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An infant with mild blepharitis on his right side
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Blepharitis (// BLEF-ər-EYE-tis) is a common eye condition characterized by often chronic inflammation of the eyelid, generally the part where eyelashes grow. It generally presents when very small oil glands near the base of the eyelashes don't function properly, resulting in inflamed, irritated, itchy, and reddened eyelids.
It is typically caused by excess growth of bacteria that is ordinarily found on the skin, blockage of the eyelid's oil glands, and sometimes allergies. A number of diseases and conditions can lead to blepharitis.
The severity and time course of it can vary. Onset can be acute, resolving without treatment within 2–4 weeks (this can be greatly reduced with lid hygiene), but more generally is a long-standing inflammation varying in severity.
It may be classified as seborrhoeic, staphylococcal, mixed, posterior or meibomitis, or parasitic. It may be a chronic condition that is difficult to treat, though it usually does not cause permanent damage.
It is typically caused by excess growth of bacteria that is ordinarily found on the skin, blockage of the eyelid's oil glands, and sometimes allergies. The eyelid oil gland dysfunction that leads to blepharitis is triggered by a hormone imbalance. Various diseases and conditions can lead to blepharitis, such as rosacea, herpes simplex dermatitis, varicella-zoster dermatitis, molluscum contagiosum, allergic dermatitis, contact dermatitis, seborrheic dermatitis, staphylococcal dermatitis, and parasitic infections (e.g., Demodex and Phthiriasis palpebrarum).
Symptoms associated with blepharitis include:
- Watery eyes
- Red eyes
- Red/swollen eyelids
- Crusting at the eyelid margins/base of the eyelashes/medial canthus, generally worse on waking
- Eyelid sticking
- Eyelid itching
- Flaking of skin on eyelids
- Gritty/burning sensation in the eye, or foreign-body sensation
- Eyelids appear greasy
- Frequent blinking
- Light sensitivity/photophobia
- Misdirected eyelashes that grow abnormally
- Eyelash loss
- Infection of the eyelash follicle/sebaceous gland (hordeolum)
- Debris in the tear film, seen under magnification (improved contrast with use of fluorescein drops)
It is the most common cause of dry eyes. Among its other potential complications, blepharitis may lead to eyelid scarring following long-term untreated blepharitis, excess tearing, difficulty wearing contact lenses, development of a stye (an infection near the base of the eyelashes, resulting in a painful lump on the edge of the eyelid) or a chalazion (a blockage/bacteria infection in a small oil glands at the margin of the eyelid, just behind the eyelashes, leading to a red, swollen eyelid), chronic pink eye (conjunctivitis), keratitis, and cornea ulcer or irritation.
The lids may become red and may have ulcerative, non-healing areas which may actually bleed. Blepharitis does not tend to cause problems with the patient's vision, but due to a poor tear film, one may experience blurred vision.
Also, the tears might seem frothy or bubbly in nature and mild scarring might occur to the eyelids. The symptoms and signs of blepharitis are often erroneously ascribed by the patient as being due to "recurrent conjunctivitis".
Although pain is not common among blepharitis symptoms, if the condition persists or becomes painful, the individual is recommended to seek medical attention.
It may be uncomfortable and may be unattractive, but usually doesn't cause permanent eyesight damage, though left untreated it can cause injury to the eye's tissue. Chronic blepharitis may result in damage of varying severity which may have a negative effect upon vision and therefore upon the eyeglass prescription.
Staphylococcal blepharitis is caused by infection of the anterior portion of the eyelid by Staphylococcal bacteria. Patients notice a foreign body sensation, matting of the lashes, and burning. Collarette around eyelashes, a ring-like formation around the lash shaft, can be observed, which is an important sign of this condition. Other symptoms include loss of eyelashes or broken eyelashes. The condition can sometimes lead to a chalazion or a stye.
Staphylococcal blepharitis is a condition which may start in childhood and continue through adulthood. It is commonly recurrent and it requires special medical care. The prevalence of Staphylococcus aureus in the conjunctival sac and on the lid margin varies among countries, probably due to climate.
Posterior blepharitis or rosacea-associated blepharitis
Posterior blepharitis is inflammation of the eyelids secondary to dysfunction of the meibomian glands. Like anterior blepharitis it is a bilateral chronic condition and manifested by a broad spectrum of symptoms involving the lids including inflammation and plugging of the meibomian orifices and production of abnormal secretion upon pressure over the glands. It may be associated with skin rosacea, and there is growing evidence that in some cases it is caused by demodex mites.
Though typically tests may not be required, blepharitis may be tested for by: a) a doctor examining eyelids and eyes; and b) in some instances swabbing to collect a sample of the material that has formed on the eyelid, to analyze it for bacteria, fungi, and allergy.
Treatment and management
The single most important treatment principle is a daily routine of lid margin hygiene, as described below. Self-care measures can for most people be the only treatment necessary. Such a routine needs to be convenient enough to be continued for life to avoid relapses as blepharitis is often a chronic condition. But it can be acute, and one episode does not mean it is a lifelong condition.
