Blepharitis

This condition occurs when the eyelids are inflamed and affects its margins or edges. Blepharitis is not serious but it can cause discomfort as irritation would occur. This condition is chronic and affects both eyes. The vision of the patient is not that affected.

Types and Causes of Blepharitis

Blepharitis has three types and these can cause the same symptoms:

  • Staphylococcal blepharitis. This is caused by the bacterial strain staphylococcus which thrives in small numbers in the skin but does no potential harm to the person. But for some patients, this bacterial strain can cause the localized infection of eyelids which can lead to blepharitis. The reason why this bacterial strain can affect other people while it can not affect others is still not clear.
  • Seborrhoeic blepharitis. This type is associated to the skin condition known as seborrhoeic dermatitis where the skin becomes very oily and scaly. This skin condition can cause severe dandruff and rash in the upper body and face. Why seborrhoeic dermatitis happens is not known but some suggests that a yeast bacterial strain called Malassezia furfur may be involved. this yeast bacterial strain thrives in the oil of human skin especially in adults. For some people, this strain does not cause any harm but some people would experience inflammation and irritation due to this. Seborrhoeic dermatitis is not contagious.
  • Meibomian blepharitis. This is also known as meibomian gland dysfunction. Meibomian glands are found in the eyelids, behind the lashes. These glands secrete an oily fluid that goes out in back of the eyelids. This oily secretion is part of the outer surface of the tear film. The tear film lubricates the cornea. People who have this condition have an abnormality in their meibomian glands which can affect the amount of oily secretion a person can produce. This problem can cause inflamed eyelids.

Combinations of the Above

It is very hard to tell the three types of blepharitis apart from each other because they cause the same symptoms. In some cases, seborrhoeic dermatitis occurs alongside meibomian blepharitis. Skin that is inflamed will be infected by staphylococcus almost immediately. So these three types can contribute to the occurrence of each type of blepharitis.

Recurrence of Blepharitis

Blepharitis becomes severe and then level off after some time. This condition is a long time problem because it recurs once a person has been infected by it. For example, if a person has mild inflamed eyelids and then he rubs it in, the inflammation could get worse. The eyelids could become more sore or swollen.

Symptoms for Blepharitis

  • Eyelids becoming sore are the main symptom for this condition. Both eyes will be affected as a result.
  • The eyelids will become inflamed or feel greasy.
  • The eyes would start to secret a sticky discharge and result in making the eyelids stick together after sleeping.
  • Small flakes or even scales could appear on the eyelids. The tiny flakes could be mistaken for dandruff. Crusts below the eyelashes could also start to develop.
  • A single meibomian gland or more can be blocked and be filled with an oily secretion.

The symptoms could get worse and then improve in a matter of days but one thing is sure, it will recur once a person is infected. This is a longtime problem and some patients will not experience the symptoms for a long time.
Aside from the conditions that occur alongside blepahritis, there are three more conditions that are associated with the condition. These are the following:

  • Dry eye syndrome. This can also occur especially when the patient has meibomian blepharitis because the small glands located in the eyelids are not functioning normally.
  • Seborrhoeic dermatitis
  • Rosacea. The symptoms for this condition include having persistent and chronic facial flushing and central redness.

Complications for Blepharitis

Blepharitis is not serious but causes a lot of discomfort. The complications associated with this condition are rare and are not very serious. They would include the following:
In most cases, blepharitis is uncomfortable but not serious. Complications are uncommon and most are not usually serious. They include:

  • Chalazion or meibomian cyst. This condition occurs when there is a swelling in the inner eyelids. This is normally painless and is caused by an obstructed meibomian gland. This condition makes the eyelids bulge and the person becomes unsightly to look at. This is easily treated by hot compress.
  • Stye. This is condition where there a swelling of the outer portion of the eyelids. This is painful and is caused by the infection of a root follicle of an eyelash.
  • For those patients who wear contact lenses, wearing them while having blepahritis may not be such a good idea because it causes great discomfort and may aggravate the symptoms.
  • Eyelashes can also be affected if the blepharitis has been recurring for a very long time:
    • Madarosis or the loss of a lot eyelashes
    • Trichiasis or the eyelashes being misdirected towards the eyes.
    • Poliosis or the discoloration of the eyelash.
  • Eyelid scarring and ulceration are very rare and can be due to the eyelids turning inwards in opposition to the eyeball or entropion or outwards or ectropion.
  • Inflammation of the conjunctiva or conjunctivitis
  • Conjunctival phlyctenules are tiny, triangular, yellowish-white and hard nodules or lumps that surround a big part of small blood vessels. These nodules appear on the lower portion of the eye below the cornea.
  • Keratitis or corneal inflammation, scarring and ulceration. This is a rare and serious complication because it can affect the vision of the patient. The patient should see a doctor immediately if he should feel any eye pain, dryness, loss of vision or grittiness from an infected eye.

