BLEPHARITIS

WHAT IS IT?

Blepharitis” literally means “eyelid”(bleph),  “inflammation”(itis).  It is an extremely prevalent condition that causes ocular discomfort in several ways.  Children can sometimes develop blepharitis, but typically it is present to greater degrees in older persons.  There is no absolute “cure” for the condition, but the symptoms can be controlled in most cases by adopting a lid care regimen and sticking to it.

THE TEAR FILM

 

 

 

 

 

 

To understand the symptoms of blepharitis, you must first know about the tear film.  Oils that are produced by the meibomian glands usually stabilize the normal tear film.   These oils act to keep the tear film intact even as we stare, and slow down tear evaporation. If the oil component of the tear film is abnormal or missing, people develop intermittent symptoms of dry eye.

SYMPTOMS

The symptoms of blepharitis are mainly the symptoms of dry eyes.  This is because even though a person may produce abundant tears, the chemistry of the tears is wrong because the oil component is abnormal.  Symptoms usually include all or some of the following:

  • Tearing, pain, foreign body sensation, burning, red eye, intermittent blurred vision, irritation, and crusting of the lid margins
  • Severe blepharitis can cause lid ulceration, corneal ulceration, and corneal vascularization and scarring

People are often surprised that tearing is a common symptom of dry eye.  It happens when the brain senses the surface of the eye is dry and stimulates a reflexive increase in tear production.  This tends to happen frequently in the morning, after reading, using the computer, or in any situation that would decrease the blink rate or increase evaporation of the tear film.  Blepharitis is often present for many years before people are symptomatic.  By the time they are symptomatic, there is usually some permanent redness of the white of the eyes and the lid margins. This will improve with lid care but never totally go away.

HOW DID I GET BLEPHARITIS?

This is the big question.  Believe it or not, the answer is still a bit of a mystery.  We know that the basic problem with blepharitis is that the oils produced by the eyelids become semi-solid and can plug the oil glands.  The oils are supposed to be liquid at body temperature.  Glands make the oils deep in both the upper and lower eyelids, and they are deposited at the lid margin into the tear film on a continuous basis.  The oil is important in creating a good stable tear film.  When people have blepharitis, the oils are waxy and thick and do not mix with the tear film.  Bacteria normally live in the oil glands, but they increase in population in this scenario because the flow in the oil glands is decreased.  The immune system recognizes the increase in bacteria and creates an inflammatory response.  This along with the surface changes from dryness is what causes the eyes to become red and the lid margins irritated.  The abnormal tear film causes dry eye symptoms.  Generally, the problem goes on for years before an individual experiences symptoms. Why the oil becomes waxy is the question to be answered.  It may be that bacteria present make enzymes that change the oil.  Alternatively, it may be thick oil that traps the bacteria.  In either case, the treatment recommendations are the same.

TREATMENT

There is no way currently to change the character of the oils produced in the lids on a permanent basis.  The mainstay of treatment for blepharitis is the use of warm compresses to the lids.  Soaking moist heat on the lids for a period of at least four minutes will help liquify the oils in the lids that have become too thick.  The oil will then move while the heat is present, and carry out with it the bacteria that built up in the glands.  The problem is, when the heat is removed the oils will go back to solidifying.  That is why people have to make doing warm compresses part of their daily routine if they want to control this condition.  Doing warm compresses once or, better yet, twice a day will help just about everyone with blepharitis. In addition, massaging the oil glands by scrubbing the eyelids helps to keep the glands healthier.  Using artificial tears in the morning, prior to reading, and as needed is helpful. The difficulty is sticking with the treatment.  The symptoms will wax and wane, but doing the compresses must be continued even when the symptoms are not present to prevent recurrence.

Because there had to be a better way than prescribing antibiotic ointment, Total Lid Care (TLC) ointment was formulated by Dr. Kahle.  This all natural product contains antioxidant and anti- inflammatory ingredients.  Designed to be used at bedtime at the base of the eyelashes of the upper and lower lids after doing the warm compress,  TLC has proven to help many of our patients.  We KNOW this product works which is why a 100% satisfaction guarantee is offered for Total Lid Care (TLC).  You can read more information at:  www.totallidcare.com.

When all the other treatments are not working, additional therapies are sometimes needed, such as using an antibiotic ointment prior to sleep. Sometimes the use of oral omega 3 fatty acids can improve blepharitis symptoms. Some oral antibiotics have the side effect of causing the oils to be less thick at dosage levels less than that used to treat infection.  This is especially helpful in treating blepharitis associated with Rosacea. 

Lastly, some people are helped with the judicious use of topical anti-inflammatory agents for the eye.  Anti-inflammatory agents can greatly help to alleviate the symptoms of blepharitis, especially during flare-ups.  Anti-inflammatory agents carry the risk of elevated eye pressure, viral infection, and increased rate of cataract formation.  Nevertheless, if used properly, these agents can really make having blepharitis more tolerable.  Only Eye doctors should prescribe anti-inflammatory eye drops, as they are the ones who can diagnose and treat the potential side effects if they occur.


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