Blepharitis simply means ‘inflammation of the eyelids’. There are several different causes but the most common type, known as seborrhoeic blepharitis, occurs for no known reason. This can even start in childhood.
WHAT DOES BLEPHARITIS LOOK LIKE?
The eyelids look red. There is usually ‘flaking’ and ‘crusting’ along the base of the eyelashes. The eye can also look red. The eyelids will sometimes have a cyst or stye on them.
WHAT HAPPENS WITH BLEPHARITIS?
• Eyelid inflammation
• Dry eyes
• Gradual eyelid scarring, causing:
-permanent new blood vessels (redness)
-permanent tear film problems
Blepharitis causes an increase in acids along the eyelid margin. These acids irritate the eyelids and the eye, causing inflammation.
The acids also damage the normal tear content, causing a type of dry eye.
The eyelids often become infected on top of the inflammation. Over a long time, scarring develops. This causes eyelashes to turn in towards the eye, scratching the surface of the eye and requiring surgical removal of the eyelashes. Long term scarring also reduces the number of glands for producing part of the tear film and so the eye is frequently too dry, needing a long term tear substitute.
HOW DOES BLEHARITIS CAUSE PROBLEMS?
In the healthy eyelid, fats are produced in the glands between the eyelashes, along the eyelid margins (the meibomian glands). The fats from these glands normally coat the outer portion of the tear film upon blinking. This prevents the tear film from evaporating too quickly and keeps the eye moist and comfortable.
In blepharitis, the normal fats are converted to irritating acids. These cause inflammation along the eyelid, clogging up the glands and causing new blood vessels to enter the eyelid, making it red. The clogged glands can also fill up with mucus, get infected and cause eyelid cysts (like large pimples along the lid margin).
WHAT DOES BLEPHARITIS FEEL LIKE?
The eyes can feel gritty and irritable. This is mainly due to the poor tear quality. The eyelids normally glide over the front of the eye. When the tears are inadequate, blinking the eyelids can scrape the front of the eyes like ice skates. The tiny scrapes feel like grit in the eye. Patients often want to wash their eyes with water, first thing in the morning, to relieve the grittiness on awakening.
WHEN ARE SYMPTOMS WORSE?
Symptoms are usually worse in dry conditions. When the air is dry eg windy weather or sitting near a fire, tears dry up faster. Symptoms can also be worse after reading. This is because people often blink less while reading, allowing the eyes to dry up more.
WHAT CAN YOU DO FOR BLEPHARITIS?
Treatment depends on how severe it is. Remember that there are different types of blepharitis and there are other conditions which may be associated with it that may also require treatment eg Acne Rosacea. Your general practitioner will tell you if you also need to see an ophthalmologist or a dermatologist. Treatment is aimed at keeping the condition under control and treating complications. It is unusual for blepharitis to disappear forever.
Treatment: involves some or all the following:
• Washing the eyelid margins
• Tear film substitute eg Vidisic gel, Artelac, Tears Naturale etc
• A course of antibiotic drops (for lid infections and cysts)
• A course of steroid drops (for severe disease)
• A long course of antibiotic tablets (for severe disease)
• Surgical drainage of an eyelid cyst.
HOW TO WASH THE EYELID MARGINS:
This is very important. It prevents build up of acids, crusts and flakes and helps to prevent infection. It also increases the flow of healthy tears from the unclogged glands.
Use a dilute solution of baby shampoo (this doesn’t sting). Take a cup of clean water (eg cool boiled water) and add a teaspoon of baby shampoo. Dip a cotton bud into this solution and gently wipe between the base of your lashes with it. You might need to do this four times a day until your blepharitis is under control.
TREAT THE DRY EYE:
You will get great comfort from using an artificial tear substitute. This should be used 4 times a day to start, then reduced until you are at a comfortable level.
You may only need the drops or gel at certain times eg before going out in the wind or on a hot sunny day.
It is a good idea to use gel or lacrilube ointment last thing at night in order to protect your eyes while sleeping.
Remember, you might also have other causes of “dry eye” (eg post menopause) and if grittiness persists, your doctor might investigate further.
Your doctor might prescribe a course of antibiotic drops and ointment if you are prone to lid cysts and conjunctivitis. Remember that some people are allergic to antibiotics, so go back to your doctor immediately if your eyes get very itchy or puffy (signs of allergy).
Your doctor may put you on a long course of antibiotic tablets which are used to prevent the production of acid from fats, not just for infection.
Keep your eyelids clean with baby shampoo. Use a tear substitute such as artelac or artelac advanced.
Moderate or infected blepharitis:
If still uncomfortable despite above: time to see your doctor. You might need antibiotic drops.
You will need a six week intensive course of lid washing 4 times a day, steroid eye drops 4 times a day, tablets 4 times a day and tear substitutes (eg vidisic) in-between. Your doctor might refer you to an ophthalmologist to examine for less common causes of blepharitis and to get the condition under control.