Disease: Blepharitis

    Blepharitis facts

    • Blepharitis is inflammation of the eyelids.
    • Signs and symptoms of blepharitis include red, irritated, itchy eyelids, and the formation of dandruff-like scales on the eyelashes.
    • The cause of most cases of blepharitis is a malfunction of the oil glands of the lids, although allergies, infections, and systemic diseases can also cause blepharitis.
    • In many cases, good eyelid hygiene and a regular cleaning routine can control blepharitis. In other instances, medications may be required.

    What is blepharitis?

    Blepharitis is the medical term for inflammation of the eyelids. The word "blepharitis" is derived from the Greek word blepharos, which means "eyelid," and the Greek suffix itis, which denotes an "inflammation" in English. Inflammation is the process by which white blood cells and chemicals react to and protect us from foreign substances, injury, or infection. Signs of inflammation are swelling, redness, pain, warmth, and change in function. Blepharitis is an inflammation of the eyelids, causing red, irritated, itchy eyelids, and the formation of dandruff-like scales on the eyelashes. It is a common eye disorder with a wide variety of causes. It affects people of all ages. Although it may be uncomfortable, annoying, or unattractive, blepharitis is not contagious and does not cause permanent damage to eyesight. The condition can be difficult to manage, and it tends to recur. Another term for blepharitis is granulated eyelids. Angular blepharitis describes inflammation which primarily affects the outer corners of the eyelids.

    Picture of blepharitis

    What causes blepharitis?

    Blepharitis involves the eyelid margins, where the eyelashes grow and the openings of the tiny oil glands are located. There may be involvement of the skin adjacent to the outer edges of the eyelid margins and/or the inner edge of the eyelid that comes into contact with the eyeball secondary to the underlying disorder of the lid margins.

    Most cases of blepharitis are posterior blepharitis, due to inflammation of the meibomian glands of the lids. There are about 40 of these glands in each of the upper and lower lids. The eyelid margins can become inflamed, irritated, and itchy when these glands produce abnormal secretions. Blepharitis is often seen in patients with acne rosacea, a generalized illness of oil glands.

    Anterior blepharitis is due to inflammation of the lid margin around the lashes. Seborrheic blepharitis is similar to dandruff of the scalp. Staphylococcal blepharitis is a result of bacterial infection of the lashes. Microscopic mite infection causes demodex blepharitis.

    Allergies due to reactions from  mascara, contact lens solutions, sprays, exposure to animals, environmental chemicals, or airborne allergens can also cause blepharitis.

    Less commonly, inflammation of the lids can be caused by head lice.

    What are the symptoms and signs of blepharitis?

    Signs and symptoms of blepharitis usually are present in both eyes, affecting the upper and lower lids. They can appear at any age.

    Symptoms (what you feel in the eyes or eyelids) include

    • itchy or irritated eyelids,
    •  mild tearing,
    •  dryness of the eyes,
    • burning sensation,
    • gritty or sandy sensation,
    • foreign-body sensation (the feeling that something "may be in the eye"),
    • crusting of the eyelids,
    • decreased comfort while wearing contact lenses, and
    • sensitivity to light.

    Signs (observations that you make) of blepharitis include

    • red eye lid margins,
    • swollen eyelids,
    • increased shedding of skin cells near your eyelids, causing flaking of the skin around the eyes,
    • matting of the lashes or eyes "glued together" in the morning,
    • eyelids that appear greasy and crusted with scales that cling to the lashes,
    • crusted eyelashes upon awakening,
    • tears that are frothy or bubbly in nature,
    • eyelashes that grow abnormally,
    • loss of eyelashes,
    • mild scarring of the eyelid margins,
    • mild ulceration of the lid margins,
    • dry and flaky patches of skin on the lid, and
    • dandruff of the lashes and eyebrows.

    The symptoms and signs of blepharitis are often erroneously ascribed by the patient as being due to "recurrent conjunctivitis." They are also often mistakenly attributed to "dry eye" by patients due to the gritty sensation that may occur. Lubricating drops, however, do little to improve the condition.

    How is blepharitis diagnosed?

    Blepharitis can be usually diagnosed by a physician based on the history as given by the patient and the physical examination.

    Taking a history includes a discussion of symptoms that the patient is experiencing and a review of any general health problems that may be contributing to the eye problem.

    The physical examination concentrates on an evaluation of the eyelids, lid margins, base of the lashes, oil gland openings, tear quantity and quality, and the front surface of the eyeball using a slit lamp, which allows a magnified view with sufficient illumination.

    The type of blepharitis is determined based on this examination, and appropriate treatment recommended.

    Occasionally, cultures are taken by swabbing the discharge and sending this to the laboratory. In some cases, an allergy evaluation may be required.

    What are complications of blepharitis?

    It is unusual for blepharitis to cause serious problems. However; blepharitis can lead to a number of other conditions.

