Life & Science 2021 Vol. 2, No.

4 Clinical Presentation, Risk Factors and Outcomes of Demographic Analysis of Blepharitis

ORIGINAL
ARTICLE
Clinical Presentation, Risk Factors and Outcomes of Demographic Analysis of Blepharitis
in Adults Presenting at Multiple Healthcare Centres
Adeel Ahmad Siddique1*, Kamran Haider Shaheen2, Irum Raza3, Muhammad Awais Ashraf4, Ghazi Khan Maree5,
Azfar Ahmed Mirza5, Talha Alvi6
ABSTRACT
Objective: To identify symptoms, risk factors and outcomes of demographic analysis in adult patients with
blepharitis.
Study Design: Cross-sectional study.
Place and Duration: The study was conducted in the Department of Ophthalmology at THQ Hospital, Kabirwala
th th
from 8 January 2020 to 8 June 2020.
Materials and Methods: 100 patients were included in the study. Aged above 21 with symptoms of Blepharitis.
Fluorescein strips and Slit lamp 90 D techniques were used to evaluate the patients for the presence of visual
indications of blepharitis.
Results: Sixty-five females and thirty-five males were included in the study. The age group of 21-30 years had
the highest number of patients. Dry eyes, poor hygiene, low-socioeconomic factor and seborrhoea dermatitis
were significant risk factors. Most common symptoms included irritation, foreign body sensation, swelling over
eyelids, hyperaemia, Epiphora and photosensitivity.
Conclusion: Proper guidelines for protection and good hygiene should be provided to people. Dry eyes, poor
hygiene, low-socioeconomic factor, seborrhoea dermatitis, irritation, foreign body sensation, swelling over
eyelids, hyperaemia, Epiphora and photosensitivity are the most common symptoms and risk factors to find the
reason behind Blepharitis, in this study. Females, due to their hormonal changes, are more prone to having this
disease.

Key Words: Blepharitis, Diabetes, Epiphora, Poor Hygiene, Socioeconomic Status, Seborrheic Dermatitis.

How to cite this: Siddique AA, Shaheen KH, Raza I, Ashraf MA, Maree GK, Mirza AA, Alvi T. Clinical Presentation, Risk Factors and
Outcomes of Demographic Analysis of Blepharitis in Adults Presenting at Multiple Healthcare Centres. Life and Science. 2021; 2(4): 160-
163. doi: http://doi.org/10.37185/LnS.1.1.203
This is an Open Access article distributed under the terms of the Creative Commons Attribution License
(http://creativecommons.org/licenses/by/4.0), which permits unrestricted use, distribution, and reproduction in any medium,
provided the original work is properly cited.
1
Department of Ophthalmology Introduction
THQ Hospital, Kabirwala
2
Department of Ophthalmology Blepharitis is an eye disorder that leads to
DG Khan Teaching Hospital, DG Khan inflammation of the eyelid margins. It is an
3
Department of Ophthalmology ophthalmologic condition that is mostly chronic, but
Civil Hospital, Multan it can be acute in some cases. It involves both eyes
4
Department of Ophthalmology
Ibn- e- Sina Hospital, Multan
and causes irritation of the lid margins and flaking of
1
5
Department of Ophthalmology the eyelashes. The location of the problem is the
Liaqat University of Medical and Health Sciences, Jamshoro leading cause of blepharitis. But in the acute process,
6
Department of Medicine it may be ulcerative or non-ulcerative. Bacteria,
Riphah International Hospital, Islamabad known as staphylococcal, mostly cause it. It can also
Correspondence:
Dr. Adeel Ahmad Siddique
be caused by a virus or infection like Herpes Simplex
Consultant, Ophthalmology and Varicella Zoster. A patient who suffers from
THQ Hospital, Kabirwala chronic Blepharitis will have seborrheic dermatitis of
E-mail: [email protected]
the scalp and face. As chronic Blepharitis depends on
Funding Source: NIL; Conflict of Interest: NIL
Received: Apr 20, 2021; Revised: Mar 11, 2021
the location of the problem, anterior blepharitis is
Accepted: Aug 27, 2021 associated with rosacea, and posterior blepharitis is

