Blepharitis Causes and Treatment

Blepharitis (pronounced blef-a-right-is) or lid margin disease is an eye condition that is caused by inflammation and bacteria around the base of the eyelashes. Over time, bacteria builds up creating a structure called a biofilm. It can produce clumping and stickiness around the eyelashes and can contribute to dry eye disease. This is a chronic condition that is often difficult to treat.

There have been some exciting and revolutionary ways in how we manage Blepharitis and lid margin disease. These conditions are often the root of what causes some of our patients to be frustrated, dissatisfied or unhappy with their results after cataract or refractive surgery.

This condition can also interfere with our ability to read, use the computer and wear contact lenses. Blepharitis is frequently associated with systemic skin conditions such as ocular rosacea, seborrheic dermatitis or psoriasis. 

Lid margin disease is usually divided into anterior blepharitis involving the front part of the lid where the lash inserts into the skin and where bacteria likes to colonize, while posterior blepharitis or meibomian gland disease involves the lid margin behind the lashes and usually results from inflammation and clogging of the oil (meibomian) glands.

Anterior blepharitis causes the lids to become inflamed resulting in redness at the lid margin, misdirected or lash loss, While posterior blepharitis affects the health of the meibomian gland which can cause an unstable tear film resulting in burning, irritation and blurred visual acuity (VA).

Blepharitis and meibomian gland disease often coexists. The most common cause of anterior blepharitis is from staphylococci bacteria causing scaling, eyelid crusting and debris and affects predominantly the lid region at the base of the eyelashes. More common in younger patients and females.

A less well known but still common type of Blepharitis is associated with parasitic eyelash mites called Demodex (Demodex brevis or folliculorum) These microscopic mites and their waste materials are thought to clog the base of the lashes and cause irritation and redness. This form of blepharitis is much more prevalent in the elderly population. The below video ( courtesy of Terrence O'Brien, MD) shows a Demodex brevis moving along an eyelash.

Lid margin disease is a common and very ubiquitous, affecting millions of Americans. The build up of biofilm and bacteria creates a toxic environment, similar to the plaque that forms on your teeth, and can serve as a food source for eyelash mites. 

Bacteria in the eyelid biofilm also produce substances caused exotoxins that cause inflammation of meibomian glands in the eyelid margins. These glands normally secrete oils that are important for a healthy layer of tears on the surface of the eye. Inflammation of meibomian glands affects the quality and quantity of tears in the eye, and because our tears contain natural antibodies, fewer tears on the eye means even more bacteria can grow in the eyelid biofilm. This worsens inflammation; eventually leading to malfunction of the meibomian glands (MGD) and problems with other tear glands in and near the eyelids. These changes lead to chronic dry eye and discomfort.

Clogged meibomian glands also can cause the formation of a stye at the lid margin or a chalazion within the eyelid. Chronic lid margin disease, is the number 1 reason why patients see their eye doctor and causes symptoms that can significantly affect our patient’s quality of life and can literally cause misery for many patients affecting their ability to work and wear contact lenses. 

The Symptoms of Blepharitis

The most common symptoms of blepharitis include:

• Eye Pain
• Swollen / Red Eyelids
• Eye Irritation
• Watery Eyes
• Puffy Eyes
• Contact Lens Intolerance
• Dryness of the Eyes
• Eyelash Rubbing Against the Eyeball Gritty or Foreign Body Sensation
• Blurred Vision
• Crusting at the Eyelid Margin/Base of the Eyelashes
• Light Sensitivity
• Misdirected Eyelashes
• Abnormal Eyelash Loss
• Peeling of Skin On Eyelids
• Crusty or Greasy Eyelids

Blepharitis Treatment

There is no cure for Blepharitis, but treatment should begin with a visit with your eye doctor to determine the cause of your sore, red, itchy eyelids. Your doctor will closely examine your eyes and eyelids to evaluate whether you have blepharitis, meibomian gland and/or dry eye disease along with what type of treatment is most appropriate.

Typically, blepharitis treatment includes:

Eyelid scrubs. Blepharitis typically is a chronic condition, meaning it can come back frequently and be a recurring problem. Removing the buildup of biofilm, mites and excess bacteria from the lid margins is essential for successful treatment of Blepharitis and to prevent it from reoccurring . Your eye doctor typically will recommend a daily regimen of warm compresses and lid scrubs to clean your eyelids and reduce the amount of bacteria and Demodex mites on your lids. Cleaning agents may include prescription eyelid cleansers (NovaBay; Avenova) or non-prescription eyelid cleansers (Ocusoft; Hypochlor)

In-office procedures. Though eyelid scrubs at home are helpful, in-office eyelid hygiene procedures often are recommended for more effective blepharitis treatment. Possible procedures include:

Lid margin debridement (BlephEx) using a medical grade micro-sponge to efficiently exfoliate the lid margin and lashes which removes bacteria, biofilm and Demodex mites from your eyelids and maintains the health of the meibomian glands.

Thermal pulsation treatment (Lipiflow) is an in office procedure designed to melt and express material obstructing the meibomian glands. This is the only FDA-Cleared treatment for clogged meibomian glands. The effects from this treatment have been very positive. Studies have shown that this treatment can last up to a few years and prevents the progression of meibomian gland atrophy.

Intense pulsed light (IPL) therapy is being studied to close off abnormal blood vessels and potentially open clogged eyelid glands and help produce a healthier tear film.

Medicated eye drops and/or Ointments may be prescribed by your doctor to destroy excessive bacteria or other microbes on the eyelids — particularly if there is a risk of eye infection or it appears you have pink eye or some other type of eye infection as well as blepharitis.

Nutritional supplements like re-esterified omega-3 fatty acids may also be recommended by your doctor to help keep your meibomian glands healthy and your eyes moist and comfortable.

Eyelid hygiene is important and it should be continued even when symptoms have improved. Awareness and self-care is the number one factor in managing blepharitis.

Alice Epitropoulos, MD [email protected]

Ophthalmic Surgeons and Consultants of Ohio 1-800-964-9969 https://ohioeyesurgeons.com