Blepharitis is inflammation of the eyelid margins and secondary conjunctivitis. The typical signs are redness of the lid margins, an abnormal tear film, and blocked Meibomian glands (the oil secreting glands in the eyelids). The Meibomian gland and tear film changes are difficult to visualize without a microscope. Meibomian secretions become viscous and chemically irritating when exposed to inflammatory enzymes, so as the inflammation spreads so does the blockage of the glands. The lack of an oily layer in the tear film increases tear surface tension, making the eye watery and preventing normal lubrication (you can’t lubricate your gearbox with water). Part of the response to irritation is more Meibomian secretions and more tears – both of which lead to increased symptoms. People at risk of blepharitis usually have a pre disposing “dryness” of the Meibomian glands. An attack can be triggered by almost any external irritant – including many common eye medications.
Increased sensitivity to irritants such as smoke and wind, episodes of gritty, burning, or watery eyes, and intermittent difficulty retaining a sharp focus whilst staring at a visual target. Waking with crusting, red-rimmed watery eyes is common. Long term complications include in-growing eyelashes, lid “styes” and ulcers if the condition is not properly managed.
The aim of management is to produce and maintain a “remission” of symptoms – since a permanent “cure” is no more likely than a cure for dry or oily skin. The cornerstone of management is to regularly empty the Meibomian glands before sleep and always go to bed with the tear film free of inflammatory material. This is accomplished by a 2 step clean up before bed.
Massage the lids through a warm steamy flannel for 2 minutes. If there is a build up of
dried secretions on the lashes this material should then be wiped away using a cotton ball dipped in dilute bicarbonate solution (1/3 tsp to a cup of warm water)
Flush the eyes with a suitable artificial tear solution that is non-irritating (Optive drops
During the day protect the eyes from strong drafts, dust, and chemical irritants, and regularly use artificial tear drops to maintain tear film chemistry. Use tearsagain spray at breakfast and dinner time each day when symptoms are present to replace the missing Meibomian secretions. This is best applied by spraying a tiny drop onto a clean finger tip then wiping it onto the lashes whilst the eye is closed. Other treatments include "2 match-heads worth" of 1% Siguent Hycor eye ointment wiped onto the lower lid border from the finger tip before sleep to minimize inflammation. This is only used when inflammation is very obvious. It is best to store this ointment next to your bed and apply it after you are between the sheets. In the morning wash the eyes out again with the artificial tears. Stop the ointment when the inflammation clears. The Meibomian glands drain better if you take a small amount of Tetracycline antibiotic daily, but fish oil capsules in a dose of 2 per day are also useful and are a more appropriate long term treatment. Both your diet and your environment – especially air conditioning and cigarette smoke - will affect the course of your blepharitis.
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Raimo Suhonen MD, prof. Selection of published papers / valikoima julkaistuista artikkeleista ym. julkaisuista ja koulutustuotteista Allergology / Allergologia • Jolanki R, Estlander T, Suhonen R , Eckerman M-L H, Kanerva L. Contact allergy to phenoxyethoxy ethylacrylates. Abstract. Second ESCD Congress, Barcelona, Spain, Oct. 1994. • Suhonen R . Contact allergy to Alstroemeria