How can I differentiate between seborrheic blepharitis and staphylococcal blepharitis in a primary care setting?

Differentiating seborrheic blepharitis from staphylococcal blepharitis in primary care relies mainly on clinical features:

• Seborrheic blepharitis is typically associated with greasy, scaly skin at the base of the eyelashes and may be linked with seborrhoeic dermatitis on the scalp or face. The scales are usually yellowish and less inflammatory.
• Staphylococcal blepharitis (anterior blepharitis) often presents with more pronounced inflammation, redness, and crusting around the eyelid margins. There may be collarettes or flakes around the lashes, and the eyelid margin can be more erythematous and swollen.
• Both types can cause eyelid margin irritation and discomfort, but staphylococcal blepharitis tends to have more bacterial colonization and may respond better to topical antibiotics.
• In primary care, diagnosis is clinical, based on the appearance of the lid margins and associated skin changes, as microbiological testing is not routinely performed.

Management includes eyelid hygiene and warm compresses for both types, but topical antibiotics (e.g., chloramphenicol ointment) are more commonly used in staphylococcal blepharitis to reduce bacterial load ¹.