Blepharitis
Blepharitis means inflammation of the eyelid margins and represents a range of conditions which includes meibomium gland disease (MGD) and ocular rosacea. Blepharitis exacerbates DED by destabilizing the tear film and the two are often experienced together.
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What is Blepharitis
The eyelids contain between 20 and 50 meibomium glands which produce the lipid component of the tear film, this is important in allowing tears to spread evenly and also to delay tear film evaporation allowing the eyes to be lubricated for longer between blinks. Blepharitis is associated with MGD in which inflammation plays a prominent role, less lipid of higher viscosity is produced which in turn leads to higher bacterial cell counts and inflammation of the eyelid margins. Symptoms include red rimmed eyelid margins, irregularity of the lid margins, a crusting or a dandruff-like appearance along the eyelids, loss or clumping of eyelashes and the eyelids sticking together on waking. Higher bacterial cell counts along the lids, particularly with Staphlococcus aureus can lead to infections around the meibomium glands causing a chalazion (link to Other Eye Conditions page) also called a meibomium cyst.
People with ocular rosacea will often be aware of red rash or fine telangiectasia in a butterfly distribution across the bridge of the nose and cheeks and just over half will experience symptoms of blepharitis. Ocular rosacea tends to be worse in the 30 – 50 year age group.
Blepharitis and Demodex Folliculorum
Blepharitis may also be associated with Demodex infestation in which higher concentrations of the mite Demodex folliculorum are found in the eyelash follicles causing loss of the lashes, a dandruff like appearance to the eyelashes and may cause itching of the eyelids and forehead. Demodex infestation is age-related and Demodex mites are present normally at low concentration in individuals who have no symptoms of blepharitis and cause no harm. Tea-tree oil is particularly effective against Demodex but is an ocular irritant so specific ocular preparations are available for treatment, often as pre-soaked eyelid wipes.
Treatment for Blepharitis
Blepharitis may also be associated with Demodex infestation in which higher concentrations of the mite Demodex folliculorum are found in the eyelash follicles causing loss of the lashes, a dandruff like appearance to the eyelashes and may cause itching of the eyelids and forehead. Demodex infestation is age-related and Demodex mites are present normally at low concentration in individuals who have no symptoms of blepharitis and cause no harm. Tea-tree oil is particularly effective against Demodex but is an ocular irritant so specific ocular preparations are available for treatment, often as pre-soaked eyelid wipes.
The LipiFlow® Thermal Pulsation System is an outpatient treatment in which heat is applied to the eyelids which are massaged by rollers from top to bottom. Treatment typically takes around 10 – 15 minutes.
Medical treatment for blepharitis will involve a course of treatment to reduce ocular surface inflammation and control lid margin Staphlococcus aureus. Longer term treatment can include a course of macrolide antibiotic therapy. As blepharitis is a chronic medical condition it is important to realize that it cannot be cured as such although symptoms can often naturally wax and wane and once controlled, many people can control their symptoms using lid hygiene measures alone.
Managing blepharitis is important in preparing for any eye surgical procedure and also in maximizing the visual results obtained from surgery as disruption of the tear film caused by DED or blepharitis degrades the quality of the optical image before it enters the eye. We will advise you on the best strategies for managing blepharitis either as part of routine surgical management or as part a comprehensive treatment strategy for treating blepharitis and DED.
