Eyelid Care
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What is Blepharitis?
Blepharitis is a generic term for a common chronic eyelid inflammation usually surrounding the lid margin and eyelashes. This condition frequently occurs in people who have a tendency towards oily skin, dandruff, or dry eyes. Blepharitis is not "curable" but is easily managed in most people by treatment. It is not contagious. If left untreated, certain types of Blepharitis may lead to infection, eyelid or corneal scarring and loss of vision. |
What causes blepharitis?
Everyone has bacteria on the surface of their skin. In some people, bacteria tend to colonize on the skin at the base of the eyelashes or in the oil glands of the lid (meibomian glands). Large amounts of bacteria, usually staphylococcal, are found dandruff-like scales and particles formed along the lashes and eyelid margins. Blepharitis is often associated with inflammation and dysfunction of the meibomian glands or "MGD".
Everyone has bacteria on the surface of their skin. In some people, bacteria tend to colonize on the skin at the base of the eyelashes or in the oil glands of the lid (meibomian glands). Large amounts of bacteria, usually staphylococcal, are found dandruff-like scales and particles formed along the lashes and eyelid margins. Blepharitis is often associated with inflammation and dysfunction of the meibomian glands or "MGD".
Warm Compresses and Lid Massages
Warm compresses heat the debris and dried oils on the lid margin to or above the melting point so that they are more easily removed with lid scrubs. Technique: Soak a washcloth in water as warm as the eyelids can stand, wring, and then place the cloth on the lid surface (eyelids closed) for five to ten minutes. Several innovative techniques work well such as use of a fresh-boiled egg (in its shell wrapped in a washcloth)or a small microwaved red potato. Warm compresses should be combined with eyelid massage. This is especially important in patients who have Meibomian gland dysfunction (MGD). Naturally, the oils produced by these glands to help prevent tear evaporation are the consistency of vegetable or motor oil. In MGD, the meibomian secretions are thickened and the gland openings become clogged. After warm compresses of the lids, thickened meibomian gland secretions are more fluid, but massage is necessary to express them. After every 1 minute of warm compresses, massaging the eyelid as follows will be useful: Gently close the eyelids. Put your index finger on the outer corner of the eyelid. Pull the eyelid towards the ear, so that the eyelids are stretched taut. Next use the index finger of the opposite hand to apply direct pressure to the taut eyelids starting at the inner aspect of the eyelid near the of the nose. Sweep with firm but gentle pressure towards the ear. Repeat this maneuver four to five times. Remember that the goal is to apply gentle pressure to the eyelids - so just rubbing the eyelid surface will do little good.
Warm compresses heat the debris and dried oils on the lid margin to or above the melting point so that they are more easily removed with lid scrubs. Technique: Soak a washcloth in water as warm as the eyelids can stand, wring, and then place the cloth on the lid surface (eyelids closed) for five to ten minutes. Several innovative techniques work well such as use of a fresh-boiled egg (in its shell wrapped in a washcloth)or a small microwaved red potato. Warm compresses should be combined with eyelid massage. This is especially important in patients who have Meibomian gland dysfunction (MGD). Naturally, the oils produced by these glands to help prevent tear evaporation are the consistency of vegetable or motor oil. In MGD, the meibomian secretions are thickened and the gland openings become clogged. After warm compresses of the lids, thickened meibomian gland secretions are more fluid, but massage is necessary to express them. After every 1 minute of warm compresses, massaging the eyelid as follows will be useful: Gently close the eyelids. Put your index finger on the outer corner of the eyelid. Pull the eyelid towards the ear, so that the eyelids are stretched taut. Next use the index finger of the opposite hand to apply direct pressure to the taut eyelids starting at the inner aspect of the eyelid near the of the nose. Sweep with firm but gentle pressure towards the ear. Repeat this maneuver four to five times. Remember that the goal is to apply gentle pressure to the eyelids - so just rubbing the eyelid surface will do little good.
