Blepharitis: Dealing With Aggravated Eyelids

“Blephara” is the medical term for the eyelids. "Itis" is the Latin suffix for irritation. Put them together and you have blepharitis, a condition that affects up to 15 percent of Americans. Although it’s uncomfortable and unsightly, blepharitis is usually only a minor annoyance — but it can lead to serious complications if left untreated. Blepharitis can also cause considerable psychological distress, because its symptoms can be mistaken for excessive crying, alcohol use, or even drug abuse.

Classic symptoms noticed upon awakening include:

• Eyelids crusting or flaking.
• Eyelids stuck together.
• Red eyes or eyelids.

Other symptoms include:

• Excessive tearing.
• Frothy tears.
• Itchy eyelids.
• Swollen eyelids.
• A gritty, burning sensation in the eye.
• Flaking skin around the eye.
• Dry eye.
• Sensitivity to light.
• Misdirected or missing eyelashes.
• Blurred vision.
• Inflammation of other eye tissue, especially the cornea.

There are two types of blepharitis:

• Anterior blepharitis, which affects the outside front edge of the eyelid where the eyelashes are attached.
• Posterior blepharitis, which affects the inner eyelid that makes contact with the eyeball.

Getting to the Root of Blepharitis

Anterior blepharitis is caused by:

• Bacterial infection (staphylococcal blepharitis), which causes a mild sticking together of the eyelids, a thickened outside front edge of the eyelid, or misdirected or missing eyelashes.
• Dandruff on the scalp or eyebrows (seborrheic blepharitis), which causes mild redness of the eyelids and greasy flakes or scales at the base of the eyelashes.
• Less common causes include allergies and lice infestations of the eyelashes.

Posterior blepharitis is caused by:

• Malfunctioning oil glands in the eyelids (meibomian blepharitis), which causes poor-quality tears and redness in the inner eyelid.
• Other skin conditions. These include acne rosacea, seborrheic dermatitis of the face or scalp, and scalp dandruff.

Preventing Blepharitis

Good hygiene practices can help you avoid blepharitis. These include:

• Regular face washing (morning and evening). Be sure to carefully clean your eyelids.
• Regular hand washing (as often as necessary).
• Avoidance of eye rubbing, especially with dirty fingers, a soiled handkerchief, or other contaminated surfaces.
• Removal of all eye makeup before bedtime.
• Dandruff shampoo (if dandruff is present).

Home Treatment of Blepharitis

Mild cases of anterior and posterior blepharitis can be managed by avoiding eye makeup, discontinuing the use of contact lenses, using dandruff shampoo if necessary, and practicing this step-by-step daily regimen:

• Warm compress. At least once or twice a day, thoroughly wash your hands and apply a warm, clean compress to the affected eye for 10 minutes to loosen the crusts.
• Eyelid and eyelash scrub. Moisten a clean washcloth with warm water and a few drops of "no tears" baby shampoo or an over-the-counter lid cleansing solution, and lightly scrub to remove oily debris and scales. Rinse with warm water, and pat dry with a clean towel.

Medical Treatment of Blepharitis

If your symptoms worsen or don't improve after following the above regimen for a few days, make an appointment with your doctor, preferably an eye-care professional. He or she may recommend additional home remedies, such as applying an over-the-counter antibiotic ointment to the eyelid immediately after compresses and scrubs, or using artificial tears. If you have posterior blepharitis, you may be advised to regularly massage your eyelid to clean the oil accumulated in the glands.

More severe cases of blepharitis can be managed with a combination of home treatments and prescription medications, which include:

• Eyedrops that contain antibiotics and/or steroids. A newer treatment on the market — an eyedrop containing 1 percent azithromycin — is gaining favor with eye doctors because it needs to be applied less frequently than other eyedrops, has more potent antibacterial and anti-inflammatory activity, and has continued effectiveness long after the one-week course of therapy.
• Oral antibiotics such as tetracycline or doxycycline, which reduce bacterial colonization on the skin and may normalize oil-gland dysfunction.
• Treatments for other skin conditions.

A comprehensive eye exam will help your doctor identify and treat any of several complications that may be associated with blepharitis. These include:

• Stye, a painful lump on the surface of the eyelid caused by a bacterial infection.
• Chalazion, a painful lump on the inside of the eyelid caused by a blocked and infected oil gland.
• Corneal ulcer.
• Pinkeye.
• Eyelid scarring.
• Dry eye, which can also be caused by Sjogren's syndrome or diabetes.

Although blepharitis generally doesn’t cause any permanent damage to eyesight, it's a beauty bummer because it's often chronic or recurring. But with proper home or medical management, you can control the itching, irritation, and redness — leaving your eyes to simply be the windows to your soul.