What Can I Do About Blepharitis?

Celeste Robb-Nicholson, M.D.

Harvard Health Letters

Q. I suffer from blepharitis and have tried many medications, but the condition always returns. How can I cure it?

A. Blepharitis is chronic inflammation of the eyelids. It tends to wax and wane, causing considerable discomfort when it flares up. The vexing symptoms may include red eyes, a burning or gritty sensation in the eye, red and swollen eyelids, itchy eyelids, flaking of the eyelid skin, crusting on the eyelashes (especially upon waking), and blurred vision. The eye and eyelid become more vulnerable to infection, and eyelashes may fall out or grow abnormally. There's no definitive cure, but you can reduce day-to-day symptoms as well as flares if you're willing to commit to a regular program of eyelid cleansing and care.

Blepharitis is classified as either posterior (occurring on the inner edge of the eyelid) or anterior (occurring on the outer part of the eyelid). Anterior blepharitis affects the eyelash follicles (where the eyelashes attach to the eyelid). The follicles may become inflamed, clogged by flaking or crusting skin, or infected by skin bacteria.

Posterior blepharitis, which is more common, causes inflammation surrounding the Meibomian glands, which line the inner edge of the eyelid. Normally, these glands secrete the oily part of the fluid that coats the eyeball, lubricating the surface of the eye and preventing evaporation of tears. In posterior blepharitis, the Meibomian secretions decrease or become abnormal; that can cause dry eye and in the long run may damage the surface of the eye (cornea). Abnormal secretions also create an environment that promotes the overgrowth of bacteria, leading to infections of the eyelid, glands, and other eye tissues.

Blepharitis is often associated with inflammatory skin conditions, such as eczema, which causes flaky skin at the edges of the eyelids, and seborrheic dermatitis (scalp dandruff), which causes flaking and greasy scales around eyelashes. Acne rosacea, a common skin condition in postmenopausal women, is also associated with blepharitis. All forms of blepharitis may be caused by or result in bacterial infection of the eyelid -- usually with staphylococcus, the bacterium most commonly found on the skin.

Blepharitis can lead to many other eye conditions, including a stye -- a small red lump in the eyelid caused by infection in an eyelid gland -- and a chalazion, an oil-filled cyst caused by a blocked Meibomian gland (see illustration).

Blepharitis can cause an oil-filled cyst called a chalazion to form in a Meibomian gland.

With your clinician, you can do a number of things to minimize flares and the effects of blepharitis. Start with a thorough eye exam, to rule out other causes for your symptoms. You should also talk to your clinician about treatments for any underlying causes of blepharitis, such as eczema, seborrheic dermatitis, and acne rosacea.

The mainstay of treatment is eyelid hygiene -- keeping the lids clean and free of crusts and particles that may lodge between the lashes. The following should be part of your daily routine:

Warm compresses.

Soak a soft washcloth in warm water and place it over your eyes for five to 10 minutes to loosen crusts, melt secretions, and soften the Meibomian glands. (As the washcloth cools, resoak it and reapply.) You should do this two to four times a day during a flare, less often when the condition eases off.

Lid massage.

To unclog stubborn Meibomian glands, use your washcloth or a clean fingertip to lightly massage the eyelids with a circular motion.

Lid washing.

After applying warm compresses, gently wash along the eyelid with a washcloth, gauze pad, or cotton swab using warm water alone or highly diluted baby shampoo (1:10).

If your eyes are dry, your clinician may recommend artificial tears or steroid eye drops for short-term treatment of inflammation. If you have scalp dandruff, use a dandruff shampoo.

Antibiotics are recommended for flares that involve infections. Topical antibiotics (usually erythromycin or a bacitracin ointment) are applied to the edge of the lid one or more times a day. Oral antibiotics (usually tetracycline or doxycycline) may be prescribed in very low doses to prevent flares in people with severe blepharitis that doesn't improve with eyelid hygiene. New topical treatments are under study, including low-dose antibiotic eye solutions. -- Celeste Robb-Nicholson, M.D., Editor in Chief, Harvard Women's Health Watch

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