Blepharitis

Blepharitis refers to inflammation of the eyelids, particularly at the lid margins. It's a common disorder and may be associated with a low-grade bacterial infection or a generalized skin condition.

Blepharitis occurs in two forms: anterior blepharitis and posterior blepharitis. Anterior blepharitis affects the outside front of the eyelid where the eyelashes are attached. The two most common causes are bacteria and scalp dandruff.

Posterior blepharitis affects the inner eyelid and is caused by problems with the oil (meibomian) glands in the eyelid. Two skin disorders are the cause: acne rosacea and scalp dandruff.

Regardless of which type of blepharitis you have, you will probably have such symptoms as eye irritation, burning, tearing, foreign body sensation, crusty debris (in the lashes, in the corner of the eyes or on the lids), dryness and red eyelid margins.

It is important to see an eye doctor and get treatment. If your blepharitis is bacterial, possible long-term effects are thickened lid margins, dilated and visible capillaries, trichiasis, eyelash loss, ectropion and entropion. The lower third of the cornea may exhibit significant erosion.

Blepharitis can be difficult to manage because it tends to recur. Treatment depends on the type of blepharitis you have. It may include applying warm compresses to the eyelids, cleansing them, using an antibiotic and/or massaging the lids. If your blepharitis makes your eyes feel dry, the doctor may also prescribe artificial tears or lubricating ointments or suggest silicone punctal plugs. Sometimes steroids are used to control inflammation, but the potential side effects speak against long-term use.

The warm compress portion of treatment is designed to loosen crusts on your eyes before you cleanse them; it can also warm up and loosen the plugs blocking the meibomian glands in meibomianitis. Wash your hands, then dampen a clean washcloth with warm water and place it over your closed eyes. When you first begin treatment, your doctor will probably suggest that you do this four times a day, for about 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 essential to blepharitis treatment. Your doctor will recommend what to clean them with: warm water only, salt water, baby shampoo diluted with warm water or a special over-the-counter product specifically made for cleansing the lids. First wash your hands, then dip a clean washcloth, cotton swab or gauze pad into your cleaning solution. Gently wipe it across your lashes and lid margin. Rinse with cool water. Use a different washcloth, swab or pad for your other eye, and repeat the process. When you first begin treatment, your doctor may have you cleanse your lids several times a day. Later on, he or she will probably instruct you to cleanse them about once a day.

Antibiotic treatment is recommended only for certain types of blepharitis. Your doctor may prescribe either a topical antibiotic ointment or an oral antibiotic.

If you have meibomian gland dysfunction, your doctor will probably recommend massaging the lids to remove excess oil. He or she will show you the correct technique.

Recently, some authorities have suggested using flaxseed oil supplements (omega-3 fatty acid), either by pill or by liquid, to stabilize the meibomian secretions associated with meibomian seborrheic blepharitis. Be sure to discuss any supplement use with your doctor.
 

Because blepharitis tends to be chronic, expect to keep up therapy for a prolonged period of time to keep it at bay. Depending on the type of blepharitis you have, if you wear contact lenses, your doctor may want you to discontinue wearing them during the treatment period and even beyond. Some patients who wear soft contact lenses are prescribed RGP contacts instead. Others are urged to replace their soft lenses more frequently because of the potential for excessive deposit buildup. Some people simply don't do well with contact lenses and will have to consider other options.

Not wearing eye makeup is also a good idea, since it can get in the way of eyelid hygiene and massage treatments. With some kinds of blepharitis it is recommended that you use an anti-dandruff shampoo for your scalp and eyebrows; be careful not to get the shampoo in your eyes, as it can be very irritating.