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The Evolution of Lid Margin Changes in Blepharitis

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Advances in Corneal Research

Abstract

Anterior blepharitis affects the lash-bearing region of the lids. It may be seborrhoeic or non-seborrhoeic and is associated with an increased prevalence of lid commensals. Colonization with S. aureus, although not necessarily associated with blepharitis, increases the risk and may be accompanied by lid crusting, collarettes, styes, and folliculitis. Enhanced cell-mediated immunity to S. aureus may provide a partial explanation for the folliculitis. S. aureus carriage is very high in atopes, while ulcerative blepharitis is associated with Candida superinfection. There is a strong link between anterior blepharitis and skin diseases such as seborrhoeic dermatitis, acne rosacea, atopy, and psoriasis.

Posterior blepharitis is usually due to obstructive meibomian gland disease resulting from hyperkeratinization of the meibomian ducts, or from cicatricial events. The latter may dominate the picture in cicatrizing disorders such as trachoma. Posterior blepharitis is strongly associated with skin disorders; focal blepharitis occurs with seborrhoeic dermatitis and diffuse blepharitis with atopy and acne rosacea. Meibomian seborrhoea may be a hypersecretory disorder, although an obstructive element may explain the excess of expressible lipid; a hyposecretory form of meibomian gland disease is also a theoretical possibility. In both anterior and posterior blepharitis, constitutional features of meibomian lid composition, together with the action of lipid commensals on such lipids, may determine some features of the diseases.

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  1. Nuffield Laboratory of Ophthalmology, University of Oxford, Oxford, UK

    A. J. Bron & J. M. Tiffany

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  1. A. J. Bron
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  1. Case Western Reserve University and University Hospitals of Cleveland, Cleveland, Ohio, USA

    Jonathan H. Lass

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Bron, A.J., Tiffany, J.M. (1997). The Evolution of Lid Margin Changes in Blepharitis. In: Lass, J.H. (eds) Advances in Corneal Research. Springer, Boston, MA. https://doi.org/10.1007/978-1-4615-5389-2_1

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  • DOI: https://doi.org/10.1007/978-1-4615-5389-2_1

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