Challenges in the Diagnosis and Management of Anterior Blepharitis


  • Etty Bitton, BSc, OD, MSc, FAAO, FBCLA École d’optométrie, Université de Montréal



Blepharitis is defined as inflammation of the eyelids, classified according to anatomical location: anterior (eyelid skin, base of the lashes including the eyelash follicle) or posterior (meibomian glands) blepharitis. Although blepharitis is one of the most common ocular disorders, epidemiological data on the condition is lacking, making prevalence difficult to assess. A 2009 survey of eyecare practitioners reported observing blepharitis in 37%–47% of patients in their clinical practice. This observation may vary depending on the age, sex, and types of patients (i.e., dry eye) in the practice. Younger females are found to have more acute short-term presentation of blepharitis, whereas older, more fair-skinned females present with chronic blepharitis often concurrent with rosacea. Large population‑based studies, using a standardized definition and diagnostic technique, are needed to properly assess the prevalence and incidence of blepharitis and to allow for study comparisons among various age groups.

The ocular surface, including the lid margin, has a natural flora or microbiome, which is imperative in maintaining the health and defence mechanism of the ocular surface. This can be affected by age, gender, inflammation, disease, medication, cosmetics, and treatment (systemic or topical). An overgrowth of microbes or an imbalance of the natural flora may result in an inflammatory response, leading to blepharitis, conjunctivitis, keratitis, or a combination of these. 

Author Biography

Etty Bitton, BSc, OD, MSc, FAAO, FBCLA, École d’optométrie, Université de Montréal

Dr. Bitton completed her Optometry degree at the University of Waterloo (1988) in Canada, followed by a Master’s in Physiological Optics (1994) from the Université de Montréal in the area of tear film clinical physiology and its relevance in patients exhibiting dry eye. Dr. Bitton presently holds the rank of full professor, and is the Director of the Externship Program at the School of Optometry at the Université de Montréal.  She is a member of several national and international professional organizations. Her areas of interest are in the evaluation of the tear film, dry eye and contact lens wear. In 2012 she inaugurated and became the Director of the Dry Eye Clinic at the school, a first in an optometry school in North America. Dr. Bitton was invited by the Tear Film Ocular Society (TFOS) to participate in the TFOS DEWSII and the Lifestyle Epidemic: Ocular Surface Disease reports, a global initiate to redefine dry eye and its etiologies. She represents this organization as one of the ambassadors for Canada. In 2019 Dr. Bitton received a certificate on the Management of Dry Eye from the British Contact Lens Association.


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How to Cite

Bitton E. Challenges in the Diagnosis and Management of Anterior Blepharitis. Can Eye Care Today [Internet]. 2024 Jun. 18 [cited 2024 Jul. 24];3(2):40–46. Available from: