Blepharitis is inflammation of the eyelids. In some cases the eyelids can become extremely swollen, they may be itchy, they may discharge purulent mat

Blepharitis is inflammation of the eyelids. In some cases the eyelids can become extremely swollen, they may be itchy, they may discharge purulent material.

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Clinical signs of blepharitis

The eyelids are usually hyperaemic and swollen. In most cases there is a large amount of purulent discharge that resembles cases of dry eye. Many cases are pruritic and affected dogs will rub there eyelids. In rare cases you may see blepharospasm and corneal ulceration.

Differential diagnosis of severe purulent discharge includes dry eye, conjunctivitis, conjunctival foreign body, dacryocystitis, blepharitis, retrobulbar abscess and melting corneal ulcer.

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Causes of blepharitis

There are numerous causes of blepharitis.

1. Allergies—atopy or specifically to drugs, soaps, shampoo, and food.
2. Bacterial infections – puppy impetigo or a hypersensitivity to normal bacteria in the skin
3. Solar irritation – solar blepharitis
4. Insect bites
5. Chemical burns
6. Parasite infections (mites) or fungal infection
7. Immune-mediated diseases
8. Nutritional imbalances like zinc deficiency
9. Endocrine abnormality like hypothyroidism
10. Secondary to infection associated with eyelid cancer

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Diagnosis of blepharitis

Workup of blepharitis cases should include thorough history and physical examination. Careful examination of the eyelid margins and meibomian gland openings is important. Swollen and or impacted meibomian glands suggests a bacterial infection of the glands.

Always perform a Schirmer tear test. The mucopurulent discharge seen with blepharitis resembles the discharge seen with dry eye. Look behind the third eyelid to rule out foreign bodies. Use fluorescein to rule out corneal ulceration. In some cases a biopsy may be helpful.

Treatment of Blepharitis

Treatment depends upon the underlying cause. In most cases we do not find an underlying cause and we assume allergy is the cause with secondary pyoderma. If blepharitis is a result of other ongoing health conditions, these should be concurrently addressed. Warm compresses (washers soaked in plain warm water) will aid in removing the discharge from around the eyelid. The hair around the eye can be clipped short.

If no underlying cause is found we usually treat these with oral antibiotics (doxycycline 2.5-5mg/kg BID 3-4 weeks minimum) and oral prednisolone (anti-inflammatory doses). We find Panolog® ointment helpful when applied TID after cleaning. Prolonged treatment may be needed. If there us no response to doxycycline, cephalexin may be used (skin doses). If the affected dog has signs of other allergies a referral to a dermatologist may be required.

Solar blepharitis affecting non-pigmented eyelid margins may be treated with 1% hydrocortisone ointment BID until inflammation resolved then SID long term, particularly in high UV months. Oral prednisolone may be required initially in severe cases.

Prognosis

The long term prognosis depends upon the underlying cause. Most dogs will respond well to a prolonged course of antibiotics and cortisone. If the response is poor then further testing to find an underlying cause is indicated.

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