A typical lid margin hygiene routine consists of four steps. The steps are more challenging to perform by visually disabled or frail patients as they require good motor skills:
- Soften lid margin debris and oils: Place a very warm, wet compress – such as a washcloth with hot water – over the closed eyelids for five minutes. As it cools, re-wet it and reapply it repeatedly. This warms, softens, and loosens crusty and oily eyelid gland deposits.
- Remove lid margin debris: Immediately after, gently wash your eyelids with a warm, wet, soapy washcloth regularly. Use non-burning baby shampoo (make sure to dilute the soap solution 1/10 or 1/2 with water first). This will remove oily debris or scales at the base of the eyelashes, and clean gland orifices. Rinse the eyelid with warm water and pat it dry with a dry towel. Gently and repeatedly rub along the lid margins while eyes are closed. Too much soap or shampoo may remove the essential oily layer of the eyes' own tear film and create further problems with dry eye discomfort. A moist cotton swab soaked in a cup of water with a drop of baby shampoo may be used to rub along the lid margins while tilting the lid outward with the other hand.
- Artificial tears. Lubricating eyedrops or artificial tears, available over-the-counter, may help relieve dry eyes.
- Antibiotics (at the discretion of a physician): To reduce lid margin bacteria to help control blepharitis caused by a bacterial infection, antibiotics such as erythromycin or sulfacetamide may be used via eyedrops, cream or ointments on the eyelid margin, or pills. If used by cream or ointment, after lid margin cleaning, spread small amount of prescription antibiotic ophthalmic ointment with finger tip along lid fissure while eyes closed, using prior to bedtime to avoid blurry vision.
- Steroid eyedrops/ointments. Eyedrops or ointments containing steroids such as testosterone, sometimes combined with antibiotics, can help control eye and eyelid inflammation for short treatments.
- Treat underlying conditions. Blepharitis caused by seborrheic dermatitis, rosacea, or other diseases may be controlled by treating the underlying disease.
- Eye make-up. It may be a good idea to avoid the use of eyeliner and eye make-up until inflammation symptoms subside, as makeup may make it more difficult to keep eyelids clean, and could possibly reintroduce bacteria or cause an allergic reaction.
- Dandruff shampoo. If dandruff is contributing to the blepharitis, using a dandruff-controlling shampoo may relieve blepharitis symptoms.
A 12-minute procedure known as LipiFlow may be used that warms clogged oil glands and applies mild pressure to “milk out” gland oils.
Microbial blepharitis is treated with antibiotics such as sulfacetamide eye ointment applied on a cotton applicator once daily to the lid margins. Ophthalmologists may prescribe low-dose oral antibiotics such as Doxycycline and occasionally weak topical steroids.
Blepharitis caused by demodex mites can be treated using a diluted solution of tea tree oil and using a cotton swab for 5–10 minutes per day. It is typically necessary to continue the treatments for 4–6 weeks to eliminate the infestation.
Physicians may consider allergy testing and ocular antihistamines. Allergic responses to dust mite feces and other allergens can cause lid inflammation, ocular irritation, and dry eyes. Prescription ocular antihistamines and over-the-counter ocular antihistamines can bring relief to patients whose lid inflammation is caused by allergies.
There are no alternative medicine treatments that have been found to conclusively ease symptoms of blepharitis. However, a diet rich in omega-3 fatty acids, or supplements containing omega-3 fatty acids, help treat blepharitis associated with rosacea. Omega-3 fatty acids are found salmon, tuna, trout, flaxseed, and walnuts. Researchers have found Omega-3 supplementation in the form of fish oil or flaxseed to be beneficial in reducing the primary symptoms of blepharitis.
A Cochrane Systematic Review examined 34 studies, consisting of over 2,000 participants suffering from blepharitis or blepharoconjunctivitis. Topical antibiotics were shown to be effective in providing symptomatic relief and clearing bacteria for individuals with anterior blepharitis. Topical steroids provided some symptomatic relief but were ineffective in clearing bacteria from the eyelids. Lid hygiene measures such as warm compresses and lid scrubs were found to be effective in providing symptomatic relief for participants with anterior and posterior blepharitis.
- Emmett T. Cunningham, Paul Riordan-Eva. Vaughan & Asbury's general ophthalmology. (18th ed. ed.). McGraw-Hill Medical. ISBN 978-0071634205.
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|Wikimedia Commons has media related to Blepharitis.|
- Blepharitis Resource Guide from the National Eye Institute (NEI).
- Mayo Clinic
- Basic Guide for Effective Self Treatment of Blepharitis
- Blepharitis description from the American Optometric Association
- eMedicine Health: Eyelid Inflammation (Blepharitis)
- Blepharitis Fact Sheet
- Blepharitis Causes and Symptoms
- Blepharitis, Uptodate