Blepharos is the greek word for eyelid and – it means inflammation. Blepharitis can give symptoms of irritation, burning and grittiness and red eyelid margins and sometimes cysts or infections in the eyelids. Blepharitis can impair the normal functioning of the tear film, which keeps your eye comfortable and keeps you seeing well. 

Anterior Blepharitis

Crusts and debris develop at the eyelid margin and are especially visible at the base of the lashes. This debris is made up of waxy deposits (seborrhea) and bacteria. In some cases, the debris is caused by the demodex mite, which is a tiny mite that lives on our skin and is not visible to the naked eye. The presence of the mite is not related to hygiene and can affect anyone. 

Posterior blepharitis/ Meibomian gland disease

The meibomian glands are positioned in the upper and lower eyelids and there are between 25-30 of them in each eyelid. They produce an oily material that contributes to making up a healthy tear film. If they become diseased, inflammation causes a reduction in oil production and as a result, the tears evaporate more quickly, resulting in dry eye. 

Hot compresses and Lash Cleaning for Anterior Blepharitis

The crusts on the eye lashes can be very adherent so usually a gentle wipe with a cotton pad is not usually sufficient. Prior to wiping the eyelids, hot compressed with a clean face towel might help loosen the crusts.

To wipe the lashes of all four eyelids, a cotton bud soaked in baby shampoo solution can be used and a mirror is useful to use. The lash roots need to be wiped in a sideways movement and then up and down. Alternatively, over the counter eyelid wipes such as Blephaclean or Optase can be obtained from your local pharmacy or optician. These can be more convenient and are safe to use. 

Baby shampoo works well for bacteria but not if you have demodex mites or posterior blepharitis. For these, a diluted tea tree shampoo has been shown to be more effective. The shampoo can be diluted down so it does not sting too much however tea tree oil is very stingy and is better avoided. The water used to dilute the shampoo need not be boiled or sterile, tap water alone should be sufficient. 

The process of cleaning should be performed daily initially but eventually this can be reduced to once a week after one to two weeks. One may need to continue the cleaning more or less frequently depending on flare ups and individual eyelid condition.

Antibiotics for Anterior and Posterior Blepharitis

A short course of antibiotic ointment can help reduce the number of bacteria that live on the eyelid margins. Chloramphenicol ointment is the most commonly used and is available as an ocular preparation which is safe if enters the eye. Because it is an ointment and therefore paraffin based, the vision will be blurry for a time if it does go in the eye.

A course of antibiotic tablets for several weeks can be used. Antibiotics such as Doxycycline, Oxytetracycline and Lymecycline can all be used as a 6-8 week course and they can help treat particularly posterior blepharitis. These antibiotics have properties which are separate to their ability to treat infection – they also act as matrix metalloproteinase inhibitors – and this activity helps with blepharitis management.