Blepharitis

The term blepharitis means inflammation of the eyelid. Inflammation means redness and swelling of tissue. If the inflammation becomes severe enough, there can be pain and tenderness in the affected eyelid.

ANTERIOR BLEPHARITIS

Anterior blepharitis refers to inflammation mainly centered around the skin, eyelashes, and lash follicles.

There are two principal types of anterior blepharitis. Frequently, these two forms are mixed, and occur simultaneously in the same eyelid:

1. 

   Seborrheic blepharitis

   • Greasy scaling of the eyelid margins characterizes the seborrheic form of blepharitis. There is also redness and thickening of the eyelid margins. This condition is virtually identical to common dandruff, except that it involves the eyelashes rather than the scalp hair.
2. Infectious blepharitis
   • Small abscesses that occur adjacent to the eyelash follicles are present in the infectious form of blepharitis. An abscess is a tender mass that the body produces in response to an infectious

     

     organism, such as a bacterium. Pimples are common examples of abscesses. The staphylococcus bacteria usually cause these small eyelash abscesses. When infectious blepharitis occurs, there is redness, swelling, and thickening of the eyelids. If left untreated, destruction of the eyelash follicles occurs with permanent loss of the eyelashes. Also, hordeola and chalazia (discussed next) will result when the infectious form of blepharitis goes untreated. Even with proper treatment, healing can be associated with scarring and distortion of the eyelid margins. Although bacteria cause this condition, it is not something that can be easily given to another person.

POSTERIOR BLEPHARITIS

Posterior blepharitis is an inflammation or infection of the meibomian glands of the eyelid. Meibomian glands are oil glands located at the posterior (back) of the eyelid close to the eye. In comparison, the eyelashes are at the anterior (front) of the eyelid. These glands make oil that is an essential part of the eye’s tears. The oily layer is the outside of the tear film that keeps tears from drying up too quickly.

When the meibomian glands are infected, they no longer produce pure oils. Instead, they harbor and shed bacteria. They also allow bacterial toxins to flow onto the eye and conjunctiva.

When there is posterior blepharitis, the meibomian glands no longer produce a clear oil. Instead, they create a turbid, or cloudy, oily discharge. This discharge is, in some respects, similar to pus.

TREATMENT

HOT COMPRESSES

Apply heat to the closed eyelids for 10 minutes. The application must be HOT, not warm. Shower water is not hot enough. The purpose is to increase the blood supply to the area and to liquefy the oils in the sebaceous glands. Increasing the blood supply will increase the number of infection-fighting cells that migrate to the affected part. Take care not to burn the skin.

EYELID MASSAGE

Apply firm pressure across the surfaces of the eyelids for 30 seconds immediately after the hot compresses. The application of heated compresses will liquify the waxes in the oil glands. In the liquified state, the patient can express the oil from the meibomian glands by massaging the eyelids. Simple pressure across the entire surface of all four eyelids will force the oils out of the oil glands. Once the eyelids are no longer hot, these oils will, once again, become waxes.

SCRUBS

Close the eyes and gently clean the lids and lashes with a commercial eyelid scrub (such as OCuSOFT, Sterilid or Systane Lid Wipes). If these products are too costly, you can use Johnson’s Baby Shampoo placed on a damp washcloth to clean the lids.

The purpose of the scrubbing is to remove debris and scales from the eyelid gland openings mechanically. The openings of these glands are located at the edge of the eyelid. Gently scrub the eyelids and lashes with the eyes closed.

ANTIBIOTIC/STEROID OINTMENT

Place a small amount of the antibiotic/steroid ointment on the tip of a cotton-tipped applicator. Rub this ointment onto the narrow area between your eyelashes and the back of your eyelid. The purpose of this antibiotic/steroid ointment is to reduce the number of infecting organisms that are present at the openings to the eyelid glands.

SYSTEMIC ANTIBIOTIC

When the infection is more widespread, the patient will need to ingest an antibiotic orally as opposed to applying it topically to the eyelid. If you are pregnant, consult your obstetrician before taking the prescribed medication.

Warnings for: Minocycline and Doxycycline

• Use a sunblock. The tetracycline family of drugs can cause a sunburn.
• If you are currently using birth control pills, please use an additional form of birth control while you are taking the Minocycline or Doxycycline and for two weeks after finishing the antibiotic therapy.

DIETARY SUPPLEMENTS

Blepharitis is, in part, due to inadequate flow of the meibomian glands. The following will promote proper flow.

Take these oils on a daily basis, as indicated on the product.

• Flaxseed oil (liquid is best)
• Fish oil (liquid is best)
• Borage oil (liquid is best)
• Water (increase intake significantly)
  • Increase water intake to about one gallon per day for an average individual. If you are a “small” or a “large” person, adjust your dosage accordingly. If you engage in aerobic exercise, increase your dosage accordingly.
• Reduce caffeine intake
• Reduce alcohol intake

Specifically, we recommend:

Barlean’s Total Omega, liquid form only (not soft gels). Liquid Total Omega is available in a flavored form. We strongly recommend the flavored form as it does not have an offensive taste.

NOTE #1: Consult with your primary care physician before starting ANY over the counter supplement. There may be a contraindication for a specific supplement.

NOTE #2: If the supplement indicates a range of dosages, take the maximum dosage unless you are below average in size which may require a dosage adjustment accordingly.