Blepharitis

1 What is Blepharitis?

Blepharitis is a common, chronic condition affecting the eyes, in which the eyelids appear swollen with a coating of oily substances and bacteria at the base of the eyelashes.

It affects both eyelids and occurs if small oil glands situated below the eyelashes get clogged, leading to irritation, itchiness and redness of the eyes.

Although the underlying cause of belpharitis is not known, it may be associated with a bacterial eye infection, dry eye, or certain skin conditions such as acne rosacea.

Blepharitis may have an unsightly appearance, but does not cause any permanent damage to your vision, and is non-contagious.

2 Symptoms

The signs and symptoms of blepharitis include:

  • Irritation of the eye and eyelids
  • Excessive tear discharge from the eyes
  • Redness in the eyes
  • A gritty, burning or stinging sensation in the eyes
  • Eyelids that appear greasy
  • Crusting of the eyelashes and itchiness in eye
  • Red, swollen eyelids
  • Flaking of the skin around the eyes
  • Eyelids sticking to each other
  • More frequent blinking
  • Sensitivity to light
  • Eyelashes that grow abnormally (misdirected eyelashes)
  • Loss of eyelashes

If your symptoms of blepharitis do not improve in spite of taking good hygienic measures such as regular cleaning and care of the affected area, make an appointment with your doctor.

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3 Causes

The exact cause of blepharitis isn't clear. It may be associated with one or more factors, including:

  • Seborrheic dermatitisdandruff in the scalp and eyebrows
  • A bacterial infection
  • Clogged or malfunctioning of the meibomian oil glands in your eyelids
  • Acne rosacea — a skin condition that causes facial redness
  • Allergies, including allergic reactions to cosmetics, eye medications, or contact lens solutions
  • Eyelash mites or lice

In some people, normal skin bacteria may flourish at the base of the eyelashes.

A large amount of bacteria thriving around your eyelashes may lead to dandruff-like scales on the eyelashes and margins of the eyelids.

4 Making a Diagnosis

Making a diagnosis of blepharitis is done by:

  • Physical examination of your eyelids: Your doctor will carefully examine your eyelids as well as your eyes using a special magnifying instrument.
  • Swabbing skin for testing: In some cases, your doctor may collect a sample of an oily layer or crust formed on your eyelid using a swab. This sample is then tested for the presence of bacteria, fungi or evidence of an allergy.

When you have symptoms of blepharitis, you should initially consult your family doctor or a general practitioner.

If required, your doctor may refer you to an eye specialist (optometrist or ophthalmologist).

At the time you make an appointment, ask if you need to know any pre-appointment restrictions or do anything in advance, such as remove your contact lenses.

  • Make a list of all the symptoms you have, including those that may seem unrelated to blepharitis.
  • List all your medications, vitamins or other supplements  

List the questions you need to ask your doctor in the order of the most important to least important.

For blepharitis, some basic questions to ask your doctor include:

  • What is the most likely cause of my symptoms?
  • What are the other causes for these symptoms?
  • What type of tests will I need?
  • What are the treatments available, and which do you think would be the best for me?
  • Is this condition temporary or long lasting?
  • Is my blepharitis contagious?
  • Can I continue to wear contact lenses?
  • Will I need a follow-up visit? If so, when?

Your doctor is likely to ask you a number of questions such as:

  • When did you notice your symptoms, first?
  • Are your symptoms intermittent or continuous?
  • Do your symptoms occur at a specific time of the day?
  • Do you wear contact lenses?
  • Have you changed the brand of your cosmetics recently?
  • Is there anything that seems to improve or make your symptoms worse?
  • Did anyone in your family have a recent eye infection?
  • Have you ever had any eye diseases or injuries?
  • Do you have any other diseases or conditions?

Temporary relief

You may get some relief from the irritation in your eyes by gently washing your eyelids several times a day.

Follow these steps to wash your eyelids:

  • Apply a warm washcloth to your closed eyelids for up to five minutes.
  • With a clean finger or washcloth, gently rub your closed eyelids with a diluted solution of baby shampoo.
  • You should hold the lid away from the eye while you are using the wash cloth to rub along the lash margin. It may require several minutes of gentle rubbing to get rid of the scales.
  • Rinse your eyes thoroughly with warm water.
  • Avoid wearing anything that causes irritation to your eyes, such as eye makeup and contact lenses.

