Blepharitis

Medical quality assurance by Dr. Albrecht Nonnenmacher, MD at May 19, 2016
StartDiseasesBlepharitis

Blepharitis is a common condition in which there is inflammation of the eyelids. The eyelids will itch and appear red, swollen, and scaly at the eyelash base. It is also referred to as eyelid inflammation or meibomian gland dysfunction. The condition may occur once or present as a chronic condition. Although it is uncomfortable and affects one's appearance, it does not normally cause permanent vision loss with proper treatment. Doctors diagnose more than 200,000 cases of blepharitis annually.

Contents

Definition & Facts

Although the severity of the condition varies from case to case, blepharitis usually runs its course within two to four weeks with or without treatment. Untreated, it can lead to other issues. For instance, blepharitis is the most common cause of dry eyes. It can also lead to the development of a stye or chalazion. The condition occurs in two forms, anterior and posterior with five sub-types:

  • Seborrhoeic.
  • Staphylococcal.
  • Mixed.
  • Meibomitis.
  • Parasitic.

The anterior type affects the outside front of the eyelid, the point where the eyelashes connect. The posterior type affects the inner eyelid and the meibomian glands. All forms occur equally in both genders' except staphylococcal blepharitis, which occurs more often in women. Although it can occur in childhood, the condition usually presents in adults, most commonly in the 40s and 50s.

Conditions that may develop in cases of long-term, untreated blepharitis include chronic pink eye (conjunctivitis), keratitis, and corneal ulcers. The eyelids may redden, and ulcerative, bleeding, non-healing areas may develop. Eyelid scarring may also occur.

Symptoms & Complaints

Symptoms occur bilaterally. The most common symptoms include swollen eyelids and a discharge that becomes crusty upon drying. The crusting may appear worse during the morning upon waking. Symptoms associated with blepharitis include: dry or watery eyes; red eyes; swollen eyelids; crusting at the eyelid base; sticky eyelids; itchy eyelids; flaking of skin near the eyelids; a burning sensation in the eye; greasy appearance of eyelids; frequent blinking; light sensitivity; eyelash growth in the wrong direction; eyelash loss; infection of the eyelash follicle/sebaceous gland.

It may affect tear production. Tears keep the cornea healthy, so a break in tear production increases the risk of corneal infection. The eyelid inflammation may also cause styes or chalazion. A stye is a tender red bump on the eyelid. These may occur during outbreaks of acute infection of the eyelid's oil glands. A chalazion forms from a stye. A firm lump, it may present as painless and white or, if infected, painful and red. Not all symptoms occur in every case.

Causes

No single cause exists. However, blepharitis is commonly caused by the following:

Various other infections and conditions can trigger blepharitis, including parasitic infections, rosacea, molluscum contagiosum, herpes simplex virus infection, varicella zoster virus infection, allergic contact dermatitis, contact dermatitis, and staphylococcal infection.

Diagnosis & Tests

An optometrist examines the eyes for blepharitis during a comprehensive eye examination. Testing focuses on the eyelids and front surface of the eyeball. The doctor takes a patient's medical history to determine symptoms and health problems that may contribute to the condition. An external examination of the eye, especially the lid structure, skin texture and eyelashes, follows. Using bright light and magnification, the doctor examines the lid margins, the eyelash base, and the meibomian gland openings.

Finally, the doctor evaluates the quantity and quality of the patient's tears. The optometrist may swab the skin to obtain a sample of the oil on the eyelid and of the crust that has formed. In some cases, the doctor may conduct a vision test, perform a slit-lamp microscope exam, and/or test eye pressure. Sometimes, a skin cancer tumor appears to be a stye or chalazion from blepharitis, and these serious conditions must be ruled out to render a diagnosis of blepharitis.

Treatment & Therapy

Blepharitis has no known cure, though depending on the cause, proper treatment can clear up a single outbreak. Although reoccurrence can occur, successful treatment exists for control of outbreaks. Topical antibiotics provide symptomatic relief and clear bacteria. Common antibiotics used include erythromycin and sulfacetamide in the form of eye drops, cream, or ointment.

Topical corticosteroids in the form of eye drops or ointment provide symptomatic relief. The doctor may prescribe artificial tears solutions or lubricating drops. Careful cleaning of the lids with warm compresses and using lid scrubs provide symptomatic relief for those diagnosed with anterior or posterior blepharitis. Patients with blepharitis ought to use antibiotics and steroids as directed by their doctor.

There are also home remedies. Individuals can place a warm, wet wash cloth over closed eyes for five minutes, re-wetting and re-applying. They can then follow this by washing the closed eyelids, especially the lid margins, with diluted baby shampoo or other gentle cleanser for 30 seconds, using a separate wash cloth for each eye. The individual can then pat the area dry with a towel. This routine can be repeated first thing in the morning and just before going to bed.

One should also gently massage the eyelids to clean out oil accumulated in the glands, if blocked. Daily washing of the scalp with anti-dandruff shampoo may help clear up an outbreak. One should avoid wearing eye makeup during outbreaks as this can exacerbate the problem; one should also avoid wearing contact lens.

Prevention & Prophylaxis

Regular, proper hygiene can prevent outbreaks. Those who cleanse their face twice daily, including the eyelid area reduce the chance of blepharitis developing. If it does develop, once the initial outbreak clears, careful daily washing of the eyelids on the same schedule as in treatment phase has shown to prevent future outbreaks.

Treating underlying conditions such as rosacea or dermatitis, as directed by the physician, is an important preventative measure. If dandruff contributed to the outbreak, using a dandruff shampoo to wash hair and eyebrows may help prevent blepharitis.