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Medical Disability Advisor > Blepharitis see more: ACOEM - Eye

Definition | Diagnosis | Treatment | Prognosis | Differential Diagnosis | Specialists | Comorbid Conditions | Complications | Factors Influencing Duration | Length of Disability |
Return to Work | Failure to Recover | Medical Codes | References

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Related Terms
Nonulcerative Blepharitis

Disability
Blepharitis
Eye Cancer
Differential
Diagnoses
Basal cell carcinoma of
the eyelid
Conjunctivitis
Meibomian gland
dysfunction
Ocular rosacea
Squamous cell
carcinoma
Trachoma
Trichiasis

Eye Examination
Eye Drops Dry Eyes
Eye Doctor
Specialists
Ophthalmologist

Eye Sight
Puffy Eyelids
Eye Exam Prices
Comorbid
Conditions

Blepharitis
Medical Codes

ICD-9-CM:

373, 373.0, 373.00, 373.01, 373.02, 373.3,

373.32, 692.8, 692.81

Definition
Blepharitis is a chronic inflammation of the upper and lower
eyelids that develops as a result of bacterial infection,
inflammation, skin conditions, or allergic reactions. Usually both
eyes are affected. Over-production by the glands of the eyelids
(meibomian blepharitis) may attract bacteria that irritate lid edges
(margins), creating redness and scaling of skin. Secretions may
cause the eyelids to become crusted or "glued" together.
Blepharitis is often associated with other facial skin disorders,
such as rosacea and seborrhea. It is aggravated by exposure to
dust, smoke, irritating chemicals, and eye makeup and by poor
facial hygiene.
Anterior blepharitis affects the outer or front portion of the eyelids.
An ulcerative form of anterior blepharitis can be caused by
staphylococcal infection in the eyelash roots or follicles.
Nonulcerative anterior blepharitis resembles dandruff and is
frequently accompanied by scaling of the scalp, eyebrows, and
ears (seborrhea).
Posterior blepharitis occurs when glands found in the inner portion
of the eyelid (meibomian or tarsal glands) are inflamed or blocked,
resulting in irregular production of the oily coating that normally
helps protect the eye. Thicker-than-normal secretions or infection
may obstruct the glands, causing inflammation and a painful
burning sensation in the eyes.
Blepharitis tends to occur in both eyes (bilateral). If only one eye
seems to be involved, an underlying cancer (sebaceous cell
carcinoma) or infection of the tear sac (dacryocystitis) should be
ruled out.
Blepharitis is usually a chronic, recurrent condition. This can be
frustrating to patients, who must take extra measures to keep the
lids clean and avoid makeup and must see a doctor for antibiotics
when infections occur.
Susceptibility to blepharitis may be inherited. Although it can be
uncomfortable, blepharitis does not directly affect eyesight.
However, over time the effects of scarring and infection can affect
other eye structures and endanger vision.
Risk: Blepharitis occurs equally in individuals of all races and both
genders. It affects people of all ages but is more common among
older individuals, with a mean apparent age of 50 years (Lowery).

Incidence and Prevalence: Since many cases of blepharitis go

unreported, the true incidence is unknown. However, blepharitis is a

Factors Influencing Duration

Although this disorder is unlikely to affect eyesight, its
chronic and painful nature may be distracting for individuals
engaged in tasks requiring extreme concentration. Factors
that might influence disability include the underlying cause
of the condition, severity of symptoms, response to and
compliance with treatment, and presence of complications.

Down syndrome
Keratitis
Seborrheic dermatitis

unreported, the true incidence is unknown. However, blepharitis is a

common eye disorder, both in the US and worldwide.

Source: Medical Disability Advisor

Diagnosis
History: Individuals may report irritation, itching, and burning at the
edge of the eyelids, or the sensation of a foreign body in the eyes.
Individuals may see scales or "granulations" clinging to both upper
and lower eyelids and may awaken in the morning with their eyes
"glued" shut. Individuals who have ulcerative blepharitis may report
dry scales, red eyelids, and tiny ulcerations along the edge of the lids.
Lashes also tend to fall out. Nonulcerative blepharitis produces
greasy scales. In this form of the condition, individuals may only have
slightly red eyelids. In a mixed infection, which is common, both dry
and greasy scales are present. Eyelid edges are red and may be
ulcerated. With posterior blepharitis, a history of repeated stye
infections (hordeolum) or inflammation of the meibomian (tarsal)
glands (chalazia) may be reported. In advanced cases, blurring of
vision may be reported.

