Blepharitis is inflammation of the eyelid margin.

The eyelid margin

The eyelid margin has two separate and important zones that occur in the narrow zone.

The anterior zone is where the roots of the eyelashes can be found. The posterior zone contains small oil glands known as the meibomian glands.

Types of blepharitis

There are three types of blepharitis:

  • Anterior blepharitis
  • Posterior blepharitis
  • Mixed blepharitis

Anterior blepharitis

Anterior blepharitis affects the front edge of the eyelid and eyelashes. This type of blepharitis looks similar to dandruff. Thus the eyelid margin appears greasy and crusted. Bacterial infection can commonly occur. In severe cases eyelash loss may occur.

blepharitis
Anterior blepharitis

Posterior blepharitis

Posterior blepharitis affects the back edge of the eyelid and the meibomian glands. This type of blepharitis looks similar to acne. The meibomian gland secretions thicken and the glands then become blocked and inflamed. Infection rarely occur.

blepharitis
Posterior blepharitis

Mixed blepharitis

Mixed blepharitis is inflammation of the entire lid margin.

How is it diagnosed?

Changes are present in the eyelid and may also be apparent in the tears and cornea.

Changes in the eyelid

The most important changes that occur on the eyelid margin are:

  • Greasiness of the skin
  • Crusting of the lashes
  • Plugging of the meibomian glands
  • Altered oily secretions
  • Dilated blood vessels
  • Eyelid cysts
  • Scarring of the eyelid margin

Changes in the tears

blepharitis
Severe blepharitis with marked inflammation of the eyelid margin

The most important changes in the tears include:

  • Thinning tear layer which is assessed by staining the tears with a fluorescein dye and evaluating the time span where the tears remain stable.
  • Thickened oily secretions
Thinning of the oily layer of the tears (dark patches) and loss of epitheial cells of the cornea (bright dots)
Thinning of the oily layer of the tears (dark patches) and loss of epitheial cells of the cornea (bright dots)

Changes in the cornea

Common corneal changes include:

  • Loss of cells of the epithelium
  • Inflammatory ulcers

Medical Treatment

Blepharitis is a chronic condition that can never be cured but it can be treated to provide optimal comfort and vision.

The key to successful treatment is in the diagnosis of type of blepharitis as well as the co-operation relationship between you and the ophthalmologist.

Anterior blepharitis treatment

Anterior blepharitis is a dandruff-like condition that responds to treatments similar to those used to treat dandruff. These include:

  • Gentle cleaning of the lid margins
  • Lid hygiene
  • Short courses of antibiotics where needed

Posterior blepharitis treatment

Posterior blepharitis is an oil gland dysfunction. Posterior blepharitis responds well to therapies used to treat acne such as:

  • Hot compresses
  • Eyelid massage
  • Anti-inflammatory drugs
  • Steroid eye drops, ointments and injections
  • Manual expression
  • Omega-3

Omega-3

Omega-3 supplementation is a recognized treatment for posterior blepharitis, reducing inflammation and providing the meibomian glands with the essential fatty acids with which to synthesise the oily gland secretions.

Omega-3 and -6 can be found in food whereby Omega-3 is a “good fat”  and Omega-6 is a “bad fat”. Omega-3 is used by the body to both produce anti-inflammatory compounds and block the activity of inflammatory mediators. Omega-6 promotes inflammation. It is not always possible to decrease dietary Omega-6 intake, but adding Omega-3 to your diet is a very effective way to reduce inflammation.

The best sources of Omega-3 are:

  • Fish such as salmon and tuna
  • Flaxseed oil
  • Capsules of fish and flaxseed oils

Surgical Treatment

Chalazia, blocked meibomian glands, in both the upper and lower eyelids
Chalazion

Some patients with blepharitis require surgery for a chalazion.

Chalazion

Posterior blepharitis may result in total obstruction of the openings of the meibomian glands. The oily secretions cannot escape and form cysts in the lid called “chalazion”.

Chalazion drainage

Chalazion can be treated with an in-office procedure where it is drained to remove the oily contents.

Myth

Blepharitis  is contagious
False

 

Meibomian Gland Expression

Expressing the meibomian glands with cilia forceps – this patient has thick buttery secretions
Expressing the meibomian glands with cilia forceps – this patient has thick buttery secretions

Manually expressing the contents of the meibomian glands is a proven therapy for posterior blepharitis and evaporative tear dysfunction.

Why is it done?

Thick stagnant secretions plug the meibomian gland openings, which furthermore irritate the eye and then allow the tears to evaporate. When the secretions is expressed, it allows the glands to produce new, better-quality secretions.

Anaesthetic

The eye and eyelid are anaesthetised with local anaesthetics.

What does it all mean?

Generally the thinner the secretions and the more glands that can be expressed, the better. Repeated expression usually results in thinner and thinner secretions which aid in the comfort of your eyes and the tear layer stability.

What will you notice?

You may notice a significant improvement within a few days after expression but usually it takes more than one expression before the glands recover completely.

Who can express your meibomian glands?

Most optometrists and ophthalmologists have the needed skills and training.

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