Intended for healthcare professionals

Practice 10-Minute Consultation


BMJ 2012; 344 doi: (Published 23 May 2012) Cite this as: BMJ 2012;344:e3328

Re: Blepharitis

Dear Editor,
I felt disapointed after reading the Ten Minute Consultation concerning Blepharitis,(Turnbull AMJ & Mayfield MP, BML Vol 345 No7872 1st September 2012 General Practice Page 40-41.) because the authors have not progressed beyond repeating that it is a chronic disease. Controversy has existed in the profession for many years concerning the cause of this common condition as to whether Demodex Folliculorum infestation is implicated or not.
Many state that this organism, not dissimilar to the scabies mite, is merely a commensal.It is an Arachnid with a two week life cycle, which paracitises sebaceous glands, meibomian glands and the follicles of eyelashes.
The conflicting views are clearly explained in Albert & Jakobiec's Principles and Practice of Opthalmology.
It may seem that this is a minor condition and the authors suggest that patients should only be referred to see an Opthalmologist if they present with complications. It is however extremely common and affects many millions of persons world wide, especially the elderly and it results in considerable morbidity and distress to suffers as well as the costs of repeat prescriptions for dry eyes etc. Interestingly it also lies between the disciplines of Dermatology and Opthalmology, both of which are 'fully occupied' and not looking for extra work. And where is the demarkation between the two ?
Should I refer patients to the Opthalmology OPD or to the Dermatology Department ? Or should they see their Vet, who has been treating demodecosis in animals successfully for many years with acaricides.? !
The pictures obtained by Frank English and Others in Brisbane in 1990, using the scanning electron microscope are the most compelling, regarding a condition from which I used to suffer.
As an added bonus, several other lesions affecting my forehead that I had been assessing as incipient actinic keratoses and contemplating seeing my GP for cryotherapy, have also disappeared.
Yours sincerely,
Graham Edwards
References: 1, Chan AS & ColbyKA Lid Inflammations Albert & Jakobiec's Principles and Practice of Opthalmology 3rd Edition Philadelphia Saunders Elsevier 2008 Pages 628-635
2, English FP Zhang GW McManus DP & Campbell P American Journal of Opthalmology Vol 109 No 2 Page 239-240 Feb 1990.
ps., Knowing your keeness in the use of images in your Journal, it might be possible to reproduce the images from the American Journal of Opthalmology with the appropriate permission, should it be forthcoming. I have attached the photos that I took from the Journal, to encourage you with this.
Dr T G Edwards
Locum in Greneral Practice
+44(0)1243 514652
+44(0)7831 139062
ffolletts Birdham Chichester West Sussex PO20 7QL

Competing interests: No competing interests

20 October 2012
T Graham Edwards
Locum GP
The Health Centre Bognor Regis West Sussex
ffolletts Birdham West Sussex PO20 7QL