    • Sty: A sty or hordeolum is a bacterial infection in one of the oil glands whose opening is clogged. The result is a painful lump on the edge or inside of your eyelid.
    • Chalazion: A chalazion or conjunctival granuloma occurs when blockage in the oil glands causes them to become enlarged and scarred.
    • Chronic pink eye: Blepharitis can lead to recurrent bouts of pink eye (conjunctivitis).
    • Ulceration of the cornea: Constant irritation from inflamed eyelids or misdirected eyelashes may cause a sore (ulcer) to develop on your cornea.

    Blepharitis does not affect vision generally, although a poor tear film may intermittently blur vision, causing varying amounts of fluctuating vision during the day.

    Call your ophthalmologist if you develop these symptoms, which are not due to blepharitis:

    • Significant changes in vision
    • A sore on the eyelid that persists or increases in size, especially if it is red, bleeding, and not healing.
    • Significant pain in either or both eyes
    • Symptoms that become worse or last for longer than two weeks

    What is the treatment for blepharitis?

    In many cases, good eyelid hygiene and a regular cleaning routine can control blepharitis. This includes frequent scalp and face washing, using warm compresses to soak the eyelids, and doing eyelid scrubs.

    The single most important treatment principle is a daily routine of lid margin hygiene. The following is a typical lid margin hygiene routine:

    • Soften lid margin debris and oils: Apply a warm wet compress to the lids, such as a washcloth with hot water, for five to 10 minutes two to four times a day. To keep the compresses warm for a longer period of time, you may place a small hot water bottle over the compress. Using a clean washcloth for each cleansing is important.
    • Mechanically remove lid margin debris: After using the compresses, clean the eyelids with a cotton applicator stick soaked in a 4 to 1 mixture of water and baby shampoo or an over-the-counter lid-cleansing product. Gently and repeatedly rub along the lid margins while the eyes are closed. Be careful to avoid rubbing or scratching your eyes.

    Limit or stop using eye makeup, as its use will make lid hygiene more difficult.

    If you wear contact lenses, you may have to temporarily discontinue wearing them during treatment.

    Other treatment depends on the specific type of blepharitis. The key to treating most types of blepharitis is keeping the lids clean and free of crusts.

    Dandruff shampoo is a standard recommendation.

    Antibiotics such as doxycycline, tetracycline, azithromycin or erythromycin may be prescribed topically or systemically.

    If the blepharitis is due to allergy, efforts should be made to identify and reduce exposure to the offending agent. Prescription, over-the-counter drops, or oral antihistamines may be used. If it is caused by an allergy at home or at work, simply avoiding the allergen (for example, a dog or cat) may avoid future problems.

    Oral omega-3 fatty acids, pulsating thermal lid massage, and intense pulsed light treatment to the meibomian glands have also been effective in chronic or severe cases.

    What causes blepharitis?

    Blepharitis involves the eyelid margins, where the eyelashes grow and the openings of the tiny oil glands are located. There may be involvement of the skin adjacent to the outer edges of the eyelid margins and/or the inner edge of the eyelid that comes into contact with the eyeball secondary to the underlying disorder of the lid margins.

    Most cases of blepharitis are posterior blepharitis, due to inflammation of the meibomian glands of the lids. There are about 40 of these glands in each of the upper and lower lids. The eyelid margins can become inflamed, irritated, and itchy when these glands produce abnormal secretions. Blepharitis is often seen in patients with acne rosacea, a generalized illness of oil glands.

    Anterior blepharitis is due to inflammation of the lid margin around the lashes. Seborrheic blepharitis is similar to dandruff of the scalp. Staphylococcal blepharitis is a result of bacterial infection of the lashes. Microscopic mite infection causes demodex blepharitis.

    Allergies due to reactions from  mascara, contact lens solutions, sprays, exposure to animals, environmental chemicals, or airborne allergens can also cause blepharitis.

    Less commonly, inflammation of the lids can be caused by head lice.

    What are the symptoms and signs of blepharitis?

    Signs and symptoms of blepharitis usually are present in both eyes, affecting the upper and lower lids. They can appear at any age.

    Symptoms (what you feel in the eyes or eyelids) include

    • itchy or irritated eyelids,
    •  mild tearing,
    •  dryness of the eyes,
    • burning sensation,
    • gritty or sandy sensation,
    • foreign-body sensation (the feeling that something "may be in the eye"),
    • crusting of the eyelids,
    • decreased comfort while wearing contact lenses, and
    • sensitivity to light.

    Signs (observations that you make) of blepharitis include

    • red eye lid margins,
    • swollen eyelids,
    • increased shedding of skin cells near your eyelids, causing flaking of the skin around the eyes,
    • matting of the lashes or eyes "glued together" in the morning,
    • eyelids that appear greasy and crusted with scales that cling to the lashes,
    • crusted eyelashes upon awakening,
    • tears that are frothy or bubbly in nature,
    • eyelashes that grow abnormally,
    • loss of eyelashes,
    • mild scarring of the eyelid margins,
    • mild ulceration of the lid margins,
    • dry and flaky patches of skin on the lid, and
    • dandruff of the lashes and eyebrows.

