Blepharitis

 
Man with blepharitis in one eye

Is a condition of chronic inflammation of the edge of the eyelids near where the eyelashes are. As the eyes blink this inflamed lid margin rubs the eye causing the eyeball itself to also become inflamed. If you have MGD, the oil secretions become thick and sticky. Bacteria multiply in these abnormal gland secretions releasing inflammatory toxins and also produce an organic material called biofilm which builds up on the lid margins. Bacteria love to grow in this biofilm releasing even more toxins which causes even more eyelid inflammation.

Treatment of Blepharitis

Treatment is threefold:

Kill the bacteria and reduce the inflammation.
Initially blepharitis patients will benefit from a combined antibiotic/cortisone ointment applied to the edge of the lids. This will reduce the number of bacteria releasing toxins and reduce the inflammation so that you are more comfortable fairly quickly. Unfortunately this is not a good long term option as there are side effects from long term cortisone use such as cataracts and glaucoma. Also, eventually the bacteria build up a resistance to the antibiotic so it no longer is effective.

Make the edge of the lids an inhospitable place for bacteria to grow.
This is done by using medicated lid scrubs and sprays which remove the biofilm and leave behind an antibacterial medication. This would be analogous to brushing your teeth to remove the plaque. If this isn’t done regularly, bacteria grow in the plaque releasing inflammatory toxins causing inflamed gums (gingivitis) which can lead to destruction of the tooth roots and loss of the tooth. Just as twice a year you should have a deep cleaning of your teeth to much more effectively remove the plaque, people with severe blepharitis often benefit from an occasional mechanized biofilm cleansing procedure called Blephex . This is a non painful 10 minute procedure done in the office.

Thin out the oily secretions from the meibomian glands.
This has 2 beneficial effects. Bacteria are not able to grow in thin oil that is constantly secreted as opposed to stagnant, thick secretions. Additionally the oil component of your tears prevents their evaporation. If you are not getting good, thin oil entering your eyes, the tears evaporate quickly causing dry eye syndrome. So, improving the quality of this oil will also help relieve the accompanying dry eye symptoms . Taking oral fish oil can help thin these secretions. Taking a low dose of the oral antibiotic tetracycline and applying warm compresses to your lids may also help. However, in some people, the secretions are so thick, the only way to unclog the glands and get them working again is by doing a Lipiflow procedure.

Some people with severe blepharitis unresponsive to these treatments may also have an infection of the lid margins of an organism called demodex. This is a dust mite so it does not respond to antibiotics or antibacterial lid scrubs. These patients must be treated with something called tea tree oil on a twice yearly basis with the Blephex procedure and daily with a special tea tree oil lid wipe.

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