Blepharitis is the inflammation of the lids, and it affects the glands that reside within these tissues. The incidence of lid infection ranges from 3.2% in young adults and increases with age to 71.1% with seniors. The cause of Blepharitis is almost always bacterial in nature, and tests positive in cultures. The bacteria grow in the lipids (fats) of the gland, and produce enzymes that break the lipids down into soaps and fatty acids. These 2 byproducts disrupt the tear film causing dry eye symptoms, and all the discomfort that follows. In some cases there is even a microorganism that attaches itself to the lashes called Demodex Folliculorum. Regardless of the cause, the result is red, painful lids and dry eyes.
The diagnosis is made during an eye exam, and some of the clinical signs are collarets around the lash bases, gland obstructions on the lid margins, red crusty lids, and waxy discharges on the lids. In addition, Chalazion is seen in the lids, and inflammation on the cornea as well as marginal ulcers at the cornea/limbal region.
The etiology or cause of Blepharitis can be from Staphylococcal bacteria, Seborrhea, allergic, Psoriatic and even start in the glands themselves. Meibomitis is the inflammation of one of the primary lid glands that produce a tear component. The major problem that occurs with Blepharitis is that the bacteria break down the enzymes, disrupting the tear film. This in turn irritates the eye and the cycle begins of red, painful eyes and in turn red, painful lids.
The goal of therapy is to alleviate the signs and symptoms, but will not cure the condition. Blepharitis is a chronic condition that will require on going maintenance, and treatment for many years. It most often will reoccur. The acute phase of treatment is to bring the condition under control, and improve comfort and appearance of the lids and eyes. The chronic treatment is to maintain control and keep the lids healthy.
The most important part of the therapy is to simply clean the lids. This is done with a soapy solution of diluted baby shampoo and warm water. This solution is employed to clean the lid margin twice per day with a Q tip for at least 2 weeks. Each cleaning must be followed by warm compresses, and gentle lid massage. The warm compresses dissolve the waxy build up on the lids, and the massage removes it while increasing blood flow to the affected areas. In addition, topical antibiotics are always added. The newest and best one is called Azasite. It is Zithromycin in drop form. It is used twice per day for about 3-4 days, and then once per day after that. In addition, another medication is now often added to increase tear production. Restasis decreases inflammation in the tear producing mechanism, and thus increases tear flow. This medicine must be used twice per day for at least 6 months and perhaps even longer. Once the acute phase is treated, then only the Restasis, and once per week lids scrubs are employed.
If a very severe case is encountered then oral antibiotics may be used as well. Doxycycline has been shown to be the best for this condition.
Blepharitis is a long term problem, but when properly treated and managed; patients can be free of many of the dry eye, lid and painful symptoms. Compliance can become an issue because of the long term care required, but good results and appearances are the reward.