Blepharitis refers to chronic inflammation of the eyelids. Blepharitis is one of the most common disorder of the eye and is often the underlying reason for eye discomfort, redness and tearing. Other eye symptoms of blepharitis include:  Burning, itching, light sensitivity, and an irritating, sandy, gritty sensation that is worse upon awakening.
There are 3 forms of blepharitis (staphylococcal, seborrheic and Meibomian Gland Dysfunction MGD).

All three forms of blepharitis are chronic in nature. Patients with staphylococcal blepharitis are relatively young and often have a history of styes as a kid or adult. Patients with seborrheic blepharitis and MGD blepharitis are generally older and have a longer history of symptoms.

In staphylococcal blepharitis there is scaling and crusting along the eye lashes. In seborrheic blepharitis there is greasy scaling along the eyelashes. Patients frequently have seborrheic dermatitis as well.  In Meibomian gland dysfunction (MGD) there are prominent blood vessels crossing the eyelid margin. In addition there is plugging of the meibomian gland openings, and poor expressibility and/or turbidity of the oily meibomian secretions. Patients with MGD frequently are noted to have coexisting rosacea and seborrheic dermatitis (Rosacea's Red Face).

Blepharitis Treatment

Blepharitis is a chronic disease for which there is no cure, and requires long-term treatment to keep it under control. Treatment consists of 2 phases (Acute phase and Maintenance phase). Acute phase treatment involves intensive therapy to rapidly bring the disease under control. In the maintenance phase the goal is to indefinitely continue the minimum amount of therapy that is necessary to keep the disease quiet.

Warm Compresses followed by Lid Scrubs is the most critical element of effective blepharitis control. This therapy removes the eyelid debris (which can be colonized by bacteria), reduces the bacterial load and stabilizes the tear film by releasing oily secretions from the meibomian glands, thus reducing tear evaporation (so the dry eye symptoms are also reduced).

Warm Compresses
Warm compresses heat the debris and crust on the lid margin to or above the melting point of their individual components so that they are easily removed with the lid scrubs.
Technique: Soaking a washcloth in water as warm as the eyelids can stand, and then placing the cloth on the lid surface (eyelids closed) for a five to ten minute period. In the acute phase this is performed 20 minutes a day, twice a day.

There are various ways warmth may be applied to the eye. One method  is the use of a fresh-boiled egg (in its shell wrapped in a washcloth). Another method described is to use a stocking filled with grains of uncooked dry rice heated in a microwave oven to a comfortable warm temperature. Another method is the use of a small baked potato wrapped in a washcloth.

Warm compresses may be combined with eyelid massage. This is especially important in patients who have Meibomian gland dysfunction (MGD). In MGD the meibomian secretions are turbid and the gland openings are clogged. Think of a toothpaste tube which has butter (instead of toothpaste). When cold, you will not be able to express the butter out of the tube. However, once you heat it, then the butter will soften enough to come out of the tube, but pressure on the tube (squeezing) would still be necessary. Going by this analogy, after warm compresses, the turbid meibomian gland secretions are more fluid, but massage is necessary to express them. Therefore after every 1 minute of warm compresses, massaging the eyelid as follows will be useful:

Gently close the eyelids. Put your index finger on the outer corner of the eyelid. Pull the eyelid towards the ear, so that the eyelids are stretched taut. Next use the index finger of the opposite hand to apply direct pressure to the taut eyelids starting at the inner aspect of the eyelid near the base of the nose. Sweep with firm but gentle pressure towards the ear. Repeat this maneuver four to five times. Remember that the goal is to apply gentle pressure to the eyelids .


Lid Scrubs
There are several ways of performing lid scrubbing. You can choose whichever one you are most comfortable with. The scrubbing should be directed at the base of the eyelashes on the eyelid margin.

Baby Shampoo: The baby shampoo is first diluted one-to-one with water in a 'cup' in the palm of the hand. This is then mixed by rubbing clean fingertips or a washcloth wrapped around a finger, and then applied in a gentle oval scrubbing motion to the margin and eyelash bases of the closed eyelid for 1 minute, followed by a fresh water facial rinse.

Some patients prefer to use a cotton tip applicator or cotton pad which is easily discarded after use. There are commercially available cleansing pads that are presoaked in a cleansing solution (OCuSOFT Lid Scrubs). These cleansing pads are equally effective albeit more expensive method of lid scrubbing and are claimed to be less irritating to the eyelids. One study showed then to be preferred choice by patients as compared to other methods of lid scrubbing


Antibiotic treatment
The use of an ointment on the eyelid margin immediately after lid scrubbing may help to increase patient comfort.  In addition, the antibiotics help to further reduce the bacterial load on the eyelids.

Oral tetracyclines (doxycycline or minocycline) for about 3 months can be used in stubborn Meibomian Gland Dysfunction (MGD) cases. Tetracycline antibiotics affect the meibomian gland secretions, inhibit bacterial lipases as well as reduce the eyelid bacterial load.

Teresa Lui, O.D.       Palo Alto Optometrist         Optical Boutique           650-321-9525          info@drteresalui.com