Blepharitis is one of the most common (and most frustrating) eyelid conditions seen in eye care. It is a condition characterized by inflammation of the eyelids causing redness, watery eyes, irritation and crusting along the eyelashes. It is not typically a sight-threatening condition, but can cause a multitude of symptoms and even lead to other more serious eye problems. The good news is that maintaining eyelid hygiene can significantly reduce or even prevent blepharitis altogether, and help to reduce dry eye symptoms at the same time.
In this article, we will cover what blepharitis is, how it is related to dry eye disease and the most effective management tools and devices to mitigate symptoms.
What is blepharitis?
Blepharitis is eyelid inflammation which is most commonly caused by buildup of excess bacteria along the eyelid margin, skin mites (Demodex) which live in the eyelash follicles or inflammatory skin conditions like ocular rosacea. The longer that bacteria, debris or skin mites are able to continue accumulating on the eyelids, the more likely you will encounter symptoms described above. Left untreated, blepharitis can lead to more complicated problems like eyelid infections, recurring styes or even spread to the ocular surface itself.
How is blepharitis related to dry eye disease?
Blepharitis and dry eye disease often go hand-in-hand. Here’s why:
- The eyelids house the meibomian (oil) glands. These produce the oil that stabilizes and protects the tear film.
- If bacteria or debris block the openings of these glands (a condition known as meibomian gland dysfunction or MGD), oil secretion is reduced.
Without a healthy oil component, tears evaporate quicker than they should. This causes ocular dryness and other related symptoms like burning and gritty sensation. The dryness itself then causes even more irritation on the eye’s surface. Managing blepharitis is therefore a crucial first step in controlling dry eye symptoms.
Best eyelid hygiene practices
Maintenance of eyelid hygiene is very important in prevention of blepharitis flare-ups and reducing symptoms from chronic dry eye disease. Here are some basic and practical steps in maintaining eyelid hygiene:
- Ensure that all makeup is removed at the end of the day. Makeup and debris can trap bacteria along the eyelid margins.
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Use an eyelid wipe or cleanser (with antimicrobial action). Antimicrobial eyelid wipes are great for repelling excess bacteria.
Note: Demodex skin mites will not be responsive to standard eyelid wipes or cleansers, even with antimicrobial action in them. These will need specific agents like tea tree oil or an in-office eyelid exfoliation to be removed effectively. If you are struggling to keep eyelid inflammation at bay with traditional methods, you may need a visit with your eye care practitioner to find out if an alternative method may be better suited for you. - Use a warm compress. A warm compress applied nightly can help open clogged meibomian glands as well as loosen any debris still present on the eyelid.
Electronic eyelid cleansing devices
For patients who struggle with manual methods, an electronic cleansing device could make a significant difference. These could also be quite beneficial for patients with poor dexterity due to conditions like rheumatoid arthritis. Electronic devices have soft vibrating or oscillating ends that can help loosen and dislodge debris more effectively. They could be an easier-to-use alternative and less work than the traditional manual methods mentioned previously. Pairing an electronic device with traditional manual lid hygiene methods could be an ideal solution for stubborn or severe cases.
Note: Avoid using abrasive or harsh electronic devices if you have active eyelid inflammation as they could potentially make the inflammation worse. Always ask your optometrist if you are unsure.
Other advanced blepharitis treatments
If at-home management is not satisfactory, your optometrist might recommend:
- Prescription medications like antibiotics, steroids or a combination of the two.
- In-office treatments like Zest or Blephex (both are eyelid exfoliation treatments) or intense pulsed light (IPL).
- Demodex-specific therapies as mentioned previously.
Conclusion
Blepharitis is a persistent but manageable ocular condition. The key is daily eyelid hygiene whether that consists of manual or electronic devices or a combination of both. Optimizing eyelid hygiene can help to reduce symptoms and flare-ups from blepharitis and chronic dry eye, as well as prevent other more complex eye problems. Incorporating an electronic cleansing device into your routine could be a time-saving management option compared to traditional methods alone. If symptoms persist after regular eyelid hygiene is implemented, always consult with your eyecare practitioner for personalized advice and treatment options.
References:
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Rocha, Karolinne Maia, et al. "Eyelid margin disease (blepharitis and meibomian gland dysfunction): clinical review of evidence-based and emerging treatments." Journal of Cataract & Refractive Surgery 50.8 (2024): 876-882.
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Lin, Amy, et al. "Blepharitis preferred practice pattern®." Ophthalmology 131.4 (2024): P50-P86.
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Ballesteros-Sanchez, Antonio, et al. "Eyelid exfoliation treatment efficacy and safety in dry eye disease, blepharitis, and contact lens discomfort patients: a systematic review." Asia-Pacific Journal of Ophthalmology 12.3 (2023): 315-325.
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Onghanseng, Neil, et al. "Oral antibiotics for chronic blepharitis." Cochrane Database of Systematic Reviews 6 (2021).
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Shah, Paras P., Rebecca L. Stein, and Henry D. Perry. "Update on the management of demodex blepharitis." Cornea41.8 (2022): 934-939.
Contributors:
Sarah Farrag, OD
Dr. Sarah Farrag is originally from Halifax, Nova Scotia, and is happy to be practicing optometry in her hometown. She graduated with honors from the University of Waterloo Doctor of Optometry program in June 2015. In addition to routine optometric care, Dr. Farrag also facilitates an advanced dry eye clinic offering specialty consultation and treatment for severe dry eye.
