Blepharitis

What is blepharitis?

Blepharitis is a common condition that causes inflammation of the eyelids. The condition can be difficult to manage because it tends to be chronic or recurrent.

What are the symptoms of blepharitis?

Symptoms of either form of blepharitis include a foreign body or burning sensation, excessive tearing, itching, sensitivity to light, red and swollen eyelids, redness of the eye, blurred vision, frothy tears, dry eye, or crusting of the eyelashes on awakening.

What causes blepharitis?

Blepharitis occurs in two forms:

Anterior blepharitis affects the outside front of the eyelid, where the eyelashes are attached. The two most common causes of anterior blepharitis are bacteria (Staphylococcus), demodex mites and scalp dandruff.

Posterior blepharitis affects the inner eyelid (the moist part that makes contact with the eye) and is caused by problems with the oil (meibomian) glands in this part of the eyelid. In this form of blepharitis oil glands produce thick oil that can clog the pore and result in low level of oil in tear film, discomfort from clogged pores or Styes and Chalazia.  Two skin disorders are linked with this form of blepharitis: acne rosacea, which leads to red and inflamed skin, and scalp dandruff (seborrheic dermatitis).

Many people have both anterior and posterior blepharitis at the same time

What other conditions are associated with blepharitis?

Complications from blepharitis include:

Stye (hordeolum): A red tender bump on the eyelid that is caused by an acute infection of the oil glands of the eyelid. 

Chalazion: This condition can follow the development of a stye. It is a usually painless firm lump caused by inflammation of the oil glands of the eyelid. Chalazion can be painful and red if there is also an infection. Treatment of Stye and Chalazion should include warm compresses but may also require antibiotics steroids or surgery.

Tear problems: Abnormal or decreased oil secretions that are part of the tear film can result in excess tearing or dry eye. Normal tears are essential for the health of the eye and clear vision.  Tear film consists of three layers: mucus, liquid tears and oil on surface. Oil cuts down on evaporation and is essential for healthy tear film.  Blepharitis is a common cause of tear film problems.

How to diagnose blepharitis?

A close examination of your eyelids and eyelashes by an eye doctor is usually all that is needed to diagnose blepharitis. However to rule out other problems your ophthalmologist will usually perform comprehensive eye exam upon initial presentation.

How is blepharitis treated?

Treatment for both forms of blepharitis involves keeping the lids clean and free of crusts. Eyelids and lashes needs to be cleaned twice a day in order to remove build up of crusts, dust and particles and wash off bacteria that are present on eyelids.

Warm compresses : If eyelids are red, warm (but not burning hot) compresses for 5 minutes with a wet clean washcloth or towel prior to eyelid washing will help to loosen crusts and melt the clogged oils.

Lid scrubs: To properly clean eyelids wash your hands with soap and water, then with your eyes closed wash eyelids and lashes by rubbing with your cotton swab, special toweled or fingertips along the base of eyelashes back and force for 5-10 times.  Diluted soap like Johnson and Johnson baby shampoo or special eyelid cleanser (Sterilid, Ocusoft) that does not sting the eye should be used daily. Taking a shower does not clean eyelids adequately.  In the shower we instinctively try to avoid getting water in the eye and do not wash eyelids enough.

When scalp dandruff is present, a dandruff shampoo for the hair is recommended as well. In addition to the warm compresses, patients with posterior blepharitis will need to massage their eyelids to clean the oil accumulated in the glands. Patients who also have acne rosacea should have that condition treated at the same time.

Because blepharitis rarely goes away completely, most patients must maintain an eyelid hygiene routine for life. If the blepharitis is severe, your ophthalmologist may also prescribe antibiotics or steroid eye drops.

Nutritional therapy:  In recent years importance of dietary intake of omega three fatty acids in treatment of blepharitis has been recognized. Ask your ophthalmologist about a proper diet and nutritional supplements to help treat this imbalance.