Physical exam: The eyelid margins will be red and swollen and
may have dry and/or greasy scales. A slit-lamp examination may
show missing or encrusted eyelashes. The mucous membrane that
lines the eyelids will be irritated and inflamed; the mucous
membrane covering the anterior surface of the eyeball (conjunctiva)
may also be inflamed (conjunctivitis). In posterior blepharitis,
meibomian glands at the edges of the lids may be sore and swollen
and produce an abnormal soft, cheesy substance when pressure is
applied. Examination of the eyelashes may reveal lice infestation, and
examination of the scalp may reveal dandruff (seborrheic dermatitis).

Tests: Normally, a comprehensive eye examination is able to

diagnose blepharitis; no diagnostic tests are needed. However, a
culture of eye secretions may be done to rule out infection or to
identify the causative bacteria, especially if the individual has not
responded to treatment. An individual who fails to respond to
treatment may be tested for allergies.

Source: Medical Disability Advisor

Treatment
The American Optometric Association reports that self-treatment
at home is the most important part of controlling blepharitis.
Treatment involves three steps. First, warm compresses are
repeatedly applied to the eyelids to loosen scaly and crusty
material and help open up blocked glands. Next, the eyelid edges
are cleansed several times daily with warm water and baby
shampoo to remove scales. The scalp and eyebrows must also
be kept clean. Medicated antidandruff shampoo may be
recommended. Finally, when bacterial infection is suspected as
the cause of blepharitis, antibiotic ointment is applied to the edge
of the eyelids several times daily. The use of eye drops, facial
makeup, and contact lenses that may have caused nonbacterial
blepharitis is discontinued during treatment; suspected or proven
allergens should be discontinued indefinitely. The inner eyelids
may be treated with systemic antibiotics and topical steroids if
meibomian gland dysfunction is present. In some cases, a
chronic inflammatory granuloma of the meibomian gland
(chalazion) that develops in conjunction with blepharitis may be
incised or injected with steroids.
Source: Medical Disability Advisor

ACOEM

ACOEM's Practice Guidelines, the gold standard in effective

medical treatment of occupational injuries and illnesses, are
provided in this section to complement the disability duration
guidelines.*
Eye
* The relationship between the MDGuidelines (MDA) content and ACOEM's
guidelines is approximate and does not always link identical diagnoses. The
user should consult the diagnostic codes in both guidelines, as well as the
clinical descriptions, before assuming an equivalence.

Source: ACOEM Practice Guidelines

Prognosis
Individuals rarely lose their vision or sustain permanent eye
damage from blepharitis, but the disorder is annoying, sometimes
painful, and difficult to cure. It tends to become a chronic
condition, improving for a while, then recurring (except in the case
of contact blepharitis, which usually resolves once the substance
causing irritation is eliminated). Scarring of the eyelids or
permanent loss of lashes may occur in prolonged, serious cases.
Source: Medical Disability Advisor

Complications
Nonulcerative blepharitis frequently causes conjunctivitis, an
inflammation of the inner lining of the eye. Ulcerative blepharitis
can cause small sores along the lids. Eyelashes may fall out or
turn inward, and corneal ulcers may form. Red swollen sores
(styes) may form from an abscess. A firm mass of granulomatous
tissue (chalazion) in the meibomian gland of either eye may also
accompany blepharitis. Corneal scarring, growths, thinning,
ulceration, and perforation may occur, though perforation is rare.
Source: Medical Disability Advisor

Return to Work (Restrictions / Accommodations)

Breaks may be needed several times daily for application of
medicated ointment to the eyelids.
Source: Medical Disability Advisor

Failure to Recover
If an individual fails to recover within the expected maximum
duration period, the reader may wish to consider the following
questions to better understand the specifics of an individual's
medical case.

Regarding diagnosis:
Was individual exposed to dust, smoke, or irritating chemicals? Does
individual use makeup or eye drops? Is individual receiving treatment
for any chronic facial skin problems?
What is individual's personal hygiene? Is it good?
Does individual have irritation, itching, and burning at the edge of the
eyelids or the sensation of a foreign body in the eyes?
Does individual have dry scales, red eyelids, and tiny ulcerations along
the edge of the lids?