Blepharitis and Dry Eye

Blepharitis is an inflammation of the eyelids. This common problem typically affects the edges (margins) of the eyelids and is usually present in both eyes.

The inflammation is usually caused by bacterial infection and then inflammation of the meibomien oil glands in the eyelid. This changes the composition of the tears so they are less refreshing to the eye. In turn, the eye dries out. Despite the eye often compensating by secreting more tears, the eye remains uncomfortable. 

Blepharitis is often difficult to treat. The reasons for the development and persistence of this condition are usually not well known.

Blepharitis is an irritating problem that can cause discomfort, pain and great inconvenience. It is not a threat to general health, or to vision. With on-going conscientious management, blepharitis usually responds well to treatment. 

The main signs and symptoms of blepharitis include:

• Painful eye and around the eye
• Redness and swelling of the eye and eyelids
• A feeling of “something in my eye”
• Excessive tears
• Photophobia (sensitivity to light)
• Crusty or sticky eyelashes, particularly in the morning
• Sensitive to wind/air conditioners

 Blepharitis is usually a chronic condition. In most cases, blepharitis cannot be cured, but regular long-term treatment usually helps to control the symptoms for long periods, before recurring in varying degrees of severity.

Careful long-term care of the eyelids is the main treatment for blepharitis. Treatments include all of the following:

1. Eyelid cleaning, shown in the illustration (right), is carried out once or twice daily until the inflammation is controlled. It can then be done twice weekly, but if symptoms return, daily cleaning must be started again. Use diluted baby shampoo and warm water and gently wash the eyelid margin with a cotton bud. An alternative is the use of “lid care” (see over – Picture A) which is available from your local pharmacy.
2. You may be prescribed antibiotic ointment. Apply the ointment to the eyelid margin (where the eyelashes emerge) to change the bacterial content of the eye lid margin (see over – Picture B).
3. Eye shadow, eyeliner and other cosmetics around the eye can aggravate the condition and should be discontinued during treatment. Contact lens should not be worn until the condition is under control.
4. Do no rub or scratch itchy eyelids as this worsens the inflammation. A cold compress or ice pack over the eyes is usually effective in relieving itchiness. Antihistamines are often helpful if the itch is a prominent feature. This is especially true in people affected by hay fever, asthma or eczema.
5. Artificial tears may be helpful. These may be with preservatives (e.g. anything in a bottle) or without preservatives (e.g. anything in single use vials). Use whichever brand is most effective for you. Preservative free drops are usually more expensive and more difficult to store.
6. Steroid ointments are also commonly used to reduce inflammation. These should be rubbed around the eye/eyelashes. When put into the eye, steroids can increase intraocular pressure when used for prolonged periods. Steroids (like Hycor ointment) should just be used to a maximum of 2 weeks.
7. Lacritec tablets containing fish, flaxseed and other oils, has been shown to reduce discomfort from dry eyes. Care should be taken when using this if your medications include Warfarin.

Treatment may take some weeks or months before the condition is controlled and symptoms are eased.