Blepharitis

Courtesy of David Kinshuck © Good Hope Hospital

Blepharitis is the medical term for inflamed eyelids. The inflammation is like eczema of the skin, with red, scaly eyelids.You may notice tired, or gritty eyes, which may be uncomfortable in sunlight or a smoky atmosphere. They may be slightly red, and feel as though there is something in them.The eyelids have tiny glands in them, especially the lower lids. These glands make substances that mix with tears, and help the tears to spread across the eye.

cartoon drawaing of blepharitis

A cartoon drawing of blepharitis: inflamed eyelids causing a sore eye
meibomian glands, diagram, side view

meibomian glands, diagram, front view

side view

front view

The glands in the eyelids shown in purple

This thin layer of tears lubricates the eyes, stops them drying out, and keeps them comfortable.

healthy tear film, side view

healthy tear film, front view

side view

front view

Evenly spreading tears: a comfortable eye

However, as you get older, and particularly if you have dry skin, these glands can block. As a result the glands do not make the chemicals that enables the tears to  spread evenly across the front of the eye.

As a result, the tears break up, and dry patches develop develop on the surface of the eye. These patches make the eyes feel sore or gritty. The eyelids evert during sleep.

poor tear film in blepharitis

poor tear film in blepharitis
side view front view

Poorly spreading tears: dry patches develop on the surface of the eyes making them sore.

 

The condition can be graded (ARVO 2010)

  1. mild…noticed by the doctor only. No treatment needed, except may need to treat just prior to cataract surgery. A healthy diet with a little fish is helpful as below.
  2. moderate
    • when the treatments below are needed…lid cleaning/antibiotic cream/lubricants.
    • more severe cases may need short courses of steroid creams for the eyelid.
  3. Corneal involvement…may need more steroid and antibiotic tablets.

Treatment

Blepharitis is not usually a serious condition. However, treatment is needed if you want to make the eye more comfortable.
In a very few people the blepharitis can be severe and damage the eyelids, and treatment can prevent more damage occurring.

The treatment is aimed at

  1. unblocking the glands in the eyelid, which may be infected and inflamed, like acne on the face or a tiny boil by Lid Cleaning
  2. replacing the tears if the eyes are dry with Lubricants (dry eyes and blepharitis may occur together: see below).
  3. treating any infection present with Antibiotic Cream antibiotic cream
  4. omega 3’s…th long chain type that are in oily fish, are very helpful and important. Shorter molecule omega 3s such as flaxseed oil are probably helpful helpful
  5. to treat infection and reduce the inflammation using Antibiotic tablets
  6. steroid creams (only to be used by ophthalmologists/expert professionals)
  7. if possible reduce doses of drugs likely to contribute to sore eyes, although this is often not possible as they are often essential. Proton pump inhibitors often contribute and their dose can be reduced.

The treatment should make your eyes more comfortable, but there is no magic cure. Even with treatment your eyes may remain a little sore, but no harm will come to them and there is nothing to worry about.

Start with lid cleaning, use antibiotic cream if this is not helpful. Tablets are for people with very troublesome sore eyes.