BLEPHARITIS AND
OCULAR SURFACE DISEASE

Eyelid margin disease is a very common eyelid skin condition characterized by persistent inflammation of the eyelids.  Symptoms may include:

•   eye & eyelid irritation or itching

•   redness of the eye

•   whitish mucous-like discharge from the eye

•   transient difficulty with vision & focusing, esp. during tasks requiring concentration such as reading, driving, etc.

The condition is more common in individuals with other facial skin problems, such as rosacea or acne.  With blepharitis, the bases of the eyelashes can become coated with oily particles from the eyelid tear glands as well as by bacteria that may cause symptoms as described above.  

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WHAT CAUSES BLEPHARITIS ?

Everyone has bacteria on the skin surface, but in some individuals the bacteria can thrive in the skin at the base of the eyelashes.  This is very common, and if there are no symptoms present the condition is not treated.  In many individuals though, these bacteria can trigger a localized inflammation of the eyelid skin leading to a poor quality tear film over the eye surface.  When this occurs, a variety of symptoms may result including irritation, burning, and redness.  Also, since the focusing ability of the eye is highly dependant on a smooth eye surface, affected people can have difficulty with focusing when the eye dries out.  Furthermore, since the oil glands of the eyelid margin may become inflamed as well, the resulting blockage of the gland openings may lead to firm swellings of the gland contents (i.e. styes or chalazion).

HOW IS BLEPHARITIS TREATED ?

It is very important for patients to realize that blepharitis is a chronic inflammatory condition of the eyelid margin skin.  Although there may be significant symptoms that hamper everyday functioning, there is very rarely any hazardous effect to the eye itself.  The condition normally cannot be cured – rather, treatment is aimed at minimizing the uncomfortable eye symptoms.  Many treatment modalities are available, and some may not work in all individuals.

Warm water compresses (with baby shampoo) – it is recommended in all individuals with blepharitis that they moisten the eyelid margin skin with a warm water-soaked cloth (at least once daily) to soften & remove the accumulated debris.  Even more effective is the addition of a small amount of over-the-counter baby shampoo to the cleansing cloth, & then gently rubbing the eyelid margins a few times with the eyes closed.  This will serve to dissolve the oily film that builds up on the lid margin skin & at the bases of the lashes.

Dietery supplements of fish or flax seed oil – there is substantial evidence to suggest that dietary supplementation with these products improves oily gland function throughout the body, & may minimize the irritating effect of oily accumulations on the lid margin.  These should be used as directed on the packaging, & can be purchased at most grocery & health food stores.

Artificial tear drops – if symptoms of eye dryness or fluctuating vision are prominent, commercial artificial tear drops often help in maintaining a moistened & comfortable eye surface.  These drops can be purchased at any pharmacy, & can be used liberally throughout the day on an “as needed” basis.  

Antiobiotic/anti-inflammatory eye drops or ointments – In recalcitrant cases, your ophthalmologist may recommend short courses of eye medications containing an antibiotic and/or a steroid anti-inflammatory agent (i.e. dexamethasone).  These are highly effecting in minimizing the inflammatory component of the condition.  In rare cases, the chronic use of steroid eye medications can cause elevation of the pressure inside the eye, predisposing the individual to an eye disease known as glaucoma.  For this reason, it is stressed that patients on steroid medications use them only as instructed & attend scheduled follow-up to monitor for this pressure elevation.

Oral antibiotics – the tetracycline class of antibiotics (i.e. tetracycline, doxycycline, minocycline) have long been used treat skin condition characterized by oil gland inflammation (i.e. acne, rosacea, etc.).  This anti-inflammatory effect is independent of their antibiotic properties.  Short 4-6 week courses of these agents have shown to be highly effective in treating the symptoms of chronic blepharitis.

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Eyelid scrubs with “tea tree oil” – some cases of blepharitis are caused by particular skin bacteria known as Demodex.  These organisms attach firmly to the base of eyelashes, making them particularly resistant to conventional eyelid scrubbing hygiene techniques.  Your ophthalmologist may recommend supplementing your eyelid cleansing shampoo solution with tea tree oil to facilitate the removal of these Demodex.  The solution can also be purchased at most grocery or health food stores, & is diluted by adding 2-3 tablespoons of the oil to about one cup of your regular baby shampoo wash.  Eyelid scrubbing is then performed as described above

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