Blepharitis

What is blepharitis?

Blepharitis is a common condition that causes inflammation (irritation) of the eyelids making them red rimmed and sore.

It can affect people of any age but more common in those who have skin conditions such as eczema and acne or allergic diseases like asthma.

(pronounced Blef-a-ry-tis)?

What causes blepharitis?

Eyelids contain tiny glands that make an oil that keeps the eyes moist. In blepharitis, these glands become blocked, which causes irritated eyelids and dry sore eyes. In some cases, dandruff like flakes build up at the base of the eyelashes. It is also thought that, in some people, blepharitis is partly caused by sensitivity to the bacteria (staphylococcus) which normally live on the skin. But don’t worry it tends not to be harmful.

What are the signs and symptoms?

Typical symptoms are:

  • Red, inflamed, swollen eyelids
  • Sore eyes
  • Itching, irritation, discomfort
  • Crusting around the eye lashes
  • Tiny flakes, scales or crusts at the base of the eyelashes that resemble fine dandruff
  • Sticky eyelids, especially when you wake up

What is the treatment?

Remember blepharitis is a long-term condition. There is no cure but symptoms can be improved and controlled and it may take some time before these treatments are successful.

It responds well to this simple eyelid care routine which involves wiping away the bacteria and deposits from the lid margins and expressing the lid glands.

Cleaning your eyelids

Always wash your hands thoroughly before and after you have cleaned your eyelids. Remove contact lenses if worn

There are three main steps to eyelid hygiene that should be performed once or twice a day:

  • Warm compresses
  • Gentle lid massage
  • Lid margin hygiene

Warm compresses

Apply a warm compress for 5-10 minutes, twice a day. This can provide some relief from the soreness and itching. Simply moisten a clean facecloth under a running tap of hot water (as hot as you can stand) and then place over the eyelids for approximately 5 minutes. Reheat the compress regularly by soaking it in hot water, so that the flannel is not allowed to cool – the warmth melts the oils in the stagnated eyelid glands and softens any lash flakes. Do this twice a day for a month, then twice a week (even after your eyelids are clear of the crusting). This will help to prevent the condition from returning.

Some people find a microwavable eye mask (Eyebag, Blephamask) useful. Make sure that you clean the eye mask before and after use. It is important to carefully follow the manufacturers’ guidelines if using one of these products, to prevent burning your skin.

Eyelid massage

Gently massage your closed eyes by rolling your little finger in a circular motion; this will help to push the melted oil out of the glands. You cannot see the oil coming out as the droplets are tiny.

Next take a cotton-tipped applicator (cotton wool bud) and with your eyes shut, gently roll the cotton bud sideways along the whole length of the upper eyelids and then repeat along the whole length of the lower eyelids. This will help to remove all residues from the margin of the eyelids after having initially dissolved the fatty contents with the heat.

If the oils have been stagnant in the glands for quite some time, they might have changed their chemical structure. It is possible that when the oil drains onto the surface of the eye after gentle expression, it may cause irritation, a bit like getting soap in your eyes. This is normal and should get better with time as the Blepharitis comes under control.

Lid margin hygiene

The expressed oils should be wiped away from the eyelid margin. This also helps to reduce bacteria, dust or grime ( that may have accumulated along the eyelids whilst blinking) and also any remaining crusts.

There are many recipes for cleaning solutions and the best proportions or products to use may vary between individuals. For example, boil a pint of water, fill an egg cup and allow the water to cool. Add either a drop of baby shampoo, a drop of tea tree shampoo or half a teaspoon of bicarbonate of soda. You could also use a wipes or cleaning solutions that you can purchase as an alternative to this.

Soak clean lint free makeup remover pads in the warm solution and remove crustiness from around the eyelids, paying special attention to the eyelashes. Throw the makeup remover pad away.

If necessary repeat with a clean makeup remover pad, paying attention to the roots of the lashes, the bases of the lashes and the length of the lashes.

