Blepharitis

Blepharitis
Specialty	Ophthalmology

Blepharitis (Template:Pron-en BLEF-ər-EYE-tis) is an ocular disease characterized by chronic inflammation of the eyelid margins. Blepharitis may cause redness of the eyes, itching and irritation of the gritty sensation that may occur, however lubricating drops do little to improve the condition.

Classification

There are two types of blepharitis:

Seborrhoeic blepharitis

Seborrhoeic blepharitis, the most common type of blepharitis, is usually one part of the spectrum of seborrhoeic dermatitis which involves the scalp, lashes, eyebrows, nasolabial folds and ears. Treatment is best accomplished by a dermatologist.

Staphylococcal blepharitis

Staphlycoccal blepharitis is caused by infection of the anterior portion of the eyelid by Staphylococcal bacteria. As the infection progresses, the sufferer may begin to notice a foreign body sensation, matting of the lashes, and burning. Usually, the primary care physician will prescribe topical antibiotics for staphylococcal blepharitis, as this is an acute condition and should heal quickly. The condition can sometimes lead to a chalazion or a stye.

Posterior blepharitis or rosacea-associated blepharitis

The most common type of blepharitis is often found in people with a Rosacea skin type. The oil glands in the lid of rosacea sufferers secrete a modified oil which leads to inflammation at the gland openings which are found at the edge of the lid.

Treatment and management

The single most important treatment principle is a daily routine of lid margin hygiene, as described below. 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 life-long condition.

A typical lid margin hygiene routine consists of four steps:

1. Softening of lid margin debris and oils: Apply a warm wet compress to the lids - such as a washcloth with hot water - for about two minutes. New, dry, warm compress masks can be conveniently warmed in a micro-wave oven and maintain a comfortable 40C temperature for 10 minutes while the waxy oils blocking the glands are cleared.
2. Mechanical removal of lid margin debris: At the end of a shower routine, wash your face with a wash cloth. Use facial soap or non-burning baby shampoo (make sure to dilute the soap solution 1/10 with water first). 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.
3. Antibiotic reduction of lid margin bacteria (at the discretion of your physician): After lid margin cleaning, spread small amount of prescription antibiotic ophthalmic ointment with finger tip along lid fissure while eyes closed. Use prior to bed time as opposed to in the morning to avoid blurry vision.
4. Avoid the use of eye make-up until symptoms subside.

An alternative after washing is to coat the eyelids with a good quality hair conditioner. Leave in place for several minutes then rinse. The conditioner seems to break the bacteria / crusting /irritation cycle, and daily use can eliminate the symptoms.

The following guide is very common but is more challenging to perform by visually disabled or frail patients as it requires good motor skills and a mirror. Compared with the above, it does not bear any advantages:

1. Apply hot compresses to both eyes for five minutes once to twice per day. The "hot wet flannel" treatment is often recommended, however this does not stay hot for long enough, is very messy & potentially unhygienic. A very effective alternative is a flax filled mask which is heated in a microwave oven.
2. After hot compresses, in front of a mirror, use a moist Q-tip soaked in a cup of water with a drop of baby shampoo, or a drop of antibiotic such as Chloramphenicol. Rub along the lid margins while tilting the lid outward with the other hand.
3. In front of mirror, place small drop of antibiotic ophthalmic ointment (e.g. erythromycin) in lower conjunctival sac while pulling lid away from eye with other hand.

Often the above is advised together with mild massage to mechanically empty glands located at the lid margin (Meibomian glands, Zeis glands, Moll glands).

Dermatologists treat blepharitis similarly to seborrhoeic dermatitis by using a safe topical anti-inflammatory medication like sulfacetamide or brief courses of a mild topical steroid. Although anti-fungals like ketoconazole (Nizoral) are commonly prescribed for seborrhoeic dermatitis, dermatologists and optometrists usually do not prescribe anti-fungals for seborrhoeic blepharitis.

If these conventional treatments for blepharitis do not bring relief, patients 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 are very safe and can bring almost immediate relief to patients whose lid inflammation is caused by allergies.

See also

• Seborrhoeic dermatitis
• List of skin diseases
• List of eye diseases and disorders
• Stye
• Chalazion
• Conjunctivitis

External links

• Blepharitis Resource Guide from the National Eye Institute (NEI).
• Mayo Clinic
• Blepharitis description from the American Optometric Association
• eMedicine Health: Eyelid Inflammation (Blepharitis)
• Blepharitis Fact Sheet