What is Blepharitis?
Blepharitis is a condition that causes the edges of your eyelids to become inflamed, or swollen. It can happen suddenly or develop over time, but it’s usually a long-term condition. It’s vital to note that it frequently occurs in both eyes at once and that symptoms can come and go.
Your healthcare provider may identify this condition based on irritations like scaliness and crustiness around the eyelashes. The main treatment for blepharitis includes keeping the eyelids clean and avoiding triggers that can make symptoms worse. Sometimes, antibiotic creams for your eyes may be prescribed.
If your symptoms aren’t getting better following these treatments, your provider may suggest you see an eye specialist, also known as an ophthalmologist. The goal of the treatment is to reduce symptoms. As blepharitis is usually a long-term condition, maintaining a regular eyelid cleaning routine can help prevent it from coming back.
While there’s no definitive cure, rest assured that the outlook for this condition is positive. Remember, blepharitis tends to cause discomfort more than it poses a significant threat to your health.
What Causes Blepharitis?
Blepharitis, or inflammation of the eyelid, can be caused by many different factors. It can be both short-term (acute) or long-term (chronic), and various issues can cause each type.
Acute blepharitis can either be ulcerative, where it’s caused by an infection, or non-ulcerative, where it’s typically due to an allergic reaction. The infections that cause ulcerative blepharitis are primarily bacterial, often due to staph bacteria. However, viral infections, like Herpes simplex and chickenpox, can also contribute. Non-ulcerative blepharitis is usually an allergic response, such a reaction to allergens in certain seasons or environments.
Chronic blepharitis, which lasts for a long time, is identified based on the location of the problem. For instance, in anterior blepharitis (affecting the front part of the eyelid), the culprit is frequently an infection (often from staph bacteria) or a skin condition called seborrheic dermatitis, which affects the face and scalp. Rosacea, another skin condition, can also cause anterior blepharitis.
On the other hand, posterior blepharitis (affecting the inner part of the eyelid) is usually caused by a dysfunction of the Meibomian glands, which are tiny oil glands in the eyelid. These glands can produce too much oil, leading to blockage and swelling. This condition is often related to acne rosacea, and hormonal causes are suspected as well.
Lastly, both anterior and posterior blepharitis can be caused by a mite called Demodex. However, it’s worth noting that the exact role of these mites in causing blepharitis is unclear, especially since people without symptoms can also carry these mites.
Risk Factors and Frequency for Blepharitis
Blepharitis is an eye condition that can affect anyone, regardless of age, race or gender. However, it’s more commonly seen in people over the age of 50. The exact number of people currently having blepharitis in the US is unknown. In a survey conducted in 2009, about 37% of patients who visited an ophthalmologist and roughly 47% of those who saw an optometrist showed signs of blepharitis. A study in South Korea, which took place over a decade from 2004 to 2013, found that the overall occurrence was 1.1 for every 100 people per year. It was observed that this rate steadily increased over time and was higher among female patients. The overall percentage of patients over the age of 40 who had the condition was 8.8%.
Signs and Symptoms of Blepharitis
Blepharitis is a condition that causes itching, burning, and crusting on the eyelids. People with this condition might also have teary or blurry eyes, and feel like there’s something in their eyes. These symptoms usually feel stronger in the morning, especially crusting on the eyelashes. This problem usually affects both eyes and can come and go. Checking for blepharitis usually involves using a special lamp called a slit lamp.
In anterior blepharitis, the lamp helps reveal swelling and redness on the outer edge of the eyelid. There might be small, widened blood vessels present. Small, flaky skin, like dandruff can be seen around the eyelashes, forming “collarettes”. Furthermore, there could be changes in the eyelashes such as loss of lashes, paleness or misdirection.
In posterior blepharitis, glands near the eyes called meibomian glands are widened, blocked and might look greasy. Their secretions might seem thicker than normal, and there might be scar tissue in the area around these glands. Lastly, people with any type of blepharitis can have a fast tear evaporation, which can be measured.
This is done using a slit lamp. Fluorescein dye is placed in the eye and the patient blinks fully then keeps an eye open for 10 seconds. The tear film is examined for breaks or dry spots under a cobalt blue light. It’s generally agreed that a tear break-up time less than 10 seconds is considered abnormal.
Testing for Blepharitis
Blepharitis, which is an inflammation of the eyelids, is typically diagnosed by your doctor based on your symptoms and a physical examination of your eyes. There are no specific tests needed to diagnose this condition.
However, if the usual treatments for long-term (chronic) blepharitis are not working, your doctor may recommend a biopsy of your eyelid. A biopsy is a medical procedure where a small sample of tissue is taken for further examination under a microscope. This is particularly important if you have lost eyelashes, as it could indicate a more serious problem, like carcinoma (a type of skin cancer).
Treatment Options for Blepharitis
Maintaining good eyelid cleanliness is usually the core treatment for blepharitis, which refers to inflammation of the eyelids. This involves applying a warm, wet cloth on the eyes for about 5 to 10 minutes. This helps break down oily residue and debris, and helps clear the oil channels in the glands of the eyelids. After that, you should gently clean the rims of your eyelids using a cotton swab dipped in baby shampoo to remove any built-up dirt and oil. Just be careful not to use too much soap, as this can lead to dry eyes.
For those with a specific type of blepharitis that affects the inner part of the eyelids, massaging the eyelids can help to get rid of oils from the glands. This involves using a cotton swab or finger to gently massage the eyelid rim in tiny circular motions. When symptoms flare up, this cleaning routine should be done up to four times a day. For those with long-term blepharitis, this kind of daily eyelid care is important to prevent symptoms from coming back. Using less eye makeup and avoiding things that trigger symptoms can also help. If you have any other conditions that might be contributing to blepharitis, make sure you get them treated as well.
Topical antibiotics, which are applied directly to the affected area, are often used for treating sudden (acute) cases of blepharitis or cases that affect the outer part of the eyelids. These creams, like bacitracin or erythromycin, can be applied to the eyelid for 2 to 8 weeks and help with relieving symptoms and getting rid of bacteria. For more stubborn cases that do not respond to the usual eyelid cleansing routine or cases connected with a skin condition called rosacea, doctors might prescribe oral antibiotics like tetracyclines or macrolides. These antibiotics not only fight bacteria but also reduce inflammation and regulate the production of oils.
Short courses of steroid eye drops can be helpful for those who also have eye inflammation. Recent research shows that combining antibiotics and steroids can be quite effective in relieving symptoms. These are often used together in a topical treatment for patients not helped by eyelid hygiene practices.
For patients who have an overgrowth of a microscopic skin bug called Demodex, scrubs madefrom tea tree oil have been shown to be useful when used for six weeks or more.
New treatments have recently become available for blepharitis. These include the LipiFlow device that applies heat and pulsations to the eyelids to remove debris and crustings from the oil glands, and the MiBoFlo that applies heat onto the outside of your eyelids. There’s also the BlephEx, a rotating light tool used to remove debris from oil gland openings, and the Maskin probe, a small probe used to apply a mild electrical current to unblock the oil glands. While these new treatments have shown promise, more research is needed to confirm how well they work.
What else can Blepharitis be?
Here are a few eye-related conditions that a physician would have to consider when diagnosing a patient’s eye problem:
- Bacterial conjunctivitis
- Bacterial keratitis
- Basal cell carcinoma
- Chalazion
- Contact lens complications
- Dry eye disease
- Epidemic keratoconjunctivitis
- Hordeolum
- Ocular rosacea
- Trichiasis
