Blepharitis is a common condition that causes inflammation of the eyelids. It is characterized by redness, swelling, styes, cysts, and flaky crusts at the eyelid margin and along the lash line. Symptoms also include scratchy, swollen, tender, and irritated eyes.
Various types of bacteria can cause blepharitis. It may be chronic or acute in presentation. People with skin conditions such as rosacea, acne, and eczema are more prone to have flare-ups. Poor facial hygiene can also be a contributing factor.
Types of Blepharitis
There are various types of this condition. Anterior blepharitis occurs on the outside of the eye. You may see redness, swelling, and possibly crust near the line of the eyelashes. Posterior blepharitis happens near the inside of the eyelid where it contacts the eye and can be due to problems with the lubricating meibomian glands inside the eyelids. Both forms of blepharitis require treatment to maintain appearance and eye comfort.
There are many treatment options. They may include the following:
- Initial treatment includes lid hygiene with Tea tree oil, specifically the terpinin-4-ol component, is effective in treating meibomian gland dysfunction (MGD) associated with Demodex mites and warm moist compresses with a Bruder mask.
- AzaSite 1% Azithromycin one drop bid for the first 2 days and then 1 drop qd for the next 30 days (may need to be used recurrently for 3-4 months depending on severity and clinical response).
- Oral Doxycycline 100mg bid for 3-4 months may be necessary for significant cases.
- Bruder hot compresses achieving an internal gland temperature of 113 degrees F for a sustained period of 7-10 minutes for moderate to severe MGD.
- Microblepharoexfoliation to remove eyelash debris, crusting, accumulated lid scurf and bacterial exotoxin-laden biofilm.
- Oral nutritional supplementation with gamma-linoleic acid (GLA) from plant-based oils, such as evening primrose and black currant oils, and with proportionate quantities of eicosapentaenoic acid (EPA) / docosahexaenoic acid (DHA).
- Intraductal gland probing to achieve disimpaction and dilatation of the meibomian glands.
- Thermal pulsation therapy with the LipiFlow device to effect gentle expression of the meibomian glands.
- Intense pulsed light therapy (IPL) to target the underlying pathophysiology of MGD. IPL energy is selectively absorbed by abnormal telangiectasias that leak pro-inflammatory mediators into adjacent tissue and glandular structures. IPL produces beneficial effects for MGD by stimulating collagen turnover, reducing epithelial cell turnover and epithelial obstruction of the gland, or eradicating Demodex and other lid margin flora.
- Culture indicated with recurrent anterior blepharitis w/ inflammation and patients not responding to therapy. Biopsy of eyelid to exclude carcinoma in cases of marked asymmetry, resistance to therapy or unifocal recurrent chalazia that does not respond well to therapy.
- Follow-up evaluations are critical and entail interval history, visual acuity, external exam, slit-lamp biomicroscopy, and on-going care. Any topical corticosteroid treatment must be re-evaluated within a few weeks to determine response to treatment, intra-ocular pressure (IOP), and assess treatment compliance.
Dr. Craig Rouse can diagnose this eye health condition or spot other potential problems during a comprehensive eye exam. If you have any concerns about your eyes or questions about changes to your vision, please contact us or speak with us at your next appointment.