This is a common inflammatory condition of the eyelid margin where the eyelashes grow. It is associated with a skin condition, rosacea, and is more common in people with oily skin and dandruff. It is often a chronic condition that can be treated but not cured. Blepharitis causes discomfort, but it does not usually cause permanent damage to sight.
Exactly what causes blepharitis is unknown. It has recently been suggested that problems with the surface of the eye may be responsible. Changes in the components that make up tears are associated with blepharitis.
Symptoms of blepharitis include itchy, red or swollen eyelids, particularly near the lashes; crusting of the lashes or flaking of the skin around the lashes; lashes that grow in an abnormal direction or loss of eyelashes; and burning, itching, redness, and tearing of the eyes.
Treatment of blepharitis begins with regular cleaning of the eyelash margins. Cleaning with a warm washcloth once or twice daily for about 15 seconds per eyelid is the only treatment that is needed for most people. Warm, dilute baby shampoo applied with a washcloth or commercial cleaning solutions may be used once or twice weekly. Artificial tears can be used to lubricate the eyes and relieve dry eye symptoms. Warm compresses using a heated rice sock are very effective for loosening scales and debris from the lashes and diluting secretions from oil glands in the eyelids.
To make your own rice sock: Begin with a long, clean, thick cotton sock. Fill it with 1 cup of uncooked rice. Do not pack too tightly. You want the grains to be able to conform to the shape of your lid. Tie the top of the sock. Put the sock in the microwave for about 1 minute. You want the grains to be warm but not so hot that they burn your face. Shake the sock to distribute the heated rice. Lie down and place the sock over both eyes. Leave it in place for 15 minutes. The rice sock can also be put in the freezer for an hour to use it as a cold compress.
During flares in the disease, antibiotic or steroid eyedrops or ointments may be used for a few weeks. Patients with dandruff should use a shampoo designed to control this condition.
The meibomian glands of the eyelid secrete an oily material that makes up part of the normal tear film. There are about thirty glands in each eyelid. Dysfunction and inflammation of these glands (meibomitis) can cause them to become filled with thick secretions. Dysfunction of the meibomian glands increases with age and is present in 2/3 of people over the age of 60 years. Meibomitis causes symptoms of dry eyes (burning, itching, redness, and tearing) because of the loss of the oily material that is intended to keep the tears from evaporating away from the surface of the eye. The thick secretions that are left behind in the glands can provide a food source for bacteria that normally live on the skin. These bacteria break down these secretions and create fatty acids that irritate the surface of the eye as well as causing the formation of dandruff-like scales on the lashes and eyelid margins.
Patients may respond to treatment with oral antibiotics for several months. These antibiotics have anti-inflammatory properties and that change the consistency of the meibomian gland sectretions. Restasis eyedrops can also be effective to decrease inflammation in the meibomian glands. Dietary supplements of omega -3 fatty acids have been shown to decrease inflammation at the eyelid margin and decrease the abnormal thickness of meibomian gland secretions.
When the meibomian gland becomes swollen from secretions, it produces a chalazion, a lump in the eyelid. About a quarter of the time, the chalazion will go away without any treatment. Chalazia usually respond well to treatment with warm compresses and antibiotic ointments. For chalazia that do not resolve, steroid injections or surgical removal can be performed.
Bacterial infection inside a meibomian gland or a gland of Zeiss or Moll (associated with the eyelashes) produces a stye or hordeolum, a red, sore lump near the edge of the eyelid. It can cause rather sudden swelling of the eyelid and is often very tender to the touch. The stye usually resolves on its own over about a week and often does not require medical treatment. Cool compresses applied to the area up to every three hours for 15 minutes at a time can help to reduce swelling and pain. In a few days when the pain resolves, warm compresses can help with drainage. Squeezing or puncturing the stye is not recommended as this can cause the infection to spread into the surrounding tissues of the eyelid. Tylenol can be used for pain. Medical treatment includes the use of antibiotic ointment or drops. Oral antibiotics are used when the infection has spread out of the gland. Surgery is a last resort for styes that do not respond to other treatment.
To prevent the spread of bacteria, hand washing and avoiding touching the eyes are very effective. Cosmetics and applicators should never be shared with other people. Makeup should be removed nightly and replaced when contaminated or aged. Mascara should be replaced at least every 6 months. Eye shadow and eye pencils should be replaced at least yearly.