Blepharitis
What is blepharitis?
Seborrheic blepharitis
Staphylococcal blepharitis
Demodex blepharitis
Blepharitis treatment
References
What is blepharitis?
Blepharitis is inflammation of the eyelids. The margins of the eyelids usually thicken and look red. It may also cause redness of the eyes, itching and a gritty irritation. It affects people of all ages but is more common in those older 50 years. Blepharitis is likely to be the most under-diagnosed, undertreated, and underappreciated eye disease worldwide. (1)
Blepharitis is often confused with conjunctivitis or Sjogren's syndrome (dry eyes) due to its gritty sensation. It can also be confused with an allergic response to dust mite faeces and other allergens. If your red eyelids are caused by an allergy, prescription ocular antihistamines and over-the-counter ocular antihistamines can bring almost immediate relief. Treatment of the underlying root causes of the allergy.
There are two primary types of blepharitis:
- Anterior blepharitis affects the outside or edges of the eyelids, where the eyelashes are attached. Bacteria, fungi, rosacea, mites or dandruff that spreads to the eyelashes are the common causes of anterior blepharitis. Poor hygiene often causes anterior blepharitis and it can usually be cured.
- Posterior blepharitis affects the inner eyelid, where it is in contact with the eye. Posterior blepharitis is often associated with meibomian gland dysfunction when the oil glands surrounding the eyelashes are not secreting enough oil, often because they are plugged or crusty. Posterior blepharitis is difficult to cure, but can be managed with remedies that clean, massage and stimulate the meibomian glands. If posterior blepharitis is not managed, it can progress to more serious conditions like vision loss, inflammation of the cornea or even eyelid cancer.
Blepharitis can also be acute or chronic. When blepharitis becomes a chronic condition, which is common, it requires daily attention and regular eyelid scrubs. (2)
Seborrheic blepharitis
Seborrheic blepharitis is the most common type of blepharitis. It is usually associated with seborrheic dermatitis which infects the scalp, lashes, eyebrows, the folds around the nose, and the ears. People usually get it when they have a seborrheic dermatitis infection on the scalp that eventually spreads.
Staphylococcal blepharitis
Staphylococcal blepharitis is caused by infection of the skin on the outside of the eyelid by Staphylococcal bacteria. As the infection progresses, the sufferer may begin to notice a foreign body sensation, matting of the lashes, and burning. Usually a doctor will prescribe topical antibiotics for staphylococcal blepharitis, as this is an acute condition and should heal quickly. The condition can sometimes lead to a chalazion, cyst or sty.
Demodex blepharitis
Demodex blepharitis is common, but often unacknowledged by the medical profession. This type of blepharitis is caused by a mite infestation, usually by demodex mites. These mites live in hair follicles and oil glands, and can be found in nearly all of people aged over 60. Less than one third of children have mites. Tea tree oil blended with castor oil, and tea tree oil shampoo, are the most effective treatment to kill these small (up to 0.2 mm) mites.
When blepharitis is caused by a mite infestation, you can usually observe cuffing or collarettes around the base of the lashes.
Blepharitis treatment
Establish a daily routine of lid margin hygiene. After some weeks or months and after noticeable improvement, perhaps once or twice a week may be sufficient. You will need to experiment to find what suits you. Too frequent, and you irritate the eyelids and remove the natural oils. Not frequently enough, and there is a build-up of crust and gunk between the lashes and on the edges of the lids. This is something you may need to do for months, years or even the rest of your life. Blepharitis is often a chronic condition that is prone to recurring.
Here is a lid margin hygiene routine:
1. Soften the lid margin debris and oils. Apply a warm wet compress on the lids - cotton wool balls dipped in warm water, a clean washcloth or a makeup removal pad. Leave it on for a minute or two. I use comfortably warm or tepid water, especially in the summer, as I have found that hot water causes irritation and inflammation. In the winter perhaps use warm water. You will need to experiment to find what temperature is most soothing for you.
2. Mechanical removal of lid margin debris. Use clean fingers or the balls / washcloth / pad to gently massage along the lid margins for a few seconds while eyes are closed. Gently wipe a couple of times to remove the crusting and debris. Some people put a little baby shampoo or liquid castile soap on the pad to make it more effective at removing the crusting. However, too much soap or shampoo may remove the essential oily layer of the eyes own tear film and create further problems with dry eye discomfort.
3. When the blepharitis is caused by mites, tea tree oil is usually the most effective treatment. However, you cannot put neat tea tree oil on the eyelids, it would burn painfully and may damage the eye. It must be diluted and applied carefully. You can buy blepharitis wipes that are impregnated with only some of the TTO components, so they do not burn. (2)
4. Antibiotic reduction of lid margin bacteria. Grow Youthful's visitors have tried several remedies to reduce the harmful bacteria and soothe the inflammation (see Remedies).
5. Re-establish a balance of good probiotic bacteria on your eyelashes and eyelids. Sour, not sweet, home-made water kefir is a rich source of a variety of Lactobacillus subspecies, and may be taken daily and also a few drops applied to the eyelashes and eyelid margins. Apply it after cleaning, and leave it on the lids - do not rinse it off. If you get a drop of water kefir in your eye, it may feel comfortable, or it may sting slightly if you are using an old and slightly acid brew. Wipe with a towel if necessary, but do not rinse it.
- Castor oil. Smear half a drop on a clean finger and gently wipe it onto the eyelashes and eyelid margins. I would not do this as a long-term treatment, but it can be effective when done a couple of times per week.
- Water kefir. Put some sour home-made water kefir on a cotton wool swab to clean the eyelid margin. Do NOT use a store-bought water kefir - it must be home-made and very sour.
- Black tea. Place a warm, wet teabag over the eye. The black tea has anti-inflammatory and anti-microbial properties.
- Avoid the use of eye make-up.
- Keep blinking. Blinking helps the meibomian glands secrete oil.
- Yawning or opening the jaw as wide as possible stimulates the production of tears in some, but not all people.
References
1. Geerling G, Tauber J, Baudouin C, Goto E, Matsumoto Y, O'Brien T et al.
The international workshop on meibomian gland dysfunction: report of the subcommittee on management and treatment of meibomian gland dysfunction.
Invest Ophthalmol Vis Sci 2011; 52: 2050-2064.
2. Hossain P, Konstantopoulos A.
Blepharitis: remains a diagnostic enigma. A role for tea tree oil shampoo?
Eye (Lond). 2015 Dec;29(12):1520-1. doi: 10.1038/eye.2015.139. Epub 2015 Aug 21. PMID: 26293141; PMCID: PMC5129805.