Blepharitis

What is Blepharitis?

Blepharitis is a common chronic inflammatory condition of the eyelids. It makes your eyelids red, swollen, itchy and irritated. Blepharitis is one of the most common ocular disorders encountered in clinical practice and is one of the major causes of dry eyes. As blepharitis is chronic in nature, there is no cure instead good hygiene is required to avoid any flare ups.

Blepharitis can be uncomfortable, but it is not contagious.

What are the types of blepharitis?

There are two types of blepharitis depending on the anatomical location of the inflammation, although there is considerable overlap, and both are often present.

• Anterior Blepharitis: Anterior blepharitis affects the eyelid skin at the base of your eyelashes. This type of blepharitis causes redness, swelling and irritation at the base of your eyelashes
• Posterior Blepharitis (meibomian gland dysfunction): Posterior blepharitis affects your meibomian glands at the inner edge of your eyelid (the part that touches your eye). This type of blepharitis causes your oil glands to become clogged up.

What are the causes of blepharitis?

Blepharitis is suspected to be multifactorial in nature.

Anterior blepharitis is caused by a bacteria overgrowth around the base of your eyelashes. Another cause is an excessive build-up of eyelash mites called Demodex.

Posterior blepharitis (meibomian gland dysfunction) is characterised by abnormalities of the meibomian (oil) glands and altered secretion of oil. This causes a poor-quality tear film leading to dry eyes. An overpopulation of bacteria contributes to posterior blepharitis. Common skin conditions such as rosacea, seborrheic dermatitis, allergies and scalp dandruff can also cause posterior blepharitis.

What are the symptoms of blepharitis?

Symptoms of blepharitis include:

• Red eyelids
• Eye irritation
• Watery eyes
• Crusty eyelids
• Itchy eyes
• Dry eyes
• Burning sensation
• Sensitivity to light
• Blurry vision

What conditions can blepharitis cause?

• Dry eyes: blepharitis can cause disruption of the tear film and an increased evaporation of tears
• Stye (hordeolum) is an infected meibomian gland, it presents as a red painful lump.
• Chalazion is a hard painless lump on your eyelid often caused by a previous stye that has not gone away
• Corneal damage from prolonged inflammation and irritation, which may lead to ulcerations, corneal neovascularisation (blood vessels growing across the cornea) and scarring.
• Chronic red eyes from prolonged inflammation

How do I treat blepharitis?

As blepharitis is a chronic condition with frequent flare ups, the aim of treatment is to reduce the symptoms. Eyelid hygiene remains the main stay of treatment.

Anterior Blepharitis

• Lid scrubs involves cleaning the base of your eyelashes with anti-microbial products to remove excess oil, debris, bacteria, and other irritants that can contribute to inflammation.
• Blephex is an in-office eyelid hygiene which mechanically exfoliates the eyelid margins. Blephex gently removes debris, crusts, and biofilm from the surface of the eyelids.
• Zest is an in-office lid cleaning and debridement system using a natural okra-based gel. It is an effective treatment for killing demodex mites, removing dirt and debris and relieving associated inflammation.

Posterior Blepharitis (meibomian gland dysfunction)

• Hot compress is used to soften meibum (oil) and open the oil glands, allowing for the release of accumulated oil and debris.
• Intense Pulsed Light (IPL) therapy is a treatment option for posterior meibomian gland dysfunction. It reduces inflammation around the meibomian glands and stimulates the meibomian glands.  
• Omega-3 fatty acid supplements such as Lacritec have been shown to improve meibomian gland function and reduce symptoms of blepharitis
• Medical therapy such as anti-biotics and anti-inflammatories to reduce inflammation and bacterial overgrowth
• Management of Underlying Conditions: Treating underlying conditions such as rosacea, seborrheic dermatitis, or allergic reactions may be necessary to effectively manage blepharitis symptoms.

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