Blepharitis is a very common, chronic eye condition that primarily affects the eyelids and margin of the eyelid. Some patients are very symptomatic with itching, redness, swelling, crusting or burning sensation around the eye. There are 2 main types of blepharitis detailed below.
In this common condition, the skin around the eyelashes becomes very dry, scaly and flaky. The crusting of the skin leads to inflammation and irritation in the eyes. This can also be caused by bacteria along the eyelid margin, or a mite called Demodex. In other patients, there are seborrheic changes similar to dandruff along the lashes. In some patients, blepharitis is a cause of chronic red eyes. Treatment commonly involves warm compresses to the eyelids, artificial tears, and commercial lid wipes such as Ocusoft and Systane lid wipes. In more severe cases, a topical antibiotic ointment such as Eythromycin or Bacitracin or thick drop like Azasite or Tobradex ST are needed if there is colonization with skin bacteria. A last resort is a steroid eye ointment to reduce inflammation, but this should be limited to short term use only.
Posterior Blepharitis (now called Meibomian Gland disease)
Meibomian glands are found at the edge of the eyelid in the upper and lower lids. Their role is to produce oils in the tear film to prevent our tear film from evaporating. When these glands do not work properly, the normal oils, which should be the consistency of olive oil, become thickened (more like honey or even toothpaste). When these oils are missing on the surface, between blinks the eyes dry out quickly. This causes burning, blurry vision, redness, watering, and tends to worsen as the day goes on or worsens with prolonged reading or computer use.
Treatment needs to be continued chronically for this condition. Options include warm compresses, which liquefy the clogged oils, lid scrubs, AzaSite, or oral doxycycline. Adding fish oil or flax seed oils (omega 3 supplements) to the diet may also help.
If a meibomian gland gets completely blocked, a chalazion forms in the lid as the oil is trapped in the lid and hardens. Patients with roseacea and certain ethnic backgrounds are more prone to meibomian gland dysfunction and chalazia.
A stye is also called a hordeolum. It is caused by an infected eyelash follicle and tends to be more painful than a chalazion. A large chalazion or stye may distort the shape of the eye causing blurry vision. There may be a small white spot in the center.
Treatment often needs to be continued chronically for this condition. Options include warm compresses with eyelid massage, oil based tears such as Systane Balance, low dose doxycycline or minocycline, and omega 3 fatty acids (fish oil or flax seed oil). If a chalazion is not treated promptly with heat, eyelid surgery to drain the chalazion may be needed. The surgical procedure is done usually in the office with injection of lidocaine to aid in comfort in the drainage.
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