CORNEA EWAP SEPTEMBER 2023 39 Anterior blepharitis due to staphylococcal overgrowth can be recurrent, Dr. de Luise said. Additionally, posterior blepharitis due to meibomian gland dysfunction can be chronic and recalcitrant to treatment. These types of blepharitis may require ongoing episodic treatment over months to years. Complex cases of blepharitis, Dr. de Luise said, include blepharitis from neoplastic etiologies, such as sebaceous cell carcinoma or basal cell carcinoma. These cases require individualized treatment including cryosurgical or surgical removal with wide margins and eyelid plastic reconstruction. Blepharitis from Stevens - Johnson syndrome is often cicatrizing. Stevens-Johnson syndrome is often associated with cicatrizing conjunctivitis and requires coordinated management of the eyelids and the conjunctival sequelae. Oculocutaneous rosacea can be associated with blepharitis. Topical corticosteroids should be used with caution in the management of rosacea keratitis as corneal melts can occur. EWAP References 1. Lemp MA, Nichols KK. Blepharitis in the United States 2009: a survey-based perspective on prevalence and treatment. Ocul Surf. 2009;7:S1-S14. 2. Rynerson JM, Perry HD. DEBS – a unification theory for dry eye and blepharitis. Clin Ophthalmol. 2016;10:2455 – 2467. 3. Nelson JD, et al. The International Workshop on Meibomian Gland Dysfunction: report of the Definition and Classification Subcommittee. Invest Ophthalmol Vis Sci. 2011;52:1930–1937. 4. Amescua G, et al. Blepharitis Preferred Practice Pattern. Ophthalmology. 2019;126:P56–P93. 5. Bouchard C. Diagnoses and management of blepharitis. Review of Ophthalmology. 2022. 6. Romero JM, et al. Conservative treatment of meibomian gland dysfunction. Eye Contact Lens. 2004;30:14–19. Editors’ note: Dr. de Luise is Assistant Clinical Professor of Ophthalmology, Yale University School of Medicine, New Haven, Connecticut, and disclosed no relevant financial interests. Dr. Perry is Chief, Cornea Service, Nassau University Medical Center, East Meadow, New York, and has interests with Azura Ophthalmics, BlephEx, Novaliq, and Tarsus Pharmaceuticals.
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