Blepharitis is an ocular condition characterized by chronic inflammation of the eyelid, the severity and time course of which 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 meiobomitis, or parasitic.
Sign and symptoms
Signs and symptoms of blepharitis usually are present in both eyes, affecting the upper and lower lids. They can appear at any age.
Symptoms (what you feel) of blepharitis include
itchy eyelids,
abnormal or decreased oil secretions can result in mild tearing of the eyes,
abnormal or decreased oil secretions can result in a feeling of dryness of the eyes,
burning sensation in the eyes,
gritty sensation in the eyes,
sandy sensation in the eyes,
foreign-body sensation (the feeling that something "may be in the eye"),
crusting of the eyelids,
irritation,
decreased comfort while wearing contact lenses, and
sensitivity to light.
Signs (observations that you make) of blepharitis include
red eye lid margins,
swollen eyelids,
increased shedding of skin cells near your eyelids, causing flaking of the skin around the eyes,
matting of the lashes or eyes "glued together" in the morning,
eyelids that appear greasy and crusted with scales that cling to the lashes,
crusted eyelashes upon awakening,
tears that are frothy or bubbly in nature,
eyelashes that grow abnormally,
loss of eyelashes,
mild scarring of the eyelid margins,
mild ulceration of the lid margins,
dry and flaky patches of skin on the lid, and
dandruff of the lashes and eyebrows.
The symptoms and signs of blepharitis are often erroneously ascribed by the patient as being due to "recurrent conjunctivitis." They are also often mistakenly attributed to "dry eye" by patients due to the gritty sensation that may occur. Lubricating drops, however, do little to improve the condition.
Treatment
In many cases, good eyelid hygiene and a regular cleaning routine can control blepharitis. This includes frequent scalp and face washing, using warm compresses to soak the eyelids, and doing eyelid scrubs.
The single most important treatment principle is a daily routine of lid margin hygiene. The following is a typical lid margin hygiene routine:
Soften lid margin debris and oils: Apply a warm wet compress to the lids -- such as a washcloth with hot water -- for five to 10 minutes two to four times a day, depending on the degree of symptoms. If you want to keep the compresses warm for a longer period of time, you may want to place a small hot water bottle over the compress. Using a clean washcloth for each cleansing is important.
Mechanically remove lid margin debris: After using the compresses, cleanse the eyelids with a cotton applicator stick soaked in a 4 to 1 mixture of water and baby shampoo or an over-the-counter lid-cleansing product. Gently and repeatedly rub along the lid margins while the eyes are closed. Be careful to avoid rubbing or scratching your eyes.
Limiting or stopping the use of eye makeup when treating blepharitis is often recommended, as its use will make lid hygiene more difficult.
If you wear contact lenses, you may have to temporarily discontinue wearing them during treatment.
Other treatment depends on the specific type of blepharitis. The key to treating most types of blepharitis is keeping the lids clean and free of crusts.
If you have dandruff, using a dandruff shampoo may help alleviate your symptoms.
In cases where a bacterial infection is the cause, various antibiotic drops or ointment and other medications may be prescribed along with eyelid hygiene.
Depending on the degree of inflammation of the lid margin, a combination of topical antibiotic and steroid drops or ointments can be prescribed by your physician.
If the blepharitis is thought to be secondary to acne rosacea, treatment with oral doxycycline might be prescribed together with the above lid-margin hygiene routine.
If the blepharitis is due to allergy, efforts should be made to identify and reduce the exposure to the offending agent. Prescription and over-the-counter drop or oral antihistamines may be used. If it is caused by an allergy at home or at work, simply avoiding the allergen (for example, a dog or cat) may avoid future problems.
Recently, there has been some evidence that oral omega-3 fatty acids may be helpful in the treatment of blepharitis.
Prognosis
Good hygiene (regular cleaning of the area) can control signs and symptoms of blepharitis and prevent complications. Good eyelid care is usually sufficient for treatment. Such a routine needs to be convenient enough to be continued lifelong to avoid relapses, as blepharitis is often a chronic condition. One episode, however, does not signify that you have a lifelong condition.
If your blepharitis is linked to an underlying cause such as dandruff or rosacea, treating those conditions may alleviate the blepharitis.
In patients who have multiple episodes of blepharitis, the condition rarely disappears completely. Even with successful treatment, relapses are common. Taking the time to devote extra attention to good hygiene at those times may help to control the condition.
