What is Blepharitis?

How Is Blepharitis Diagnosed?

Blepharitis refers to inflammation of the eyelid margins. There are two broad categories of the condition - Anterior Blepharitis and Posterior Blepharitis.

Anterior Blepharitis affects the front part of the eyelid margin, near the roots of the eyelashes. It is commonly caused by bacteria that normally live on our skin, that produce an irritative toxin that causes inflammation. The lid margin often looks 'crusty' and when seen under a microscope, the appearance can be similar to dandruff. Anterior Blepharitis can cause the eyelids to become red, itchy and sometimes slightly swollen too.

 

 

Posterior Blepharitis is also referred to as Obstructive Meibomian Gland Disease. The meibomian glands are located within the eyelid, and the pores of the glands open onto the lid margin, behind the roots of the eyelashes. The glands normally produce a special oily secretion for the tears. The meibomian glands sometimes become inflamed and blocked, causing a reduction in amount, and disturbance in quality of the oily secretions. This can not only cause eyelid margin irritation, but also has secondary dry eye effects on the ocular surface.

Who Gets Blepharitis?

Blepharitis is very common indeed - 5% of eye problems in primary care are said to be related to blepharitis. People of any age can be sufferers, but it is more common in older people over the age of 50. It is not something 'caught' or inherited. The reason for some people developing blepharitis is poorly understood.

What are the symptoms of blepharitis?

People who have blepharitis may not suffer from any symptoms at all. However, for those that do report symptoms, one or any combination of the following symptoms are common:

  • Irritation of the eyelids and/or eyes
  • Redness of the eyes
  • Sore eyelids - sometimes red and swollen lid margins
  • Crusting of the eyelid margins
  • Eyelids may stick together on waking in mornings
  • Burning and tearing of the eyes
  • Gritty sensation in eyes
  • Pain on looking at bright lights (photophobia)
  • Small eyelid margin cysts

How Is Blepharitis Diagnosed?

Blepharitis can be diagnosed on the clinical history alone. However in our Clinics we use a slit lamp so that the lid margin can be examined closely, and photographed. Simple visualisation of the lid margin along with the history is how the diagnosis is normally made.

How Is Blepharitis Treated?

We generally recommend lid margin cleaning and heat which allows the natural oils to flow through the glands found in the lid margin.

Lid Margin Hygiene

Both types of blepharitis can be helped with what is commonly referred to as 'lid margin hygiene'. Put simply, this means regular cleaning of the lid margins. The use of the following regimen works for most people.

We recommend using an EyeBag and special cleaning solutions 

begin by cleaning the eye area thoroughly but gently with Blephasol, Blephaclean or Blephagel depending on severity, to remove all crusting and flakes.

  1. Put the EyeBag in a microwave on full power for 30 seconds.
  2. Hold the EyeBag by its tips and shake so that the flax seeds are mixed and the heat is evenly distributed.
  3. Check the EyeBag feels comfortably warm.
  4. Lie back in a comfortable position and apply the EyeBag over your closed eyes for about 5- 10 minutes.
  5. Patients with severe disease will benefit from intensive eyelid warming and massage for the first fortnight. Intensive use means 10 minutes 4 times a day. Milder disease can be controlled with 5 minutes 2 times a day. 

 

Most people will experience a reduction in symptoms using the EyeBag together with the use of a lotion to clean the lids and lashes such as Blephasol.  New studies show the use of additives to water such as baby shampoo or sodium bicarbonate may actually increase the amount of irritation, this is not now recommended. Talk to our Optometrist or Contact Lens Optician for further information.

Other management measures are briefly mentioned below.

Avoid Irritants

Minimising chemical irritants that include certain eye drop preservatives and makeup can help reduce blepharitis symptoms.

Dietary Changes

There is some evidence to suggest omega 3 oils such as those in Flax-seed  and Omega 7 in sea buckthorn can improve the quality of meibomian gland secretions. Hyabak caps from Thea are available from us, which is a food supplement for the maintenance of vision and the treatment of dry eye. Anecdotal response from our patients suggests it's very helpful. 

Antibiotics

Occasionally, if there is marked bacterial anterior inflammation, or if there is an associated skin condition such as Seborrheic Dermatitis, or Acne Rosacea, your doctor may prescribe antibiotic eye ointment,  and in severe cases oral tablets.

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