Blepharitis

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Blepharitis

Blepharitis is inflammation of the eyelids, occurring particularly at the lid margins.  It’s a common disorder and is associated with a low-grade bacterial infection or a generalized skin condition.

Blepharitis occurs in two forms: anterior blepharitis and posterior blepharitis.

Anterior blepharitis affects the front of the eyelids, usually near the eyelashes.  The two most common causes of anterior blepharitis are bacteria and a skin disorder called seborrheic dermatitis, which causes itchy, flaky red skin.

Posterior blepharitis affects the inner surface of the eyelid that comes in contact with the eye.  It is usually caused by problems with the oil (Meibomian) glands in the lid margin. Posterior blepharitis is more common than the anterior variety, and often affects people with a rosacea skin type.

Blepharitis signs and symptoms

Regardless of which type of blepharitis you have, you will probably have such symptoms as eye irritation, burning, tearing, foreign body sensation, crusty debris (in the lashes, in the corner of the eyes or on the lids), dryness and red eyelid margins.  It’s important to see us  and get treatment.  If your blepharitis is bacterial, possible long-term effects are thickened lid margins, dilated and visible capillaries, misdirected eyelashes, loss of eyelashes and a loss of the normal position of the eyelid margin against the eye.  Blepharitis can also lead to styes and infections or erosions of the cornea.

Blepharitis treatments

Blepharitis can be difficult to manage because it tends to recur.  Treatment depends on the type of blepharitis you have. It may include applying warm compresses to the eyelids, cleaning your eyelids frequently, using an antibiotic and/or massaging the lids to help express oil from the Meibomian glands.

The go-to treatment choice is topical ointment.  Favorite antibiotic ointments include erythromycin and bacitracin, prescribed every night at bedtime for up to a month, after which the patient is re-evaluated for possible continuation or default to control using lid hygiene alone.

Although used off-label, Azasite administered twice daily for two days, then once daily for a month, has proven to be a favored treatment for many.  While cost is an issue (check for insurance coverage), Azasite provides minimal obscuration of vision and has anti-inflammatory properties that serve as an adjunctive therapy.

Posterior Blepharitis, characterized by meibomean gland dysfunction (MGD), can be treated with doxycycline or minocycline.  Usual therapy consists of prescribing 50mg to 100mg per day for several weeks, followed by titrating the dosage down for maintenance therapy.  Note that these drugs photosensitize the patient increasing the risk  of severe sun burn.  In addition they should not be taken by pregnant women or children under 8 years of age.

If your blepharitis makes your eyes feel dry, artificial tears or lubricating ointments may also be recommended.  In some cases, anti-bacterial or steroid eye drops or ointments may be prescribed.

Always wash your hands before and after touching your eyelids when treating blepharitis. Your eye doctor will provide instructions on the products and techniques to use to relieve symptoms and get your blepharitis under control.  Thereafter, a daily regimen of lid hygiene is helpful in preventing recurrences of blepharitis.

There is some evidence to suggest that taking a daily flaxseed or fish oil supplement that contains omega-3 fatty acids may help prevent or reduce the severity of posterior blepharitis.

Because blepharitis tends to be chronic, expect to keep up therapy for a prolonged period of time to keep it at bay.  If you normally wear contact lenses, you may need to discontinue wearing them during the treatment period and even beyond.  In other cases, contact lens discomfort caused by blepharitis can be relieved by replacing soft contact lenses more frequently or changing to one-day disposable lenses.

The following drugs and medications are in some way related to, or used in the treatment of blepharitis.

  • Azasite
  • Bacitracin Ointment
  • Blephamide
  • Ciloxan Ointment
  • Doxycycline
  • Erythromycin Ointment
  • Maxitrol
  • Minocycline
  • Neosporin Ophthalmic Ointment
  • Pred G
  • Tobradex Ointment
  • Vasocidin

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