Blepharitis

Do you often experience a burning sensation in your eyes, watery or itchy eyes or noticed crusty debris at the base of your eyelashes? Chances are, you suffer from the effects of blepharitis. Blepharitis is a common cause of sore, red eyes and crusty eyelashes.

Depending on the severity, patients may experience all or some of these symptoms. An extreme case of blepharitis can even cause eyelash loss (i.e. madarosis). Contact lens users are likely to experience more discomfort from this condition.

Anterior Blepharitis shown above.

Chalazion or Hordeolum illustrated up top.

Meibomian Gland Dysfunction visible here at the lid margin.

Blepharitis and its Causes

Blepharitis has many causative factors, some of which are outlined below:

• Bacterial overgrowth on the eyelids (staphylococcal)
• Meibomian gland dysfunction (MGD)
• Dry eyes due to various health and lifestyle factors (results from MGD)
• Parasitic infestation (Demodex eyelash mites)
• Seborrhea

Generally, overgrown bacteria near the margins of eyelids is the main cause of blepharitis. When the disease progresses, a biofilm is formed on the surface of the eyelids due to bacterial multiplication. Parasitic eyelash mites may feed and prosper on this biofilm, that worsens the eyelid inflammation. Another result of this growing bacterial population is exotoxin release. Exotoxins are substances that are released by bacteria and irritate the ocular surfaces, especially more upon waking as the act of blinking to remove these irritants from the surface of the eye are absent during sleep. MGD often worsens the discomfort and pain caused by dry eyes. In extreme cases, MGD causes styes or chalazions. Seborrheic Blepharitis typically presents with complaints of eyelash flaking and eyelid redness or irritation. A fungus may be the culprit here. Because seborrheic blepharitis is more of a dermatological condition, scaly eyelids and flaky debris are typical.

Conditions Associated with Blepharitis

Blepharitis is also known to be associated with certain skin conditions: Acne Rosacea, Eczema, Dandruff and Psoriasis. A common condition known generally as pink eye (i.e. conjunctivitis) can also occur in tandem with blepharitis.

Chalazion, Stye and Hordeolum

Chalazions are hard, pain-free nodules or seen as localized areas of redness on the inner eye lid tissue.  They represent inflammation of a blocked meibomian gland. Styes are infections, and as such are painful. They can lead to preseptal or orbital cellulitis if not treated in a timely fashion.

Occurrence Rate

According to a patient survey of American ophthalmologists and optometrists, 37% and 47% of their patients respectively have experienced symptoms of blepharitis. The same survey also found that blepharitis is more common among the younger population, thus contradicting the conventional belief around eyelid inflammation. Even though the statistics around this infection are not as positive, thanks to medical intervention, the inflammation can be minimized or reversed before it harms ocular tissue.

Treatment Modalities

The first step in blepharitis treatment is visiting your doctor for an examination, proper diagnosis and staging of the condition should it exist. Depending on the cause and intensity of inflammation, your eye care specialist will recommend an appropriate line of treatment. This can include:

Eyelid Scrubs

Regular and gentle cleaning of  your eyelids with medicated lid wipes (such as tea tree oil and coconut oil) to help get rid of the biofilm build-up and bacterial colonization from the eyelid margins. In addition, you may also be recommended to apply daily warm compresses to loosen debris and promote healthy meibomian gland functioning.

Omega-3s are known to lower blood pressure, protect mental functioning, reduce arthritis symptoms, but they also reduce the viscosity of meibomian gland secretions. Meibomian glands are located on the eye lid margin and number between 20 to 40 per lid. The lower the viscosity of the oil, the less likely a back up of secretions occur within the gland. Omega-3 is known to help promote healthier secretions, reducing dry eye symptoms and lowering the incidence of chalazions. Their effects are typically seen after 3 months of consumption of  2000mg per day, specifically Omega-3 in the DHA and EPA forms, which are best absorbed by the digestive system. Additionally, vitamin D supplementation has been found to be beneficial against dry eye, which is known to be associated with eye lid disorders. A combination of Omega-3 and Vitamin D3 in liquid form is ideal.

Hot Compresses

Heat delivered over a sustained period can lead to better secretions from the meibomian glands.  The heat should reach about 40 degrees Celsius and the mask applied for a period of 8 to 10 minutes, with moderate pressure, so that the meibum oil secretions are melted and pushed through the glands to prevent stasis or backup, inflammation (i.e. chalazions) and infection (i.e. styes) from developing. The masks are typically microwavable and can be washed. The internal beads are excellent heat conductors, enabling the mask to deliver sustained heat and pressure to the eyelids in an efficient, non-messy and comfortable manner.  To use, heat in microwave for  roughly 30 seconds, then test temperature is not too hot by touching with your finger.  If adequate temperature reached, apply as a wrapped mask and wear for 10 minutes preferably.

In-Office Procedures

In more serious cases of Blepharitis, in-office eye lid procedures like electromechanical lid margin debridement (to remove biofilm), thermal pulse treatment or Intense Pulsed Light (IPL) therapy to stimulate meibomian gland secretion, may be required. In addition, antimicrobial/inflammatory eyedrops/ointments may be recommended for short- or long-term use. Oral antibiotics may be needed in advanced cases such as chalazion or styes, in the presence of systemic disease such as Acne Rosacea, or prominent meibomian gland dysfunction.

Maintaining lid health can include a combination of long-term hygiene using OTC lid care products, warm compress application and taking supplements of omega-3 fatty acids. Collectively or individually, these treatments can help maintain both ocular tear film and surface integrity and promote normal functioning of meibomian glands. This long-term approach can prevent recurrences or progression of disease in the presence of blepharitis and ultimately more comfortable, happy eyes.