Blepharitis

What is blepharitis?

Blepharitis is a term that is used to refer to chronic inflammation of the eyelid margins. It can be sub-divided into two broad categories. These are:

  • Chronic Anterior Blepharitis

This affects the front portion of the eyelid margin, specifically around the bases of the eyelashes. It can be caused by bacteria, in which case you get crusting or ‘dandruff’ of the eyelashes, or a change in the sebaceous (i.e. sweat) glands associated with the eyelashes, causing the eyelids to look greasy and the eyelashes to clump together.

  • Chronic Posterior Blepharitis

This can also be referred to as Meibomian Gland Dysfunction (MGD) as it primarily affects the meibomian glands located within the eyelids. The pores of these glands open out on to the eyelid margins, behind the bases of the eyelashes, and the glands themselves produce an oily secretion that normally prevents the tear film from drying out. In MGD, bacteria cause these glands to become blocked, preventing this oily secretion from being released and thus compromising the quality of the tears being produced.

Although this suggests that there are technically two types of blepharitis, they rarely occur in isolation and both tend to contribute to the same symptoms. They can also cause the eyes to look red, the eyelids to look swollen and ocular surface changes associated with dry eye.

Who suffers from blepharitis?

Blepharitis is a very common condition and approximately 5% of all eye problems in primary care are said to be related to it in some way. It can affect people at any age but tends to be more common in people over the age of 50 years. It is not something that is 'caught' or inherited and sometimes it is not always clear as to why someone may have developed it in the first place.

What are the symptoms of blepharitis?

There are people with blepharitis who may not suffer from any symptoms at all. However, those who do experience symptoms could report any and/or all of the following:

  • Burning sensation in the eyes
  • Gritty sensation in the eyes
  • Irritation/Itchiness of the eyelids and/or eyes
  • Pain/Discomfort on looking at lights (i.e. photophobia)
  • Sticking together of eyelids on waking in the morning
  • Increased watering of the eyes
  • Intermittent blurring of vision (i.e. having to blink to clear the vision)

 

The symptoms associated with blepharitis tend to be worse in the morning but could get worse as the day goes on.

How is blepharitis diagnosed?

In primary care, a GP would generally diagnose blepharitis based on the patient’s history and symptoms alone. However, when a slit lamp bio microscope is available, as would always be the case in community optometric practice or at the hospital eye department, the eyelid margins can actually be examined under magnification. This visualisation of the eyelid margins along with the patient’s history and symptoms helps to confirm the diagnosis and enable the practitioner to facilitate an appropriate management plan for that patient.

How is blepharitis treated?

Unfortunately there is no cure for blepharitis and so any treatment of the condition is with a view to managing the symptoms associated with it. It also doesn’t help that blepharitis is a chronic condition, meaning that the symptoms may recur if the patient stops treating it. This is why many patients with blepharitis may be treating the condition on and off for the rest of their lives depending on how severe the symptoms are.

There are many different ways in which blepharitis can be treated and naturally with ongoing research and developments in the field the advice given to patients has varied over the years. The fact that there is no definitive treatment indicates that there is no one regimen that works significantly better than the others. It really just depends on what provides the most symptomatic relief for the patient.

Any treatment of blepharitis is generally with the intention of improving the overall hygiene of the eyelid margins in order to reduce the associated inflammation. Put simply, this means regular cleaning of the eyelid margins. This can be achieved in a number of ways and here at John Weygang Optometrists LLP we provide a range of products that are specifically designed to help do this in the most effective way possible. For more information on these products, please contact us at any of our practices.

Another approach, particularly if you have been told that you have blocked glands in your eyelids (i.e. MGD – please see above), is to use a hot compress over each eye followed by eyelid massage. You can try this at home using the following procedure:

  1. Wash and dry your hands
  2. Take a clean flannel and soak in a bowl of hot (but not too hot!) tap water (cooled boiled water isn’t necessary)
  3. Place the flannel over your closed eyes and apply gentle pressure until the flannel cools.
  4. Rewet the flannel and repeat Step 3
  5. Keep doing Steps 3 – 4 for approximately 5 – 10 minutes.
  6. Once complete, run your index finger along the length of each eyelid separately (i.e. upper and lower for each eye) starting from the edge of your nose and whilst applying gentle pressure

 

Ideally it would be useful to do this procedure twice a day (or at least once a day) for about 4 – 6 weeks as it can generally take 4 – 6 weeks of routinely treating blepharitis before noticing any improvement in the symptoms. However, if the flannel is not working for you then we do provide a range of hot compress products that tend to be more effective in the long-term. For more information, please contact us.

Is there anything else that can be done?

In addition to what has already been discussed, other management options include:

  • Avoiding irritants

Minimising exposure to certain chemical irritants (i.e. eye drop preservatives, makeup etc.) can help to reduce the symptoms associated with blepharitis

  • Making dietary changes

There is some evidence to suggest that increasing our intake of omega-3 oils such as those found in Flaxseed can help to improve the quality of our meibomian gland secretions

  • Antibiotics

Occasionally if there is marked bacterial involvement suspected or if there is an associated skin condition such as seborrhoeic dermatitis or acne rosacea then your GP may prescribe antibiotics either in the form of an eye ointment or tablets taken orally

It is important to note that the cleaning of the eyelid margins with diluted additives such as baby shampoo or sodium bicarbonate tends to exacerbate the symptoms of blepharitis and so for this reason would not be advisable.

If you are struggling with the symptoms outlined above and suspect that you may have blepharitis then it would be advisable to book an appointment to see one of our optometrists in the first instance. They will be able to advise accordingly and make further recommendations, referring you on to your GP or to the hospital eye department if necessary.  

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