Bloody tears: a case of bilateral ulcerative blepharitis

Chronic blepharitis leading to bilateral ulceration is rare to encounter. A 49-year-old African American female presents with bloody tears, severe pain, and photophobia in both eyes. Clinical presentation called for ulceration on the upper lid margins with excavated wound which bled on gentle rubbing. A systemic health review in combination of the symptoms and clinical picture led to the diagnosis of severe ulcerative blepharitis. Immediate oral antibiotics were started along with topical antibiotic cream. Ulcerative blepharitis can be easily misdiagnosed with sebaceous cell carcinoma. The pathophysiology of ulcerative blepharitis points to synergy between infectious entity and inflammatory aetiology, with either bacterial or fungal microorganisms as the trigger agents. Almost all cases of ulcerative blepharitis should include a dermatological evaluation given there is a strong association between ulcerative blepharitis and atopic dermatitis.