Managing Blepharitis

What is Blepharitis?

Blepharitis is an eye disorder characterized with chronic eyelid inflammation, the severity of which varies. The word comes from Latin for “eyelid” suffixed with “itis” to denote an inflammation. Although the condition causes discomforts and dismaying facial features, it does not cause permanent visual impairment and unless it is caused by bacterial infection, it is not contagious. Another medical term used is Angular Blepharitis which affects the corners of the eyelids. Left without treating, it resolves itself within 2-4 weeks. But it is more commonly experienced as a long standing swelling that can be classified according to its cause.

Signs and Symptoms

The most common symptom is itching and burning sensation in the eyelid and often comes with a feeling of foreign body sensation in your eye, often confirmed with a debris in the tear film that covers the eyes. Some are known to experience dry eye syndrome which can lead to discomforts. A reddening and flaking of the eyelid underskin manifested by dandruff-like scaling on the eyelashes are common, along with crusting at the eyelid edges that’s often worse when waking, cysts in the same location (hordeolum), red eye, gritty sensation, and impaired vision. Unlike conjunctivitis, the reddening of the eye whites and swelling of the eyelids appear in advanced cases and are rarely a common symptom at the onset.

People who wear contacts and develop the condition will often find wearing them problematic in coping with the symptoms. Eye irritation is the common complaint among contact lens wearers with the condition.

Types and Causes of Blepharitis

Inflammatory blepharitis occurs on the eyelid margins where the eyelashes grow as well as the oil glands at the base of the lower eyelashes. It often involves either the inner edges of the eyelids that come in contact with the eyeball or the outer edges. The most common trigger is a malfunction of the oil glands of the eyelids and there are about 40 such glands in each of the upper and lower lids. If any of these glands secrete too little, too much or a wrong type of oil, the lid gets irritated, inflamed and itchy. Acne Rosacea, or an abnormal oil gland secretion of the skin is a common cause. Hence, it is not surprising that the most common type is Posterior or Rosacea-induced Meibomian Blepharitis which occur in folks with acne rosacea skin problems/ The oil glands in the eyelids secrete modified oil that result in inflammation of the Meibomian glands at the edges of the eyelids.

Allergic blepharitis is triggered by irritants in the environment like chemicals used in the workplace or at home. It can also be triggered after an exposure to pollen, animal feces, dander, mites and other allergens.

Other blepharitis types include seborrheic blepharitis which is akin to scalp dandruff and staphylococcal blepharitis which is a more severe type caused by bacterial infection of the lash base or anterior portion of the eyelid.

Dealing with Blepharitis

The one simple most important treatment is a daily hygiene routine of the eyelid margin or edge. This routine is important not only to treat the disorder but also to prevent any relapse. Typical hygiene routine consists of using warm wet compress maintained at 40° applied to the eyelids for 10 minutes and a mechanical cleansing of the eyelid margin to remove any debris using a mild non-burning baby shampoo.

After cleansing the eyelid, stand before a mirror and a fingertip application of antibiotic ophthalmic ointment such a erythromycin along the eyelid fissure or eye sac while the eye is closed is recommended before bedtime. Alternatively, you can use gently rub a moist cotton bud soaked in water with a drop of Chloramphenicol across the eyelid while tilting it outward with your other hand. It is also advised that a mild massage over the eyelids can help mechanically empty the glands located at the eyelid margins such as the Meibomian, Moll and Zeis glands.

Dermatologists manage the disorder similarly to Seborrhoeic dermatitis by with the use of topical anti-inflammatory ointments like sulfacetamide or mild topical steroid. But while anti-fungals like Ketoconazole (Nizoral) are typically prescribed for Seborrhoeic dermatitis, both ophthalmologists and dermatologists are one in not prescribing anti-fungal drugs in treating Seborrhoeic blepharitis.

Staphylococcal blepharitis is the infectious kind and is treated with prescriptive topical antibiotics and should heal quickly. If left untreated, it could lead to chalazion or stye.

If conventional therapies do not bring the wanted relief, patients may consider undergoing allergy testing and using ocular antihistamines. Blepharitis can occur as a result of allergy to dust mite feces as well as allergens that cause eyelid inflammation, dry eyes and other instances of ocular irritation. Over the counter and prescriptive antihistamines are generally safe and can bring immediate relief to allergy-caused blepharitis.