Blepharitis is one of the most common, chronic, long lasting and also a very complex eye disorder. The condition causes severe inflammation of the eyelid margins, involving hair follicles and oil glands known as Meibomian glands.

Blepharitis shows symptoms of several disorders. Most blepharitis is not contagious. The condition tends to involve both eyes. Blepharitis, despite being a chronic condition, does not usually lead to corneal scarring or blindness.

Till recently, the disorder has been very difficult to treat because the condition tends to recur. However, in the last 25 years considerable progress has been made in the diagnosis and treatment of blepharitis. Today, past experience combined with the emergence of advanced instruments and medicines, has made treatment of blepharitis easier.

Symptoms

Symptoms include inflamed and swollen eyelids, redness of the eye, eyelid burning and itching, excessive tearing, sensitivity to light, crusty lid margin and blurred vision. Also observed are associated conjunctival and corneal changes and loss of eyelashes. The severity of the symptoms varies widely.

Types of blepharitis

There are 3 types of blepharitis. These are staphylococcal, seborrhea, and Meibomian gland dysfunction (MGD). All three forms of blepharitis are chronic in nature.

Staphylococcal blepharitis is a low-grade bacterial infection of the eyelashes and eyelid skin. People with staphylococcal blepharitis are relatively young, at around 42 years on the average, with a short history of about 1.8 years of eye problems. In staphylococcal blepharitis, there is scaling and crusting along the eyelashes.

Seborrheic and MGD blepharitis patients are generally older and have a longer history of eye problems. In seborrheic blepharitis, there is greasy scaling along the eyelashes. Patients frequently have seborrheic dermatitis as well.

In Meibomian gland dysfunction (MGD) there are prominent blood vessels crossing the eyelid margin. In addition, there is plugging of meibomian gland openings. MGD frequently tends to affect people who already have rosacea and seborrheic dermatitis.

Causes
Blepharitis is most commonly caused by bacteria, dandruff, rosacea, poor eyelid hygiene, excessive oil produced by the eyelid glands and allergic reactions. However, often the causes are unknown, particularly in older people.

Blepharitis occurs when there is excessive growth of bacteria, dandruff or rosacea at the eyelid margin. This is a moist surface with many substances for bacteria to thrive on, including scaly skin and oil secretions. The condition is further aggravated when people neglect cleaning the eye. Bacteria at the lid margins create irritating toxins, which irritate the eye, and the Meibomian glands of the eyelids themselves can become infected.

There are about 30 Meibomian oil glands opening at the edge of each eyelid. Some people suffer from dysfunctioing Meibomian glands where the oil secretion is excessive and becomes trapped in the gland. This produces further irritation and can lead to stye formation. People with the skin condition known as "rosacea" tend to have blepharitis and dysfunction of these oil glands.

Use of the drug isotretinoin, for severe cystic acne, can also cause blepharitis.

Treatment

There is no cure for this disease. It needs long-term treatment. The first and the critical step is to keep the eyelids clean of the offending agents. One of the oldest and most common ways to do this has been to use warm compresses and cleansing by lid scrubs.

Generally, cleaning by lid scrubs have been effective, their effectiveness depending on the type of cleaning solution used. Some solutions like alkanity in soaps are believed to be more effective. Alcohol and some non-alkaline detergents can also be quite effective in removing substances like lipids.

Antibiotics have been used for treating; usually severe types of blepharitis, for a long time and some organisms have become resistant to them. The main reason for developing resistance to antibiotics is their long-term systemic use. However, there are still some old antibiotics and new ones, which give good results, if not used systemically. For the lids, antibiotics must be used in ointment form, while for the eye surface the antibiotic can be used either in drop or ointment form.

Systemic use of tetracycline type drugs is more effective in blepharitis patients with rosacea and in patients with recurring staphylococcal blepharitis. In severe cases, steroid drops may also be used. In case of scalp dandruff, dandruff shampoo is recommended.

However, all treatment will come to naught if good eye hygiene is not maintained. That requires regular cleaning of the eyes as recommended by the doctor. Good hygiene is all the more important in blepharitis since the condition lasts for a long time and tends to relapse.