How is Blepharitis diagnosed?

Blepharitis refers to inflammation of the eyelid margins. There are two broad categories of the condition – Anterior Blepharitis and Posterior Blepharitis.

Anterior Blepharitis

affects the front part of the eyelid margin, near the roots of the eyelashes. It is commonly caused by bacteria that normally live on our skin, that produce an irritative toxin that causes inflammation. The lid margin often looks ‘crusty’ and when seen under a microscope, the appearance can be similar to dandruff. Anterior Blepharitis can cause the eyelids to become red, itchy and sometimes slightly swollen too.

Posterior Blepharitis

is also referred to as Obstructive Meibomian Gland Disease. The meibomian glands are located within the eyelid, and the pores of the glands open onto the lid margin, behind the roots of the eyelashes. The glands normally produce a special oily secretion for the tears. The meibomian glands sometimes become inflamed and blocked, causing a reduction in amount, and disturbance in quality of the oily secretions. This can not only cause eyelid margin irritation, but also has secondary dry eye effects on the ocular surface.

Who gets Blepharitis?

Blepharitis is very common indeed – 5% of eye problems in primary care are said to be related to blepharitis. People of any age can be sufferers, but it is more common in older people over the age of 50. It is not something ‘caught’ or inherited. The reason for some people developing blepharitis is poorly understood.

What are the symptoms of blepharitis?

People who have blepharitis may not suffer from any symptoms at all. However, for those that do report symptoms, one or any combination of the following symptoms are common:

• Irritation of the eyelids and/or eyes
• Redness of the eyes
• Sore eyelids – sometimes red and swollen lid margins
• Crusting of the eyelid margins
• Eyelids may stick together on waking in mornings
• Burning and tearing of the eyes
• Gritty sensation in eyes
• Pain on looking at bright lights (photophobia)
• Small eyelid margin cysts

How is Blepharitis diagnosed?

Blepharitis is normally diagnosed in primary care by GPs on the clinical history alone. When a slit lamp microscope is available, for example at the optometrist’s or ophthalmologist’s clinic, the lid margin can be examined closely. Simple visualisation of the lid margin along with the history is how the diagnosis is normally made.

How is Blepharitis treated?

Unfortunately, there is not a definitive cure for blepharitis. There are many different ways clinicians have managed patients with blepharitis over the years. The fact there is not a definitive treatment is an indicator that no single treatment works significantly better than all others.

Lid margin cleaning

Both types of blepharitis can be helped with what is commonly referred to as ‘lid margin hygiene’. It is important that the lids are cleaned every day, whether there is discomfort or not. It should be considered as part of the daily routine, like showering, or teeth cleaning.

Ophthalmologists, Optometrists, Contact Lens Practitioners, GPs, Nurses and other health professionals recommend the application of regular warm compresses to soften and melt the solidified meibomian secretions. Usually the warm compresses are applied twice daily. The EyeBag maintains a temperature of over 40 degrees C. for 8 minutes. Hot wet flannel treatment is less effective as the flannel cools rapidly and the Meibomian secretions are not softened adequately.

1) Effective eyelid warming is the primary treatment for MGD. The MGDRx® EyeBag®, a reusable warm compress, which heats quickly and conveniently in a microwave.

2) Following the warming of the eyelids a lids message will help clear the blocked glands.

3) Use specially developed lid wipes to help cleanse the lid margins.

Do not use baby shampoo, bicarbonate of soda, or any other “home-made” solutions which may irritate or infect your eyes.

Carry out this cleaning regimen twice a day for at least a month by which time there should be a noticeable improvement. If not, seek expert help from your optometrist who will be able to make further recommendations. Ocular lubricants, antibiotics, or a short course of steroids may be needed in some cases to get blepharitis under control.

Avoid irritants

Minimising chemical irritants that include certain eye drop preservatives and makeup can help reduce blepharitis symptoms.

Dietary Changes

There is some evidence to suggest omega 3 oils such as those in Flax seed can improve the quality of meibomian gland secretions.

Antibiotics

Occasionally, if there is marked bacterial anterior inflammation, or if there is an associated skin condition such as seborrheic dermatitis, or even Rosacea, your doctor may prescribe antibiotic eye ointment, or indeed oral tablets.