen for patients who are infants, toddlers, or school-age children, requires optometrists to use not only their knowledge but their clinical art of practice as well.
The telltale signs of blepharitis are not likely to be missed.
Common ocular findings include bilateral eyelid inflammation, vessel telangiectasia, and hard, fibrinous, crusts and scales with occasional misdirected or missing lashes.1
Anterior segment examination—with a slit lamp and/or transilluminator and magnifying lens—is important because many patients (even those old enough to talk) will not report symptoms. Often diagnosis is made based on findings alone.2,3
The onset of blepharitis usually occurs between the ages of six to 10 years. The prevalence of pediatric blepharitis is thought to be on the rise, due to the increase in pediatric contact lenses wear, particularly orthokeratology lenses, in this population.4
Based upon the anatomical location of the inflammation, there are two broad types of blepharitis: anterior and posterior.
Anterior blepharitis involves the skin of the “outer lid” and lashes, while posterior blepharitis involves the cutaneous mucous junction of the lid and as well as meibomian glands.5,6 Both types commonly occur in children, with anterior blepharitis—characterized by flakes and debris along the skin and lashes—being slightly more frequent than posterior blepharitis, that often manifests as meibomian gland dysfunction (MGD).7
The most frequent causes of blepharitis include:
• Overgrowth of bacteria, most commonly Staphylococcus species
• Seborrheic dermatitis characterized by dandruff of the scalp, eyebrows, and skin
• Clogged or malfunctioning meibomian glands
• Combination of two or more of these etiologies
MGD occurs as meibomian gland secretions thicken and become clogged due to inflammation, obstruction, and/or gland atrophy. The clinical picture of blepharitis is thought to be the result of several factors, including eyelid gland secretions, bacterial flora, and in some cases, immune dysfunction in the form of Type 3 hypersensitivity reactions to bacterial exotoxins.1,8,9
Less common causes of blepharitis include:
• Rosacea, a skin condition characterized by facial redness
• Mite infestation of the eyelash follicles and meibomian glands
• Herpes simplex infection