Blepharitis is an uncomfortable condition that usually produces inflamed and itchy eyelids, but it doesn’t permanently damage eyesight. Eyelid margin disease can begin during childhood and last throughout life—or it can begin during adulthood. The best way to manage the condition is with good eyelid hygiene, including regularly cleaning the lids and lashes.
Types
The eyelids play an important role in eye health. They protect the cornea (the clear outer layer at the front of your eye) and spread tears over the front surface of your eyes. Eyelid margin disease can affect different parts of the eyelid, and the location is usually dependent on the cause.
Anterior Blepharitis
Bacteria are often present on our skin, and they can proliferate on the eyelid, lashes, and eyebrows, contributing to eyelid margin disease. However, eyelid margin disease is not a bacterial infection—these bacteria are considered colonization (the presence of bacteria) and not infection (being sick from bacteria).
Anterior blepharitis can also be caused by a mite called Demodex folliculorum. Demodex mites are a natural part of the human microbiome (the microorganisms that naturally live within and on the body) and are, therefore, very common. They can increase in number as we get older, however.
Although Demodex can be present in higher amounts in people who do not practice good hygiene, their presence does not necessarily mean you are doing an inadequate job with your personal hygiene.
Posterior Blepharitis
The meibomian glands inside the eyelid have an opening on the eyelid margin, and they normally contribute oils to the tears that protect your eyes. Typically, posterior blepharitis develops due to meibomian gland dysfunction, which is irregular oil production in the glands of the eyelids (meibomian blepharitis). The oil can create a favorable environment for bacterial growth.
Meibomian gland dysfunction is very common, and mild cases often go undiagnosed. Full, complete blinks are important to meibomian gland secretion. Decreased blink rates can contribute to blepharitis by decreasing the excretion of meibomian gland content. Additionally, when the eye remains open and exposed for longer, increased evaporation of tears can contribute to eyelid margin disease.
Meibomian gland dysfunction also causes evaporative dry eye (EDE), the most common form of dry eye syndrome.The consistency and quantity of the tears can also be examined to identify this problem. With EDE, the tears may seem thick or frothy.
When meibomian gland dysfunction is chronic, the glands may clog, and sometimes the glands will actually atrophy (waste away).
Treatment
Blepharitis treatment varies depending on the cause, duration, and other systemic medical problems a person may have.
Full blinks and artificial tears are important for managing dry eye if it develops with blepharitis.
The mainstay of blepharitis treatment is to apply warm compresses several times a day followed by eyelid scrubs once or twice per day. Eyelid scrubs can be as simple as applying lathered baby shampoo onto a warm washcloth. When doing this, close your eye and scrub gently with a washcloth, using a gentle back and forth motion. Baby shampoo is recommended because it does not sting your eyes.
Many eye doctors also prescribe topical antibiotics and antibiotic-steroid combination drops and ointments for the eye and eyelid. However, blepharitis is not infectious—the oral antibiotics used to treat the condition decrease ocular flora burden (bacteria), helping to reduce inflammation and clogged glands. Additionally, the antibiotics may have an anti-inflammatory effect.