5 Treatment

Generally, self-care measures such as washing your eyes frequently and application of warm compresses may be the only treatment needed in most cases of blepharitis.

In cases where this is not sufficient, your doctor may suggest prescription medications such as:

  • Medications that fight infection: Topical antibiotic cream can be applied to the eyelid. It provides relief from symptoms and resolves the bacterial infection of the eyelids. These medications are available in the form of eyedrops, creams, and ointments. If topical antibiotics are not effective, your doctor may suggest an antibiotic that can be taken orally.
  • Medications to control inflammation: Eye drops containing steroids or ointments may be prescribed to help reduce inflammation. Your doctor can prescribe both antibiotic and anti-inflammatory drugs.
  • Medications that affect the immune system: Topical cyclosporine (Restasis) is a calcineurin inhibitor that offers relief from the few signs and symptoms of blepharitis.

Treatment of underlying conditions

Blepharitis associated with seborrheic dermatitis, rosacea or other diseases may be controlled by treating the underlying disease.
Blepharitis is a chronic condition and requires daily care with eyelid scrubs.

It rarely resolves completely. If your response to the treatment is not satisfactory, you have lost eyelashes or only one eye is involved, the condition could be due to a localized eyelid cancer.

6 Alternative and Homeopathic Remedies

No alternative remedies have been found to effectively manage the symptoms of blepharitis.

However, a diet rich in omega-3 fatty acids or supplements containing omega-3 fatty acids are helpful in treating blepharitis associated with rosacea.

Omega-3 fatty acids are largely found in foods such as salmon, tuna, trout, flaxseed, and walnuts.

7 Lifestyle and Coping

For most cases of blepharitis following certain self-care measures in lifestyle are the only treatment necessary.

Clean your eyes daily

Cleaning should be done two to four times a day during flare-ups and once or twice a day after the condition is under control.

Wash your eyes by following these steps:

  • Apply a warm compress over your closed eyes for several minutes to moisten the crusty deposits on your eyelids. Then, use a soft washcloth dampened with warm water and a few drops of diluted baby shampoo to clean away any oily debris or scales present at the base of your eyelashes. Use a clean and different cloth for each eye. While cleaning the edge of your eyelids, gently pull your eyelid away from your eye and rub the washcloth gently on the base of the eyelashes. This avoids damage to your cornea that may occur with the washcloth. Rinse your eyelids with warm water and gently pat it dry with a clean, dry towel.
  • Stop using eye makeup when your eyelids are swollen. Makeup can make it difficult to keep your eyelids clean and free of debris. Also, cosmetics may reintroduce bacteria to the area or result in an allergic reaction.
  • Lubrication of your eyes: Try over-the-counter lubricating artificial tear drops to help relieve dry eyes.
  • Control dandruff and mites: An anti-dandruff shampoo may be recommended if you have dandruff contributing to your blepharitis. Use of tea tree shampoo to clean your eyelids daily may help control the mites. Gently scrub your eyelids once in a week with a 50% tea tree oil, which is available over-the-counter.

8 Risks and Complications

The risks associated with blepharitis include the following:

  • Eyelash problems: Blepharitis may lead to loss of your eyelashes or may cause abnormal growth (misdirected eyelashes).
  • Eyelid skin problems: Long-term blepharitis may cause scarring of your eyelids or the edges of your eyelids turning inwards or outwards.
  • Excessive tears or dry eyes: Abnormal oily secretions and other debris deposited on the eyelids shed and accumulate in your tear film. This abnormal tear film hinders with the healthy lubrication of your eyelids, which can cause irritation of your eyes and symptoms of dry eyes or excess tearing.
  • Difficulty wearing contact lenses: As blepharitis affect the lubrication in your eyes and contact lenses may be uncomfortable.
  • Sty: A sty is an infection that results in a painful lump near the base of the eyelashes on the outside part of your eyelid.
  • Chalazion: A chalazion is a lesion that results from the blockage in one of the small oil glands located on the eyelid margin, just behind the eyelashes. These glands may get infected with bacteria, which results in a red, swollen eyelid. A chalazion is more prominent on the inner portion of the eyelid.
  • Chronic pink eye: Blepharitis can lead to recurrent episodes of pink eye (conjunctivitis).
  • Corneal injury: Continual irritation from swollen eyelids or misdirected eyelashes may result in a sore (ulcer) on your cornea. An inadequate amount of tearing may also predispose you to a corneal infection.
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