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Blepharitis – itchy, burning eyes

Blepharitis

Blepharitis is inflammation of the eyelid margins (around the lashes and the part that touches the eyeball) and is one of the most common causes eye irritation. It affects more than 10% of the population and fills the Sydney Eye Emergency clinic with hundreds of people a month seeking relief from their symptoms. The trouble with blepharitis that there is no magic cure and it tends to recur. The good news is that most symptoms can be controlled with a few simple measures, but it takes persistence and dedication. The most common symptoms patients with blepharitis complain of are:

  • burning
  • itching
  • foreign body sensation (like sand or grit inside the eye)
  • sticky or crusty eyelids
  • light sensitivity
  • watering eyes
  • red, swollen, heavy eyelids
  • blurred vision

There are 3 main types of blepharitis, though there may be significant overlap.

  1. Staphylococcal blepharitis: in these patients bacterial infection of the eyelids predominates. Patients are generally younger and describe the irritation and burning sensations as being worse in the morning. On examination, doctors frequently see loss of the eyelashes, yellow crusts around the base of the lashes and in severe cases ulceration along the eyelid margin.
  2. Meibobian gland dysfunction: in these patients the normal glands within the eyelids produce a chronic abnormal oily secretion that irritates the eye. One third to two thirds of these patients will also have rosacea on their cheeks. On examination the doctor will see inflammation on the inside of the eyelids, changes around the opening of the glands and there may be a foamy appearance to the tears.
  3. Seborrheic blepharitis: in these patients there is an oily or greasy crust around the eyelashes. It is frequently associated with scalp dandruff, which should be treated at the same time.

How does this cause dryness of the eyes? The lacrimal gland and other glands under the upper eyelid produce watery tears that keep our eyes moist and provide nutrients to keep the cornea healthy. The glands in the eyelids (meibobian glands) produce an oily substance that forms a thin film over the top of the watery tears, preventing them from evaporating. If the tears evaporate too quickly, you can be left with a dry eye that burns or feels as if there is sand in it. The staphylococcal bacteria, which cause one form of blepharitis, produce substances that can make natural tears evaporate faster than normal. In those patients with meibobian gland dysfunction, their own natural oil is abnormal or not produced in the quantities needed to stop tears evaporating. For this reason your doctor may also suggest that you use artificial tears to help relieve the symptoms of blepharitis. Treatment Eyelid hygiene is the mainstay of treatment for all patients with any type of blepharitis. Here is a good technique for cleaning your eyelids:

  1. Warm compress: this involves placing a face cloth in warm water and then across your closed eyes, or even a wheat heat pack (usually used for arthritis) over the eyes for a few minutes. Make sure that the cloth or heat pack isn't too hot before putting it on your eyes. The idea is to loosen the crusty build-up around the eyelashes and soften the oily secretions.
  2. Massage: gentle massage of the eyelids working towards the eyelid margin. The aim is to express the abnormal secretions out of the eyelids via the gland openings, which are just behind the eyelashes.
  3. Cleaning: now the eyelid margin needs to be cleaned to clear up the crusts and oil that you have just loosened up and expressed. This can be done with a clean washcloth or cotton bud (careful not to poke yourself in the eye!) dipped in warm water. The water can be plain or you can add a small amount of baby shampoo which helps clean up the oil without irritating the eyes.

As I said before treatment is relatively simple, but people with blepharitis need to follow a regimen of cleaning their eyelids for life as it rarely goes away completely. You wash your hair regularly, so think of it like a regular hair wash for your eyelashes! Initially when your symptoms are bad the doctor may recommend you clean your eyelids up to 4 times per day. That kind of dedication is not very practical long term, so we recommend that you find a regimen that you are likely to follow on a regular basis – daily or alternate daily. It may take a month or more of regular cleaning until you feel a real difference in your symptoms. Some months of the year your symptoms may get worse again, particularly in the winter. If this is the case, step up the frequency at which you are cleaning your eyelids. Your doctor may prescribe an antibiotic ointment to use on your eyelashes at night for the first month; in Australia the most common one used is called chlorsig (chloramphenicol). The aim is to clear up those staphylococcal bacteria that have been causing some of the irritation. Rosacea is chronic disorder that can affect the skin and eyes, and is associated with dysfunction of the oily (sebaceous) glands on the face and shoulders. Patients often have fine capillaries (blood vessels) visible on the forehead, cheeks and nose. Though rosacea is often found in those with a history of excessive alcohol consumption, this is not always the case. If you have rosacea as well as blepharitis your doctor may prescribe a course of oral antibiotics such as low dose doxycycline. These are not being used so much for their ability to kill bacteria, but because they can alter the nature of the oil produced by your glands. It can take 3-4 weeks before a response is seen to this form of treatment, so don't despair and don't stop taking the antibiotics because you don't think they are working – have patience. So in conclusion, if you have blepharitis you are not alone, there are many people like you. Though the symptoms can range from annoying to painful, there is help. I cannot emphasize enough that this is a chronic condition which can't be cured but can be controlled. You need to perform your eyelid hygiene regularly, keep doing it and be patient – the best results may take months. Good luck.

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