Blepharitis: Causes, Symptoms, Complications, Diagnosis, Treatment, Prognosis and How to Avoid It

It is one of the most common eye conditions and is characterized by inflammation, peeling, redness and crusting of the eyelid.

Blepharitis is the inflammation of the margin of the eyelid, it is common and treatable. It can also cause burning, itching or a grainy sensation in the eye.

The general etiology is the result of bacteria and inflammation of congested meibomian sebaceous glands at the base of each eyelash. Other conditions can lead to Blepharitis, whether infectious or non-infectious, including, among others, bacterial infections or allergies.

The different Blepharitis variations can be classified as seborrheic, staphylococcal, mixed, posterior or meibomitis, or parasitic.

In a survey of American ophthalmologists and optometrists, between 37% and 47% of patients seen by respondents had signs of blepharitis, which can affect all ages and ethnic groups.

A single center study of 90 patients with chronic blepharitis found that the average age of the patients was 50 years.

Facts about Blepharitis

These are some key points about Blepharitis. More details and supporting information are in the body of this article:

  • Blepharitis is an inflammatory condition that affects the area around the base of the eyelashes.
  • The underlying causes of chronic blepharitis are not well understood.
  • Blepharitis is not caused by poor hygiene.
  • The most obvious signs of Blepharitis are redness and stickiness of the eyelid, with agglutination of scaly skin around the base of the eyelashes.
  • The goal of treatment is to relieve symptoms, but it can not cure the condition.

Causes

It is caused by inflammation around the base of the eyelashes; We all have some bacteria on our skin. Some people, however, have more bacteria at the base of the eyelashes than others. This can form scales similar to dandruff.

In addition, some people have problems with the sebaceous glands in their eyelids, which produces Blepharitis.

There are several possible causes of Blepharitis, which include:

  • Bacterial infection of the eyelid.
  • Dysfunction of the meibomian glands.
  • Dry eyes.
  • Fungal infection in the eyelids.
  • Parasites (eyelash mites).

Some ophthalmologists believe that Blepharitis is actually a precursor to dysfunction of the meibomian gland and dry eyes, rather than being caused by these other conditions.

Blepharitis is also frequently associated with skin conditions such as ocular rosacea, seborrheic dermatitis and psoriasis . Often, blepharitis and pink eye occur at the same time.

Although Blepharitis is not menacing to the eye, it can cause permanent alterations of the eyelid margin. Unfortunately, there is no cure for Blepharitis, but there are several things you can do to help control the symptoms.

symptom

The most common symptoms of Blepharitis are:

  • Tearful eyes, due to an excessive tear.
  • Red eyes, due to dilated blood vessels in the sclera.
  • Swollen eyelids, due to inflammation.
  • Formation of scabs on the margins of the eyelids / base of the eyelashes / medial canthus, generally worse upon awakening, due to excessive bacterial accumulation along the margins of the eyelid.
  • Eyelid stuck, due to the formation of crusts along the margin of the eyelid.
  • Eyelid itching, due to irritation caused by inflammation and flaking of the epidermis of the eyelid.
  • Peeling of the skin on the eyelids, due to the tear film suppressed by the meibomian glands.
  • Sensation of grit / burning in the eye, or sensation of a foreign body, due to the crust of bacteria and sebaceous glands obstructed.
  • Frequent blinking, due to a tear film affected by the obstruction of the sebaceous glands, unable to prevent tears from evaporating.
  • Sensitivity to light / photophobia.
  • Badly directed eyelashes that grow abnormally, due to permanent damage to the eyelid margin.
  • Loss of eyelashes, due to the excessive accumulation of bacteria along the base of the eyelashes.
  • Infection of the eyelash follicle / sebaceous gland (hordeolum).
  • Debris in the tear film, observed with magnification (contrast enhanced with the use of fluorescein drops).

Depending on the severity of Blepharitis, the patient may have some or all of these symptoms, which may be intermittent or constant. In some cases, Blepharitis also causes loss of eyelashes ( madarosis ).

Blepharitis is a frequent cause of discomfort in contact lenses, forcing many people to stop using them.

Complications

If you have Blepharitis, you may also experience:

Difficulty using contact lenses : Because blepharitis can affect the amount of lubrication in your eyes, wearing contact lenses can be uncomfortable.

Stye : is an infection that develops near the base of the eyelashes. The result is a painful lump on the edge (usually on the outside) of your eyelid. A stye is usually more visible on the surface of the eyelid.

Chalazion : occurs when there is a blockage in one of the sebaceous glands in the margin of the eyelid, just behind the eyelashes. The gland can become infected with bacteria, which causes a red and swollen eyelid. A chalazion is more prominent on the inside of the eyelid.

