What is blepharitis?
Blepharitis is an inflammation of the eyelids in which the eyes become red and irritated, and itchy flakes and dandruff form on the eyelashes. It is a fairly common eye condition caused by bacteria or a skin problem, such as dandruff on the scalp or rosacea (a chronic condition involving redness and inflammation of the skin).
This condition affects people of all ages, but is more common in those with oily skin, dandruff or dry eyes. Although it is somewhat uncomfortable, blepharitis is usually not painful, is not contagious and generally does not cause any permanent damage to eyesight.
Blepharitis can be classified into two types: anterior blepharitis, which occurs on the outer edge of the eyelid where the eyelashes attach; and posterior blepharitis, which affects the inner edge of the eyelid that comes into contact with the eyeball.
Causes of blepharitis
There are three different types of blepharitis, depending on the external factor causing them.
Staphylococcal blepharitis
This type of blepharitis is caused by a bacterium called staphylococcus. This bacterium is found everywhere in our environment and generally lives on our skin without causing us any harm. However, it can occasionally cause skin infections, such as impetigo and acne.
In some people, this bacterium appears to penetrate the skin along the edge of the eyelids, causing this type of blepharitis. It is not yet entirely clear why this happens, but fortunately it is quite rare.
Seborrhoeic blepharitis
Seborrhoeic blepharitis is closely associated with a condition known as seborrhoeic dermatitis. With this condition, the skin tends to be oily and may become flaky. It usually causes a lot of dandruff and sometimes rashes on the face and scalp.
The specific cause of seborrhoeic dermatitis is not entirely clear. However, it is believed that a yeast called Malassezia furfur is involved in triggering the condition.
Seborrhoeic dermatitis is not contagious and is not painful, although it can cause discomfort.
Meibomian blepharitis (MGD) or posterior blepharitis.
Also known as meibomian gland dysfunction (the glands are located in the eyelids, just behind the eyelashes). The average person has around 25–30 of these glands in each eyelid, both upper and lower. Their job is to produce a small amount of oily fluid to lubricate the eye.
People with meibomian blepharitis undoubtedly have a problem with these glands and the fluid they produce, or, in other words, the fluid they fail to produce. This can cause inflammation and dryness in the eye, as the fluid lacks the correct balance of oils that the eye requires.
A combination of all three or mixed.
In practice, it is quite difficult to distinguish between the different causes of blepharitis and, in many cases, all three may be present at the same time. Seborrhoeic blepharitis commonly occurs alongside meibomian blepharitis. This means that, regardless of what triggers the condition, by the time treatment is sought, it is essential to address all three possible causes.
BLEPHARITIS AND DRY EYE OFTEN OCCUR AT THE SAME TIME
BLEPHARITIS AND DRY EYE OFTEN OCCUR AT THE SAME TIME
The signs and symptoms of blepharitis are generally present in both eyes, affecting both the upper and lower eyelids. Symptoms include: itching or irritation of the eyelids, mild tearing, dry eyes, a burning sensation, a gritty sensation in the eye, a feeling of a foreign body in the eye, the appearance of scabs or flaky skin on the eyelids, reduced comfort when wearing contact lenses, and sensitivity to light.
Signs include:
Red edges around the eyelid
Swollen eyelids
Thickened eyelids
Increased shedding of skin cells near the eyelids, causing flaking of the skin around the eye
Crusty eyelashes upon waking
Mild scarring at the edges of the eyelid
Mild ulceration in the same area
Dry, scaly patches on the skin, amongst others.
Patients often mistakenly attribute all these symptoms and signs to “recurrent conjunctivitis”. They also attribute them to "dry eye" because of the gritty sensation. However, lubricating eye drops (prescribed for dry eye) do little to improve the situation.
Diagnosis of blepharitis
Blepharitis can be diagnosed through a comprehensive eye exam. The tests, with particular focus on the eyelids and the front surface of the eyeball, may include: a patient history to identify any symptoms and health issues, external examination of the eye to assess skin texture and the appearance of the eyelashes, evaluation of the Meibomian gland openings using a bright light and magnifying lenses, analysis of tear quantity and quality to check for any abnormalities, amongst others.
Treatment of Blepharitis
Treatment depends directly on the type of blepharitis and whether it is a mild or more severe case. However, the key to treating most types of blepharitis is to keep the eyelids clean and free of scabs.
In general, it is recommended to limit or stop using eye make-up for a while when dealing with blepharitis, as its use makes hygiene more difficult. The use of warm compresses can loosen the scabs or flakes that form around the eye; to do this, it is important to gently rub the area with a mixture of water and baby shampoo or a mild cleanser.
There are also other recommendations for people with blepharitis. These include: if the glands in the eyelids are blocked, it is important to massage them to clear the build-up of oil; the use of lubricating eye drops or ointments is essential (only if prescribed by a doctor); use anti-dandruff shampoo on the scalp; stop using make-up during treatment; temporarily stop wearing contact lenses; amongst others.
In cases of bacterial infections, more complex treatment plans may be required and antibiotics may be prescribed. If, on the other hand, it is caused by an allergy at home or at work, then simply avoiding the allergen is enough to prevent future problems.
Blepharitis rarely goes away completely. Even with successful treatment, this condition may recur.
Blepharitis and dry eye
Blepharitis and dry eye, although they have similar symptoms, are distinct from one another. Dry eye is characterised by a reduction in the quality or quantity of tears, resulting in insufficient lubrication and moisture on the surface of the eye. The symptoms of this condition include dryness, itching and a burning sensation in the eyes. However, blepharitis is an inflammation of the eyelid caused, in most cases, by a bacterial infection.
The two conditions are often confused because, simply put, dry eye presents with symptoms similar to those of blepharitis. However, it is important to always bear in mind the significant difference between them.
Blepharitis is a chronic condition that can be managed but cannot be cured. By “cure” we mean the complete disappearance of the condition.
Blepharitis is a NON-contagious condition.