BLEPHARITIS

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Blepharitis is a common and persistent inflammation of the eyelids. Symptoms include irritation, itching and occasionally a red eye. Blepharitis frequently occurs in people who have oily skin, dandruff or dry eyes. Bacteria are on the surface of everyone’s skin, but in certain individuals they thrive in the skin at the base of the eyelashes. The resulting irritation, sometimes associated with over activity of the nearby oil glands causes dandruff-like scales and particles to form along the lashes and eyelid margins.

For some people the scales or bacteria associated with blepharitis produce only minor irritation and itching, but in others it may cause redness, stinging or burning. Some people may develop an allergy to the scales or to the bacteria which surround them. This can lead to a more serious complication with inflammation of other eye tissues, particularly the cornea.

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Blepharitis can begin in early childhood, producing “granulated eyelids” and continuing throughout life as a chronic condition, or it can develop later in life.Blepharitis can be controlled through a careful, regular program of hygiene.
Note: Always consult your doctor before beginning a course of treatment.
The cleansing routine below should be followed at least twice a day at first; perhaps less often as the condition improves. Take a clean washcloth and wet it with warm (not boiling) water. It is often best to use this after a hot shower. Prepare your own cleansing solution by filling a small glass or jar with warm (previously boiled) water and adding ¼ tsp of bicarbonate of soda. There are other sterile preparations available e.g. blephaclean.

Pull down the lower eyelid with your finger and then gently massage the area along the eyelashes for 15 to 30 seconds. Then close the eyes and massage the upper eyelids at the base of the eyelashes for 15 to 30 seconds. Your eyes should not be squeezed tightly shut, but closed softly as if you were sleeping.Looking into a magnifying mirror, use a Q-tip moistened in the cleansing solution to gently brush the scales away from the eyelids. You can brush either in a horizontal or vertical direction, as long as the granular debris trapped in the eyelashes is effectively loosened and removed. This procedure should take approximately 30 seconds for each eyelid.

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Thoroughly rinse your eyes with cool clean water and pat gently dry with a clean towel. Discard any cleansing solution left in the small glass and rinse it clean. If medication has been prescribed, it should be applied to the eyes and/or eyelids along the lashes, following your ophthalmologist’s instructions. Oral Tetracyclines may be prescribedBlepharitis is a common and chronic condition for which there is often no cure. However, once the initial acute phase is controlled, vigorous lid hygiene and patient cooperation results in excellent control of the disease.
Often, blepharitis is associated with eczema, rosacea or Meboimian Gland Disease. Very often, an associated dry eye state coexists. Your ophthalmologist will advise you on other treatments which might help such a dietary supplements like Flaxseed oil.

Meibomian Gland Disease

MGD is a the cause of particular form of blepharitis-a group of conditions characterised by inflammation of the eyelid margins.
MGD patients typically have choked meibomian glands which prevents adequate tear film distribution and therefore dry eyes as well as lid inflammation.

The Meibomian Gland is considered the ‘chapstick’ of the eye.

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Position of meibomian glands

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Normal tear film

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Poorly spread tears in MGD causing dry spots on the surface of the cornea

Thus, MGD is often a key element in patients suffering from dry eyes and requires adequate treatment. It may produce only minor irritation and itching, but in others it may cause redness, stinging or burning. Some people may develop an allergy to the scales or to the bacteria which surround them. This can lead to a more serious complication with inflammation of other eye tissues, particularly the cornea.
MGD can begin in early childhood, producing “granulated eyelids” and continuing throughout life as a chronic condition, or it can develop later in life.

Symptoms
  • Itching, irritation, red eyes.
  • “Gritty” or “sandy” feeling.
  • Flakes on the lashes.
  • Abnormality of the oily layer often exacerbates dry eye conditions.
  • Occasionally blepharitis predisposes to cysts as the glands block and swell.
Treatment

1. Expression of the glands and lid toilet.
The thickened contents need to be subjected to mild heat in order to help with expression. This is best done via a heat mask. An example of such a mask is the Blephamask warm compress mask. An excellent video presentation can be found HERE

2. Lid massage. This is best done after the hot compress, using a clean finger. The lower lid is swept from the nose out, pressing the finger against the skin under the eyelashes firmly. This lower lid is easier to treat as the bony orbit provides something to massage against. The upper lid needs to be massaged too—again with a sweep, four or five times from in to out, over the skin just above the upper lashes.

3. The expressed material can be cleaned away with a cotton but dipped in warm water or bicarbonate solution.

4. Lubricants need to be applied for dry eyes.

5. Omega 3 supplements in high dose. These have a proven anti-inflammatory effect on the lid. Flaxseed oil is an example.

6. occasionally, low dose antibiotics are prescribe as doxycycline or erythromycin in a prolonged low dose regimen.

7. Azithromycin 1.5% -(Azyter) this adheres to lid margin tissue and is applied twice a day for 3 days and then at night for a month. Especially useful in rosacea.

8. Steroid ointment or drops may be necessary to control inflammation in the lid or cornea. Sometimes low dose maintenance therapy is needed. If steroids are used, regular intra-ocular pressure checks are needed.