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The blepharitis explained by Dr. Alex Shortt


What is blepharitis?

Blepharitis is a very common eye disease where the edges of the eyelids become inflamed and sore. Patients with blepharitis find that they have irritable sore dry eyes and they can also have red inflamed eyes. If you think you might have blepharitis then it is something that's diagnosed by an ophthalmologist and you need to go to an ophthalmologist to be examined and treated.

How do you diagnose blepharitis?

Blepharitis is diagnosed using both symptoms and also signs that the ophthalmologist sees, so if you have blepharitis you need to see an ophthalmologist. The symptoms of blepharitis are irritation on the edge of the eyelid or sometimes itching of the edge of the eyelid. You can also have redness of the eyelid or of the eye. Patients with blepharitis also have gritty sore tired eyes and need to blink frequently. When you're examined by an ophthalmologist he will see signs of redness and inflammation in the eyes and also signs of dry eye disease which is something that blepharitis can trigger.

What are the different types of Blepharitis?

There are three main types of blepharitis. The first is anterior blepharitis where the problem is an overgrowth of bacteria on the edge, the outer edge of the eyelid, the anterior surface of the eyelid. The next type is intermediate blepharitis where there is a buildup of abnormal oils and secretions on the middle part of the eyelid and the last type of blepharitis is posterior blepharitis where the oil glands in the back surface of the eyelid become blocked and start to produce abnormal quality oil.

What are the causes?

So we're not entirely sure of the exact cause of blepharitis but we think we have made some progress in understanding this range of conditions. We think that anterior blepharitis is caused by a buildup of bacteria that live on the skin on the front surface of the eyelid and in some patients they are particularly sensitive to the overgrowth of these bacteria. Intermediate blepharitis, we believe, is caused by abnormal breakdown of oil that is normally present on the eyelid and in the tears by bacteria. And the third type of blepharitis, posterior blepharitis, we believe is due to blockage and inflammation of the oil glands on the back surface of the eyelid.

What are the treatments for blepharitis?

When someone has blepharitis, there's a combination of treatments that are necessary. There is no one single treatment or eyedrop for blepharitis. It's about a combination of therapies in order to treat the condition. A brief overview is that patients with blepharitis need to reduce the amount of oil and secretions, and bacteria that are built up on the edge of the eyelid and that's through eyelid hygiene using special safe and non-toxic wipes. The second treatment that we give patients with blepharitis is heat therapy and we asked them to apply a special eye bag that is heated and delivers heat to the eyelids followed by massage of the eyelids. The third component of treatment of blepharitis is medicated therapy given by your ophthalmologist. The medicated therapy varies from lubricant eyedrops right up to anti-inflammatory eyedrops and sometimes anti-inflammatory tablets. It depends on how severe your symptoms and signs are as to which level of treatment you will need.

What should I do if I think I have blepharitis?

If you think you have blepharitis the first thing to do is you really do need to see an ophthalmologist. But there are other things you can do alongside what the ophthalmologist will treat you with. The first thing is what we call lid hygiene and the idea is that you should use a specially medicated wipe to remove the bacteria and built-up oil and the dead skin from the edge of the eyelid. The best wipes are ones that are non-toxic and do not sting or irritate the eyes such as Blephaclean® wipes. It is also available in a solution called Blephasol® solution which you can have the solution in a bottle and you can use eye makeup remover pads or cotton pads to cleanse the edge of the eyelid. The second thing you should do even before you've seen the ophthalmologist is to purchase a heat device that applies heat to the eyelids for ten minutes a day and there's numerous of these devices available. Lastly the last thing you should do even before you see the ophthalmologist is consider some modifications to your diet such as taking omega fatty acids, particularly omega-3, and also avoiding air-conditioned environments, avoiding exposure to pollutants or very polluted air or very dry air.

Why do your eyes water in cold weather?

What happens in cold weather in patients who have blepharitis or dry eye disease is that they are particularly sensitive to cold air. A normal person has a nice layer of tears in front of the eye which prevents the cold air from reaching the surface of the eye. If patients have dry eye or blepharitis the quality or the amount of their tears is not enough to protect the eye from the effects of cold air. So that the cold air can actually reach the surface of the eye and cause reflex watering of the eye. So if you want to reduce this effect the answer is to see an ophthalmologist and to determine whether or not you have any dry eye disease or blepharitis and to have specific treatment for dry eye disease and blepharitis to improve this symptom.