Microblepharoexfoliation (BlephEx Treatment) – An Adjunctive Therapy for Blepharitis

Dr Au Eong Kah Guan
Dr Au Eong Kah GuanMedical Director & Senior Consultant Ophthalmologist
MBBS(Singapore), MMed(Ophthalmology)(Singapore), FRCS(Edinburgh), FRCS(Glasgow), DRCOphth(London), MRCOphth(London), FAMS(Ophthalmology)(Singapore)
Por Jia Yee Davina
Por Jia Yee DavinaOptometrist

By Por Jia Yee Davina1 and Dr Au Eong Kah Guan2

1Optometrist 2Medical Director and Senior Consultant Ophthalmologist

International Eye Cataract Retina Centre at Mount Elizabeth Medical Centre and Farrer Park Medical Centre, Singapore


The normal eyelid margin is lined with oil glands (called Meibomian glands) that secrete meibum, an oily substance that prevents evaporation of the eye’s tear film. When the Meibomian glands become dysfunctional, the eyelid becomes inflamed, resulting in a common eye condition called blepharitis.

In blepharitis, the Meibomian glands secrete excessive or poor quality meibum which hardens over the tiny gland openings along the eyelid margin. This contributes to a build-up of a layer of biofilm containing an overgrowth of bacteria along the eyelid margin.

Like a plaque that forms on your teeth, this eyelid biofilm becomes a toxic environment. Bacteria in the eyelid biofilm produce toxic substances called exotoxins that cause inflammation of the Meibomian glands and eyelid. In addition, parasitic eyelash mites called Demodex feed on the biofilm and multiply on the eyelashes, causing the eyelid inflammation to worsen.

Blepharitis is associated with other skin conditions such as rosacea, eczema, dandruff and psoriasis.

Blepharitis causing a build-up of a biofilm and crusting on the eyelid margin near the base of eyelashes

Blepharitis causing a build-up of a biofilm and crusting on the eyelid margin near the base of eyelashes


Studies have shown that up to 35% of all eye patients have some form of blepharitis symptoms. Common symptoms include eye redness, itching of eyelids, burning sensation in the eye and dandruff-like crusting on the eyelids and eyelashes.

Blepharitis and dry eye often occur together, causing some confusion whether blepharitis causes dry eye or dry eye causes blepharitis. For this reason, some eye doctors now believe that these two conditions may be part of a single chronic eye problem called dry eye blepharitis syndrome (DEBS). According to this theory, dry eye is simply a late manifestation of blepharitis, and treating blepharitis will prevent, reduce or eliminate dry eye symptoms.

Blepharitis may also cause other problems such as contact lens intolerance and eyelid swelling called chalazion from blockage of the Meibomian gland.

Redness and swelling of the upper eyelid due to inflammation caused by blepharitis

Redness and swelling of the upper eyelid due to inflammation caused by blepharitis


Typically, blepharitis treatment involves a daily regimen of warm compresses and eyelid scrub to remove the build-up of biofilm and bacterial overgrowth from the eyelid margins. This eyelid hygiene routine is very helpful to treat and control blepharitis, but only if performed properly and regularly.


Although eyelid scrubs at home are helpful, many patients fail to perform the procedure properly or are unable to perform it as regularly as is needed. For this reason, some eye doctors recommend an in-office eyelid hygiene procedure such as microblepharoexfoliation (BlephEx treatment) to supplement the home therapy in order to treat blepharitis more effectively.

Microblepharoexfoliation is a painless procedure performed by an eye care professional using a medical device called BlephEx. The instrument has a tiny rotating disposable medical grade micro-sponge to physically scrub the edge of the eyelids and eyelashes, removing the biofilm and exfoliating the eyelids. This procedure takes about 10-15mins for both eyes.

Regular microblepharoexfoliation helps to reduce or eradicate the symptoms caused by blepharitis. It can be performed every 4 to 6 months or as needed.

Lubricating eye drops, steroid-antibiotic combination eye drops and oral antibiotic can also aid in the treatment of blepharitis.

Microblepharoexfoliation is an adjunctive therapy for blepharitis

Microblepharoexfoliation is an adjunctive therapy for blepharitis