Some patients may find the use of cleaning products or shampoo makes their eyes dry. These patients should use commercial products for example Blephasol lotion or Blephaclean wipes

Are there any other treatments for blepharitis?

Artificial tear drops to soothe dry eye symptoms and tear film instability. Use them whenever your eyes feel dry.

Antibiotic eye-drops and ointments may be needed to treat any serious infection. Ointments for the lids: Chloramphenicol ointment is used at night, for a few months to treat low-grade infections with the staphylococcus bacteria. If the lids are very inflamed then a short course of Betnesol (steroid) ointment is given to settle the inflammation. Both these ointments are applied with a cotton bud, and rubbed into the base of the eyelashes.

Mild steroid eyedrops to treat any associated corneal and conjunctival
inflammation. These are only given for short courses and only under the supervision.

Antibiotics – Some forms of blepharitis such as posterior types and those
associated with rosacea need to be treated with a course of antibiotic tablets (tetracyclines).

Cautions

  • You may need to take these for several months. If you are pregnant or breast feeding you should not take tetracyclines.
  • You may not be able to take them if you have had liver disease or kidney disease. Please let us know if you have had a history of these conditions.
  • Long-term use of tetracyclines has been linked to the failure of oral contraception, but this is rare.
  • You should not take tetracyclines with milk or antacids.

Anti-yeast shampoo may help a form of blepharitis linked to the overgrowth of yeast in your skin.

Omega 3 supplements have been shown to reduce the symptoms of blepharitis and eye dryness. They are not available on prescription, but you can buy them from a range of pharmacies and health food shops.

Gentle face washes and shampoos containing tea tree oil can be of benefit by reducing the population of the demodex mite, which can sometimes contribute to someone getting blepharitis. These can be bought from most pharmacists and supermarkets.

Helpful tips

Hygiene is very important and should be continued even after the condition has apparently cleared. The face should be washed at least twice a day and the hair should be kept clean and free of dandruff, as should the eyebrows. Using an anti-dandruff shampoo will help to reduce the dandruff.

Never share towels and facecloths and ideally use clean ones each day.

If you wear eye makeup at all, you should remove this thoroughly before going to bed.

Do not share your eye makeup or use anybody else’s.

Once the condition has cleared, clean the lid margins once or twice per week in the same way.

Use any prescribed medications as directed. Are there any other treatments available?

Antibiotic ointment may be prescribed in short courses to get the condition under control. If this has been advised, rub the ointment into your eyelid after undertaking your lid hygiene. Only use the ointment for the prescribed period.

Antibiotic tablets such as doxycycline may be prescribed if there are associated skin related problems; however for most patients this is not necessary.

Lid solutions and wipes are available commercially but not on the NHS. If you interested in learning more about these products, please speak to the practitioner treating you, your family doctor (GP) or local Optician.

Are there any complications associated with Blepharitis?

Blockage of the glands can lead to a chalazion or meibomian gland cyst, leaving a round, painless swelling sometimes with discolouration underneath the eyelid. Sometimes these can be red and sore to start with. Most disappear within a few months without treatment. To help the cyst to go, warm compresses can be used (see above).
Much less commonly, blepharitis can lead to changes on the clear window of the front of your eye (the cornea), which will usually require further treatment and a check-up.

Will the Blepharitis come back again?

It is likely that the Blepharitis will reoccur if you stop the eyelid cleaning regime. Some people have to carry on with treatment for a long time to prevent it reoccurring, sometimes forever. Should the symptoms come back and you have stopped the eyelid cleaning, you should start the regime again and continue with it.

What happens if I do not get treatment?

Blepharitis will not go away. It may get worse and irritate the front surface of your eye (the cornea). This could lead to discomfort and infection.

When to seek advice:

If your eye becomes increasingly red or painful, your sight becomes more blurred or you develop very noticeable and spreading redness together with a lot of swelling of the eyelids, you should get in touch with us or attend your local A&E department for further examination.