Introduction to Blepharitis
Blepharitis refers to chronic inflammation of the eyelids. Blepharitis
is one of the most common disorders of the eye and is often the underlying
reason for eye discomfort.
Symptoms of Blepharitis
· Chronic itchy, burning, watery eyes
· Sore eyes
· Light sensitivity
· Dilated blood vessels
· Sticky discharge along lash line
· Redness of the eyelid edges
· Frequent sty formation
· Distortion of the front edges of the eyelids
· Chalazia (nodules on the eyelids)
· Loss of lashes due to crusting or greasy, waxy scales
· Tiny pimples on the eyelid edges
· Scaly skin flakes along the eyelid margins
· Gritty, irritating sensation, worse upon awakening
· Blurred vision
· Inflamed cornea
Forms of Blepharitis
Blepharitis is chronic (ongoing) in nature and occurs in two forms depending upon location:
Anterior blepharitis affects the outside front of the eyelid, where the eyelashes
are attached. The two most common causes of anterior blepharitis are bacteria
(Staphylococcus) and scalp dandruff.
Seborrhea blepharitis (pictured at the top of the
page) is the most common and least severe form. Patients are generally older
and have a long history of ocular symptoms. It is not an infection, but is caused
by improper function of the oil glands, causing greasy, waxy scales to accumulate
along the eyelid margins. Seborrhea may be a part of an overall skin disorder
that affects other areas of the body. Hormones, nutrition, general physical condition
and stress are factors in seborrhea. Patients have seborrhea dermatitis as well. Posterior blepharitis affects the inner eyelid (the moist part that makes contact
with the eye) and is caused by problems with the meibomian (oil) glands in this
part of the eyelid. Two skin disorders can cause this form of blepharitis are:
acne rosacea (chronic red and inflamed skin) and seborrheic dermatitis (scalp
Staphylococcus blepharitis is a contagious form,
caused by a germ called staphylococci, commonly known as staph. It often
is contracted in childhood and continues throughout adulthood. On average, patients
with staphylococcal blepharitis are relatively young (around age 42 years) with
a short history of ocular symptoms (around 1.8 years).
Symptoms include any of
the following: scales, matted, hard crusts around the lashes, crusting (that make opening the eyes in the morning difficult), chronic redness
at the lid margin, dilated blood vessels, loss of lashes, sties, and chalazion (pronounced
chuh-LAY-zee-un) - an enlarged lump caused by clogged oil secretions in the eyelid.
Causes of Blepharitis
Meibomian gland openings are plugged with oily secretions.
Notice also prominent blood vessels on eyelid margin.
Meibomian gland dysfunction (MGD) Meibomian glands
are present embedded in upper and lower eyelids. They produce an oily secretion
which forms an important part of the tear film. Dysfunction of the meibomian
glands produces abnormal oily secretions. The tear film becomes unstable and
results in a 'dry eye' as well as chronic red irritated eye. Patients are generally
older and have a long history of ocular symptoms. There are prominent blood vessels
crossing the eyelid margin. In addition there is plugging of gland openings,
resulting in the inability to secrete oil properly and/or thick oily secretions.
Everyone has bacteria on the surface of their skin, but in some people, bacteria
especially thrive in the skin at the base of the eyelashes. Excessive amounts
of bacteria around the eyelashes can cause dandruff-like scales and particles
to form along the lashes and eyelid margins.
Blepharitis is also associated with meibomitis - dysfunction and inflammation
of the nearby oil glands of the eyelids (called meibomian glands). When functioning
normally, these glands secrete a thin oily coating into the natural tear film
that helps to prevent rapid evaporation and therefore helps keep the eyes moist.
Generally, the main causes of blepharitis are:
· Excessive oil produced by the glands in the eyelid Treatments of Blepharitis
· Bacterial infection, often staphylococcal
· Allergic reactions
· Inadequate eyelid hygiene
Treatment is usually ongoing and sometimes frustrating, depending on the type
of blepharitis you have. Expect to keep up therapy for a prolonged period of
time to keep it at bay. Treatment may include:
In addition to alleviating the redness and soreness, proper treatment may prevent
future infection and scarring of the cornea. A complete eye examination by a
qualified eye care professional is essential.
