Blepharitis

What is Blepharitis?

Blepharitis is a relatively common inflammatory condition which affects the eyelid margin, known as the edge of the eyelid. It can affect the eyelash roots, which is referred to as ‘anterior blepharitis’, and the area immediately behind this, referred to ‘posterior blepharitis’. 

In posterior blepharitis, the tiny meibomian glands which lie between the eyelids may also be affects and can cause a froth discharge behind the eyelids – this is referred to as ‘meibomianitis’. Your meibomian glands are responsible for the secretion of an oily substance that helps to prevent the layer of tears on the front of the eye from evaporating in between blinks.This causes a frothy discharge behind the eyelashes.

What causes Blepharitis?

In most patients, the cause is unknown. In anterior blepharitis, excessive bacterial activity may play a role. Posterior blepharitis is more commonly seen among patients with skin conditions such as seborrhoeic dermatitis (which is associated with dandruff) and rosacea (which causes a redness of the skin of the cheeks and nose).

What are the features of blepharitis?

The following symptoms and signs are common for patients suffering from blepharitis:

An irregular tear film (due to failure of the oily meibomian secretions) can lead to localised areas of dryness on the surface of the eye. This can stimulate the excessive production the watery component of the tears, with patients sometimes describing a very uncomfortable ‘streaming’ of the eyes. In the absence of the correct proportions of mucus, watery and oily components of the tears, excessive watering does not adequately lubricate the surface of the eye (the cornea), and further cycles of excessive watering can occur as a reflex.

With blockages of the ducts which conduct the oils within the meibomian glands to the surface of the eye (this is more likely to occur in colder climates), the gland can burst inciting a local inflammatory reaction to the exposed oils. Inaccurately termed ‘cysts’, these swellings are in fact localised inflammatory reactions to collection(s) of oil within the eyelid. Acutely, the ‘cyst’ can become inflamed or even infected, and over a few weeks the inflammation either settles completely or leaves a residual lump within the eyelid (a “chalazion” or “meibomian” cyst).

These changes can occur in long-standing disease, but can also occur in other eyelid disorders – for this reason an ophthalmic opinion should be sought.

Is blepharitis a life-long condition?

No. The disorder tends to wax and wane and, in most patients, does not tend to last – in its most severe form – for more than a few months.

What factors make blepharitis worse?

Blepharitis tends to be worse in cold and windy weather, airconditioned environments, prolonged computer usage, sleep deprivation, contact lens wear, and with general dehydration. It also tends to be worse in the presence of active skin disease, such as acne rosacea or seborrheic dermatitis.

What factors make blepharitis worse?

Blepharitis is a clinical diagnosis, although in severe cases particularly if only one eyelid appears to be affected and if the diagnosis is in doubt, a surgical biopsy may be required to exclude the presence of a tumour which very rarely can mimic blepharitis.

How do you treat Blepharitis?

Strict hygiene of the eyelids is the mainstay of treatment and should be undertaken in the morning and evening for the first 2-3 weeks, and then at least once every day indefinitely to keep the inflammation under control.

There are 3 steps needed for effective lid hygiene:

1. The application of heat:
Applied to the eyelids for 5 minutes, which helps to soften the skin and any crusts that are attached to the eyelids/eyelashes. This also helps to unplug the ducts of the meibomian glands. The traditional method is to apply a hot, moist flannel or cotton pad to the closed eyelids.

This however is somewhat tedious because the flannel/cotton wool pad quickly cools and needs to be repeatedly reheated in hot water. The EyeBag™ is a more convenient and effective method as it provides sustained warmth for 5-10 minutes – www.eyebagcompany.com.

Figure 1.1 - A patient suffering from Blepharitis

2. Massage:
Using your forefingers, massage your eyelids straight after applying the warmth. This helps to force out the oily fluid from the meibomian glands, which in turn helps to stabilise the tear film on the surface of the eye. Massage the upper and lower eyelids gently towards the eye. This action should be repeated 5 – 10 times over 30 seconds immediately following the application of heat. The pressure applied should not be too gentle or too firm, and should not hurt your eyes under the closed eyelids.

3. Cleaning:
After applying heat and massaging, clean the eyelids. Blephaclean® wipes twice daily for 1 – 2 weeks are an excellent way to achieve rapid control of blepharitis. These wipes are particularly useful in removing eye makeup, avoiding irritation associated with other eye makeup removers. Blephasol® solution on a cotton bud once daily can then be used as a daily maintenance to keep the eyelid margins clean.

Oral antibiotics 
Occasionally if posterior blepharitis cannot be controlled with local treatment as described above then your consultant ophthalmologist may recommend a 6-12 week course of oral doxycycline. These capsules (typically 100mg) are taken orally once daily and can reduce the inflammation associated with blepharitis. 
N.B. This cannot be used during pregnancy.

Antibiotic Ointment
In severe blepharitis a topical antibiotic (e.g. Chloramphenicol ointment) can be applied to the lid margins after performing lid hygiene for a period of 2 weeks. This can reduce the bacteria contributing to eyelid margin inflammation and make it easier to control blepharitis using the treatment described above. Ointments/drops containing steroids should not be used unless prescribed by an ophthalmologist.

Is there anything else I can do?

Since blepharitis causes tears to be abnormal, artificial tears can help to give relief from irritation, even when your eyes are watering. Eyes can water as a reflex reaction to a basic dry eye problem or tear film abnormality.

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