Blepharitis Causes, Symptoms & Treatment
Blepharitis is the medical term for an inflammation of the eyelids. Symptoms commonly include itching, redness, swelling of the eyelids, and a crusty discharge in the eyelashes. It can be resistant to treatment and generally will recur in people who are prone to it.
Blepharitis is often a chronic condition requiring regular treatment and application of home care.
Blepharitis is generally related to an overgrowth of bacteria living along the eyelash edges and at their base. However, it’s not contagious and doesn’t typically pose a serious threat to eye health or vision. It can be distressing and uncomfortable, though, and it’s often unsightly, too.
Blepharitis is surprisingly common. Studies have shown that anywhere from roughly one-third to almost one-half of all eye care patients show some sign of it.
In susceptible individuals, bacteria living along the edges of the eyelash base following the eyelid curve and within each eyelash hair base forms a toxic environment called a biofilm. You can compare this in your mind to the plaque that forms on your teeth and contributes to tooth decay and gum infections.
This biofilm provides food for a type of mite called Demodex. Due to an abundance of bacterial food, this Demodex multiplies rapidly and contributes to the inflammation already present in the area.
Tears are composed of both water and lipids or fats. It’s these fats that allow the tears to coat the eyeball properly and remain long enough to aid eye functions. It’s the tiny meibomian glands that produce these lipids.
The lipid and the water portions of tears are secreted by different glands in the eye and do not mix until they are released into the eyes.
Biofilm bacteria produce and release noxious substances called exotoxins. These exotoxins further irritate and inflame the oil-producing glands. When this occurs, it’s called meibomian gland dysfunction and can contribute to and intensify problems with dry eye syndrome.
The inflammation associated with blepharitis may also be linked to unrelated skin conditions like eczema, rosacea and ocular rosacea, dandruff, and psoriasis.
The condition has many possible causes and conditions related to it: Dry eye syndrome, clogged oil glands along the inner edges of the eyelids where the eyelashes attach, pink eye, and eyelashes growing in the wrong direction, rubbing against the cornea.
Other potential blepharitis causes include bacterial and fungal eye infections, bacterial eyelid infections, certain parasites like eyelash mites or lice, and seborrheic dermatitis. This last cause is just a medical term referring to dandruff, like that of the scalp.
However, seborrheic dermatitis can also affect the eyebrows and eyelashes. It can contribute to clogging the tiny oil glands located along the inner edges of the eyelids when it does.
The meibomian glands can become clogged with these bits of dandruff, causing or worsening blepharitis symptoms. The glands can also become clogged with the oil secreted by the glands themselves in some instances.
Pink eye is a bacterial or viral infection causing the white part of the eye to turn a reddish pinky color. The inner eyelid is often involved as well. It can also be caused by allergies.
When caused by bacteria or viruses, pink eye can be highly contagious. Always wash your hands before handling or inserting contact lenses and before lens care. Wash your hands before touching your face and especially the eye area as well.
Blepharitis is a leading cause of contact lens discomfort and failure to adjust to comfortable contact lens wear.
Symptoms are generally rather nonspecific and require evaluation by an eye care professional because the following possible blepharitis symptoms may have other causes:
Itchy eyes and eyelids with a crusty discharge in the eyelashes.
Sensitivity to light and a feeling that something is in the eye.
Red, swollen eyelids and eye redness, watering, burning and stinging.
Blurry vision that comes and goes and is temporarily improved by blinking.
Stye and Chalazion
These may also be present with blepharitis. A stye is like a boil. Caused by bacteria, a stye will form a red, painful bump inside an oil-producing gland or at the base of an eyelash. While they may require medical attention in some cases, a stye tends to be self-limiting and will clear on its own in time.
A chalazion is a clogged oil gland in the eyelid. It may appear as a large, red bump on the eyelid area.
Treatment of Blepharitis
Treatment consists of a combination of medical and home care. Your eye care professional will provide you with necessary medical treatments, such as antibiotic eye drops or other topical preparations and office procedures. Still, you must be vigilant with home blepharitis care as well.
If you are not, you can fully expect further blepharitis attacks to occur in the future.
This is the mainstay of blepharitis control. Keeping bacterial populations at bay is critical in the home treatment of this condition. It’s best to set aside specific times each day for preventative blepharitis care, especially at bedtime.
As you sleep, you want to ensure that harmful bacteria have been cleaned away and cannot multiply quickly during the night.
Use a disposable compress or clean washcloth that has been laundered after any prior use. Then:
Wash your hands and wet the compress or washcloth with nearly hot water. The idea is to melt any clogged oil inside the meibomian glands and keep them open.
Close your eyes and hold the cloth against your eyelids. Press gently along the eyelids’ edges to express any clogged oil. The glands are tiny, so you’re unlikely to see anything coming from the glands.
Your eye care professional will tell you how many times a day to do this. You can expect to do this kind of eyelid care for about five minutes at a time up to several times a day to get symptoms under control.
Keeping Your Eyelids Clean
This is intended to keep bacterial eyelid counts down as low as possible. Bacteria usually live on the skin, so you will not be able to eliminate them all. Your eye care professional will recommend a cleaning agent, and there are over-the-counter cleansers available.
However, a standard cleanser is just plain diluted baby shampoo.
1. Wash your hands, and moisten a clean washcloth, gauze pad or cotton swab with your cleansing solution.
2. Very gently wipe your eyelids, eyelashes, and eyelash base. Rinse with warm water until all traces of the cleaning solution are gone.
3. Repeat for the other eye using another clean washcloth, a gauze pad, or a cotton swab.
Blepharitis Treatment and Office Procedures
In addition to antibiotic and antiviral medications, your eye care professional may use several in-office treatments to augment both medicines and home care:
1. Electromechanical treatments like BlephEx are intended to remove mites, biofilm, and dandruff from the eyelid area.
2. Lipiflow treatments or similar to clear out any oil from clogged meibomian glands.
3. IPL (intense pulsed light) laser therapy to resolve clogged oil glands and help oils to flow normally into the tear film.
Prevention of Blepharitis: Eye Makeup
Female blepharitis patients need to know that eye makeup can become contaminated with bacteria in general and interfere with eyelid hygiene. For these reasons, it’s best to discontinue the use of all eye makeup during acute blepharitis attacks.
Discard any eye makeup used before and during any blepharitis attack.
If you’re female and seem prone to blepharitis, you may want to consider discontinuing eye makeup altogether, and you should discuss this with your eye care professional.
Understand that bacteria from your eyelids can be transferred to mascara, eyeliner, and eyeshadow and their containers no matter how careful you are. It’s also easier to maintain clean eyelids when you don’t have to clean away eye makeup residue first.
Contact Lenses and Blepharitis
The wearing of contact lenses will worsen acute blepharitis attacks. Discontinue them until your eye care professional says it’s safe to use contacts again. Wearing your lenses too soon after a blepharitis attack can potentially result in severe eye conditions like pink eye and others.
Anyone prone to blepharitis should consider using daily wear lenses to reduce bacterial problems as much as possible. It’s essential to also have a current pair of prescription eyeglasses, preferably with photochromic lenses. These will darken when exposed to sunlight.
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