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associated with Meibomian gland dysfunctioning.2 and are exposed to chemical irritants and allergens.13
These glands over secrete an oily substance that
clogs the skin and causes acne. It can affect people of
all ages and gender. Individuals older than 50 have
more chances of being affected. In 2009, 47% seen
by an ophthalmologist of the USA had signs of
Blepharitis.3 The number of patients is increasing day
4
by day, and it is becoming more common in females.
The main symptoms of Blepharitis are burning,
itching, and crusting of the eyelids. A patient can
experience blurry vision, water in the eyes, and
foreign body sensations. These symptoms can affect
both eyes and become worse day by day. In anterior
Blepharitis, erythema and oedema is the most
There are two types of Blepharitis, anterior and
common symptom which can be tested by slit lamp
5 posterior which are further classified in Meibomian
exam. Clinical symptoms of the disease include pain
Blepharitis, Seborrheic blepharitis, Staphylococcal
in the eyelids, itchy eyes, you may feel the dust in
Blepharitis and ulcerative Blepharitis.14
your eyes, oily crusts or flakes accumulated in the
Classification of Blepharitis
roots of eyelashes, redness of eyelids or eyes and
many more. Also, when you wake up, your eyelids
may stick together.6
Several risk factors can cause blepharitis. These risk
factors include Seborrheic dermatitis, Acne rosacea,
Contact allergies, Diabetes, Chemical irritants, Poor
hygiene, Low socioeconomic status, Cosmetic
7,8
makeup and advanced age. Seborrheic dermatitis,
also known as scalp dandruff, has a connection with A comprehensive and physical eye examination can
blepharitis. It can cause the accumulation of oily diagnose the disease. Also, slit lamp examination, lid
scales and flakes surrounding your eyelashes that margin imaging and tear film stability are some
9
eventually leads to Blepharitis. Acne rosacea is a techniques used to diagnose the disease. No proper
common disorder of the oil glands of the skin that treatment has been discovered for the disease yet,
can lead to redness, dryness and itching of the eyes, so it is preferred to take some preventive measures
causing Blepharitis. The thin layer of eyelids is to prevent the disease from spreading.15
susceptible; hence, any allergen cannot be tolerated. The purpose of this study is to identify risk factors for
Whenever the allergens come in contact with the blepharitis in the adult population with an aim to
eyelids, they cause rash or irritation, which are determine the aetiology of disease.
apparent symptoms of Blepharitis as well.10 Materials and Methods
In addition to these risk factors, applying mascara or A cross-sectional study was carried out on patients
other beauty products can react with the eyelid skin having symptoms of blepharitis, at Department of
and cause the disorder. It is observed in some studies Ophthalmology at THQ Hospital, Kabirwala. Total
that mostly the people of age more than 50 years are 100 patients were included in the study. The sample
prone to the disease. Diabetes, a common disease size was calculated with 5% error probability and
among our population, is one of the risk factor for 95% confidence level. Only adult patients having
11
blepharitis. Blood pressure lowering medications symptoms of blepharitis and age above 21 years
can also potentially increase the risk of blepharitis. were included. Exclusion criteria were the patients
Poor hygiene is one of the significant risk factors for having other eye diseases and the ones who were
Blepharitis.12 It is observed that usually the people below 21. Fluorescein strips and Slit lamp 90D
with low socioeconomic status have poor hygiene techniques were used. A fluorescein strip is soaked

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Life & Science 2021 Vol. 2, No. 4 Clinical Presentation, Risk Factors and Outcomes of Demographic Analysis of Blepharitis

with saline and touched gently on the inner side of that means scalp dandruff can cause Blepharitis in no
the eyelid. For best precision, this test is performed time. In this regard, anti-dandruff shampoos are
prior using any eye drop. Patient is seen with a cobalt recommended for scalp care.16
blue channel and diffuse light at a slit lamp 90D to Bacteria is present usually on the skin, but excess
evaluate the presence of visual indications of bacteria on the eyelids or eyelashes can cause
blepharitis. The eyes were examined clinically. Then, blepharitis. A biofilm is formed on eye when these
a swab was used to collect the eyelid crust or oil that bacteria multiply. Exotoxins production is increased,
can be used to study or identify the bacteria or causing dysfunction of oil glands. In such condition,
allergy by culture examination. Also, the history of anti-bacterial shampoos are recommended.17 Taking
the patients through self- designed questionnaire care of daily hygiene reduces symptoms. Washing
was taken that specifies their hygiene and hands, and cleaning the eyelids from wet and mild
socioeconomic status via enquiring about eyelid hot c lean washcloth can protect your eyes.18 Foreign
hygiene awareness and their income, whether chemical irritants or allergens can invade the eye and
owner or rental etc. Seborrheic Dermatitis condition cause serious infections, especially in the people
19
was also enquired in this questionnaire by asking working in rural areas or industrial area. Foreign
whether they were experiencing dandruff problem body sensation was observed among the patients.
along the areas of face, eyelids or scalp etc. Other Due to the flakes and crusts, the vision of most of the
than these things, the family/genetic disease history patients was blurred. Swelling being the most crucial
like diabetes, hypertention etc, of the patients was feature found in almost all the patients that also
also examined that can be a cause of Blepharitis. caused difficulty in vision.20 Meibomianitis, means
Results swelling of oil releasing or sebaceous glands was also
One hundred patients were registered for the study, commonly found symptom.
out of which 65 were women and 35 were men with Conclusion
mean age 48 ± 13 years. The highest frequency of the Blepharitis is associated with several other diseases
disease was found among patients of age 21-30 and risk factors. But the most common risk factors
years. Seborrheic dermatitis, dry eyes and poor included poor hygiene, low socioeconomic status,
hygiene was observed in most of the patients. dry eyes and seborrheic dermatitis. To protect
Patients with low-socioeconomic status, living in people from blephritis, proper guidelines should be
damp places of the city were more likely to have poor provided. Several symptoms including corneal
hygiene and eventually blepharitis. scarring, redness of eye, keratitis, limbitis and
chemosis, are associated with blepharitis. But the
most common ones are irritation, foreign body
sensation, swelling over eyelids, blurred vision,
hyperaemia, Epiphora and photosensitivity.
Females, due to their hormonal changes, are more
prone to having this disease.

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