Patient Zone: Blepharitis Explained

Blepharitis is an inflammation of the eyelids which causes them to feel sore. The eyes can become sticky with discharge and some people may notice that their eyelids stick together, especially first thing in the morning.

Blepharitis is generally a long-term condition with no one-off cure. However, careful management of the condition by means of regular eyelid hygiene tends to prevent flare-ups.
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Symptoms of blepharitis

Common symptoms of blepharitis are as follows:

  • Eyelids feel sore or are inflamed

  • Eyelids may become sticky with discharge and may stick together

  • The skin on the eyelids may be oily and look flakey or scaly. Sometimes eyelids become crusty

  • Both eyelids are affected at the same time (symptoms are bilateral)

  • Symptoms often come and go but will occasionally flare-up

  • Possible association with other conditions including dry eye syndrome, seborrhoeic dermatitis or rosacea

Causes of blepharitis

Blepharitis can be caused by a bacterial infection, through dysfunction of the meibomian glands or as a complication of a skin condition. It is rarely possible to determine the underlying cause of the condition as the symptoms tend to be same. Blepharitis is not infectious, and therefore you cannot catch blepharitis from another person who has the condition.

Staphylococcal blepharitis
Staphylococcal blepharitis is thought to be caused by staphylococcus, a type of bacteria found naturally on the skin. In some people it seems that staphylococcus causes a localised infection of the eyelids, resulting in blepharitis, but why this happens in some people and not others is unclear.

Seborrhoeic blepharitis
Seborrhoeic blepharitis is closely associated with a skin condition called seborrhoeic dermatitis. In seborrhoeic dermatitis the affected skin becomes oily due to overproduction of sebum from the sebaceous glands. The skin can also appear scaly. If seborrhoeic dermatitis occurs on the eyelids, this is known as seborrhoeic blepharitis.

Meibomian gland dysfunction

There are 30-40 meibomian glands in the upper lid (slightly less in the lower lid) and they are found just behind the eyelashes. Meibomian glands secrete meibum oil which lubricates the eye and helps to prevent the tear film from evaporating.

If the meibomian gland does not function correctly, this may lead to eyelid inflammation. Meibomian gland dysfunction can also be a cause of dry eye disease and is often associated with skin conditions such as rosacea or acne.
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Diagnosis of blepharitis

Blepharitis can be diagnosed by your GP through an examination of the eyelids and by asking questions about your symptoms. Your GP may also check for any associated medical conditions. If your symptoms are particularly severe or if the condition is interfering with your vision, your GP may refer you to an ophthalmologist. Blepharitis is generally not a serious condition and complications are rare. Occasionally, however, blepharitis may result in the following:

  • Dry eye syndrome.

  • Painless cysts on the upper eyelid known as chalazia. These are caused by blocked meibomian glands

  • Styes, which are small painful swellings on the outside of the eyelids

  • Loss of eyelashes or eyelashes which grow towards the eye

  • Conjunctivitis

Treatment of blepharitis

Blepharitis is a long-term (chronic) condition which cannot be cured, however regular treatment can ease symptoms and help mitigate or prevent the condition.

The most important part of blepharitis treatment is regular eyelid hygiene. Cleaning the eyelids keeps them free from flakes and prevents the meibomian glands from becoming blocked, thus reducing the chance of infection. A regular routine of warmth, massage and cleansing will prevent a build-up of oily secretions in the meibomian glands. Ideally this routine should be performed twice daily until symptoms stabilise and once a day thereafter to minimise further flare-ups.

WHAT IS REQUIRED FOR EYELID HYGIENE?
Good quality tears operate best when a thin layer of oil seals the eyelid to the eye, preventing excessive evaporation of the tears. This oil comes from the glands in the eyelids. A major symptom of Dry Eye Disease occurs when these oils thicken from the natural smooth oil to a buttery consistency.

3 STEPS ARE REQUIRED

Step 1
Heating of the eyelids externally - do this by using a hot eye compress in accordance with the instructions. This will allow the buttery oil to melt and become liquid again.

Step 2
Cleansing of some of the melted oil from the glands by following the Eyelid Massage Procedure allowing the glands to produce healthy oil again.

Step 3
Cleaning the base of the eyelashes – this reduces the build-up of bacteria which can be responsible for some of the symptoms.

Approved: JB027 MAY 2018