Purpose: Blepharitis is a very common disorder but the role of certain mycoses in the etiopathogenesis of blepharitis remains controversial.
Observation: We report the case of a 29-year-old man presenting with bilateral redness and intense itching of the edge of the eyelid. Slit-lamp examination showed vasodilation of the vessels of the edge of the eyelid associated with seborrhea and a sticky yellowish substance at the roots of the eyelashes. When the substance dried and fell, microulcerations were seen at the base of the eyelids, characteristic of follicular-seborrheic blepharitis. Otherwise the ophthalmological examination was normal. Treatment with eye drops (antibiotics, antiseptics, corticoids, antihistamines) was tried several times. The blepharoconjunctivitis regressed during these treatments without totally disappearing, recurring after the treatment was discontinued. Bacteriological and fungal exams were conducted, showing numerous Malassezia furfur spores and hyphae. Given that there was no antifungal eye drop preparation on the market, topical ketoconazole (Nizoral) was prescribed. Two weeks later, the condition had cleared, with no recurrence after 5 months of follow-up.
Discussion: Malassezia is a saprophyte species that may play a role in certain cases of chronic blepharitis, either through a reaction of intolerance and hypersensitivity or occasional proliferation. Treatment consists in eradicating the causal fungus using an antifungal agent associated with symptomatic treatment. We stress that fungal exams should be conducted whenever blepharitis recurs.