How to control your blepharitis (3)

In the previous posts (below) we've talked about Blepharitis being very common, indeed that most people have at least some blepharitis; and how, although it is initially relatively symptom-free, if untreated for years it can cause really serious eye disease and eventually loss of vision. We're all living much longer these days, so we need to think ahead and keep ourselves as healthy as possible so we don't spend our latter years with vision problems that could have been prevented by simple health care.

People who have a tendency to develop blepharitis will have that tendency for many years or all of their life. Cure is not possible, but complete control is absolutely possible and is important. 

Regular treatment is necessary - the inflammation tends to recur if you don't maintain this. 

Regular eyelid hygiene

This is a simple routine that consists of three parts - warmth, massage and cleaning.

1. Warmth

The purpose of warmth is to melt the oily secretions made by the eyelid's oil glands, to allow the oil to flow more freely and thereby unplug any glands blocked by that oil. Warmth applied to the eyelids for five to ten minutes is sufficient to do this.

The traditional method is to press on the eyelids gently with a flannel (facecloth) soaked in very warm water for 5-10 minutes. If the flannel cools, keep re-warming it in the warm water.

A popular alternative is to use a proprietary reusable heat pad which you place over your eyes for about five minutes. The heat pad can be more convenient than wet flannels, for example at work; they also retain their heat for longer so you can simply lie down and relax for five to ten minutes with the bag placed over your eyes. According to our patients, one of these pad types is particularly good - very convenient (you can use them wherever you are even if you don't have access to a microwave or electrical power) and the most hygienic available - click HERE to buy these quite cheaply through Amazon, or telephone (UK) 01727 812925 to buy them even more cheaply if you are local to, and can collect from, the St Albans Eye and Vision Clinic. Since these have been available, over the last few years, they have really improved the treatment results achieved by our patients.

2. Massage

Immediately after applying the warmth, massage very gently downwards on the upper eyelid, and upwards on the lower eyelid, to encourage the oily secretions toward the lid margins and out of the glands.

3. Clean

After warmth and massage, clean the eyelid margins to remove the oil and any scales or crusts. This can be done by either of the following ways, and different methods suit different people:

• Diluted baby shampoo (ten drops in a small cup of warm water) or sodium bicarbonate (a teaspoonful in a cup of warm water); use either of these on a cotton bud to clean off any crusts at the base of the eyelashes, followed by rinsing the eyelids in clean water. A flannel can be used instead of the cotton bud.
• Proprietary eyelid scrubs that you can buy; our patients have tried several of these, and one of the best can be purchased cheaply HERE. We'll keep searching for the lowest prices for these products, so you'll always get best value here.

If you've used a dry heat bag for the warmth stage, your eyelids won't have had the soaking effect of hot water, so you need to spend longer soaking crusts and scales and removing them from the lid margins, especially from between the eyelash bases. If you've used a moist heat bag, or hot wet flannels, then the crusts and scales should be already soft and ready to remove. The blepharitis is generated underneath these crust and scales, so whatever method you use, it's important to get all the crusts and scales off.

You should do the above routine - warmth, massage, clean - at least twice per day until symptoms settle. When the symptoms have eased, keep doing this routine at least three times per week to maintain control of your tendency to blepharitis. If you are prone to blepharitis it is best to think of this as part of your daily routine - just like brushing your teeth. Blepharitis tends to fluctuate and there will be times when it is a bit worse despite the treatment; overall, however, regular treatment will minimise symptoms and long-term complications.

Artificial tear drops

Blepharitis is often associated with dry eyes, so artificial tears/lubricants may help ease symptoms. Different preparations suit different people, so simply try one after the other until you find the one that suits you best.

Antibiotic and/or Steroid treatments

Antibiotic or steroid eye ointment or tablets are usually unnecessary, but may be prescribed for blepharitis unresponsive to the above treatment, or for cases where at the outset the examination suggests that bacteria are a large part of the cause.

Most people have at least some Blepharitis (inflammation of the eyelid margins) - here's why you must treat it ! (2)

Most people's blepharitis is just a mild irritation - an occasional itch on the eyelids, overcome by a quick rub or scratch. They look in the mirror and think "Oh, my eyes look a bit tired". Generally it will look no worse than this:

- just moderate redness of the lid margins, with perhaps some flaking.

