View Full Version : Blepharitis ( David Kinshuck & colleagues )

Medical Videos
12-03-2008, 05:50 PM
What is blepharitis?
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.

Eyelids and blepharitis 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.

A cartoon drawing of blepharitis: inflamed eyelids causing a sore eye</STRONG>

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.

side viewfront 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.

side view
front view

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

Treatment Blepharitis is not a serious condition, and there is seldom any damage to your eyes. 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
unblocking the glands in the eyelid, which may be infected and inflamed, like acne on the face or a tiny boil by Lid Cleaning (http://www.goodhope.org.uk/departments/eyedept/blepharitis.htm#lc)
replacing the tears if the eyes are dry with Lubricants (http://www.goodhope.org.uk/departments/eyedept/blepharitis.htm#l) (dry eyes and blepharitis may occur together: see below).
treating any infection present with Antibiotic Cream (http://www.goodhope.org.uk/departments/eyedept/blepharitis.htm#c) antibiotic cream
there are new reports that flaxseed oil is very helpful (http://www.dryeyedoctor.com/ocular.html) and here (http://www.ncbi.nlm.nih.gov/sites/entrez?Db=pubmed&Cmd=ShowDetailView&TermToSearch=17906762&ordinalpos=1&itool=EntrezSystem2.PEntrez.Pubmed.Pubmed_ResultsP anel.Pubmed_RVDocSum)
to treat infection and reduce the inflammation using Antibiotic tablets (http://www.goodhope.org.uk/departments/eyedept/blepharitis.htm#Antibiotic tablets) .
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.

1 Lid Cleaning

Dilute some baby shampoo...a teaspoon of shampoo in a pint of water
Soak a cotton wool ball in warm (almost hot) water in the dilute baby shampoo. Bathe the eyelids with the cotton wool ball over the closed eyelids for 4 minutes...just hold the ball over the eyelids ...this will loosen any scales on the eyelid
Then clean the edge of the lower eyelid with a cotton bud (or the cotton wall ball) to remove scales and debris on the edge of the eyelid.
Move the cotton bud/cotton wool ball along the eyelid, using a mirror, and pulling the lid away from the eyeball with the fingers of the other hand. Rub the edge of the lid gently.
See a video demonstration (http://www.goodhope.org.uk/departments/eyedept/images/lidcleaning.wmv).
repeat with the upper lid...this is a little harder, but not so important.
repeat this at least twice a week

side viewfront view
Lid cleaning with a cotton bud soaked in sterile water;
this is the main treatment for blepharitis

The warm bathing helps to soften up the scales first. It is preferable to boil the water first to sterilise it, and allow it to cool a little so it is almost hot. It may be two weeks for any improvement. It is safe to stop cleaning, but you may need to start again if the condition returns.
This product has been recommended by many patients: Lid Care, Novartis http://www.novartisophthalmics.ca/e/products/lidcare.shtml

2 Lubricants Lubricants can helpful to both assist the spread of your own tears and lubricate the eye, and replace tears if you have ‘dry eyes’.

gels such as ‘Gel Tears’ or ‘Viscotears’ are usually helpful
drops such as ‘Sno-tears’ may help.
if the eyes remain sore, preservative-free artificial tears may help. These are particularly useful for people with very dry eyes. Because they have no preservative they can be used more often, even every half-hour, without damaging your eyes. One example is 'Minims' tears: the ampoules (mini-bottles) contain about 14 drops, and may last a day with practice. They are moderately expensive.
These products are harmless: try and see if they help. You can buy them, but if you need them regularly they can be obtained on prescription.


3 Antibiotic Cream If the cleaning is not helpful, in addition your eyes may feel more comfortable if you use antibiotic ointment. Your GP will need to prescribe it. Try it for 3 months (chloromycetin or fucithalmic).
Sometimes the condition returns once the ointment is stopped, and you may need a repeat prescription from your GP. Some people benefit using the cream intermittently.


4 Diet and fish and flaxseed oil Diet (http://www.goodhope.org.uk/departments/eyedept/blepharitis.htm#hd) has a significant effect on the ocular surface. Avoid saturated and transfats. Some fats such as fish oils and flaxseed oil (http://www.dryeyedoctor.com/ocular.html) may be helpful, and patients have reported this to me.

5 Antibiotic tablets This treatment is sometimes useful if the other treatments do not work. It is particularly effective if you have a skin condition, such as acne rosacea, or very dry skin, or if the edge of your eyelid stays red with many scales.
Antibiotic tablets are NOT suitable for everyone, particularly if you use several other tablets or have stomach problems. You will need to discuss this treatment with your GP first. Oxytetracycline 250mg twice daily is usually used for 3 months, but not if pregnant.
Alternatives include doxcycline 50mg once daily [or erythromycin].
The benefit lasts several months after the treatment is stopped, but you may need to use further courses if the condition returns.