Blepharitis. Difficult to pronounce and almost as difficult to manage. Very little information is available as to how many Americans suffer from this common ocular disorder, but one study has placed the prevalence as high as 47%. Considering the effects of blepharitis range from entirely asymptomatic to severely affecting vision and quality of life, it would not be surprising that there are many living with this condition completely unaware. Equally unsurprising would be the number of people with blepharitis who have always thought something was not quite right but just put it down to “how things are” or “it must be the weather” or “it’s because my mother has so much pungent potpourri around the house”, and ignored the discomfort in their eyes.

So what is this mysterious condition known as blepharitis? 

There are two basic types of blepharitis – anterior and posterior. Anterior blepharitis refers to the accumulation of bacteria from the skin (typically staphylococcus), dead skin cells, and oils from the skin around the eyelashes. Under the slit lamp microscope this looks a bit like eyelash dandruff, and indeed, blepharitis can often be associated with seborrheic dermatitis and dandruff of the scalp. Posterior blepharitis involves certain glands in the eyelids known as Meibomian glands and is also called Meibomian gland dysfunction. During posterior blepharitis these glands undergo abnormal changes, which results in their secretions, known as meibum, becoming altered in their quality and/or quantity. Meibomian gland dysfunction contributes significantly to dry eye disease and also has been shown to be associated with a skin condition called acne rosacea.

You’re now probably wondering whether you are one of these unsuspecting people walking around with eyelash dandruff or mutant Meibomian glands. The most definitive way of finding out whether you have any form of blepharitis is to visit your eye care practitioner where a good look behind the slit lamp microscope and perhaps some poking and prodding will reveal the diagnosis. Suspicion of some degree of blepharitis may be raised if you experience any or all of the following:

• Dry, irritated, burning, stinging, and/or itching eyes – the irritants around the eyes in anterior blepharitis can cause – you guessed it – irritation. The poor quality of the meibum will also result in a poor quality tear film, leading to dry and irritated eyes.
• Red eyes, either of the whites of the eyes or the margins of the eyelids – with irritation of the eyes comes some inflammation, which may manifest as redness.
• Crustiness around the eyelids and eyelashes – this is commonly noted in the morning upon waking up.
• Recurring eyelid styes – styes are the result of an infected eyelash follicle or Meibomian gland, often due to the surrounding blepharitis. Frequent episodes of styes is probably your eyelids trying to tell you something.
• Increased glare sensitivity – with an unstable tear film from blepharitis this will cause light to scatter unevenly as it enters the eye, resulting in the sensation of glare.
• Frothy, sticky tears – usually associated with the poor quality meibum secretions produced in posterior blepharitis.
• Vision that often fluctuates with blink, or a filmy sensation over the vision – this is a result of the blepharitis contributing to dry eye and a degraded tear film.

Now that you’ve probably self-diagnosed yourself with blepharitis, whether anterior, posterior or both (it is not uncommon to have some degree of both forms of blepharitis), it is important to understand that there is currently no cure for blepharitis. Management and treatment options are quite simple but require a significant amount of patience and perseverance due to their long-term nature.

Anterior blepharitis is commonly managed by literally just cleaning away the irritating scurf from the eyelashes on a regular basis. An easy home remedy is to use dilated baby shampoo, a detergent that will not irritate the delicate skin around the eyes. Specially formulated eyelid wipes or foams are also commercially available with the specific purpose of cleaning away anterior blepharitis. This treatment should be done at a frequency advised by your eye care practitioner, based on the severity of the blepharitis, but will most likely involve an initial period of doing this daily and then reducing the frequency to keep the blepharitis at bay long-term.

Posterior blepharitis involves encouraging those little Meibomian glands to pull their socks up and start secreting some good quality meibum. The old school, but still very effective, method of achieving this is with the use of a hot compress over the eyes to melt the blockages of oils, and then massaging the eyelids gently to squeeze out these softened bits of gunk. Similar to the lid cleansing for anterior blepharitis, this will need to be done daily for a certain period of time and then continued long-term at a lower frequency to maintain the results. Studies have shown that a healthy intake of omega-3 and flaxseed oils can help control inflammation of the Meibomian glands and improve their secretions and more recent advances in technology have added the use of IPL laser to get these glands a-moving. For both forms of blepharitis, using a good lubricant eye drop alongside the other therapies will help to provide some soothing relief to the eyes in the short-term.

In severe cases of blepharitis, an optometrist or ophthalmologist may prescribe the use of topical antibiotics and anti-inflammatory ointments or drops, and in really severe cases may even recommend the use of an oral antibiotic. Left untreated, severe chronic blepharitis can lead to recurrent infections and eyelid styes, which can cause irreversible damage to the surrounding eye anatomy, including the cornea.

If you find yourself with irritated eyes that barely get any relief from off-the-shelf lubricating eye drops, you may be an unwary sufferer of blepharitis. A closer look behind the microscope with your eye care practitioner will help to pinpoint the exact cause and guide a more specific treatment, putting you on the road to a pair of more comfortable eyes.

References
Blepharitis in the United States 2009: A Survey-Based Perspective on Prevalence and Treatment. http://www.sciencedirect.com/science/article/pii/S1542012412706201
Blepharitis PPP. https://www.aao.org/preferred-practice-pattern/blepharitis-ppp–2013
The International Workshop on Meibomian Gland Dysfunction: Executive Summary. http://iovs.arvojournals.org/article.aspx?articleid=2126267