Blepharitis is defined as inflammation of the eyelids and eyelashes. Symptoms include red, irritated, itchy eyelids.  You may even notice crusting around the eyelashes that resembles dandruff. It is a very common problem that can be caused by bacterial infections, certain skin conditions like acne rosacea, and demodex infestation.  While blepharitis is generally not considered sight-threatening, it does cause discomfort and can have a big effect on your tears which can lead to ocular surface disease and blurry vision.

Blepharitis is classified into two types:

1. Anterior blepharitis occurs at the outside front edge of the eyelid where the eyelashes are attached.

2. Posterior blepharitis affects the inner surface of the eyelid that comes in contact with the eyeball.

Treatment of blepharitis usually involves good eyelid hygeine. This includes frequent scalp and face washing, using warm compresses to soak the eyelids, and doing eyelid scrubs. The easiest way to control blepharitis is by using Avenova eyelid cleanser twice a day (you can order your Avenova refills here). In cases where a bacterial infection is the cause, various antibiotics and other medications may be prescribed along with eyelid hygiene.

What causes blepharitis?

Anterior blepharitis is commonly caused by bacteria (staphyloccus blepharits) or dandruff of the scalp and eyebrows (seborrheic blepharitis). It may also occur due to a combination of factors, or less commonly may be the result of allergies or an infestation of lice on the eyelashes.

Posterior blepharitis can be caused by excessive oil production by the glands of the eyelids (meibomian blepharitis) which creates a favorable environment for bacterial growth. It can also develop as a result of other skin conditions such as acne rosacea and scalp dandruff.

How is blepharitis diagnosed?

Blepharitis can be diagnosed through a comprehensive eye examination. Testing, with special emphasis on evaluation of the eyelids and front surface of the eyeball, may include:

* Patient history to determine any symptoms the patient is experiencing and the presence of any general health problems that may be contributing to the eye problem.
* External examination of the eye, including lid structure, skin texture and eyelash appearance.
* Evaluation of the lid margins, base of the eyelashes and meibomian gland openings using high intensity light and magnification.
* Evaluation of the quantity and quality of tears for any abnormalities.

A differentiation among the various types of blepharitis can often be made based on the appearance of the eyelid margins:

* Staphyloccal blepharitis patients frequently exhibit mild sticking together of the lids, thickened lid margins, and missing and misdirected eyelashes.
* Seborrheic blepharitis appears as greasy flakes or scales around the base of eye lashes and a mild redness of the eyelids.
* Ulcerative blepharitis is characterized by matted, hard crusts around the eyelashes which when removed leave small sores that ooze and bleed. There may also be a loss of eyelashes, distortion of the front edges of the eyelids and chronic tearing. In severe cases, the cornea, the transparent front covering of the eyeball may also become inflamed.
* Meibomian blepharitis is evident by blockage of the oil glands in the eyelids, poor quality of tears, and redness of the lining of the eyelids.

Using the information obtained from testing, our doctors can determine if you have blepharitis and advise you on treatment options.

How is blepharitis treated?

Treatment depends on the specific type of blepharitis. The key to treating most types of blepharitis is keeping the lids clean and free of crusts.

* Warm compresses can be applied to loosen the crusts, followed by gentle scrubbing of the eyes with an over-the-counter lid cleansing product. In cases due to bacterial infection, an antibiotic may be prescribed, along with lid hygiene.

* If the glands in the eyelids are blocked, the eyelids may need to be massaged to clean out oil accumulated in the eyelid glands.

* If the blepharitis makes the eyes dry, artificial tear solutions or lubricating ointments may be prescribed.

* If lice are the cause, petroleum jelly can be applied along the base of the eyelashes to eliminate them.

Use of an anti-dandruff shampoo on the scalp can help. In addition, limiting or stopping the use of eye makeup is often recommended, as its use will make lid hygiene more difficult. If you wear contact lenses, you may have to temporarily discontinue wearing them during treatment.

Blepharitis seldom disappears completely. Even with successful treatment, relapses may occur.
Self-care

An important part of controlling blepharitis involves treatment at home. Warm compresses can be used to loosen crusts on eyelashes, followed by gently scrubbing the eyelashes.

Directions for a Warm Soak of the Eyelids:

1. Wash your hands thoroughly.
2. Moisten a clean washcloth with warm water.
3. Close eyes and place washcloth on eyelids for about 5 minutes.
4. Repeat several times daily.

Directions for an Eyelid Scrub:

1. Wash your hands thoroughly.
2. Use a commercially prepared lid scrub solution recommended by your optometrist.
3. Close one eye and using a clean cloth (a different one for each eye) rub the solution back and forth across the eyelashes and edge of the eyelid.
4. Rinse with clear, cool water.
5. Repeat with the other eye.