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What is blepharitis?

Blepharitis, which literally means “inflammation of the eyelids,” is an extremely common condition in which the eyelids become red and swollen, often leading to symptoms of burning, itching, irritation, foreign body sensation, sensitivity to light, and blurred vision. Although the condition is not an actual infection, toxins released by bacteria which normally live within the skin of the eyelids contribute to the associated inflammation. Blepharitis is often divided into two forms- anterior and posterior.

In anterior blepharitis, inflammation is most pronounced toward the front of the eyelids, involving the glands associated with the eyelashes. Usually caused by an overgrowth of staphylococcus bacteria, this condition is often seen in children and young adults. Bacterial toxins irritate the surface of the eye, causing conjunctivitis, or inflammation of the membrane which lines the eyeball. In more severe cases, the cornea becomes involved in a condition known as marginal keratitis. White inflammatory deposits develop in the periphery of the normally clear cornea, leading to significant pain, foreign body sensation, blurred vision, and often extreme sensitivity to light.

In posterior blepharitis, more commonly found in adults, inflammation involves the oil-producing Meibomian glands which line the back of the eyelid margins. The normal, smoothe oils produced by these glands, which serve to lubricate the eye, become thick and greasy, clogging the gland openings. The thick secretions are very irritating to the ocular surface, causing all of the symptoms noted above. This condition is often associated with the skin disease rosacea, in which the oil glands of the face become inflamed, leading to red, inflamed skin over the brows, nose, and cheeks.

How is blepharitis treated?

Blepharitis tends to be a chronic condition, waxing and waning with intermittent flare-ups. While not curable, most symptoms can be adequately controlled with proper care. Treatment depends on the type and degree of blepharitis present.

The mainstay of treatment for all forms of the disease is the use of hot compresses and cleansing of the eyelids regularly. This is accomplished by placing a moist, very warm washcloth or other form of hot pack over the closed eyes for a few minutes in order to loosen oils, dead skin, and excess bacteria, followed by gently massaging the upper and lower lids with either the cloth or a commercial eye scrub product to remove the remaining debris. This is best performed at least twice daily- upon waking and before bed.

Additionally, your doctor may prescribe medications. In some cases, antibiotic drops or ointments may be used to help limit the growth of eyelid bacteria. Steroid drops or ointments, alone or in combination with an antibiotic, may also be used to control inflammation and reduce redness and swelling. These medications are typically prescribed for a short, specific period of time, as side effects limit their extended use.

For more long-term control, other medications may be used. Doxycycline or minocycline, medications which have both antibiotic and anti-inflammatory properties, may be taken daily as a pill for an extended period of time in order to control the inflammation associated with the disease. Because these medications are taken orally, systemic side effects such as upset stomach and diarrhea can be a problem. In such cases a topical (eyedrop) antibiotic called Azasite® (azithromycin) can be used with similar success. Restasis® (topical cyclosporine) eye drops, a commonly used treatment for dry eye problems, have also been found helpful in controlling symptoms.

The symptoms of blepharitis are common in many other eye disorders, some benign and some more serious. A thorough eye examination will allow your doctor to distinguish among these conditions and provide the correct diagnosis. If your eyes burn, itch, ache, or get red frequently, call us today to schedule and appointment.

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