Blepharitis and how to treat it
It is caused by inflammation around the base of the eyelashes. There is a range of treatments that can reduce symptoms, including home remedies.
In this article, we will explain what causes blepharitis, how it is treated, and how it can be prevented.
Blepharitis can affect anyone of any age and is classified as either acute or chronic; chronic adult blepharitis is the most common form. For most purposes, blepharitis means a chronic form of eyelid inflammation.
Here are some key points about blepharitis. More detail and supporting information is in the body of this article.
- Blepharitis is an inflammatory condition affecting the area around the base of the eyelashes.
- The underlying causes of chronic blepharitis are not well understood.
- Blepharitis is not caused by poor hygiene.
- The most obvious signs of blepharitis are redness and stickiness of the eyelid, with clumping of scaly skin around the base of the eyelashes.
- Treatment aims to relieve symptoms, but cannot cure the condition.
Artificial tears may help relieve symptoms.
Treatment for blepharitis normally includes medical and home treatment.
A doctor will recommend home treatment, as described below, but they can also carry out the following treatments:
Electrochemical lid margin debridement (BlephEx): This removes any mites, bacteria, and the biofilm that they create from the eyelids. It also opens any clogged Meibomian glands.
Thermal pulsation treatment (Lipiflow): This melts any material that is obstructing the Meibomian glands.
Intense pulse light therapy (IPL): This opens clogged eyelid glands.
Sometimes, severe cases of blepharitis may require antibiotics, either topical or oral.
Blepharitis can be anterior or posterior.
Anterior: This affects the front edge of the eyelid, where the eyelashes join it.
Posterior: This affects the inner edge of the eyelid, where it meets the eyeball.
The main symptoms are:
- itchy eyelids.
- red eyes.
- irritated and watery eyes.
- flaking and crusting at the base of the eyelashes, similar to dandruff.
- burning or stinging eyes.
- oversensitivity to light (photophobia).
- gritty feeling in eyes and the sensation of having something in the eye.
Symptoms are often more pronounced in the mornings.
Blepharitis is not a sight-threatening problem, but it can result in decreased vision, which can come and go.
The symptoms of chronic blepharitis tend to come and go, with periods of remission (a pause in symptoms) followed by exacerbations (a flare-up). It usually affects both eyes equally.
Here are some pictures of the symptoms of blepharitis.
Blepharitis affects the eyes.
Blepharitis close up.
Image credit: DermNet New Zealand
It can cause irritation
Image credit: Indian Journal of Ophthalmology via openi.nlm.nih.gov
Tiny particles, like dandruff, may collect on the lashes
The eyes can become red
They may be sore and itchy
Complications include styes
Complications include styes.
There are a number of possible causes of blepharitis.
- an inflammatory reaction to bacteria that normally live on eyelids
- seborrhoeic dermatitis or rosacea
- parasites: Demodex eyelash mites
- infection with the herpes simplex virus (HSV)
People who have dandruff are more likely to develop blepharitis. Keeping the dandruff under control can help reduce the symptoms.
Another possible cause is dysfunction of the Meibomian glands on the rim of the eyelids. These glands produce an oily substance that prevents the eye's film of tears from evaporating.
Some doctors believe that blepharitis is a precursor of Meibomian gland dysfunction, rather than the gland dysfunction causing blepharitis.
Eyelid hygiene is important for treating both types of blepharitis. It should be continued even when symptoms have improved.
Self-care is the most important element of treatment. Symptoms of blepharitis can come back if self-care is not continued.
Blepharitis cannot be cured, but treatment can successfully manage symptoms.
In addition to home treatment, people with the eyelid inflammation should avoid using cosmetics such as eyeliner, mascara, and other makeup around the eyes.
Management of blepharitis involves:
- warm compresses, to loosen crusts
- lid cleansing, to remove crusts
- massage, to express the small oil glands of the eyelids
How to use a warm compress
Using a warm compress simply means placing a warm cloth over closed eyelids, reheating the compress with warm water when it cools and reapplying for up to 10 minutes.
- Dipping the cloth in warm water: Some patients have suffered facial burns by using a microwave to heat up the wet cloth.
- Using a soft cloth only: Scrubbing too vigorously or using a rough cloth can damage the skin and eyes.
After applying a warm compress for up to 10 minutes, cleanse the eyelids.
Warming eye masks: These may achieve the same effects as the warm cloth compresses, and they may be more convenient. They are available to purchase online. Eyelid cleansers (Ocusoft, Thera Tears Sterilid) are also available and offer an alternative to the use of dilute baby shampoo.
How to cleanse the eyelids
To do this, gently rub the margin of the eyelid—at the base of the eyelashes, and where the glands are located—with a cotton swab soaked in a dilute solution of baby shampoo. Use 2 to 3 drops in about half a cup of warm water.
This lid hygiene needs to be maintained as a self-care regime twice a day every day. This is a considerable lifelong commitment, but the symptoms will come back without it.
How to massage the eyes
After using the warm compress to loosen the sebum, massaging helps express the oily contents of the glands.
With a finger or a cotton-tipped applicator or swab, massage the margin of the eyelid, where the eyelashes and glands are, using small circular motions.
These are available without a prescription will help to counter the dryness of the eyes caused by blepharitis during the day. Artificial tears without preservatives are the best kinds to use.
Artificial tears are available to purchase online, but you should check with your doctor that they are suitable first.
Doctors will ask about symptoms, take a medical history, and examine the patient's eyelids and eyes.
The doctor will look for signs that help them determine the specific type of blepharitis. They may use a slit lamp.
This is a specially developed, low-power microscope with an intense thin-beam light source.
The lamp allows the doctor to look at the outside of the eyes and the eyelids while the patient's head is held steady by resting the chin and forehead against supports.
The doctor will then recommend treatment. This may depend on the cause. If blepharitis appears to be caused by a skin condition, such as rosacea, or if results from mites, a suitable option will be chosen.
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