Blepharitis refers to inflammation of the eyelid margins. There are two broad categories of the condition - Anterior Blepharitis and Posterior Blepharitis or Meibomium Gland Dysfunction.
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. These produce an irritative toxin that causes inflammation. The lid often looks 'crusty' and when seen under a microscope, similar to dandruff. Anterior Blepharitis causes the eyelids to become red, itchy and sometimes slightly swollen.
Meibomian Gland Dysfunction (MGD)
The meibomian glands are located within the eyelid. The pores of these glands open onto the lid margin, behind the root of the eyelashes. The glands normally produce a special oily secretion for the tears. Meibomian glands become inflamed and blocked with age. This causes a reduction in quantity, and quality of the oily secretions. This results in eyelid irritation, but also dry eye effects on the eye surface.
Who Gets Blepharitis & MGD?
Blepharitis & MGD are very common - People of any age can be sufferers, but it is more common in people over the age of 50. It is not something 'caught' or inherited.
Anterior blepharitis has sometimes been linked to demodex, which are microscopic mites that live on eyelashes. These mites are usually harmless, but may cause blepharitis in some people.
What are the symptoms of Blepharitis & MGD?
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 are Blepharitis & MGD Diagnosed?
Blepharitis & MGD are diagnosed by optometrists during a routine eye examination by using a slit lamp microscope to allow the lid margin to be examined closely. At Lynne Fernandes Optometrists the patient is then referred to a Dry Eye Clinic for detailed diagnosis and a management plan. All three practices offer this service
Visualisation of the lid margin, use of diagnostic dyes and stains along with the international standard Ocular Surface Disease Index (OSDI) assessment allows a bespoke treatment plan to be designed.
How Is Blepharitis Treated?
Unfortunately, there is not a definitive cure for blepharitis. Recent international consensus from the Dry Eye Workshop group (DEWS II) has advised particular treatment protocols. At Lynne Fernandes Optometrists we offer cleaning for the lid margin, opening and expression of the meibomium glands and enhancement of the tear film.
Rebecca Donneley, Lynne Fernandes and Gerard Fernandes can also if necessary prescribe medical therapy.
Lid Margin Cleaning
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 regimes work for most people.
BlephEx™, is an in-practice procedure performed directly by the optometrist.
16th March 2020: please note we have suspended the use of BlephEx within our clinics due to the theoretical risk from the aerosols produced by the procedure. It is possible that Covid-19 could be transmitted in this way, and although there are no proven cases of transmission worldwide, our patients safety is most important to us.
Manual Lid Hygiene
For particularly stubborn blepharitis, the optometrist will use a manual technique to clean the lid margin. They use sterile tools to precisely remove the scurf and bacterial debris, the main cause of inflammatory lid disease.
Performed by a skilled, experienced optometrists, manual lid hygiene will reduce or alleviate the chronic and debilitating symptoms. Treatments are typically repeated at regular intervals between 1-12 months depending on the severity of the disease. By eliminating the inflammatory aetiology of the blepharitis, the overall health of the eyelid is improved. Patients can then begin to produce more of their own tears and enjoy a life free from the chronic symptoms of blepharitis and consequent dry eye disease.
Meibomium Gland Expression
Meibomium Gland function can be improved by directly treating blocked glands. The lid is heated gently to soften wax deposits and melt oils inside the glands. A skilled optometrist will gently remove the solidified capping over blocked glands with a sterile specialised eyelid spud. The glands are expressed with another sterile specialised tool until the oil runs clear. The optometrist will assess the quality of this expression and may give specific lifestyle or dietary advice to improve long term quality.
Many traditional eye drops contain a preservative. This includes most glaucoma medications and other treatments prescribed by specialists. Although glaucoma eye drops are essential to prevent blindness, their long term use inevitably exacerbates dry eye in many patients.
Eye make up also contains chemicals, and preservatives that irritate the eye lid margin. Old make up can be a site for bacteria to breed
There is some evidence to suggest omega 3 oils such as those in Flax-seed can improve the quality of meibomian gland secretions. However it is always better to improve diet than use supplements if possible.
We do not recommend cod liver oil
Occasionally, if there is marked bacterial anterior inflammation, or if there is an associated skin condition such as seborrheic dermatitis, or even Rosacea, a specialist optometrist may prescribe antibiotic eye ointment, or indeed oral tablets. Lynne Fernandes Optometrists has the higher percentage of optometrists with this qualification in Bristol. Ask for Rebecca Donneley, Gerard Fernandes or Lynne Fernandes
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