Chronic conjunctivitis : Blepharitis can cause recurrent outbreaks of conjunctivitis (pink eye).

Corneal injury : constant irritation of the inflamed eyelids or misdirected eyelashes can cause a corneal ulcer. Insufficient ripping could predispose you to a corneal infection.

Blepharitis and Dry Eyes

Blepharitis and dry eyes often occur at the same time. This happens so often that some researchers and ophthalmologists now believe that these two conditions are actually part of a unique process of chronic eye disease.

The name that has been proposed to describe this unified condition is the Dry Eye Blepharitis Syndrome (DEBS, for its acronym in English).

According to supporters of the DEBS theory, dry eye is simply the late manifestation of Blepharitis, and the treatment of Blepharitis will also prevent, reduce or eliminate dry eye symptoms.

Blepharitis is usually caused by an overgrowth of bacteria that live along the margins of the eyelids and at the base of the eyelashes. Over time, these bacteria accumulate and create a structure called biofilm.

This biofilm becomes a toxic environment, like the plaque that forms on the teeth. Its content is a source of food for the parasitic mites of the eyelashes. The proliferation of mites increases the irritation and inflammation of the eyelids.

The bacteria in the biofilm of the eyelid produce substances caused by exotoxins that cause inflammation of meibomian glands. These glands secrete important oils for a healthy layer of tears. Inflammation affects the quality and quantity of tears.

And because our tears contain natural antibodies, fewer tears in the eye means that even more bacteria grow. This worsens inflammation, leading to poor functioning of the meibomian glands and problems with other lacrimal glands in the eyelids.

These changes result in chronic discomfort in dry eyes. The obstructed Meibomian glands can also cause the formation of a stye in the margin of the eyelid or a chalazion inside the eyelid.

If you wear glasses or contact lenses

If you develop blepharitis with contact lenses, you should stop using them until Blepharitis has been treated. The use of lenses when you have inflammation causes the bacteria to stick to your lenses and cause conjunctivitis or potentially more serious diseases.

If you do not have a pair of backup glasses, buy photochromic lenses, if you are sensitive to light, your eyes may feel more comfortable outside with photochromes.

After your Blepharitis has been treated successfully, you can resume the use of contacts, if you currently use reusable contact lenses, consider switching to disposable contacts, which may have a lower risk of problems related to Blepharitis.

When to see a doctor

If you have symptoms and signs of blepharitis that do not seem to be improving despite good hygiene (regular cleaning and care of the affected area), make an appointment with your doctor.

Diagnosing Blefaritis

The doctors will first determine a diagnosis of Blepharitis by asking about the symptoms (taking a history). After confirming the symptoms listed above, the doctor will examine the patient’s eyelids and eyes.

Slit lamp examination (biomicroscope):  When performing an eye exam, the doctor will look for signs that will help determine the specific type of Blepharitis.

Initial consultations may include tests without any special equipment until a more specialized examination is needed using a slit lamp.

A slit lamp is a low power microscope specially developed with a strong beam light source. With this lamp the doctor observes the eyes and the eyelids while the patient is firm supporting chin and forehead against the supports.

Using this technique, the doctor will be able to observe the telltale signs of Blepharitis.

Physical Examination:  In all forms of Blepharitis, optometrists or ophthalmologists examine the tear film, which is the most effective method to determine instability.

The most commonly used method is to measure the production of tears through tear tear time (TBUT), which calculates the duration interval between complete blinks.

This serves as a primary indication of regional dryness in the precurneal tear film after fluorescein injections. If TBUT is shorter than 10 seconds, then this suggests instability.

Staphylococcal blepharitis is diagnosed by examining erythema and edema of the eyelid margin. Patients may present alopecia areata of eyelashes and / or disorientation of growth, trichiasis .

Other signs may include telangiectasias in the anterior eyelid, collarettes that surround the base of the eyelashes, and changes in the cornea. Seborrheic Blepharitis is characterized by less erythema, edema and telangiectasia of the margins of the eyelid.

Posterior blepharitis and dysfunction of the meibomian gland are frequently associated with rosacea and can be observed during an ocular examination of the posterior margin of the eyelid.

Diagnostic Procedures:  The cultures of the margins of the eyelids can be a clear indicator for patients suffering from anterior or recurrent blepharitis, with severe inflammation, in addition to patients who do not respond to therapy.

Lacrimal osmolarity measurements are beneficial in diagnosing concurrent dry eye syndrome, which may be responsible for overlapping symptoms and allow the physician to decipher the conditions and move forward with the most beneficial protocol.

Consequently, the measurement of tear osmolarity has several limitations to differentiate between aqueous deficiencies and evaporative dry eye.

