What is Blepharitis?
Blepharitis is a chronic inflammation of the eyelids. An episode may last for a few weeks, but most frequently it is a long-lasting inflammation that can last for months. There is no cure for blepharitis but symptoms can be eased by the appropriate treatment. Once symptoms have improved, daily eyelid hygiene can usually keep the symptoms to a minimum.
Symptoms can vary a lot but include
- Redness of the eyelids.
- Flaking of the skin on the lids.
- Crusting at the lid margins.
- Eyelid cysts (chalazion)
- Red eye.
- Debris in the tear film.
- Gritty sensation of the eye.
The commonest combination of symptoms are itching of the eyelids, irritation of the eyes and eyelids, a gritty sensation in the eyes and a burning sensation. These symptoms can be worse in people who wear contact lenses or who work in dry, smoky or dusty environments. Other blepharitis symptoms include sensitivity to light, eyelashes that grow inwards or even loss of eyelashes. The tears may seem frothy or bubbly in nature. Mild scarring or pitting can occur on the eyelids.
Specialised oil glands, meibomian glands, are found in a row along the back edge of eyelids. These function abnormally in blepharitis, producing too much oil or becoming blocked due to the oil becoming more viscous. A blocked meibomian gland may then develop into a chalazion or cyst of a meibomian gland. These are often roundish swellings which are often non tender. If they become infected then they can become painful.
Types of Blepharitis
There are three main types of blepharitis.
- Staphylococcal blepharitis. This type is thought to be caused by a bacterium called staphylococcus, which commonly lives in low numbers on the skin without causing harm. However, in some people this bacteria can cause a localised infection of the eyelids resulting in blepharitis. The eyelid margins are red with dilated blood vessels. There are hard scales around the bases of the eyelashes. In severe, longstanding cases there may be notching and scarring of the eyelids with loss of eyelashes.
- Seborrhoeic blepharitis. This type is closely associated with a skin condition called seborrhoeic dermatitis. In this condition the affected skin becomes oily and scaly. The eyelids are red with oily debris and scales clinging to sticky eyelashes.
- Posterior blepharitis. The meibomian glands lie just behind the eyelashes and there are about 30 of these glands on the upper and lower eyelids. If the oil production from these glands is abnormal then the lids become inflamed and the surface of the eye irritable.
Cleaning the eyelids regularly helps to reduce the build up of oils along the eyelids and helps to unblock meibomian glands. Firstly the lids need to be heated, usually with a face flannel soaked in very warm water. The lids should then be massaged by sweeping the finger tips along the eyelid. This helps to push the oil out from the glands. Finally the lid margins need to be cleaned (see pictures below). This is simply achieved by using a cotton tipped bud dipped in baby shampoo (diluted with warm, boiled water to shampoo ratio of 10:1). The shampoo will act as a detergent on the oil and help to remove the excess from the eyelid margins. Alternatively, a solution of bicarbonate of soda can be used, placing a pinch of bicarbonate in a small glass of warm, boiled water.
Frequently, blepharitis causes and imbalance of the tear film and so many people with blepharitis find lubricating eye drops very soothing when used regularly. If lid cleaning does not relieve the symptoms of blepharitis then additional treatment with antibiotic drops or cream is necessary and steroid drops may also be needed in cases which are slow to respond. Chronic blepharitis which is very symptomatic may require oral antibiotics for several weeks to improve the condition.