    The symptoms and signs of blepharitis are often erroneously ascribed by the patient as being due to "recurrent conjunctivitis." They are also often mistakenly attributed to "dry eye" by patients due to the gritty sensation that may occur. Lubricating drops, however, do little to improve the condition.

    How is blepharitis diagnosed?

    Blepharitis can be usually diagnosed by a physician based on the history as given by the patient and the physical examination.

    Taking a history includes a discussion of symptoms that the patient is experiencing and a review of any general health problems that may be contributing to the eye problem.

    The physical examination concentrates on an evaluation of the eyelids, lid margins, base of the lashes, oil gland openings, tear quantity and quality, and the front surface of the eyeball using a slit lamp, which allows a magnified view with sufficient illumination.

    The type of blepharitis is determined based on this examination, and appropriate treatment recommended.

    Occasionally, cultures are taken by swabbing the discharge and sending this to the laboratory. In some cases, an allergy evaluation may be required.

    What are complications of blepharitis?

    It is unusual for blepharitis to cause serious problems. However; blepharitis can lead to a number of other conditions.

    • Sty: A sty or hordeolum is a bacterial infection in one of the oil glands whose opening is clogged. The result is a painful lump on the edge or inside of your eyelid.
    • Chalazion: A chalazion or conjunctival granuloma occurs when blockage in the oil glands causes them to become enlarged and scarred.
    • Chronic pink eye: Blepharitis can lead to recurrent bouts of pink eye (conjunctivitis).
    • Ulceration of the cornea: Constant irritation from inflamed eyelids or misdirected eyelashes may cause a sore (ulcer) to develop on your cornea.

    Blepharitis does not affect vision generally, although a poor tear film may intermittently blur vision, causing varying amounts of fluctuating vision during the day.

    Call your ophthalmologist if you develop these symptoms, which are not due to blepharitis:

    • Significant changes in vision
    • A sore on the eyelid that persists or increases in size, especially if it is red, bleeding, and not healing.
    • Significant pain in either or both eyes
    • Symptoms that become worse or last for longer than two weeks

    What is the treatment for blepharitis?

    In many cases, good eyelid hygiene and a regular cleaning routine can control blepharitis. This includes frequent scalp and face washing, using warm compresses to soak the eyelids, and doing eyelid scrubs.

    The single most important treatment principle is a daily routine of lid margin hygiene. The following is a typical lid margin hygiene routine:

    • Soften lid margin debris and oils: Apply a warm wet compress to the lids, such as a washcloth with hot water, for five to 10 minutes two to four times a day. To keep the compresses warm for a longer period of time, you may place a small hot water bottle over the compress. Using a clean washcloth for each cleansing is important.
    • Mechanically remove lid margin debris: After using the compresses, clean the eyelids with a cotton applicator stick soaked in a 4 to 1 mixture of water and baby shampoo or an over-the-counter lid-cleansing product. Gently and repeatedly rub along the lid margins while the eyes are closed. Be careful to avoid rubbing or scratching your eyes.

    Limit or stop using eye makeup, as its use will make lid hygiene more difficult.

    If you wear contact lenses, you may have to temporarily discontinue wearing them during treatment.

    Other treatment depends on the specific type of blepharitis. The key to treating most types of blepharitis is keeping the lids clean and free of crusts.

    Dandruff shampoo is a standard recommendation.

    Antibiotics such as doxycycline, tetracycline, azithromycin or erythromycin may be prescribed topically or systemically.

    If the blepharitis is due to allergy, efforts should be made to identify and reduce exposure to the offending agent. Prescription, over-the-counter drops, or oral antihistamines may be used. If it is caused by an allergy at home or at work, simply avoiding the allergen (for example, a dog or cat) may avoid future problems.

    Oral omega-3 fatty acids, pulsating thermal lid massage, and intense pulsed light treatment to the meibomian glands have also been effective in chronic or severe cases.

    Source: http://www.rxlist.com

    It is unusual for blepharitis to cause serious problems. However; blepharitis can lead to a number of other conditions.

    • Sty: A sty or hordeolum is a bacterial infection in one of the oil glands whose opening is clogged. The result is a painful lump on the edge or inside of your eyelid.
    • Chalazion: A chalazion or conjunctival granuloma occurs when blockage in the oil glands causes them to become enlarged and scarred.
    • Chronic pink eye: Blepharitis can lead to recurrent bouts of pink eye (conjunctivitis).
    • Ulceration of the cornea: Constant irritation from inflamed eyelids or misdirected eyelashes may cause a sore (ulcer) to develop on your cornea.

    Blepharitis does not affect vision generally, although a poor tear film may intermittently blur vision, causing varying amounts of fluctuating vision during the day.

    Call your ophthalmologist if you develop these symptoms, which are not due to blepharitis:

    • Significant changes in vision
    • A sore on the eyelid that persists or increases in size, especially if it is red, bleeding, and not healing.
    • Significant pain in either or both eyes
    • Symptoms that become worse or last for longer than two weeks

      Source: http://www.rxlist.com

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