Microscopic evaluation of depilated eyelashes may reveal mites, which have been evident in cases of chronic blepharoconjunctivitis . An eyelid biopsy can also determine the exclusion of carcinoma, resistance to therapy or recurrent unifocal chalazia.

Therapeutic treatment with medication

Oral antibiotics : Ophthalmologists or optometrists may prescribe a low dose of oral antibiotics, such as doxycycline.

Topical antibiotics : if prescribed, topical creams or ointments after cleaning the eyelid margin. A small amount extends along the fissure of the eyelid with a swab or fingertip, while the eyes are closed.

Another method to reduce the side effects of Blepharitis are antibiotics such as erythromycin or sulfacetamide, which are used through eye drops, creams or ointments in the margin of the eyelid.

Eye drops / steroid ointments : Eye drops or ointments containing corticosteroids are often used together with antibiotics and can reduce eyelid inflammation.

Home care treatment

Warm compresses : soften the residues of the lid margin and the oils by placing a very hot moist compress, like a clean, warm and moist wipe on the closed eyelids for five minutes.

Re-moisten and reapply while cooling. This heats, softens and loosens the deposits of eyelid glands with scabs and fat.

Massages : this helps to express the oily content of the glands after loosening the sebum with the warm compress. To do this effectively, use a finger to massage the margin of the eyelid with small circular movements.

Tips for eyelid hygiene

Eyelid hygiene is very useful to treat and control blepharitis, but only if it is done properly.

To begin, use a clean, warm compress to melt any blocked residue in the oil-secreting meibomian glands in your eyelids. That is how:

A cotton-tipped swab is used to clean an eye affected by Blepharitis.

  • Wash your hands, then moisten a clean cloth with warm water (almost hot).
  • Place the washcloth on closed eyelids for several minutes.
  • Next, gently rub the margin of your eyelid with the wipe before opening your eyes. (Do not press hard on your eye)

Follow your ophthalmologist’s recommendations about how often you should use a warm compress. When you begin treatment for the first time, you may be instructed to do this several times a day, for approximately five minutes.

The cleaning of the eyelids is the next step. Your doctor will recommend what to use for the cleaning agent. Options include warm water, diluted baby shampoo or a special eyelid cleaner.

To clean your eyelids:

  • Wash your hands, then moisten a clean cloth, cotton swab or gauze with cleaning solution.
  • Gently clean your eyelashes and eyelid margin.
  • Rinse with warm water.
  • Repeat the process for your other eye, using a different wipe, swab, or pad.

Your ophthalmologist may have your eyelids cleaned several times a day to start, and then once a day thereafter.

Minimize the use of makeup in the eyes when you have blepharitis, because mascara and other makeup can interfere with the hygiene of the eyelids.

If your doctor recommends an anti-dandruff shampoo, be sure to keep the shampoo out of your eyes to avoid irritation.

Blepharitis caused by mites can be treated using a diluted solution of tea tree oil, by applying a cotton swab, for 5-10 minutes per day.

Warm eye masks: some patients prefer to wear warming eye masks to achieve the same effects as a warm compress.

These masks can be more convenient. Eyelid cleaners (Ocusoft, Thera Tears Sterilid) are also available and offer an alternative to the use of diluted baby shampoo.

Artificial tears : which are available without a prescription, will help counteract the dry eyes caused by Blepharitis during the day. Artificial tears without preservatives are the best to use.

Forecast

Blepharitis is a chronic disease that has periods of exacerbation and remission. Patients should be informed that symptoms may improve frequently, but they are rarely eliminated.

Infrequently, severe Blepharitis can cause permanent alterations in the margin of the eyelid or loss of vision due to superficial keratopathy, corneal neovascularization and ulceration.

Patients with an inflammatory eyelid lesion that seems suspicious of malignancy should be referred to an appropriate specialist.

How to prevent Blepharitis from coming back

Blepharitis is usually a chronic disease, which means it can come back frequently and be a recurring problem. The best way to prevent him from coming back is by cleaning his eyelids daily.

Eyelid-free cleaning products are available, there are also prescriptions that can be more effective than baby shampoo or over-the-counter products, or you can use the same eyelid hygiene techniques described above.

Your doctor may also recommend nutritional supplements such as omega-3 fatty acids to help keep your meibomian glands healthy and your eyes moist and comfortable.

You can also recommend the routine use of eye drops that are sold without a prescription or with prescription lubricant. Your ophthalmologist may suggest routine cleaning procedures in the office to keep your eyes and eyelids healthy.

Ask your ophthalmologist which eyelid health maintenance program is best for you. And if Blepharitis symptoms return, consult your doctor immediately for an evaluation.