Treatment of Blepharitis
What is blepharitis?
Blepharitis is a chronic inflammation of the eyelid edges. It is not usually serious but may become an uncomfortable, irritating problem.
What is the cause of blepharitis?
The eyelids have tiny glands (meibomian glands) which make an oily substance that helps form the tear film. The glands open onto the eyelid margins close to where the eyelashes grow. As you get older and if you have dandruff, rosacea or dry skin, these glands can block or malfunction. Without the oily layer the tear film breaks up easily and results in dry eye symptoms.
What are the symptoms?
- Sore inflamed eyelid margins. Both eyes are usually affected.
- Gritty, itchy or burning eyes that are worse in the morning.
- Crusts may develop at the base of eye lashes.
- One or more of the meibomian glands of the eyelids may block and fill with an oily fluid.
Symptoms often come and go and can typically flare up from time to time, but you may have long periods without any symptoms.
What is the treatment?
The aim of treatment is to control or manage blepharitis, not to cure it. With regular treatment symptoms can be eased and then kept to a minimum. If you do not keep up with treatment the inflammation and symptoms tend to recur.
The main treatment is regular eyelid hygiene (see below). Other treatments that may be needed include artificial tear drops and in some cases antibiotics.
Regular eyelid hygiene
This is the most important part of treatment and prevention of blepharitis. This is a daily routine that consists of three parts – warmth, massage and cleansing. The aim is to unplug any blocked meibomian glands, clear out any stagnant oily secretions from these gland and clean and remove debris from eyelid margins and lashes. Remove any contact lenses before following the routine.
This helps soften the oil in the meibomian glands. It can be done with a hot flannel or a heated eye mask.
Hot flannel-press on the eyelids gently for 5-10 minutes with a flannel that has been rinsed in very warm water and wrung out. If the flannel cools keep re-warming it in the warm water
Eye Mask-there are a number of such eye masks available which you can buy from some opticians or online. The eye masks are warmed in a microwave then placed over your eyes for about five minutes
Massage the eyelids immediately after applying the warmth. Massaging helps to express the oily secretions from the blocked meibomian glands.
To massage the eyelids:
-With the eyes closed sweep a finger downwards along the upper eyelid and upwards when moving along the lower eyelid. Massage along the length of the upper and lower eyelids towards the eye.
-Repeat this massage action 5 to 10 times over 30 seconds.
After warmth and massage, clean the eyelid margins by any of the following ways.
Cool Boiled Water
- pull the eyelid away from the eye and using a cotton bud that has been dipped in cool boiled water, wipe along the edge of the eyelid and remove any crusts, particularly at the base of the eyelashes. You may need to use several cotton buds. Take care not to touch the eye itself.
- you may be advised to add a few drops of baby shampoo to the cool boiled water. If this causes irritation to the lids then leave out the baby shampoo or consider using medicated wipes (see below).
Medicated wipes/solutions- you can buy various medicated wipes or cleaning solutions for blepharitis from some opticians or chemists. Follow the instructions for use on the packaging.
You should do the above routine: warm compresses, massage, clean, at least twice a day until symptoms settle which may take 2 – 4 weeks. When the symptoms have eased continue this routine once a day, every day, to prevent further flare-ups. If you are prone to blepharitis it is best to think of this as part of your daily routine – just like brushing your teeth. This is the best way to keep symptoms away, or to a minimum.
Artificial tear lubricants
Blepharitis is often associated with dry eyes. This is because part of the tear film is produced by meibomian glands. So if they are blocked or not working well, your eyes will not be as well lubricated. Therefore artifical teardrops may help ease symptoms. Artifical tears are available as drops, gels and ointment. A number of tear drops can be bought over the counter, recommended by your optician or prescribed by your GP. Occassionally some people find one type may irritate, a change to a different preparation may help of the first does not suit.
Antibiotic eye ointment-may be advised for a while if an eyelid becomes infected. If you are prescribed an antibiotic ointment place it on the edge of the eyelid (not in the eye) after cleaning the eyelid in the way described above. You will normally need to use these for a month.
Antibiotic tablets-antibiotic tablets are sometimes used if symptoms are persistent despite regular lid hygiene. Antibiotics are particularly effective if you have a skin condition, such as acne rosacea or very dry skin, or if the edge of your eyelid stays red with many scales. Antibiotic tablets are NOT suitable for everyone.
Wearing eye make-up, particularly eyeliner, may make symptoms worse. It is best to avoid eyeliner, particularly during a flare-up. Rubbing your eyelids may make inflammation worse so try to avoid doing this.
Some studies suggest that increasing omega-3 (found in fish oils) and reducing omega-6 (mostly in fast foods) may improve symptoms for people with dry eye syndrome and blepharitis. This can be achieved by eating one to four portions of oily fish each week. However if you are pregnant, or trying to become pregnant, you should not eat more than 2 portions a week. The best source of omega-3s are oily fish but you can also get omega-3s from various nuts and seeds (e.g. walnuts and flaxseed), vegetable oils (e.g. rapeseed), soya products and green leafy vegetables. Alternatively omega-3 supplements are available to buy from pharmacies and health food shops. Omega-3 supplements are not recommended on NHS prescription.
The College of Optometrists have a helpful website called ‘Look after your eyes’ which can be found at this link: