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blepharitis



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BLEPHARITIS





Jorge A . Montes, MD, FACS



Ever have an itchy, irritated eyelid? We all have, and this is usually in response to local irritated skin. Although different, dandruff causes similar changes to the skin of the scalp. Our reflex will be to scratch the local irritation. In doing so, we will perpetuate the local irritation and cause the problems we see with blepharitis. To break the cycle, we have to address why the skin becomes irritated; only then will the symptoms improve.


We touch our face, tens, if not, hundreds of times daily, and this includes the eyelids. Just like touching your mouth with your hands, touching your eyelids can seed or spread bacteria over the eyelids surface.


WHAT IS BLEPHARITIS?

Blepharitis is inflammation of the eyelid margin that includes the eyelid, the eyelashes, and the oil-secreting glands. How we develop inflammation is what differentiates the different types of blepharitis.



CAUSES

There are three main types of blepharitis, but many other conditions and infections can lead to a unique form of blepharitis. The common ones are:


Staphylococcal Blepharitis

An overabundance of normal skin bacteria causes this form of blepharitis. Evidence shows that a dry eye decreases the local immune response of the eye, allowing for a higher amount of bacteria to settle in the area. Also, eyelid rubbing can exacerbate this situation by adding more bacteria to the area. Bacteria will then cause excessive inflammation and scaling to form around the eyelashes. People will also notice that their eyelids may become itchy, and their vision blurred. Eyelashes can change direction or even fall out.


Seborrheic Blepharitis

Dandruff is similar to this form of blepharitis. There is an oily-greasy appearance to the root of the eyelashes.


Meibomian Gland Disease

Meibomian blepharitis affects the inner portion of the eyelid where the oil-producing glands reside. Involved glands either produce turbid oils that flow less smoothly or will contain oil that has stopped flowing altogether. Lack of flow through these glands can cause the gland to atrophy, or die. Dry eye symptoms will start to increase as the number of glands or oil flow decreases.



Types of Blepharitis



Staph Blepharitis



Misdirected Eyelash in Blepharitis



Seborrheic Blepharitis



Meibomian Gland Disease



CONSEQUENCES OF BLEPHARITIS

Blepharitis can lead to many chronic symptoms:


• Dry Eye

• Redness

• Tearing

• Pain

• Light Sensitivity

• Blurred Vision

• Loss of Eyelashes

• Maloriented Eyelashes

• Thickened Eyelid Margin

• Styes Chalazion


Below we see meibomian gland drop-out, another long-term consequence of untreated meibomian gland disease.



STYE (ANTERIOR HORDOLEUM)

A stye is a localized bacterial infection at the base of the eyelash follicle. As such, it involves the outer-most or anterior portion of the eyelid. Styes respond well to eyelid cleansing, warm compresses, and topical antimicrobials.



Please see my Stye and Chalazion page for more information.



CHALAZION (POSTERIOR HORDOLEUM)

A chalazion is a clogged oil gland in the inner-most or posterior portion of the eyelid. Changes in the consistency of the oil produced will make it harder for oil to flow out of the gland. Additionally, the gland's opening will narrow due to local inflammation, which further inhibits flow.



Please see my Stye and Chalazion webpage for more information.



TREATMENT

Eyelid Regimens

The foundation for treating any form of blepharitis entails warm compresses and eyelid hygiene.


Topical Medications

Topical antibiotics can help decrease the overgrowth of local bacterial flora or other bacterial causes of blepharitis, while steroid eyedrops reduce surface inflammation and improve comfort.


Oral Medications

Oral tetracyclines i.e., doxycycline, help with blepharitis, and it's complications through many different mechanisms. It has anti-inflammatory and antibacterial properties, and it can thin out the meibomian gland secretions.


Surgical

Surgery is an excellent option for chalazia that is of sufficient size to warrant the risk of the procedure. Chalazion drainage is an in-office procedure with limited downtime.



eyelid hygeine shampoo and wipes



eyelid cleansers



warm compress masks



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PRESERVATION

Lipiflow®, when performed yearly, can help preserve the function of the meibomian glands but cannot restore the function of glands already lost. It works by warming up the meibomian glands to just the right temperature while also expressing the gland's contents.



Animation videos



Long Term Effects of Untreated MGD



By: Tear science lipiflow



Tear Film Animation:



Tear Layer Animation - Shows the Three Layers of the Tear Film





DHR Health Eye Institute



4500 North 10th Street, Suite 100, McAllen, TX 78504
Phone: 956-362-2070
Fax: 956-362-2074