Blepharitis (blef’ah-ri’tis) is a very common skin condition that affects the skin and oil glands of the eyelids and may inflame the eyes. “Blepharo” means”lids” and “itis” means “inflammation of.”
The symptoms and signs of blepharitis may include a gritty feeling as if there is foreign matter in your eyes, reddened eyelids, especially at the lid margins, redness of the ordinarily white part of the eye (known as the sclera), tearing, ocular burning, and occasionally blurry vision. Although anyone can develop blepharitis, this condition is particularly common among people of French, German, and Scandinavian ancestry, as well as those patients whose ancestors were native to the British Isles, and in people with fair skin and a facial skin condition called acne rosacea.
Sometimes long-standing blepharitis results in clogging of the eyelid oil glands like clogged skin pores, which may then become infected. When this happens, the lid may swell and turn red and a tender lump or pimple may form in the lid called a stye. When a stye does not drain and heal completely, a non-tender, firm lump or chalazion may result. Chalazia that do not respond to treatment with hot compresses may need to be injected with steroids or surgically drained.
For most patients blepharitis is just a nuisance in terms of occasional mild, itchy, gritty eyes with redness or occasional styes. However, it can increase the risks of infection associated with contact lens use or it can preclude the use of contact lenses entirely.
Treatment of Blepharitis
Many patients with blepharitis have been treated repeatedly with strong antibiotic drops to clear up their “conjunctivitis.” This is usually not the most effective therapy for this chronic problem.
Doctors use a variety of therapies to treat blepharitis. One of the most effective treatments is a hot compress to open the clogged pores of the lid oil glands. Fill a bowl with hot water (not so hot that it burns to the touch). Dip a washcloth in the water and wring it out, fold it, and place it over both closed eyes in a lying or sitting position. As the washcloth cools, dip it back into the water, wring it out, and repeat procedure. Be careful not to open your eyes while applying the compress. Another method is to use heated eye masks.
Your eye doctor may prescribe an antibiotic ointment to be instilled in the eyes after hot compresses. They may blur your vision, so are best applied at bedtime. A good tip for instilling these ointments is to hold the tube in your pocket or hand for 10 minutes to liquefy the product before applying it. Sometimes steroid-containing drops are prescribed when hot compresses and antibiotic ointments are not sufficient. These drops, such as Blephamide™, Tobradex™, and Lotemax™, are potent medications to be used only under the supervision of an eye doctor. Possible long-term side effects include glaucoma and cataracts. Only your doctor is able to direct you in their safe use, maximizing their therapeutic benefit and minimizing any risk.
Your doctor may prescribe tetracycline or doxycycline pills, which can be extremely effective not by treating any infection but by improving the oils secreted by eyelid oil glands. Tetracycline, like all medications, can have side effects. It can make some patients very susceptible to sunburn from sun exposure. It can interact with other medications such as blood thinners like Coumadin and, in rare instances, can produce liver or other more serious problems. To avoid stomach upset from these medicines, take them with food in the morning or at lunch and avoid taking them at night or on an empty stomach.
Children and pregnant women should not take tetracycline because it discolors the enamel of developing teeth. A recent study showed no increased risk in breast cancer in women taking this medicine for skin treatment
Responsible doctors are hesitant to prescribe medications unless they feel they are truly needed. If your doctor has recommended these antibiotics, then we feel strongly that the benefits of these relatively safe medications outweigh any small probability of risk associated with their use. After your condition improves, the dose can be tapered to low levels and often discontinued as long as you continue with the mainstay of blepharitis treatment, hot compresses. Blepharitis can be treated in most cases with excellent results; however, like flossing your teeth to prevent gum disease, it can take some commitment.
