Blepharitis and Rosacea

Blepharitis is inflammation of the eyelid edges, in the meibomian glands in the back half of the eyelid.   These glands produce oils, that stop tear film evaporation, and keep the surface of the eye moist.  When these oils fail, the eye surface becomes dry.  Patients may have variable irritation and burning of the eyes, usually worse towards the end of the day.  This can persist for years without treatment.  Sometimes patients develop eye lid cysts, called chalazion, that need surgical drainage.  Blepharitis can be kept under control with hygiene, but can flare up from time to time. 

 

Rosacea and Blepharitis is very common, and increased since we wore masks during the pandemic.  Most patients are undiagnosed.  It is more of a nuisance than a serious problem for most people.  It usually will not affect your sight, but can do so if excess mucous secretions build up in the tear film, or you develop inflammation in the cornea, called marginal keratitis.  Blepharitis is often associated with Rosacea, when sebacceous glands on the face, the forehead, cheeks and nose are inflamed.  Typically patients have facial redness, bumps and pimples, a thickened nose, and eye irritation.

 

We do not understand the cause.  This is not an infection.  It is an immune overreaction, possibly to a parasite called Demodex, or to the toxins produced by bacteria that normally live on the surface of the eye and on the eyelids.  Increasing knowledge about the imbalance of the microbiota – the bacteria in your intestine – is finding possible links to many human diseases including Blepharitis.

 

Treatment involves heat and massage of the eye lids.  We have instructional videos showing how to do this.

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There is no cure for Blepharitis.  It can be kept under control by keeping the eyelid margins clean and reducing inflammation, and keeping the eye well lubricated.

 

TREATMENT 

Artificial tear-drops and ointments for dry eye

 

Lid hygiene – do this twice a day initially.

• First of all, wash your hands. 

• Use Ocusoft, Lidcare and Steri-lid - products from the chemist.  

• Clean the eyelid at the base of the eyelashes using cotton buds

• Once symptoms have settled, you can reduce the treatment to once daily.

Warm compresses heat the glands and oils above the melting point so that they are easily removed with the lid scrubs.  Soak a washcloth in warm water and then place the cloth on the lid surface (eyelids closed) for five to ten minutes. In the acute phase this is performed 2 to 4 times day.

 

Treatment of acute flare-ups requires Hycor steroid cream.  This is effective in the short term, but cannot be taken long term because it causes cataract and glaucoma.  Ointment blurs the vision.    The antibiotics Doxycycline, minomycin and azithromycin work by slowly reducing the inflammation in the eyelid glands.  It takes several weeks to notice an effect.  Read the produce information carefully and beware of skin sensitivity to the sun.  Do not take Azithromycin if you have known heart conditions.  

 

Other treatments

Increasing the intake of Omega-3 fatty acids (flaxseed oil supplements) or Garlic may also reduce the inflammation.  Research is underway looking at Probiotics either taken orally or topically.    The retinoid drugs Roacutane used for acne seem to make Rosacea worse, and are not used.

 

Commercial products (Lipiflow) heat and squeeze the lids are under research at the moment.  

 

Intense Pulsed Light (IPL) is being used in many dry-eye clinics to reduce the bacteria and parasites on your skin, and some patients have huge relief from this treatment.

 

Please watch our education video.

 

There is no cure for Blepharitis.  It can be kept under control by keeping the eyelid margins clean and reducing inflammation, and keeping the eye well lubricated.

 

TREATMENT 

Artificial tear-drops and ointments for dry eye

 

Lid hygiene – do this twice a day initially.

• First of all, wash your hands. 

• Use Ocusoft, Lidcare and Steri-lid - products from the chemist.  

• Clean the eyelid at the base of the eyelashes using cotton buds

• Once symptoms have settled, you can reduce the treatment to once daily.

Warm compresses heat the glands and oils above the melting point so that they are easily removed with the lid scrubs.  Soak a washcloth in warm water and then place the cloth on the lid surface (eyelids closed) for five to ten minutes. In the acute phase this is performed 2 to 4 times day.

 

Treatment of acute flare-ups requires Hycor steroid cream.  This is effective in the short term, but cannot be taken long term because it causes cataract and glaucoma.  Ointment blurs the vision.    The antibiotics Doxycycline, minomycin and azithromycin work by slowly reducing the inflammation in the eyelid glands.  It takes several weeks to notice an effect.  Read the produce information carefully and beware of skin sensitivity to the sun.  Do not take Azithromycin if you have known heart conditions.  

 

Other treatments

Increasing the intake of Omega-3 fatty acids (flaxseed oil supplements) or Garlic may also reduce the inflammation.  Research is underway looking at Probiotics either taken orally or topically.    The retinoid drugs Roacutane used for acne seem to make Rosacea worse, and are not used.

 

Commercial products (Lipiflow) heat and squeeze the lids are under research at the moment.  

 

Intense Pulsed Light (IPL) is being used in many dry-eye clinics to reduce the bacteria and parasites on your skin, and some patients have huge relief from this treatment.

 

Please watch our education video.