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