Blepharitis What is blepharitis?

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What is blepharitis?
Blepharitis is an inflammation of the eyelids. It usually affects the edges (margins) of the eyelids. It is not usually serious, but may become an uncomfortable, irritating problem. Blepharitis is typically chronic (persistent). Both eyes are usually affected.
What causes blepharitis?

There are three main types of blepharitis: staphylococcal blepharitis, seborrhoeic blepharitis and meibomian blepharitis. All three types can cause similar symptoms.

  • Staphylococcal blepharitis is thought to be caused by a bacterium (germ) called staphylococcus. This bacterium commonly lives in low numbers on the skin without doing any harm. However, in some people, it seems that this bacterium causes a localised infection of the eyelids, resulting in blepharitis. Exactly why this happens in some people is unclear.

  • Seborrhoeic blepharitis is closely associated with a skin condition called seborrhoeic dermatitis. In seborrhoeic dermatitis, the affected skin becomes more oily and can become scaly. Seborrhoeic dermatitis typically causes bad dandruff and sometimes a rash, commonly on the face and upper body. The underlying cause of seborrhoeic dermatitis is not clear. A type of yeast called Malassezia furfur is involved. However, it is not just a simple skin infection and it is not contagious (you cannot catch this condition from others). This yeast lives in the sebum (oil) of human skin in most adults and usually does no harm. However, in some people the yeast seems to trigger an inflammatory reaction, causing the blepharitis.

  • Meibomian blepharitis is also known as meibomian gland dysfunction. The tiny meibomian glands in the eyelids lie just behind the eyelashes. You have about 25-30 meibomian glands on each upper and lower eyelid. They make a small amount of oily fluid which comes out on the inside of the eyelids next to the eye. This oily fluid forms the outer layer of the tear film which lubricates the front of the eye. People with meibomian blepharitis are thought to have a slight problem with their meibomian glands and the fluid they produce. This may lead to eyelid inflammation. (This also explains why people with meibomian blepharitis often have dry eyes as the fluid they make may not be adequate to lubricate the eye.)

What are the symptoms of blepharitis?

  • The main symptom is sore eyelids. Both eyes are usually affected.

  • The eyelids may look inflamed or greasy.

  • The eyes may become sticky with discharge. In particular, the eyelids may stick together in the morning.

  • Sometimes tiny flakes or scales appear on the eyelids which look like small flakes of dandruff. Crusts may develop at the base of eyelashes.

  • One or more of the tiny glands of the eyelids (meibomian glands) may block and fill with an oily fluid.

  • Symptoms often come and go. Typically, symptoms flare up from time to time, but you may have long periods without any symptoms. 

Three other conditions are commonly associated with blepharitis:

  • Dry eye syndrome (keratoconjunctivitis sicca).

  • Seborrhoeic dermatitis - described above.

  • Rosacea. Symptoms include facial flushing, spots, and central facial redness.

What is the treatment for blepharitis?

There is no one-off cure for blepharitis, as the inflammation tends to recur if you do not keep up with treatment. However, with regular treatment, symptoms can usually be eased and then kept to a minimum. This tends to prevent flare-ups. The main treatment is regular eyelid hygiene (see below). Other treatments that may be needed include antibiotics, steroid creams (occasionally) and specific treatment for associated conditions.

Regular eyelid hygiene

This is the most important part of treatment and prevention of blepharitis. The aim is to soothe the eyelids, unplug any blocked meibomian glands and clear out any stagnant oily secretions from these glands. The eyelids are cleaned and debris is removed. This is a daily routine that consists of three parts - warmth, massage and cleansing. Remove any contact lenses before following the routine.

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