Blepharitis

Blepharitis means inflammation of the eyelids. It can be a troublesome and recurring condition with no one-off cure. However, once symptoms have improved, daily eyelid hygiene can usually keep symptoms to a minimum. Eyesight is rarely affected.

What is Blepharitis?

Blepharitis is an inflammation of the eyelids or eyelashes. It usually affects the edges (margins) of the eyelids. It is not usually serious, but may become an uncomfortable, irritating problem. Blepharitis is typically chronic (persistent). Both eyes are usually affected.

What causes Blepharitis?

There are three main types of blepharitis: staphylococcal blepharitis, seborrhoeic blepharitis and meibomian blepharitis. All three types can cause similar symptoms.

Staphylococcal Blepharitis

This type of blepharitis is thought to be caused by a bacterium (germ) called staphylococcus. This bacterium commonly lives in low numbers on the skin without doing any harm. However, in some people, it seems that this bacterium causes a localised infection of the eyelids, resulting in blepharitis. Exactly why this happens in some people is unclear, but is sometimes related to dermatological disorders.

Seborrhoeic Blepharitis

Seborrhoeic blepharitis is closely associated with a skin condition called seborrhoeic dermatitis. In seborrhoeic dermatitis, the affected skin becomes oilier and can become scaly. Seborrhoeic dermatitis typically causes bad dandruff and sometimes a rash, commonly on the face and upper body.

The underlying cause of seborrhoeic dermatitis is not clear. A type of yeast called Malassezia furfur is involved. However, it is not just a simple skin infection and it is not contagious (you cannot catch this condition from others). This yeast lives in the sebum (oil) of human skin in most adults and usually does no harm. However, in some people the yeast seems to trigger an inflammatory reaction, causing the blepharitis.

Meibomian Blepharitis

This is also known as meibomian gland dysfunction. The tiny meibomian glands in the eyelids lie just behind the eyelashes. You have about 25-30 meibomian glands on each upper and lower eyelid. They make a small amount of oily fluid which comes out on the inside of the eyelids next to the eye. This oily fluid forms the outer layer of the tear film which lubricates the front of the eye.

People with meibomian blepharitis are thought to have a slight problem with their meibomian glands and the fluid they produce. This may lead to eyelid inflammation. (This also explains why people with meibomian blepharitis often have dry eyes as the fluid they make may not be adequate to lubricate the eye and prevent evaporation of your tear layer.)

Combinations of the above

In practice, it is often not possible to tell the difference between the above causes. Indeed, seborrhoeic blepharitis commonly occurs together with meibomian blepharitis. Furthermore, skin which is inflamed in any way is more likely to become infected by staphylococcus. So, all three causes may contribute to each case of blepharitis, with the main cause varying.

A vicious cycle

People with blepharitis tend to have flare-ups of symptoms from time to time. As mentioned, blepharitis is usually a long-term (chronic) problem, and its causes are usually chronic too. Sometimes a vicious cycle plays a part. Typically, you rub your slightly sore and inflamed eyelids, further irritating them, causing more inflammation. This results in your eyelids becoming more sore and itchy, and the temptation to rub them even more increases, which causes more inflammation, and so on.

What are the symptoms of Blepharitis?

  • The main symptom is sore eyelids. Both eyes are usually affected.
  • The eyelids may look inflamed or greasy.
  • The eyes may become sticky with discharge. In particular, the eyelids may stick together in the morning.
  • Sometimes tiny flakes or scales appear on the eyelids which look like small flakes of dandruff. Crusts may develop at the base of eyelashes.
  • One or more of the tiny glands of the eyelids (meibomian glands) may block and fill with an oily fluid.

Symptoms often come and go. Typically, symptoms flare up from time to time, but you may have long periods without any symptoms.

Three other conditions are commonly associated with blepharitis. They are:

  • Dry eye syndrome (keratoconjunctivitis sicca).
  • Seborrhoeic dermatitis – described above.
  • Rosacea. Symptoms include facial flushing, spots, and central facial redness.

What are the possible complications of Blepharitis?

In most cases, blepharitis is uncomfortable but not serious or sight-threatening. Complications are uncommon. They include:

  • Chalazion (meibomian cyst). This is a painless swelling, most prominent on the inside of the eyelid. It is due to a blocked meibomian gland. Although it is painless, it may make the eyelid bulge and look a little unsightly. It can easily be treated. Sometimes a chalazion can become infected and painful.
  • Stye. This is a painful infected swelling most prominent on the outside of the eyelid. It is due to an infection of the follicle (root) of an eyelash or the sebaceous glands on the skin.
  • Contact lens wearers may find their lenses feel uncomfortable when they have a flare up of blepharitis.
  • Changes to the eyelashes (which mainly occur in severe and long-standing cases). These include:
    • Loss of eyelashes (madarosis).
    • Misdirection of eyelashes towards the eye (trichiasis).
    • Depigmentation of the eyelashes (poliosis).
  • Eyelid ulceration and scarring (uncommon). This can cause the eyelid to turn inwards against the eyeball (entropion) or outwards (ectropion).
  • Conjunctivitis (inflammation of the front of the eye). This may cause a sore, red eye with discharge or watering.
  • Conjunctival phlyctenules. These are small (1-3 mm), hard, triangular, yellowish-white nodules (lumps) surrounded by prominent but tiny blood vessels. If they develop they usually occur on the lower part of the eye just below the cornea. They consist of white blood cells that collect in response to bacterial infection – such as staphylococcus.
  • Corneal inflammation (keratitis), ulceration, and scarring. This complication is rare but serious as it can affect sight. See a doctor urgently if you develop eye pain (more than the irritation/grittiness of dry eye) or any loss of vision from the affected eye.

What is the treatment for Blepharitis?

There is no one-off cure for blepharitis, as the inflammation tends to recur if you do not keep up with treatment. However, with regular treatment, symptoms can usually be eased and then kept to a minimum. This tends to prevent flare-ups. The main treatment is regular eyelid hygiene. Other treatments that may be needed include antibiotics, steroid creams (occasionally) and specific treatment for associated conditions.

Navibleph is a new foam that can be used as follows:

1.Spray the foam into the palms of your hands after washing them.

2.Massage the foam into your eyelashes for a minute(both eyes), with your eyes closed and then leave to settle on the lashes for another minute.

3. Rinse the foam off with luke warm water.

Dr Fischer eye care cleansing eye wipes can also be used twice to three times per day if the infection is confined to the eyelashes. Dr Joseph will inform you of this if it is necessary.

Antibiotic treatments

Antibiotic eye ointment or drops may be advised for a while if an eyelid becomes infected. If you are prescribed ointment, place it on the edge of the eyelid (not the eye) after cleaning the eyelid. Antibiotic tablets are also commonly used for troublesome infected eyelids. Note: a three month course of antibiotics is typically used in the treatment of blepharitis.

Other things to consider

Rubbing your eyelids may make inflammation worse, so try to avoid doing this. As mentioned above, blepharitis commonly develops in people with seborrhoeic dermatitis, rosacea or dry eye syndrome. If relevant, treatment of these other conditions may also help to ease symptoms of blepharitis.