BLEPHARITIS

Blepharitis

Fig.1 Reproduced from Patient Pictures: Ophthalmology, Health Press, Oxford 2001. Illustrated by Dee McLean

wHAT IS BLEPHARITIS?

Blepharitis is an inflammatory condition of the eyelids (Fig 1). It can affect people of all ages, but it is more common in the older population.

 

The eyelid margins, as well as having eyelashes protruding from their anterior (front)

surface, also have the openings of oil glands (Meibomian glands) behind the lashes.

The symptoms of blepharitis can include any of these: 
  • crusting, swelling and redness of the eyelids

  • dryness of the eye

  • a gritty feeling and burning sensation in the eye

  • tiny flakes on the eyelids similar to fine dandruff

  • sensitivity to light

  • blurred vision

  • loss of eyelashes/in-growing eyelashes

  • styes (an infection at the root of an eyelash) on the eyelid

  • small ulcers on the eyelids.

what are the symptoms of blepharitis?

HOW IS BLEPHARITIS DIAGNOSED?

In most cases the diagnosis is confirmed by an ophthalmologist (specialist eye doctor) using a microscope called a slit-lamp. The microscope gives a magnified view of the different parts of your eye.

 

With blepharitis, the eyelids appear red and inflamed with crusts and scales around the bases of the eyelashes. There may be blocked Meibomian gland openings and the lid may have associated notches, styes and Meibomian gland cysts. Tear film instability is often present, and can be identified by staining the tear film with a yellow dye called fluorescein. Inflammation and loss of the corneal surface skin cells (the epithelium) may also be seen on fluorescein staining.

WHAT TREATMENTS ARE AVAILABLE?

Blepharitis is a long-term condition. There is no cure but symptoms can be improved and controlled. It may take some time before treatments are successful.

Your ophthalmologist may recommend the following treatments to ease your symptoms:

 

  • Cleaning your eyelids to remove the crusts and scales from the eyelid margins and unblock the eyelid glands. To begin with you may need to clean your eyelids twice a day. In the long-term, you will need to clean them at least two or three times a week to prevent blepharitis from returning.

  • Artificial tear drops to treat dry eye symptoms and tear film instability.

  • Antibiotic eye-drops and ointments to treat acute infection, if present.

  • Flaxseed oil supplements have been shown to reduce the symptoms of blepharitis and eye dryness. They are not available on prescription, but you can buy them from a range of pharmacies and health food shops. 

  • Mild steroid eyedrops to treat any associated corneal and conjunctival inflammation. These are only given for short courses and only under the supervision of your ophthalmologist.

  • Antibiotics - Some forms of blepharitis such as posterior types and those associated with rosacea need to be treated with a course of antibiotic tablets (tetracyclines). You may need to take these for several months. 

 

** If you have any allergies to medicines please tell your ophthalmologist.

If you are pregnant or breast feeding, you should not take tetracyclines. You may not be able to take them if you have had liver disease or kidney disease. Please tell your ophthalmologist if you have had a history of these conditions. Long-term use of tetracyclines has been linked to the failure of oral contraception, but this is rare. You should not take tetracyclines with milk or antacids.

how do i clean my eyelids?

  1. Wash your hands.

  2. Soak a flannel/washcloth in warm water (make sure the water is not too hot). Close your eyes and gently press the flannel against them for three to five minutes. This will help to soften any hardened oil secretions.

  3. Massage your eyelids using your forefinger. Move in a downward motion for the upper eyelid and an upward motion for the lower eyelid.

  4. Add 2 drops of medicated baby shampoo (Fig. 3) into a small cup of boiled then cooled water (about 50 mls). Soak a cotton bud in the water. Use the cotton bud to clean your eyelids. Gently rub the cotton bud along the edge of the lower lid (Fig.2) – it helps to tilt the lid outward using a finger from your other hand. The upper lid is more difficult to clean. It is best done with the eyelid closed and pulled slightly over the lower lid – this makes sure that you can’t poke yourself in the eye.

  5. You can put in your ointment / drops after you’ve finished cleaning your eyes.

Blepharitis Treatment

Reproduced from Patient Pictures: Ophthalmology, Health Press, Oxford 2001. Illustrated by Dee McLean

Baby Shampoo for Eyes

Fig. 3. Example of an appropriate baby shampoo

SIDE EFFECTS OF BLEPHARITIS

The main side effects are an allergy or irritation to the drops, ointments and other

medication used to treat your eyes. These side effects include:

  • worsening redness

  • worsening sore eyes

  • increased itchy eyes

  • worsening / blurring of vision

 

The side effects are similar to the symptoms of blepharitis. So, if you feel your symptoms are getting worse, please contact your doctor. Because a number of different medicines may be used in the treatment of your blepharitis, it is not possible to list all potential side effects here. You should refer to the company’s

information leaflet supplied with your medicine.

what happens if i do not get treatment?

Blepharitis will not go away. It may get worse and irritate the front surface of your eye (the cornea). This could lead to discomfort and infection. 

 

As always, if any of your symptoms get worse please contact your doctor.

Video illustration on how to do a simple lid hygiene