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Blepharitis
Blepharitis is a common and persistent inflammation of the eyelids. Symptoms include irritation,
itching, burning, a foreign body sensation (scratching), lid crusting, and occasionally a red eyes or
eyelids and lashes that stick together in the morning on waking. Apart from causing annoying
symptoms, blepharitis can interfere with contact lens wear and aggravate treatment of patients with
dry eyes. Occasionally inflamed eyelids cause infections of the eyeball with potentially serious
consequences.
Who gets Blepharitis?
Blepharitis occurs frequently in people who have oily
skin, dandruff, or dry eyes. It may begin in early
childhood, producing “granulated eyelids”, and continue
throughout life as a chronic condition, or develop later in
life.
Bacteria reside on the surface of everyone’s skin, and in certain people they thrive in the skin at the
base of the eyelashes. The resulting irritation sometimes associated with abnormal function of the
nearby oil glands. For some people this is only minor irritation and itching, but in others they may
cause redness and severe stinging or burning. Some people may develop an allergy to associated
flakes of skin or to the bacteria which surround them. This can lead to a more serious complication,
inflammation of the eyeball, particularly the cornea.
Why do we get Blepharitis?
Meibomian glands are the oil-producing glands
located in both the upper and lower eyelids. They
normally slowly release oil into the tear film. This oil
keeps the eyeball slippery, improves vision and helps
to stop the tears from evaporating preventing dry
eyes. Sometimes the oil becomes abnormally thick
resulting in obstruction of the narrow ducts from the
glands into the tear film. As the oil production
continues it results in overfilling and swelling of the glands, also causing inflammation. Since the
stabilizing oil cannot reach the tear film it often also results in dry eye as the tears evaporate too
quickly. Severe blockage can lead to much enlarged glands (a cyst) or even infection. It is therefore
important to firstly, unclog the glands which are blocked and secondly to prevent them from blocking
up again as much as possible.
How do we treat Blepharitis?
Treatment requires a program of daily eyelid hygiene including eyelid cleansing at regular intervals.
This helps to remove accumulated debris, crust and toxic products from the eyelids. Warmth applied
directly to the eyelid margins is also important to open and flush the meibomian glands. A prescription
for antibiotics is often also required prescribed. Ocular lubricants are also recommended to relieve
symptoms associated with the induced dry eye syndrome and to dilute inflammatory chemicals and
toxins in the tearfilm.
It's important to know that in some cases, it may take up to eight weeks to notice an improvement
and ongoing treatment is often necessary to keep the condition under control.
Treatment Plan:
1. Warm Compresses
1.1. The first part of unblocking the glands is to liquefy the thickened oil in the glands. This is
achieved by gently applying heat to the eyelids. Then, having liquefied the oils with this
warming, press with one finger firmly on your lower eye lid, up close to the lashes.
1.2. Next gently press the edge of the eyelid upward using a clean fingertip or cotton bud, to
express the oil up into the tear film.
1.3. Do this a several times over the entire extent of lower eyelid. For the upper eyelids use a
downward rolling motion.
1.4. Repeat the entire procedure for the other eye.
This will help to unclog the blocked glands. Your eyes may initially feel more uncomfortable
afterwards for a short time afterward. This is normal and will improve over time and you’ll soon
notice a more moist and comfortable eye.
2. Lid Scrubs
2.1. In front of a well illuminated mirror, rub a small cotton pad soaked in cleansing solution
across the base of the eyelashes (with your eyes closed) for about 15 to 20 seconds per
eyelid, twice a day. Scrub the upper and lower lids by rubbing the pad back and forth along
the base of the lashes several times.
We recommend that you scrub your lid margins with the following:
_______________________________
3. Lubrication
3.1. Lubricate your eyes immediately after doing compress and massage.
3.2. Lubricate your eyes at least 6 times a day with an unpreserved lubricant preparation.
We recommend that you use in the daytime: ___________________ as a lubricant. If your
eyes are dry and uncomfortable, or stuck together on waking, a thicker lubricant is
recommended before you go to sleep. We recommend _____________________________
for this purpose
4. REVIEW
4.1. Schedule and appointment for ___________weeks.