Anterior Blepharitis

Anterior blepharitis is a chronic condition describing the inflammation of the eyelid margin. Symptoms include irritated, red, itchy or stinging eyes or eyelids, as well as fluctuating or blurred vision. Symptoms can vary in degree throughout the day, and can even be absent. As there are a number of different causes of anterior blepharitis, it is important to treat the underlying problem.

What causes Anterior Blepharitis?

Anterior blepharitis is generally caused by an over-colonisation of organisms (including bacteria and demodex mites) along the lid margin, particularly along the eyelashes and the eyelash follicles. These microbes release toxins which trigger inflammation along the eyelids, causing them to become red, swollen and crusty. The toxins also enter the eye, producing more severe symptoms. This can be an underlying cause of eye infections such as conjunctivitis. Anterior blepharitis should not be confused with posterior blepharitis / meibomian gland dysfunction, although these different conditions often occur together.

Anterior blepharitis before (left) and after (right) treatment.

Demodex Blepharitis

An important cause of Blepharitis is demodex - small mites that inhabit the lid margins, irritating in the same way as bacteria. . Demodex mites are more common on our bodies as we get older, with 100% of those of over 70s having them somewhere. Demodex are resillient to conventional bacterial blepahritis treatments and therefore require a more specific approach. Examination of the lashes under microscope is often needed to visualise the mites and make the diagnosis. This video describes more about demodex blepharitis:

Demodex blepharitis can be trickier to manage as the mites can be resistant to conventional blepharitis treatment. Alternative treatments involving multiple Bleph-Ex procedures using tea-tree oil, and daily lid scrubs with Blephadex Eyelid Cleanser (has a tea-tree oil component) at home over many weeks are often necessary to eradicate demodex from your lashes. Because of this is is important to be careful with hygiene and often a tea-tree based shampoo and facial cleanser, plus regular hot washes of linen etc. is recommended in conjunction with your eyelid treatment to prevent re-colonisation of your lids from other parts of your body.

A demodex mite from a patient's eyelash seen under the mircoscope

Certain patients, including those with roseacea, are more likely to react to the demodex mites and have symptoms. Talk to your optometrist for more detail about this if they suspect demodex blepharitis.

Video taken from our practice showing a demodex mite still wriggling after an affected lash was viewed under the microscope at 100x.

Treatment

With treatment blepharitis can be well managed once the underlying cause has been found. Treatment is aimed at maintaining good lid hygiene so that the eye can be non-irritated and functioning normally. Your lid hygiene routine may be performed more frequently in the beginning, and less frequently once under control.

SteriLid Eyelid Cleanser (also applies to Blephadex Eyelid Cleanser)

SteriLid is an antibacterial foam that gently cleanses the eyelids and lashes while conditioning the skin around your eyes. Linalool, a key ingredient in SteriLid, is a naturally-occurring liquid distilled from plant oils including tea tree oil. Linalool has been formulated into SteriLid to create a gentle, pH-matched-to-skin eyelid cleanser which cleanses yet helps to maintain naturally antibacterial skin oils. SteriLid is available from our online store here.

How do I use SteriLid?

1. Shake the SteriLid bottle well before using.

2. Clean fingertips with SteriLid and rinse.

3. Pump SteriLid foam onto fingertips.

4. Close eyes and massage foam gently into lids and eyelashes for 10 seconds. Avoid directly touching your eyes to prevent stinging. Try and massage as close to the base of the lashes as possible to remove the debris accumulating there.

5. Leave in place for 60 seconds then rinse well with water.

As blepharitis is a chronic condition, therapeutic intervention is sometimes needed initially, to treat and control inflammation in the eye and around the eyelids. Once this is settled, long term management is aimed at proper lid hygiene and maximising tear gland production.

In-Office BlephEx Treatment

This is a new and painless in-office procedure performed by your optometrist at Innovative Eye Care. A rotating cleaner removes debris on the lashes caused by blepharitis to assist home management and improve the lid quality. To see more information about this treatment visit our BlephEx page.

Patients with Demodex blepharitis benefit from this treatment with diluted tea-tree oil every 2-4 weeks as the mites are controlled.

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