Definition

Blepharitis is an eye disease in which the eyelid margins become inflamed. This inflammation can cause burning, irritation, redness and a sticky sensation of the eyes, typically most prominent in the morning. The symptoms of blepharitis are typically mild, though in more severe forms of the disease a heavy build up of crust can occur on the lashes and the lids can become markedly red and swollen.

Cause

There are several forms of blepharitis, which doctors typical classify based on which part of the eyelid margin is most affected. When blepharitis affects mostly the front part of the eyelid and the eyelash bases, it is called Anterior Blepharitis. When the back part of the eyelid margin and the eyelid oil glands are mainly involved, the condition is termed Posterior Blepharitis.

Anterior Blepharitis

Anterior blepharitis is typically caused by an overgrowth of the normal bacteria that usually reside on the skin and eyelids. This form of blepharitis is called Staphylococcal Blepharitis after the eyelid bacteria that are usually the culprit. This overgrowth leads to abnormal metabolism of the oils produced in the eyelid oil glands, causing buildup of crusts on the eyelashes and inflammation of the lash bases and lid margin. This inflammation causes the redness of the eyelid margin and the ocular irritation symptoms typical of the disease. Occasionally, the inflammation is so severe that small ulcerations in the eyelid skin begin to occur and the lashes turn white or fall out in sections where the disease is most active.

Occasionally anterior blepharitis is caused by the same skin condition that causes dandruff of the scalp. In this form of the disease, called Seborrheic Blepharitis, dandruff flakes in this form of blepharitis can collect on the eyelashes, falling into the eye and causing irritation. Inflammation of the eyelid skin can also occur. Occasionally,

Posterior Blepharitis (Meibomian gland disease)

In posterior blepharitis, they oil glands of the eye become inflamed and clogged. These glands, called the meibomian glands, play an important role in ocular health by contributing a small amount of meibomian oil to the tear film. This oil helps stabilize the tear and prevents it from evaporating too quickly. In posterior blepharitis, inflammation of these glands and the skin of the eyelid margin results in ocular irritation and redness of the lids and eye, similar to anterior blepharitis. Further, the dysfunction of the glands begins to produce cloudy or thickened meibomian oil. This abnormal oil results in malfunction of the tear film and causes dry eye syndrome to also occur. Like anterior blepharitis, bacteria play a role in posterior blepharitis by causing malfunction and inflammation of the meibomian glands and eyelid skin. Posterior blepharitis is also often associated with a more general skin and oil gland malfunction condition of the face called rosacea.

Exam

When examining your eyes, your doctor will look for several key findings to help diagnose blepharitis. In anterior blepharitis, crusts are often seen on the eyelashes. The eyelash follicles are often red and inflamed as well. Occasionally, sections of the eyelashes will turn white or patches of eyelashes will fall out. With severe anterior blepharitis, the eyelid skin can become ulcerated as well. Posterior blepharitis causes redness of the back part of the eyelid margin. Often, fine blood vessels will appear on the lid margin, giving it a flushed appearance. Your doctor may also see clogged Meibomian glands, and may press on the eyelids to help squeeze oil out of the glands to help with the diagnosis. Your doctor may also look for signs of dry eye caused by the blepharitis, including irritation of the surface cells of the cornea and conjunctiva.

Treatment

The first step in treating all forms of blepharitis is to improve the hygiene of the eyelids and lashes. For this reason, doctors recommend warm compresses and eyelid scrubs to help remove debris from the lashes and improve the function of the eyelid oil glands. A simple and effective approach to lid hygiene is to apply a hot washcloth compress to the eyelids for a minute or two, which loosens eyelid debris and helps raise the temperature of the eyelid oils, which, like heating butter, makes them more watery. The eyelids are then massaged with the cloth to remove debris and massage the oils out of the meibomian glands. Commercially available lid scrub kits are also available, which add gentle soaps and antibacterial wipes to the lid cleaning regimen.

A second key treatment goal in staphylococcal anterior blepharitis as well as in posterior blepharitis and meibomian gland disease is to decrease the amount of bacteria on the eyelids. For this reason, doctors often prescribe antibiotics for several weeks, either in ointment or eyedrop form. Oral antibiotics from the tetracycline and erythromycin families of antibiotics are often used for several months in posterior blepharitis as well. This class of drugs helps control bacteria and has also been shown to decrease inflammation in the meibomian glands.

If eyelid inflammation is severe, doctors will also sometimes use short courses of steroid drops in blepharitis treatment. These drops are typically combined with antibiotics to help control bacteria and decrease eyelid inflammation.

In cases of seborrheic blepharitis, treatments for the associated dandruff are usually prescribed as well. Dandruff shampoos applied to the scalp and foamed over the face and lids during bathing can be of significant help in this form of blepharitis.

Doctors will often also recommend dietary supplements for blepharitis treatment. Omega-3 fatty acid supplements, such as those found in fish oil, have been shown in a recent study to help improve the signs and symptoms of blepharitis. Additionally, a large study at Harvard demonstrated that higher level of Omega-3s in the diet may also be associated with lower rates of dry eye syndrome. For this reason, your doctor may recommend daily addition of Omega-3 fatty acid supplements to your diet in both blepharitis and dry eye syndrome.

Prognosis

The prognosis for blepharitis is typical very good. The symptoms of blepharitis can usually be greatly improved and controlled for the long term. However, blepharitis often recurs or flares after periods of inactivity. Maintaining good lid hygiene can often help limit these recurrences, though treatment with medication may be required again in the future in many cases. Very rarely, if blepharitis is severe and persists over a long term, permanent damage can occur the eyelid structures and the surface of the eye. For this reason, it is important to work with your eye doctor to maintain good control of blepharitis.

Prevention

Currently, there is no proven way to prevent blepharitis. However, good lid hygiene as well as a diet rich in Omega-3 fatty acids may be of benefit to individuals predisposed to developing blepharitis, as well as those who are not. Blepharitis is not contagious and therefore you should not be concerned that it can be spread from one person to another.