Blepharitis

What is blepharitis?

Blepharitis is a common condition that causes inflammation of the eyelids.¹ It may be associated with flakes on the eyelashes, loss of eyelashes, eye redness, dry eyes, light sensitivity, and irritation of the eyes.²

What causes blepharitis?

There are two main types of blepharitis, anterior blepharitis, and posterior blepharitis, both characterized by inflammation of the glands on the eyelids.³

Anterior blepharitis causes inflammation of the glands along the base of the eyelashes.³ It is most often associated with the presence of excessive bacteria at the lid margin, particularly Staphylococcus.³ 

Posterior blepharitis causes inflammation and obstruction of the oil glands along the waterline.³ It is often associated with systemic disease such as acne rosacea, atopic dermatitis, and seborrheic dermatitis.³

Blepharitis can also be caused by an infestation of mites, called Demodex, at the lid margin.⁴

How do you treat blepharitis?

Blepharitis is a chronic condition with no cure and requiring maintenance. There are several ways to treat blepharitis and patients can manage it themselves by maintaining good eyelid hygiene.⁵ 

The most common and effective treatment is to gently clean the eyelid margin and lashes using commercial lid scrubs (medicated pads)⁵, although home-made lid scrub therapy using a mild dilution of baby shampoo soaked in a cotton pad can also be used.⁵ 

Other treatment options include the use of warm compresses to express the oil glands in the eyelids, artificial tear drops to help alleviate dry eye symptoms, antibiotic eye drops or ointments to reduce bacterial activity, and steroid eye drops to reduce inflammation.⁶ In severe cases, oral antibiotics and in-clinic treatments can be used.⁶ Tea tree oil treatments can be used for Demodex.⁷
 

References

1. Nijm LM. (2013). 8 - blepharitis: classification. In EJ Holland, MJ Mannis, & WB Lee (Eds.), Ocular surface disease: cornea, conjunctiva and tear film. pp.55-60. Elsevier.
2. Fredrick DR. (2018). 81- Conjunctivitis beyond the neonatal period. In SS Long, CG Probeer, & M Fischer. Principles and practice of pediatric infectious disease (5th edition). pp.505-502. Elsevier.
3. American Academy of Ophthalmology. Blepharitis. https://eyewiki.aao.org/Blepharitis Accessed Dec 2021.
4. Zhao YE et al. Association of blepharitis with demodex: a meta-analysis. Ophthalmic Epidermiol. 2012;19(2):95-102.
5. Geerling G et al. The international workshop on Meibomian gland dysfunction: report of the subcommittee on management and treatment of Meibomian gland dysfunction. Invest Ophathal Vis Sci. 2011;52(4):2050-2064.
6. Jones et al. TFOS DEWS II Management and therapy report. Ocul Surf. 2017;15(3):575-628.
7. Gao YY et al. In vitro and in vivo killing of ocular demodex by tea tree oil. Br J Ophthalmol. 2005;89(11):1468-1473.