What is Blepharitis?
Blepharitis is a chronic inflammation of the eyelid. The eyelid has many structures within it, including eyelash follicles and oily and sebaceous glands. In blepharitis, some or all of these structures become inflamed. The cause of the inflammation is not always known, but it can be due to bacterial infection, Demodex (a microscopic mite) infections, and it can sometimes be associated with other diseases, such as rosacea.
Common symptoms of blepharitis include irritation, itchiness, a burning sensation, excessive tear production, and encrusted or sticky eyelids. As well as these symptoms, patients may experience intermittent blurring of their vision and sensitivity to light.
Why would I suffer from blepharitis?
Blepharitis is a very common condition; as we go through life, many of us will have some signs and symptoms of it from time to time. There are many different causes and they are not always understood. During your assessment, I will be able to look at what the possible causes might be and advise specific treatment – even if a specific cause can’t be identified.
How can I treat Blepharitis?
Blepharitis is a chronic (ie ongoing) condition that is rarely cured. However, there are many simple things you can do to reduce the signs and symptoms. Even when you have responded well to treatment, the condition can wax and wane – so taking a long-term approach to treatment is a good idea. We recommend the following three-part regime for treating blepharitis:
1. Hot compress and eyelid massage
The best way to do this is with heat pads or eye bags that have been specially designed for treating blepharitis. There are a large number available commercially. Here are a selection to choose from:
Each product will come with its own instructions, but in general it’s best to heat the pad (according to the specific product instructions), then apply it for five minutes. After that you’ll need to gently massage your eyelids, massaging the upper lid downwards and the lower lid upwards. Then reapply the heat pad for a further 10 minutes, and repeat the massage.
2. Lid cleaning
After heating up the eyelids and massaging them, you’ll need to carefully clean the eyelids. This can be done with a homemade solution: dissolve one teaspoon of sodium bicarbonate in a cup of water which has been boiled and then cooled. Or it can be done with pre-made (manufactured) blepharitis wipes. I recommend using the pre-made wipes; there are a number of different ones available, but I think CLIRADEX or OCUSOFT PLUS are the best ones available. When wiping your eyelids, your wiping action should be in an upwards and outwards direction on the lower lid and downwards to outwards on the upper lids.
Blepharitis has a significant effect on the quality of the tears your eyes can produce, which can result in either a dry eye or a watery eye (see: Why would I need eye drops when I have watery eyes?, below). As a result, using liquid teardrops and / or lubricant ointment can make a big difference. There are many liquid teardrops available, all of which you can purchase over the counter without a prescription. Often in blepharitis, the tears evaporate too quickly and therefore drops that help to prevent this are very helpful. There are two commercially-available drops that help to recreate the oily layer of the tears: OPTIVE PLUS and SYSTANE BALANCE. I would advise that you use these drops frequently at first (at least 4-6 times a day). I also often advise using a lubricant ointment at night – VITAPOS ointment is my personal recommendation. You should be able to get good advice from your pharmacist about which drops to use as well.
If you carry them out regularly, these three simple measures can make a big difference to your symptoms. But there are some additional therapies that can help with Blepharitis treatment – see the section What other treatments are available?, below.
What other treatments are available?
There are a number of treatments that we could consider for your blepharitis. These include:
Omega 3 fatty acid supplements: There is some evidence that these commonly available supplements can be beneficial when it comes to improving the quality of the tear film.
BlephEx treatment: This treatment uses a specially-designed device to remove the debris and material that accumulates on the eyelids due to blepharitis. If this material proves difficult to remove with the simple, three-part measure described above (see How can I treat Blepharitis?) then BlephEX could be helpful. A number of opticians provide this treatment; I would be very happy to put you in touch with recommended opticians if you are interested to find out more about it.
Antibiotics: We do occasionally prescribe either topical or systemic antibiotics for treatment of Blepharitis, but I would always recommend a trial of the simple measures listed above before you consider them. This is something we can assess with you in clinic.
Why would I need eye drops when I have a watery eye?
Watery eye is one of the common symptoms of blepharitis. This is often intermittent and worse when reading, using a tablet or computer, or when outdoors and exposed to wind. The reason for this is the effect that blepharitis has on your tear film. The surface of your eye is covered in a thin layer of tears. In fact the tear layer is itself comprised of three separate layers. The bottom layer, on the surface of the eye, is made up of mucous, which is secreted by goblet cells on the conjunctiva (the lining over the white of the eye). The next is the aqueous layer, which is secreted by the lacrimal gland. The final one is a lipid layer, which is secreted by the oily glands within the eyelid. This layer coats the top of the tear film; its purpose is to prevent the aqueous layer from evaporating. If blepharitis is affecting the function of the oily glands in your eyelids, the lipid layer isn’t as effective at protecting the aqueous layer; as a result, the aqueous layer starts to evaporate and the eye dries out. In response to the evaporation of tears, the lacrimal gland produces an excess of the aqueous layer and the eye waters. As well as causing your eyes to water, this evaporation of the tear film will cause an intermittent blurring of vision, and will often be worse when reading, using a tablet or computer, or when outside in the wind or in an air conditioned environment. Please follow the advice about managing blepharitis as well as the use of lubricant eye drops (see How can I treat Blepharitis?, above).
For more information on blepharitis please visit the BOPSS website.