The warm compress portion of treatment is designed to loosen crusts on your eyes
before you cleanse them.
Wash your hands, then dampen a clean washcloth with very warm water, wring it
out and place it over your closed eyes for at least one minute. Repeat two or
three times, wetting the washcloth again with warm water as it cools. This will loosen the scale
and debris around your eyelashes. It also helps dilute oil secretions from nearby
oil glands, preventing the development of chalazion (pronounced chuh-LAY-zee-un)
- an enlarged lump caused by clogged oil secretions in the eyelid. An alternative
variation involves adjusting the shower so that it is a very gentle stream of
very warm (but comfortable!) water that is allowed to flow over the gently closed
eyelids for about 1 or 2 minutes.
When you first begin treatment, do this four times a day, for at least five minutes
each time. Later on, you might apply the compress once a day, for a few minutes.
Your doctor will tell you the specific treatment needed for your eyes.
Back to treatment list Meticulous cleansing
Cleansing the eyelids is essential to blepharitis treatment. Dr. Seibel will
recommend what to clean them with: warm water only, baby shampoo diluted with
warm water or a special product made for cleansing the lids.
First, wash your hands, then dip a clean washcloth (typically draped over your
index finger for control), cotton swab, gauze pad, or commercial lint-free pad
into your cleaning solution. Gently wipe it across your lashes and lid margin
for about 15 seconds per eyelid. Use a magnifying mirror if necessary to avoid
accidentally rubbing the eyeball itself. Rinse with cool water. When you first
begin treatment, your doctor may have you cleanse your lids several times a day.
Later on, you will probably cleanse them about once a day.
Because blepharitis can be a persistent problem, you should practice good skin
and eyelid hygiene to prevent recurrences. In addition to careful cleansing of
your eyelashes, washing your hair, scalp and eyebrows with antibacterial shampoo
can also help control blepharitis.
Back to treatment list Medication
In some cases, it is necessary to use prescribed eye drops, ointment or oral
medication along with the daily cleansing regimen. Be careful to follow recommended
dosages. And with any medication, there is a small possibility of allergy or
other reaction, including skin rash, slight nausea and increased sensitivity
Antibiotic ointment should be applied using a clean fingertip or cotton swab;
gently apply a small amount at the base of the eyelashes before bedtime.
Artificial tears or steroid eye drops may also be prescribed temporarily to relieve
dry eye or inflammation. Although medications may help control the symptoms of
blepharitis, they alone are not sufficient; keeping the eyelids clean to reduce
bacterial count is essential.
Back to treatment list Massaging
If you have meibomian gland dysfunction (MGB), Dr. Seibel will probably recommend
massaging the lids to remove excess oil. Do not use this technique unless specifically
recommended by your doctor after a careful eye examination
In MGD, the meibomian (oil) secretions are thick and the gland openings are clogged.
Think of a toothpaste tube that contains butter instead of toothpaste. When cold,
you would not be able to squeeze the butter out of the tube. However, once you
warm it a bit, then the butter will soften enough to come out of the tube, but
some pressure on the tube (squeezing) would still be necessary.
Going by this analogy, after you have applied warm compresses, the thick oils
in your lids will be more fluid, but a particular type of massage will be necessary
to express them. Therefore after every minute of warm compresses, massage the
eyelids as follows:
Gently close the eyelids. Put your index finger on the outer corner of the eyelid.
Pull the eyelid towards the ear, so that the eyelids are stretched taut. Next
use the index finger of the opposite hand to apply direct pressure to the taut
eyelids starting at the inner aspect of the eyelid near the base of the nose.
Sweep with firm but gentle pressure towards the ear. Repeat this maneuver four
to five times. The goal is to apply gentle pressure to the eyelids as if you
were squeezing a tiny tube of toothpaste - just rubbing the eyelid surface will
not be nearly as productive. If you have any questions, please call us at Seibel Vision Surgery(310) 444-1134.