Blepharitis

Blepharitis refers to inflammation of the eyelids, particularly at the lid margins. Bacteria is on the surface of everyone’s skin but in certain individuals they thrive on the skin at the base of the eyelashes. The resulting irritation, sometimes associated with over activity of the nearby oil glands causes dandruff-like scales and particles to form along the lashes and eyelid margins.For some people the scales or bacteria associated with blepharitis produces only minor irritation and itching but in others it may cause redness, stinging or burning. Some people may develop an allergy to the scales or to the bacteria which surround them. This can lead to a more serious complication with inflammation to other eye tissues, particularly the cornea.

Stye A stye is a bacterial infection that develops near the root of an eyelash. The result is a painful lump on the edge or inside of your eyelid. A stye is usually most visible on the surface of the eyelid.

Chalazion A chalazion occurs when there’s a blockage in one of the small oil glands at the margin of the eyelid. The gland can become infected with bacteria, which causes a red, swollen eyelid. Unlike a sty, a chalazion is most prominent on the inside of the eyelid.

Excess tearing or dry eyes Abnormal oily secretions and other debris shed from the eyelid, such as flaking associated with dandruff, can accumulate in your tear film — the water, oil and mucous solution that form tears. Abnormal tear film interferes with the healthy lubrication of your eyelids and your vision. There may be enough irritation to stimulate excessive tearing. Inflammation associated with blepharitis can interfere with the function of some of the non-oil-producing glands in the eyelid and lead to dry eyes.

Chronic pink eye Blepharitis can lead to recurrent bouts of pink eye (conjunctivitis).

Injury to the cornea Constant irritation from inflamed eyelids or misdirected eyelashes may cause a sore (ulcer) to develop on your cornea. Insufficient tearing could predispose you to a corneal infection and loss of vision.

Not wearing eye makeup during the inflammatory stage of the disease process is 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.

Your own symptoms may include irritation, burning, tearing, flakes of skin around the eyes, sensitivity to light, frothy tears, loss of eyelashes, dryness, and red eyelid margins. The eyelids may appear greasy and crusted with scales that cling to the lashes. This debris can cause the eyelids to stick together at night or in the morning when you wake up.

Blepharitis is a chronic disease for which there is no cure and requires long-term treatment to keep it under control. Treatment consists of 2 phases (Acute phase and Maintenance phase). Acute phase treatment involves intensive therapy to rapidly bring the disease under control. In the maintenance phase the goal is to indefinitely continue the minimum amount of therapy that is necessary to keep the disease quiet. Controlling blepharitis itself, will reduce all the other lid and ocular related complications.

Warm Compresses followed by Lid Scrubsis the most critical element of effective blepharitis control. This therapy removes the eyelid debris, which can be food for bacteria, which will increase the number of bacteria. Warm compresses heat the debris and crust on the lid margin above the melting point so that they are easily removed with the lid scrubs.

Lid scrubs mechanically removes as well as kills bacteria due to the detergent action of the soap in the lid scrubbing pad. It stabilizes the tear film by releasing oily secretions from the ocular glands, thus reducing tear evaporation, so the dry eye symptoms are also reduced.

MANAGEMENT

Blepharitis can be difficult to manage because it tends to recur and requires good hygiene. Treatment of blepharitis 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, your doctor may also prescribe artificial tears or lubricating ointments or suggest punctual occlusion. At times steroids are required to control inflammation but usually only for short term use.

Prescription Medications and Neutraceuticals

Omega 3 and 6 provides Essential Fatty Acids containing anti-inflammatory properties which help manage eyelid inflammation. New researchhave suggested using flaxseed or fish oil (omega-3 fatty acid), either by pill or by liquid to help stabilize the ocular gland secretions associated with blepharitis. Soothe eye drops is a Castor oil emulsion mixing with the tears providing longer relief compared to just comfort drops. Restasis eye drops has Castor oil in addition to cyclosporine to help reduce the inflammation in the lacrimal gland. Azasite antibiotic eye drops also have anti-inflammatory effects and can offer additional option to help manage your eye condition.

Be sure to discuss any supplement use with your doctor. Treatment Technique

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 clogged opening of the glands.

Cleansing the eyelids with a special over-the-counter product specifically made for cleansing the lids is essential to blepharitis treatment. First wash your hands, then dip a clean gauze pad into your cleaning solution. Gently wipe it across your lashes and lid margin and wash away any oily debris or scales at the base of your eyelashes. Rinse with cool water. Use a different pad for your other eye and repeat the process.

The next phase is to soak a washcloth in hot water and placing the washcloth on the eyelids without burning them (eyelids closed) for a five to ten minute period. In the acute phase this is performed 2 to 4 times a day. Be careful not to burn your skin.

Warm compresses may be combined with eyelid massage. This is especially important in patients who have problems with the glands of their eyelids. The eyelid secretions are turbid and the gland openings are clogged. After warm compresses the turbid eyelid gland secretions are more fluid, but massage is necessary to express them. Therefore after every 1 minute of warm compresses, massaging the eyelid as follows will be useful.

Gently close the eyelids. Put your index finger on the outer corner of the eyelid. Pull the eyelid towards the ear, so that the eyelids are stretched taut. Next use the index finger of the opposite hand to apply direct pressure to the taut eyelids, starting at the inner aspect of the eyelid near the base of the nose. Sweep with firm but gentle pressure towards the ear. Repeat this maneuver four to five times. Remember that the goal is to apply gentle pressure to the eyelids – so just rubbing the eyelid surface will not give adequate results.

The scrubbing should be directed at the base of the eyelashes on the eyelid margin. Soaps and cleansing agents used should not have excessive perfume or lotion content.

There are commercially available cleansing pads that are presoaked in a cleansing solution called Ocusoft Lid Scrubs. These cleansing pads are an effective method of lid scrubbing and are also available in a foam solution that is used with cotton gauze. The pad should be applied in a gentle oval scrubbing motion to the margin and eyelash bases of the closed eyelid for 1 minute, followed by a fresh water facial rinse.

Blepharitis rarely disappears completely. Even with successful treatment, relapses are common. Paying extra attention to good hygiene at those times when your resistance is down will help bring this condition back under control.

If you have blepharitis, you may experience loss of eyelashes, abnormal eyelash growth (misdirected eyelashes) or scarring of the eyelids. This may cause tears to run down your face. Make sure you tell your doctor all of your symptoms in order to receive the best possible treatment. Other complications associated with blepharitis are caused by eyelashes and skin debris laden with bacteria. Excessive lipid production caused by the ocular glands promotes the formation of crusty debris in and around the eye. These glands eventually clog, creating a perfect home for bacteria to grow in a dark warm environment with plenty of food around, namely, skin cells and oil. These bacteria waste secretions break down directly into a toxic material to the corneal epithelium, resulting in burning, stinging and sensitivity to light, resulting in an inflammation. Disturbance to the tear layer increases tear evaporation and subsequently promotes dry eye.

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