Blepharitis, also known as meibomian gland dysfunction, meibomitis, meibomianitis or lid margin disease, is a common eye condition characterised by inflammation of the eyelids. It occurs when oil-secreting glands located in the eyelids, called meibomian glands, become inflamed. It frequently occurs in people who have oily skin or dandruff and is associated with dry eye.
The meibomian glands secrete a layer of oil over the tears to prevent rapid tear evaporation. When the oil secreted by the meibomian glands is excessive or of poor quality, the oil glands may become blocked with thickened secretions. This encourages the rapid growth of bacteria and causes the eyelids to become inflamed. If left untreated, these clogged glands eventually become unable to secrete oil. This results in permanent changes in the tear film and causes dry eye. Allergic reactions, hormonal changes and certain skin conditions such as acne and rosacea may also cause blepharitis.
Mild cases of blepharitis may not cause any symptom.
More severe cases may cause patients to experience irritation, burning sensation, excessive tearing, itch, increased sensitivity to light, red and swollen eyelids, red eye, blurry vision, dry eye or crusting on the eyelashes upon waking.
Sometimes, severe blockage of a meibomian gland may lead to an abnormal lump in the eyelid called a chalazion.
Blepharitis can be diagnosed during a slit-lamp examination by an eyecare professional.
Examination of each individual meibomian gland opening on the eyelid as well as the eyelashes under high magnification will be done. The eyelid margins may show numerous blocked meibomian glands as well as crusting and scales on the eyelashes. Applying pressure onto the eyelid margin may relieve the blockage in the glands and thick oily secretions may be expressed out of the glands.
The most important step in the management of blepharitis is to perform a good eyelid hygiene routine daily. The eyelid hygiene routine should be done at least twice a day during the initial months of starting treatment. The beneficial effects of eyelid hygiene may only become obvious after 3 to 4 months. After your condition has improved, the regime may be reduced to once a day or once every few days depending on the severity of your symptoms.
A typical eyelid hygiene routine consists of the following steps:
- Hand washing
Wash your hands with soap and water.
- Warm compress
In theory, you need to warm your eyelids to about 43°C. Warm compress helps to soften the oily secretions and open the pores of the glands, allowing the oil to flow out more easily. It also loosens scales and debris on your eyelids. You can perform warm compress using a warm gel pack or a warm face towel. A gel pack is more convenient and effective as it retains heat for a longer period of time.
- Eyelid scrub
Eyelid scrub removes oils, scales, debris and bacteria from your eyelids. You can perform eyelid scrub with a commercially available eyelid cleanser (eg, SteriLid Eyelid Cleanser, Lid-care Sterile Wipes) or with a diluted baby shampoo solution.
With eyelid foam (eg, Naviblef Daily Care Eyelid Foam)
Shake the eyelid foam before use. Pump some foam onto your clean fingertips. With your eyes closed, gently massage the foam into your eyelid margins and eyelashes. Avoid touching your eyes directly. Leave the foam in place for 60 seconds (less if it causes stinging) for maximum effectiveness. Rinse away the foam with water.
With eyelid wipes (eg, Lumecare Eyelid Wipes, i-Lid ‘N Lash Daily Cleansing Wipes)
Pull the lower eyelid downwards until is it not touching the eyeball. Use an eyelid wipe and wipe gently several times over the eyelid margin and the roots of the eyelashes, taking care not to touch the eyeball with the wipe or your fingers. You can wrap the wipe around your finger or a cotton bud if this is easier for you to handle. Do not wipe the inside of the eyelid. Repeat for the upper eyelid. After cleaning your eyelids, gently rinse your eyes with water.
- Microblepharoexfoliation (BlephEx treatment)
The BlephEx lid cleanser is a tiny, rotating lid scrubber used by eye care professionals to physically remove the scales and debris on the lid margins in blepharitis. The treatment with the BlephEx is very well tolerated and results in improved comfort almost immediately. The procedure is performed in the clinic using numbing eye drops and most people report only a mild “tickling” of the lids during the procedure. The procedure, called microblepharoexfoliation, may be repeated periodically (eg, every 4 to 6 months).
- Steroid-antibiotic combination eyedrop
Your doctor may prescribe a steroid-antibiotic combination eyedrop (eg, TobraDex, Dexa-Gentamicin) to reduce the inflammation of the eyelids and amount of bacteria on your eyelids.
- Steroid eyedrop
Your doctor may prescribe a steroid eyedrop (eg, Lotemax, FML) to reduce the inflammation of the eyelids. Steroid eyedrops should not be used long-term without medical supervision as it may cause the eyeball pressure to rise in some people.
- Oral antibiotic treatment
Our doctor may prescribe an oral antibiotic called Doxycap (doxycycline 100mg) to be taken once a day. Besides reducing the bacterial load on the eyelids, Doxycap inhibits the production of free fatty acid from the break down of eyelid oil. Free fatty acid can destabilise the tear film (causing dry eye) and can promote inflammation. By reducing the formation of free fatty acid, Doxycap makes the tear film more stable and reduces eyelid inflammation. The preferred treatment duration is typically at least 3 months.
Contact lens wearers should take special note that not all eyedrops can be used with contact lenses. Steroid-antibiotic eyedrop (eg, TobraDex, Dexa-Gentamicin), steroid eyedrop (eg, Lotemax, FML) and cyclosporine (eg, Ikervis, Restasis) should not be used with contact lenses as they can be absorbed by the lenses. Instill these eyedrops into the eye first, and wait 15 to 30 minutes before inserting the contact lenses. Most preservative-free eyedrops can be used with contact lenses (eg, Cationorm, Optive Fusion UD, Hialid Mini) but certain types (eg, Optive Advanced UD) cannot be used with contact lenses.
Blepharitis is a chronic condition that tends to persist for many months to years and it can be difficult to achieve permanent relief of the symptoms. Compliance to treatment is the key to achieving symptomatic relief from the conditions.
One approach is to treat this condition aggressively in the initial stages so that you can experience improvement in your symptoms. Early success encourages compliance to treatment. Once complete relief is achieved, you can then slowly experiment to reduce the amount or frequency of your medications and eyelid hygiene routine. The aim is to use the minimum medications to achieve the desired relief. Although it may not be possible to eradicate the conditions in every patient, most patients can get significant relief from their symptoms and improve their quality of life.