Nevertheless, scarring deep within the lid margin is occurring even in these relatively mild cases, eventually causing the lid margin to "notch" and the eyelashes to twist and turn in abnormal directions - after years of this the lashes can begin to rub against the eye -

and this is when the situation has become really serious - eyelashes rubbing against the eye causes scarring of the cornea which is the normally transparent window on the front of the eye that needs to be absolutely clear for you to see clearly.
It takes many years for blepharitis to cause this serious situation - but we're all living longer, so we need to be caring for our eyes and vision in the expectation that we have many years to live; you don't want to spend the last years of your life coping with health problems that could have been avoided with a bit of care earlier in life.

So, blepharitis needs to be taken seriously, even if it's relatively mild - in its early stages is when treatment is easiest and most effective - and that way you will avoid the above problems in future.

In the next post, we'll present the different ways of treating blepharitis, the treatment methods we know are best and, as always, the evidence that supports what we're saying.

If you have long-term itchy, uncomfortable eyes/eyelids, the most likely cause is Blepharitis. (1)

The most common reason for people to have long-term itchy or slightly uncomfortable eyes is inflammation in the skin around the bases of the eyelashes i.e. at the lid margins, and is called Blepharitis.

Blepharitis is not usually due to tissue infection, but rather is due to inflammation only. However, organisms (usually bacteria or yeasts) on the skin surface do play a part in causing the inflammation.

It can develop at any age, and symptoms can include:

• itchy, sore and red eyelids that stick together
  
• crusty or greasy eyelashes
• a burning, gritty sensation in your eyes
• increased sensitivity to light (photophobia)
• swollen eyelid margins
• finding contact lenses uncomfortable to wear
• abnormal eyelash growth or loss of eyelashes in severe cases

In most cases both eyes are affected, but one eye can be more affected than the other. The symptoms tend to be worse in the morning.

Blepharitis is usually a long-term condition. Most people experience repeated episodes, separated by periods with reduced symptoms.

Blepharitis isn't contagious.

What causes blepharitis?

Blepharitis is usually an interaction between oils produced by the eyelid glands and the bacteria/yeasts that live on the glands. Occasionally an aggressive bacterium (Staphylococcus Aureus) is a significant part of the cause, and in these cases a few days of treatment with antibiotic (ointment rubbed into the lashes twice per day) is very helpful.

Blepharitis can be divided into three types: Anterior, posterior, and mixed (anterior and posterior). The subdivision into these three types is not clinically very useful because 

i) the mixed type is by far the most common, and

ii) the treatments outlined above are used effectively for all three types.

Sometimes blockages in the Meibomian glands are associated with a skin condition called rosacea. If too much oily substance is being produced, this may be caused by seborrhoeic dermatitis which commonly affects other areas of the body (e.g. the face and/or scalp) and many people with itchy eyelids due to blepharitis also have itchy, flaky ("dandruff") scalp.

When to get medical advice

See your high-street optician (optometrist) or an eye specialist if you have persistent symptoms of blepharitis that aren't being controlled by simple eyelid hygiene measures.

If you have severe symptoms (for example severe redness or lid swelling), contact your optometrist or GP immediately. If this isn't possible, visit your nearest accident and emergency (A&E) department.

How blepharitis is treated

A tendency to blepharitis can't be cured, but the condition can be completely controlled - it's exactly the same idea as washing your hair regularly to prevent itching and inflammation of your scalp, and a daily eyelid-cleaning routine can help control the symptoms and prevent permanent scarring of the eyelid margins.

There are three main steps to eyelid hygiene that should be performed, morning and evening to start with, and then most people find that about three times per week is enough to keep control of it: 

• using a warm compress – to make the oil produced by the glands around your eyes more liquid so it can flow out of the glands instead of blocking them. Heat pads that can be warmed in the microwave and rested on your closed eyelids have been proven to be very effective in reducing/removing symptoms and preventing long-term complications of blepharitis.
• gently massaging your eyelids – to push the oils out of the glands
• cleaning your eyelids – to wipe away any excess oil and remove any crusts, bacteria, dust or grime that might have built up

More severe cases may require antibiotics that are either applied to the eye or eyelid directly, or taken as tablets.

Complications

Blepharitis isn't usually serious, although it can lead to a number of further problems.

In the next post (above) we'll begin to look at the more serious problems that can occur if blepharitis remains untreated for years, and therefore why the relatively simple treatments outlined above should be commenced whilst the condition is mild - if you have irritating eyes, don't put up with it - get it sorted.

How is the name "Blepharitis" derived ?

Inflammation is the response of the body to noxious stimulus (chemical/injury/infection).

The Greek word for eyelid is "blephar" and the suffix "-itis" (again from Greek) is appended (as it is to the name of any body structure) to indicate inflammation. 

Authoritative government source: 

http://www.nhs.uk/conditions/Blepharitis/Pages/Introduction.aspx