Blepharitis – the Dry Eye Zone takes a closer look at this common condition
Blepharitis is the name given to the inflammation of the eyelids. It is a common condition which is often seen together with meibomian gland dysfunction and dry eye. Although not usually serious if left unchecked it can lead to more severe ocular surface conditions. However, the good news is that if you follow the advice of your eye care practitioner it is easily managed – but like most treatments related to dry eye it requires a disciplined approach.
Blepharitis presents itself as swollen, red, sore or itchy eyelids. In more severe cases you might see dandruff-like flakes or crusting around the roots of the eye lashes. It is not uncommon to experience sensations of gritty irritated eyes, and some people experience light sensitivity.
There are 2 types of blepharitis
Your eye care practitioner will most likely describe your blepharitis as either anterior or posterior. These different types are classified by where the inflammation is seen: anterior is towards the outer edge of the eyelid and posterior is towards the inner edge, the part that touches the eye. Posterior blepharitis can result in blockages to the meibomian glands. They are not mutually exclusive and some people have both.
Your eye care practitioner will be aiming to address the underlying causes of your blepharitis for the best clinical outcome. Blepharitis is most commonly caused by a bacterial build up on the eye lids. Having a certain degree of bacteria on your skin is normal and beneficial but if the amount of bacteria becomes excessive (your eye care practitioner might talk about a bacterial over-load) the toxins produced result in inflammation and blocked meibomian glands. Other, rarer, root causes could be a parasitic infestation or certain skin conditions.
How to manage blepharitis
You will no doubt have been told to pay extra attention to your eyelid hygiene. Using a specialist wash like DemEx is ideal and should be used both day and night. There are also specialist lid-wipes, but make sure you use ones that have anti-bacterial properties.
Years ago it was common practice to use baby shampoo but studies have since shown that this is not ideal and that better formulations are available.
Your eye care practitioner might also suggest heat therapy and massage to clear the meibomian glands of excessive bacteria and debris. The subsequent increase in natural oils or meibum released will help to condition the eye lips and lashes.
The challenge is to keep up the cleansing morning and night to avoid a symptom relapse.
Some eye care practitioners with a specialist interest in dry eye related conditions might offer an in-practice deep cleanse and massage to start you off. If you do get offered this the Dry Eye Zone team would recommend you give it strong consideration.
Until you get your blepharitis under-control it is wise to keep make-up to a minimum, especially avoiding eyeliner and mascara which could both make things worse. It might also be time to replace old cosmetic favourites for some dry eye friendly alternatives which are free of chemicals, in common use, which could aggravate any symptoms
In more severe cases an antibiotic ointment might be prescribed but as this is an ongoing condition this is best avoided if possible.
Image source: NHS
How to keep blepharitis at bay
When you have the condition under control it is important to keep it that way. Maintaining good eyelid hygiene is critical. You can also employ the help of antibacterial sprays such as Purifeyes. This antimicrobial solution harnesses the power of our bodies own antibacterial defence – hypochlorous – it has been specifically developed to be gentle enough to use on the delicate skin of the eyelid. It is easy to use and can be sprayed on the closed eye lid as required but at least twice a day.
Helping restore your eyelashes
Long term blepharitis can result in eyelash loss. You can restore the condition of your eyelashes by applying a pin-head sized drop of Lash Builder to your eyelids. This restorative serum is dry eye friendly, unlike many others which contain ingredients which can make symptoms worse. Simply apply and leave it to work while you sleep.
Blepharitis, meibomian gland dysfunction and dry eye
There is significant overlap in the symptoms of these three conditions. They are interlinked so it is not uncommon to experience more than one. For example, severe blepharitis will affect the meibomian glands and cause MGD resulting in evaporative dry eye.
The bottom line is that this is complex and hence why dry eye, and its related conditions, are such a frequent experience for so many people. So it is not a surprise that The WHO (World Health Organisation) gives the debilitating effects of dry eye a mention in its ‘World Vision Report’ and a call for it to not be overlooked.
If you are experiencing any of the symptoms mentioned in this article then you should ask the advice of your eye care professional. There is no substitute for regular check-ups to help keep your eyes healthy.
Jones L, Downie LE, Korb D, Benitez-Del-Castillo JM, Dana R, Deng SX, Dong PN, Geerling G, Hida RY, Liu Y, Seo KY, Tauber J, Wakamatsu TH, Xu J, Wolffsohn JS, Craig JP. TFOS DEWS II Management and Therapy Report. Ocul Surf. 2017 Jul;15(3):575-628. doi: 10.1016/j.jtos.2017.05.006. Epub 2017 Jul 20. PMID: 28736343.
Dr Kelly Nichols. Blepharitis and Dry Eye: A Common, Yet Complicated Combination
The diseases often co-present, which may confound treatment priorities. The Review of Optometry August 17, 2010. https://www.reviewofoptometry.com/article/blepharitis-and-dry-eye-a-common-yet-complicated-combination
The National Eye Institute. Blepharitis at a glance.
Putnam CM. Diagnosis and management of blepharitis: an optometrist's perspective. Clin Optom (Auckl). 2016 Aug 8;8:71-78. doi: 10.2147/OPTO.S84795. PMID: 30214351; PMCID: PMC6095371.
Viswambaran V. K, Anavadhy K. A, Chandrababu G, Babu A, Rajeev G, Gupta S. Blepharitis: A Review on Human Clinical Trials with Synthetic and Natural Remedies.Biomed Pharmacol J 2020;13(4).
The WHO World Report on Vision. https://www.who.int/docs/default-source/documents/publications/world-report-on-vision-accessible-executive-summary.pdf