Blepharitis

Blepharitis refers to chronic inflammation of the eyelids. Blepharitis is one of the most common disorder of the eye and is often the underlying reason for eye discomfort, redness and tearing. Other eye symptoms of blepharitis include: Burning, itching, light sensitivity, and an irritating, sandy, gritty sensation that is worse upon awakening.
There are 3 forms of blepharitis (staphylococcal, seborrheic and MGD). All three forms of blepharitis are chronic in nature. Patients with staphylococcal blepharitis are relatively young (mean age 42 years) with a short history of ocular symptoms (mean 1.8 years). Patients with seborrheic blepharitis and MGD blepharitis are generally older and have a longer history of ocular symptoms.

In staphylococcal blepharitis there is scaling and crusting along the eye lashes. In seborrheic blepharitis there is greasy scaling along the eyelashes. Patients frequently have seborrheic dermatitis as well. In Meibomian gland dysfunction (MGD) there are prominent blood vessels crossing the eyelid margin. In addition there is pouting or plugging of meibomian gland openings, and poor expressibility and/or turbidity of the oily meibomian secretions. Patients with MGD frequently are noted to have coexisting rosacea and seborrheic dermatitis (Rosacea's Red Face). Use of isotretinoin (Accutane), an oral medication for severe cystic acne, has also been implicated as a cause of blepharitis.

Blepharitis Treatment

Blepharitis is a chronic disease for which there is no cure, and requires long-term treatment to keep it under control. Treatment consists of 2 phases (Acute phase and Maintenance phase). Acute phase treatment involves intensive therapy to rapidly bring the disease under control. In the maintenance phase the goal is to indefinitely continue the minimum amount of therapy that is necessary to keep the disease quiet. Warm Compresses followed by Lid Scrubs is the most critical element of effective blepharitis control. This therapy removes the eyelid debris (which can be colonized by bacteria), reduces the bacterial load (mechanically as well as by lysis of bacteria due to detergent action of the soap in lid scrubbing) and stabilizes the tear film by releasing oily secretions from the meibomian glands, thus reducing tear evaporation (so the dry eye symptoms are also reduced).

Warm Compresses

Warm compresses heat the debris and crust on the lid margin to or above the melting point of their individual components so that they are easily removed with the lid scrubs.
Technique: Soaking a washcloth in water as warm as the eyelids can stand, and then placing the cloth on the lid surface (eyelids closed) for a five to ten minute period. In the acute phase this is performed 2 to 4 times day.
Another method described is to use a stocking filled with grains of uncooked dry rice heated in a microwave oven to a comfortable warm temperature. Often antibiotic ointments or drops are used for limited time periods. Rarely short courses of mild steroid eye drops are useful.