Blepharitis

Dr Ben Wild

Overview

The eyelids are made up of various types of skin, muscle, glands, hair follicles and much more. Their purpose is to protect the eyes from dryness, bright lights and irritants.

Frontal view of a healthy eye.

Blepharitis is defined as inflammation of the eyelids. It is a common cause of eye discomfort. Blepharitis can be broken down into 4 main types;

1. Staphylococcal.

2. Seborrheic.

3. Demodex .

4. Meibomian gland dysfunction.

Staphylococcal blepharitis is caused by bacteria, is usually easily treatable, and can be associated with atopic dermatitis or rosacea. Seborrheic blepharitis is associated with seborrheic dermatitis, can be treated similarly to eczema, and may need a dermatology referral. Demodex mites tend to be very difficult to manage and patients with this type of blepharitis are usually most symptomatic at night or in the morning.

Meibomian gland dysfunction (MGD) can occur alongside blepharitis or on its own. There are about 40 tiny meibomian glands per eyelid that secrete oil, similar to cooking oil. This oil protects the watery tears produced by the lacrimal gland. If these glands become inflamed, they start producing toothpaste like secretions leading to dry eyes, blurry vision, and possibly, chalazion (blocked gland) or hordeolum (stye) formation.

Front view of an eye with severe blepharitis.

Angular blepharitis is a lesser know 5th type of blepharitis located at the outer corner of the eyelids. It is typically due to bacterial or herpes simplex infections, eczema, skin chaffing and/or constant tear overflow.

Front view of an eye with angular blepharitis.

Signs and Symptoms

Signs

Crusty eyelashes, red eyelids, red eyes, loss of eyelashes, greasy eyelashes.

Symptoms

Stinging, burning, gritty, itchy eyes, mild light sensitivity, poor contact lens tolerance, fluctuating vision.

Causes and Risk Factors

Causes

Immune reaction to bacteria, eczema, and/or demodex mites.

Risk Factors

Poor eyelid hygiene.

Prevention and Treatment

Prevention

Proper lid hygiene which involves washing your eyelashes along with face washing.

Treatments

Common for all: washing lids with baby shampoo, Cetaphil, Blephagel, Systane wipes or other solutions. Hot compresses where you hold a hot face mask to the closed eyelids for 10 minutes followed by massaging your top eyelids downwards and bottom eyelids upwards to clear the meibomian glands, omega 3 supplementation and artificial tear treatments.

Condition specific treatments:

1. Staphylococcal: antibiotic ointment or drops, steroid drops, cyclosporin drops.

2. Seborrheic: steroid drops or ointments.

3. Demodex: tea tree oil, radiofrequency, Intense Pulsed Light (IPL) treatment.

4. MGD: tetracycline type pills, Lipiflow treatment.

5. Angular: antibacterial ointment, eyelid surgery.

Prognosis

Unfortunately, there is usually no permanent cure for most types of blepharitis. If managed properly, there should be no permanent damage to the eyes or loss of vision. If not managed properly, it can lead to permanent scarring and vision loss.