Blepharitis

Useful Terms

Blepharitis = inflammation or swollenness of the eyelids involving bacteria and oily particles

Anterior Blepharitis = one of the two main types of blepharitis that occurs at the outside front edge of the eyelid where the eyelashes are attached; can co-occur with posterior blepharitis with varying degrees

Posterior Blepharitis = one of the two main types of blepharitis that occurs at the inner edge of the eyelid that directly contacts the eyeball; can co-occur with anterior blepharitis with varying degrees

Rosacea Blepharitis = a component of another disease known as ocular rosacea, in which skin oil glands malfunction and cause redness and swelling in the eyelids

Common Symptoms

  • Irritation in the eyes and/or eyelids
  • Eyelid and eyelash crusting
  • Itchiness
  • Tearing
  • Redness in the eyes and margins of the eyelids
  • A sensation of burning within the eyes
  • A sensation that there is a foreign substance in the eyes
  • Scant and broken eyelashes
  • Dry scaling or dandruff on the scalp and eyebrows
  • Noninfected, painless bumps in the eyelid called chalazion
    • When the chalazion becomes infected, it become a stye

Risk Factors

  • Those people who have a tendency towards experiencing:
    • 1) Oily skin
    • 2) Dry eyes
    • 3) Dandruff
  • May co-occur with meibomianitis, which is a condition marked by some kind of defect or malfunction in the meibomian glands, which are the oil glands located in the eyelids
  • Ocular rosacea may co-occur with acne rosacea, which is a common skin condition made evident by the characteristic redness in and pimple-like bumps on the face
  • Seborrheic Dermatitis is a skin condition that generates unnatural flaking and white-yellow scaling that may affect the eyelids
    • This may lead to the development of seborrheic blepharitis, which is a subtype of anterior blepharitis
  • Diabetes
  • Poor hygiene
  • Chemical irritants
  • Cosmetic makeup
  • Advanced/elderly age

Causes

  • Defective meibomian glands may reduce output or result in the production of unusual and irregular oil secretions
    • This may lead to the irritation and inflammation of the eyes and eyelids, tearing, eyelid crusting, and formation of chalazion and later stye.
  • Large amounts of bacteria near the eyelashes can cause the scaling and oily particles to develop along the eyelashes and margins of the eyelids
  • Seborrheic dermatitis is a major cause of the condition overall
    • This involves yet another malfunctioning and defective gland known as the sebaceous gland
    • Skin cells start to shed far more quickly than usual and abnormal amounts of oil are secreted
    • The large amount of skin cells and oily secretions may contribute to the growth of bacteria, such as Staphylococcus
  • Direct contact with the eyelid (ex. application of cosmetic makeup) may result in inflammation due to allergic reactions

Diagnosis

  • Review of family medical history
  • The ophthalmologist will perform a routine eye exam, paying particularly close attention to the eyelids and eyelashes
    • This is usually all that is required to diagnose blepharitis
  • The usual eye charts (ex. reading letters at certain distances) are used to test for visual acuity and clarity
  • Slit Lamp Microscope
    • As with the diagnosis procedures for eye allergies and bacterial keratitis, the slit lamp microscope also proves useful here
    • It emits a slit-like beam of light in order to illuminate various parts of the eye
    • These areas are greatly magnified to look for the extent and nature of the blepharitis in the eye and how it may impact the other areas within and around the eye
  • Laboratory Analysis
    • In those cases in which the inflammation looks to be unusual or fails to react to treatment, laboratory analysis is a highly recommended option
    • The ophthalmologist may take a sample of the oil or crust on the eyelids with a cotton swab
    • The eye is examined for the presence of bacteria, fungi, or an allergic reaction in order to determine what caused the blepharitis so as to develop an appropriate treatment plan
    • Biopsy
      • A small piece of the eyelid is collected and tested to distinguish chronic blepharitis from cancer

Treatment

  • Warm Compresses
    • Use a clean washcloth, cotton swab, or commercial lint-free pad in combination with warm water to clean out the eyelids by placing the wet washcloth on the eyelid for one minute at a time for 3 – 4 repetitions
      • Don’t forget to wring out the washcloth after placing it in the warm water and to place in the warm water again after every time it cools
    • This procedure will help loosen scales, dandruff, and any other such debris from around the eyelashes
    • Additionally, it also aids in the degenerating the abnormal oil secretions, which help prevent the formation of chalazion and, consequently, stye
    • These kinds of self-care treatments could be the only necessary treatments to successfully treat most cases of blepharitis
  • Antibiotics
    • Gentle application of an antibiotic ointment with the use of a cotton swab should be done at the base of the eyelashes before one goes to bed
      • This is usually used to treat those cases of blepharitis that are caused by bacteria, such as the Staphylococcus aforementioned
  • Steroid Eyedrops
    • This is used as a means of controlling and curbing the inflammation experienced by the eyes and eyelids
  • Artificial Tears
    • Also known as lubricating eyedrops, they may be used to bring relief to those who have a tendency towards experiencing dry eyes
    • They may also control the inflammation of the eyes and eyelids, as do the steroid eyedrops
    • Exercise caution when using these eyedrops, as some people may be allergic to the preservative chemicals contained within
  • Nutritional Therapy
    • There is much research that indicates that an imbalance of omega fatty acids could lead to the breakdown of the meibomian glands and the resulting abnormal oily secretions that aid with the lubrication in the eyes
    • It is strongly recommended to consult with the ophthalmologist about any supplements or diets to undertake to correct this imbalance
  • Good Hygiene
    • Since blepharitis is an ongoing condition, it is best to maintain regular care and washing of the skin, eyes, and eyelids in order to prevent its reoccurrence
    • It is suggested that that care also be supplemented with the usage of antibacterial shampoo when washing the scalp, hair, and eyebrows
  • Treatment of Underlying Conditions
    • Since blepharitis may be directly caused by other pre-existing conditions and maladies, such as seborrheic dermatitis and ocular rosacea, it can be controlled through the treatment of these other diseases