Treatment of Blepharitis

The treatment for this condition involves a lot of medication and intervention because blepharitis recurs if the patient does not follow through the treatment. Treatment can only ease the symptoms but not eliminate it completely. The treatment entails a regular hygiene for the eyelids. Other intervention would include taking in antibiotics or the treatment of closely associated conditions.

  • Standard eyelid hygiene. This is very important for the prevention and treatment of blepharitis. This treatments aims to relieve the discomfort in the eyelids, take the stagnant oily discharges from the meibomian gland out to unblock the passages and to strip the eyelids from debris. This regular routine is done in three parts – massage, warmth and then cleansing. The patient should remove his contact lenses when doing the routine.
    • Warmth. This part aims to soothe the skin by softening it and the crusts found attached in the eyelids. This allows the oily secretions in the small meibomian glands to freely flow. Because heat is applied to the meibomian glands, their oily secretions will become more likely to resist flow. Warmth also unplugs or unblocks the glands. Warmth is applied for about five minutes to the infected eyelids.

Traditional methods for applying warmth involve gently pressing a face cloth soaked in lukewarm water to the infected eyelids for five to ten minutes. Should the face cloth become cold, just soak it again in the lukewarm water and reapply to the eyelids.

Nowadays, a specially designed heating bag can also be placed in the infected eyelids for about five to ten minutes as well. This special heating bag can be bought from the optometrists or eye specialists. This special bag is heated inside a microwave for a very short time. The advantage of using this bag over the face cloth is that the special heating bag can retain the heat for a longer period of time. The face cloth usually cools down quickly and has to be soaked in the lukewarm water for a number of times.

    • Massage. After doing the warmth part of the routine, immediately massage the infected eyelid because it helps push the oily secretions out from the small meibomian glands. The following are steps on how to massage the eyelids:
      • Using your middle or index finger, sweep the inner portion of the eyes all the way to the outer portion.
      • Starting from the upper lid, place the finger in the inner corner of the eyes close to the nose. Make sure that the finger is just resting on the infected eyelid above the eyelashes. From there, sweep along the infected eyelid going to the outer portion.
      • Do this again for the lower lid. Place the finger below the eyelashes at the corner of the eyes and sweep outwards going to the temple.
      • Do this routine for five to ten times for thirty seconds immediately after applying warmth.
      • When doing a massage, it should never be too firm or gentle. The patient should not press down too hard on the infected eyelid because it can hurt the eyeball underneath the closed eyelids. Always remember to keep the eyes closed when doing the massage.

 

    • Cleansing. Cleaning the infected eyelids is done after applying warmth and massaging the eyelids. This is done in a lot of ways. The best effective method to clean the eyelids is not known due to lack of research but the following are very useful to clean the infected eyelids:  
      • A traditional method of cleaning the infected eyelids is to dip a cotton bud to a diluted solution of baby shampoo. Adding just a couple of drops of the baby shampoo in a tiny cup of lukewarm water so the ratio of shampoo to water is around 1:10. Take out the excess liquid in the cotton tip to prevent getting the excess solution into the infected eyelid which can cause further irritation. Particularly, clean the crusts below the eyelids. After cleansing the infected eyelids with a cotton bud, rinse the shampoo off the eyelids by dabbing it with clean face cloth.
      • Other people would recommend applying sodium bicarbonate. This is mixed in a small cup of lukewarm water. This can be applied to the infected eyelid using a cotton bud or a clean face cloth.
      • There are eyelid scrubs that the patients can purchase from their optometrists or eye specialists.
      • Some patients wash their eyelids with previously boiled water that has been cooled. This is also effective like using baby shampoo or adding sodium bicarbonate.

The routine of applying warmth, massaging and cleaning should be done at least thrice a day or until the symptoms have settled. Once the symptoms become better, the patient can keep doing the routine just once each day to prevent the symptoms from getting worse. If the patient is at risk of having blepharitis to recur, then he should think of the routine as a part of his daily routine.

  • Antibiotic treatments. Eye ointments or cream that is antibiotic in nature can be advised for patients to use for a while. The ointment should be placed at the edge of the infected eyelid after cleansing the eyelid. There are also available antibiotic tablets that can be used for recurring blepharitis.
  • Other considerations. Rubbing the infected eyelid would only make the inflammation get worse. Try to avoid rubbing your infected eyelids as blepharitis is very common to develop in people who have seborrhoeic dermatitis, dry eye syndrome and even rosacea. Treating these other conditions can also ease the symptoms of blepharitis.

 

Important notice