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.
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 – possibly due to the eyelids becoming damaged or because of a sensitivity reaction. Some types of demodex mite have also been linked to cases of posterior blepharitis.
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 is normally diagnosed by optometrists during a routine eye examination by using a slit lamp microscope to allow the lid margin to be examined closely. Visualisation of the lid margin, use of diagnostic dyes and stains along with the history during a Dry Eye appointment allows for a bespoke treatment plan to be designed.
How Is Blepharitis Treated?
Unfortunately, there is not a definitive cure for blepharitis. There are many different ways clinicians have managed patients with blepharitis over the years.
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 regimen works for most people.
BlephEx™, the newest treatment for blepharitis, is an in-practice procedure performed directly by the optometrist. With BlephEx™ the clinician thoroughly and precisely eliminates the scurf and bacterial debris, the main causes of inflammatory lid disease.
Properly performed, BlephEx™ will reduce or alleviate these chronic and debilitating symptoms in your patients. Treatments are typically repeated at regular monthly intervals depending on the severity of the disease. By eliminating the inflammatory etiology of blepharitis, the overall health of the eyelid is improved. Patients can then begin to produce more of their own tears and finally enjoy a life free from the chronic and irritating symptoms associated with blepharitis and its subsequent dry eye disease.
Maintaining Lid Hygiene
Lid hygiene can then be maintained via patient use products such as Blephagel, Blephasol and Blephaclean. Our trained Ocular Hygienists will advise on how to use the products specifically recommended by the Optometrist after a Dry Eye appointment.
Maintaining Meibomium Gland Function
Once the posterior lid margin is clean of exotoxins, Meibomium Gland function can be maintained using a hot compress regularly such as the EyeBag.
Minimising chemical irritants that include certain eye drop preservatives and makeup can help reduce blepharitis symptoms.
There is some evidence to suggest omega 3 oils such as those in Flax-seed can improve the quality of meibomian gland secretions.
Occasionally, if there is marked bacterial anterior inflammation, or if there is an associated skin condition such as seborrheic dermatitis, or even Rosacea, your doctor may prescribe antibiotic eye ointment, or indeed oral tablets.