Lid Scrubs
There are several ways of performing eyelid scrubs. You can choose whichever one you are most comfortable with. Gentle scrubbing should be directed at the base of the eyelashes on the edge of the eyelid. Johnson's Baby Shampoo: A very tiny trace amount of J & J brand baby shampoo can be applied to a thin, cheap washcloth (baby washcloths work well)and worked in to a lather. To do the bottom lids, pull the lower lid downward while looking upward then gently "scrub" the lid edge back and forth from the inner corner to the outer about a dozen times. The upper lid is done by gently closing the lids and simultaneously raising the brow to expose the edge of the lid. Scrub back and forth with the sudsy washcloth as done on the lower lid. Rinse with warm water. Over-the-counter pre-soaked cleansing pads such as OCuSOFT Lid Scrubs or Novartis Eye-Scrub are preferred over baby shampoo and washcloths.
There are several ways of performing eyelid scrubs. You can choose whichever one you are most comfortable with. Gentle scrubbing should be directed at the base of the eyelashes on the edge of the eyelid. Johnson's Baby Shampoo: A very tiny trace amount of J & J brand baby shampoo can be applied to a thin, cheap washcloth (baby washcloths work well)and worked in to a lather. To do the bottom lids, pull the lower lid downward while looking upward then gently "scrub" the lid edge back and forth from the inner corner to the outer about a dozen times. The upper lid is done by gently closing the lids and simultaneously raising the brow to expose the edge of the lid. Scrub back and forth with the sudsy washcloth as done on the lower lid. Rinse with warm water. Over-the-counter pre-soaked cleansing pads such as OCuSOFT Lid Scrubs or Novartis Eye-Scrub are preferred over baby shampoo and washcloths.
Newer products incorporate foam for eyelid cleansing such as Ocusoft Plus Foam Eyelid Cleanser or Sterilid Foam Cleanser from Theratears. A small amount of foam is applied to clean fingers which are then used to scrub back and forth directly on the closed lid margins.
Antibiotic Treatment
Sometimes it is necessary to prescribe an antibiotic ointment or gel-forming solution such as AzaSite in advanced cases of blepharitis. The use of an antibiotic ointment on the eyelid margin immediately after a lid scrub, such as erythromycin or bacitracin, is also useful in certain patients in improving comfort and reduce excessive bacteria. Oral tetracyclines (doxycycline or minocycline) for about 3 months is often needed in advanced or stubborn cases of chronic eyelid disease. Tetracycline antibiotics improve the meibomian gland secretions by reducing inflammation. They also inhibit bacterial enzymes as well as reduce the bacterial load.
Sometimes it is necessary to prescribe an antibiotic ointment or gel-forming solution such as AzaSite in advanced cases of blepharitis. The use of an antibiotic ointment on the eyelid margin immediately after a lid scrub, such as erythromycin or bacitracin, is also useful in certain patients in improving comfort and reduce excessive bacteria. Oral tetracyclines (doxycycline or minocycline) for about 3 months is often needed in advanced or stubborn cases of chronic eyelid disease. Tetracycline antibiotics improve the meibomian gland secretions by reducing inflammation. They also inhibit bacterial enzymes as well as reduce the bacterial load.
Nutritional Supplements
Use of the oral supplements Omega 3 (cold water fish oils) and certain Omega 6 essential fatty acids can markedly improve MGD and blepharitis. These products are generally good for overall health (skin, joints, brain and heart health). The most complete nutritional "cocktail" I've found is BioTears by Biosyntrx which can be ordered directly from the company or can be purchased in our office.
Use of the oral supplements Omega 3 (cold water fish oils) and certain Omega 6 essential fatty acids can markedly improve MGD and blepharitis. These products are generally good for overall health (skin, joints, brain and heart health). The most complete nutritional "cocktail" I've found is BioTears by Biosyntrx which can be ordered directly from the company or can be purchased in our office.