Blepharitis

Meibomian gland openings are plugged with oily secretions.
Notice also the prominent blood vessels on the eyelid margin.

The meibomian glands are oil glands embedded in the upper and lower eyelids. They produce an oily secretion that forms an integral part of the typical tear film. Dysfunction of the meibomian glands produces excessive oily secretions. The tear film may then become unstable, resulting in a ‘dry eye‘ as well as chronic red, irritated eyes. Patients are generally older and have a long history of ocular symptoms. Symptoms include prominent blood vessels crossing the eyelid margin and plugging of gland openings, resulting in the inability to secrete oil properly and/or thick, oily secretions.

Treatment is usually ongoing and sometimes frustrating, depending on the type of blepharitis you have. Expect to keep up therapy for a prolonged period of time to keep it at bay.

Treatment may include:

In addition to alleviating redness and soreness, proper treatment may also prevent future infections and scarring of the cornea. A complete eye examination by an ophthalmologist is essential.

Warm compresses are effective in treating all types of blepharitis. These compresses soften the debris and crust on the lid margin, making them more easily removed. Warm compresses may be combined with eyelid massage. This is especially important in patients who have meibomian gland dysfunction (MGD).

• Please wash your hands, then dampen a clean washcloth with very warm water, wring it out, and place it over your closed eyes for at least one minute. Repeat two or three times, wetting the washcloth again with warm water as it cools. This will loosen the scale and debris around your eyelashes. It also helps dilute oil secretions from nearby oil glands, preventing the development of chalazion (pronounced chuh-LAY-zee-un – an enlarged lump caused by clogged oil secretions in the eyelid). An alternative variation involves adjusting the shower so that it is a very gentle stream of very warm but comfortable water that is allowed to flow over the gently closed eyelids for about 1 or 2 minutes.

When you first begin treatment, do this four times a day, for at least five minutes each time. Later on, you might apply the compress once a day, for a few minutes. Your doctor will tell you the specific treatment needed for your eyes.

Cleansing the eyelids is crucial for effective blepharitis treatment. Your eye doctor will recommend what to clean them with: warm water only, baby shampoo diluted with warm water, or a special product made for cleansing the lids.

• First, wash your hands. Then dip a clean washcloth (draped over your index finger for control), cotton swab, gauze pad, or commercial lint-free pad into your cleaning solution. Gently wipe it across your lashes and lid margin for about 15 seconds per eyelid. Use a magnifying mirror if necessary to avoid accidentally rubbing the eyeball itself. Rinse with cool water. When you first begin treatment, your doctor may have you cleanse your lids several times a day. Later on, you will probably cleanse them about once a day.

Because blepharitis can be a persistent problem, you should practice good skin and eyelid hygiene to prevent recurrences. In addition to careful cleansing of your eyelashes, washing your hair, scalp, and eyebrows with antibacterial shampoo can also help control blepharitis.

If you have meibomian gland dysfunction (MGB), your ophthalmologist will probably recommend massaging the lids to remove excess oil. Do not use this technique unless specifically recommended after a careful eye examination.

In MGD, the meibomian (oil) secretions are thick, and the gland openings are clogged. Think of a toothpaste tube that contains butter instead of toothpaste. When cold, you would not be able to squeeze the butter out of the tube. However, once you warm it a bit, the butter will soften enough to come out of the tube, but some pressure on the tube (such as squeezing) would still be necessary.

According to this analogy, after applying warm compresses, the thick oils in your lids will become more fluid, but a specific type of massage will be necessary to express them. Therefore, after every minute of warm compresses, massage the eyelids as follows:

• Gently close your eyelids. Put your index finger on the outer corner of the eyelid. Pull the eyelid towards the ear, so that the eyelids are stretched taut. Next, use the index finger of the opposite hand to apply direct pressure to the taut eyelid, starting at the inner aspect of the eyelid near the base of the nose. Sweep with firm but gentle pressure towards the ear. Repeat this maneuver four to five times. The goal is to apply gentle pressure to the eyelids, as if you were squeezing a tiny tube of toothpaste. Simply rubbing the eyelid surface will not be nearly as effective.

In some cases, it is necessary to use prescribed eye drops, ointments, or oral medications in conjunction with the daily cleansing regimen. Be careful to follow recommended dosages. And with any medication, there is a slight possibility of an allergy or other reaction, including a skin rash, mild nausea, and increased sensitivity to the sun.

• Antibiotic ointment should be applied using a clean fingertip or cotton swab; gently apply a small amount at the base of the eyelashes before bedtime. Artificial tears or steroid eye drops may also be prescribed temporarily to relieve dry eye or inflammation. Although medications may help control the symptoms of blepharitis, they are not sufficient on their own; keeping the eyelids clean to reduce bacterial count is also essential.