Blepharitis is one of the most common eye disorders and is often the underlying cause of eye discomfort. It is characterized by inflammation of the eyelid margins and usually causes redness of the eyes, along with itching and irritation of the eyelids, typically in both eyes. The appearance of blepharitis is often confused with conjunctivitis, and due to its recurring nature, it is the most common cause of recurrent conjunctivitis in older people. Due to the gritty sensation associated with blepharitis, many patients mistakenly believe they have dry eye syndrome — although lubricating drops often provide little to no improvement in the condition. Blepharitis is a chronic condition, meaning it persists as an ongoing issue.
Everyone has bacteria on the surface of their skin, but for some people, bacteria especially thrive on the area at the base of the eyelashes and eyelid margins. Excessive amounts of these bacteria can cause dandruff-like scales and particles to form on the skin. Blepharitis is also associated with meibomitis, which is a dysfunction and inflammation of the nearby oil glands of the eyelids, known as the meibomian glands. When functioning normally, these glands secrete a thin, oily coating into the natural tear film, which helps prevent rapid evaporation and keeps the eyes moist.
There are two forms of blepharitis, depending on their location: anterior blepharitis and posterior blepharitis.
Anterior blepharitis affects the outside of the eyelid where the eyelashes are attached. The two most common causes of anterior blepharitis are seborrhea (scalp dandruff) and bacterial infection (Staphylococcus).
Seborrhea Blepharitis (dandruff)
Seborrhea blepharitis is the most common and least severe form of blepharitis. Patients are generally older and have a long history of ocular symptoms. Seborrheic blepharitis is not an infection, but rather a condition caused by the improper function of the oil glands, resulting in the accumulation of greasy, waxy scales along the eyelid margins. Seborrhea blepharitis may be a part of an overall skin disorder that affects other areas of the body. Hormones, nutrition, general physical condition, and stress are factors that contribute to seborrhea. Patients usually have seborrheic dermatitis (also known as dandruff of the scalp) as well. Symptoms of seborrhea blepharitis include any of the following: scales, matted, hard crusts around the lashes, crusting (which makes opening the eyes in the morning difficult), chronic redness at the lid margin, dilated blood vessels, loss of lashes, sties, and chalazion (pronounced chuh-LAY-zee-un – an enlarged lump caused by clogged oil secretions in the eyelid).
Staphylococcus Blepharitis (bacterial infection)
Staphylococcus blepharitis is a contagious form of blepharitis caused by the bacterium Staphylococcus, commonly known as staph. It is often contracted in childhood and continues throughout adulthood. On average, patients with staphylococcal blepharitis are relatively young with a short history of ocular symptoms.
There are two forms of blepharitis, depending on their location: anterior blepharitis and posterior blepharitis.
Posterior blepharitis affects the inner eyelid (the moist part that makes contact with the eye). It is caused by meibomian gland dysfunction (problems with the oil glands in this part of the eyelid). Two skin disorders that cause posterior blepharitis are acne rosacea (chronic red and inflamed skin) and seborrheic dermatitis (scalp dandruff).
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:
Warm compresses
Meticulous cleansing
Massaging
Medication
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.
Everyone has bacteria on the surface of their skin, but for some people, bacteria especially thrive on the area at the base of the eyelashes and eyelid margins. Excessive amounts of these bacteria can cause dandruff-like scales and particles to form on the skin. Blepharitis is also associated with meibomitis, which is a dysfunction and inflammation of the nearby oil glands of the eyelids, known as the meibomian glands. When functioning normally, these glands secrete a thin, oily coating into the natural tear film, which helps prevent rapid evaporation and keeps the eyes moist.
