Blepharitis

Is a condition that affects the eyelid margins. It may also affect the tissues lining the lids and eyeball (the conjunctiva) and the window of the eye (the cornea). There are several different types of blepharitis, which may occur alone or in combination; these types involve either the lash bearing area (anterior blepharitis) or the area behind the lashes where the meibomian glands open (posterior blepharitis or meibomian gland dysfunction).

Blepharitis is an extremely common cause of DRY EYE in people over 40, although it can develop at any age and children suffer with it too.

The symptoms of blepharitis can include:

  • burning, soreness or grittiness in the eyes
  • crusty eyelashes, sticky / watery eyes
  • red / itchy eyelids

Blepharitis can be caused by a bacterial infection, or it can be a complication of a skin condition such as:

  • seborrhoeic dermatitis, which causes an itchy rash on the skin and scalp (seborrhoeic dermatitis of the scalp is called dandruff)
  • rosacea, which causes the face to appear red and blotchy

How can blepharitis be treated?

Blepharitis cannot be cured, but symptoms can be controlled with good eye hygiene and lubricant eye drops.

Blepharitis is a chronic (long-term) condition. Most people experience repeated episodes followed by periods with no symptoms. 

Eye hygiene for Anterior Blepharitis

 It is important to clean your eyelids every day, whether or not you have any symptoms. Good eye hygiene helps ease your symptoms and prevents them from reoccurring. Follow the steps below to keep your eyes clean:

1. Apply a warm compress (a cloth or tissue dipped in with warm water) to your closed eyelids for five to ten minutes. Gently rub the compress over your closed eyelids for two to three minutes to help loosen any crusting.

2. Use a cotton bud moistened with boiled cooled water and gently rub the edge of your eyelids to clean them. If you have difficulty using a bud use proprietary cleaning pads e.g: Supranettes wipe by Alcon, Lid Care pads by CIBA, or Blephaclean/ Blephasol wipes by Spectrum Thea, or Ocusoft /Ocusoft plus eye pads by Scope Ophthalmics.

Carry out these steps twice a day at first, then once a day when your symptoms have improved. 

Eye hygiene for Posterior Blepharitis

 It is important you perform Hot compress and eyelid margin massage every day

Step 1: Hot Compress

Either heat the lids with a flannel soaked in hot water Or use a heat pad such as the “Eyebag” from www.eyebagcompany.com. Apply to closed eyes for 4-5 minutes. Reheat as necessary.

Step 2: Massage

Express the oily secretions from the meibomian glands by using a cotton bud or your finger. Firm pressure is required to milk the secretions towards the gland opening on the lid margin. Use a rotary motion down (or up) towards the lid margin. Work your way across the whole upper and lower lid. Do NOT stretch the lid

Step 3: Add Lid Scrubs or Wipes

Gently rub the edge of your eyelids with lid wipes to clean them, if you have mixed anterior & posterior blepharitis (Lid wipes advised are:  Supranettes wipe by Alcon OR Lid Care pads by CIBA OR Blephaclean/ Blephasol wipes by Spectrum Thea OR Ocusoft /Ocusoft plus eye pads by Scope Ophthalmics).

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Topical Antibiotics

If you have blepharitis that does not respond to regular cleaning, you may be prescribed a course of antibiotic ointments or steroids. You will need to use these for four to six weeks.

You may be prescribed:

  • fucithalmic or maxitrol steroid/antibiotic eye ointment (to be rubbed gently onto the edge of your eyelids as prescribed)
  • 1 % azithromycin eye drops

Oral Antibiotics

In some circumstances, you may be prescribed oral antibiotics (e.g Doxycycline or Azithromycin) at the start of your treatment. For example, oral antibiotics may be prescribed when it is clear that a skin condition, such as rosacea, is aggravating your blepharitis. Oral antibiotics may also be recommended if your blepharitis does not respond to other treatment.

Most people respond well after treatment, hence it is important for you to finish the course of antibiotics, even if your symptoms get better.

Cautions

Doxycycline used to treat blepharitis has been known to make people more sensitive to the effects of the sun. Therefore, avoid prolonged exposure to sunlight and using sun lamps or sun beds while you are taking them.

Side effects of oral antibiotics are rare because the dose is relatively low. However, they may include vomiting, diarrhoea and yeast infections in women.

Treating Other Conditions

You may need to use an anti-dandruff shampoo on your scalp and eyebrows if you have:

  • seborrhoeic dermatitis
  • dandruff (dry, flaky skin on your scalp)

If you have dry eye syndrome, which frequently occurs alongside blepharitis, you may need separate treatment for this, such as lubricant eye drops.

What happens if Blepharitis is not treated?

  • Dry eye syndrome
  • Conjunctivitis
  • Meibomian cyst
  • Styes
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