What is Blepharitis? Symptoms, Risk Factor and Management
What is Blepharitis?
To understand blepharitis, you first have to understand a little of the anatomy of the eyelid.
Along the lash line, you have the orifices of the meibomian glands. These are glands which run under the skin of the eyelid and produce meibum, an oil which is the outermost layer of your tear layer.
Your tear layer is comprised of three elements, oil (meibum) which is the outermost layer, water and mucous, which sits closest to the cornea. The meibum has a much higher evaporation point than water, as such, it prevents the watery layer from evaporating off your eye.
Blepharitis is an inflammation of the eyelids, specifically the lid margin. This can be classed as Anterior Blepharitis or Posterior Blepharitis, also known as Meibomian Gland Dysfunction.
Anterior Blepharitis affects the front of the eyelid and the lashes. It is primarily caused by bacteria or mites that occur on the skin normally but are in excessive amounts in blepharitis patients.
Meibomian Gland Dysfunction pertains more to the inner eyelid and the entrance to the meibomian glands. These glands become blocked, which impedes the flow of oil into the tear layer. This causes the oil to back up in the gland, and become thicker, so the secretion of oil may not happen at all, or it may be secreted in thicker blobs. This can lead to a number of downstream problems, like dry eye, lumps in the eye lids called chalazions, or even styes if they become infected.
As you can see, blepharitis and dry eye are therefore very closely linked. There are no readily available public health figures in Australia around the prevalence of dry eye and blepharitis, but it is estimated that up to 85% of Australians have experienced dry eyes at some point.
What are the Symptoms of Blepharitis?
Dry, itchy or burning eyes
Foreign Body Sensation (the feeling that there is something in your eye)
Redness and inflammation of the lid margin
Crusty debris in the lashes or corner of the eyes
Blurry or fluctuating vision, worse in air con or heating
Watery eyes. This is one of the most common symptoms and occurs because of reflex tearing i.e. the eye is not sufficiently lubricated and produces more water to ameliorate the situation, but this still does not lubricate the eye so the vicious cycle continues
Discomfort with Contact Lenses
Who is at risk?
Risk factors include:
Age, advancing age makes this condition more common
Gender- more common in women than men
Poor eyelid hygiene- particularly in makeup wearers or those with lash extensions
Skin Conditions- patients with certain skin conditions like rosacea and seborrheic dermatitis are more at risk
Allergies- atopic patients, (those prone to allergies) are more at risk
Medications- some medications are known to reduce tear production and may increase your likelihood of blepharitis
Systemic Health Conditions- patients with thyroid conditions, diabetes, and certain autoimmune conditions are at a higher risk
Management of Blepharitis
Blepharitis is a chronic condition and there is no cure, but it can be managed to alleviate the associated symptoms.
Our Fremantle optometrists will discuss the best way to manage your specific condition, but as a rule these are the steps we take to manage blepharitis:
1. Cleansing
Demodex mites and Staphylococcus Bacteria occur naturally on the eyelid margin, but if their populations grow out of control this will trigger inflammation. The first step to managing this is to use a product which is anti-septic and reduces their populations but does not kill them altogether. One product we find very helpful is Blephadex. This contains tea tree oil and coconut oil which clean the lid margin very effectively, reduces the amount of bacteria in the area, and leaves you less likely to have a blocked gland or stye. This can be purchased either in a foam or a wipe form.
2. Hot Compress
If the meibum in your glands has backed up, it will now be the consistency of candlewax, and needs to be melted to deal with the issue. You need to apply some heat to the lid area to melt this solidified oil and gently massage it out of the glands. The heat needs to be at least 40 degrees and applied for at least 5 minutes to be effective. The easiest way to do this is to use a heat pack specifically designed for this purpose. Our optometrists will show you how to do a simple massage after the application of heat to clear the blocked glands,
3. Lubrication
Our optometrists will let you know which drops/oil/gel will address your individual issues.
4. Supplementation
Research has indicated that a diet high in omega 3/6 and 9 improves the quality of meibum we produce and can cause it to be thinner and easier to secrete from the glands. These can be found from dietary sources like salmon, mackerel, flaxseeds, chia seeds, nuts, olive oil, and avocados. You can also look into taking a fish oil supplement or flaxseed oil supplement, but make sure to check with your doctor before starting any supplements.
If your blepharitis is not responsive to these therapies, we can consider upping the ante! We can look at prescribing medicated eye drops like antibiotics or steroids, we may communicate with your doctor so that oral medications can be prescribed, we can manually express your meibomian glands in chair under anaesthetic, or we can look at a course of IPL. For Eyes Optometrist Fremantle has the advanced Lumenis M22 IPL system for the treatment of meibomian gland dysfunction. You can read about our IPL Treatment Protocol on our website www.foreyes.com.au or ask our optometrists about the process.
