What is the first line treatment for blepharitis?

Humans are able to see the world through the eyes. It is important to take care of the eyes by making sure to get regular eye examinations and to practise good eating habits along with an active lifestyle. There are many eye disorders that could lead to vision disturbances and a certain degree of discomfort. In this DoctorOnCall’s article, we will be learning about one of the common eye diseases known as blepharitis and the first line treatment for this disease.

Blepharitis is inflammation of the eyelid margins. Blepharitis is often presented as swollen, red and itchy eyelids. Obvious sign of a blepharitis is presence of flakes or oily particles/crusts wrapped at the base of the eyelashes. These may seem as dandruff-like scales such as those seen on hair scalp, except are found on the eyelashes. Blepharitis may occur either outside of the front edge of the eyelids where the eyelashes attach (anterior blepharitis) or at the inner edge of the eyelids which touches the eyeball (posterior blepharitis). Blepharitis may affect anyone at any age and of any gender. However, a person is at high risk for blepharitis if they have skin conditions such as rosacea, seborrheic dermatitis, allergies and poor hygiene including not removing cosmetic makeup properly from the face.

There are several causes leading to blepharitis. Most common one is the infection caused by bacteria. Although bacteria do exist on the skin and the lids, some people may have more bacteria at the base of the eyelashes compared to other people or the lid area is prone to infection due to poor reaction towards the bacteria. This leads to infection which is presented as the dandruff-like flakes. Another cause of blepharitis although is less common is present of allergies or over-population Demodex, a type of mites that typically lives inside the eyelash follicle. Last but not least, blepharitis can be caused by the improper oil production of the eyelid glands, specifically the meibomian gland which enables an optimum environment for bacteria to grow.

Common symptoms of blepharitis include itchy eyes, feeling burning or stinging of the eyes, watery eyes, eyelids “glued together” in the morning, red and swollen eyes or eyelids and gritty eyes. Although in most cases it may be causing minor discomfort as mentioned above, some may lead to severe symptoms such blurry vision, missing eyelashes, eyelashes that grow in the wrong direction and swelling of other parts of the eye such as cornea. Since symptoms of blepharitis may resemble other eye disorders, it is best to get medical advice when such symptoms are experienced. Even though blepharitis may be easily spotted with the presence of the dandruff-like flakes, usage of special instruments such as slit-lamp examination can help doctors to evaluate severity of the blepharitis.

First line treatment of blepharitis is to make sure the lid hygiene is in check. This involves usage of warm compress to help lose the flakes and to prevent clogging of the oil glands. This is followed by eyelid scrubs by using clean washcloth, cotton swab or lint-free pad soaked in baby shampoo that has been diluted in warm water. This is done for about 15 seconds. Eyelid scrub may also be done with lash scrubs for about 3-5 minutes at least 2 times a day. This scrubbing practice helps to remove accumulated oil from glands and follicle debris. Doctors may prescribe antibiotics in some cases that are unresponsive to weeks of eyelid hygiene. Eye drops such as steroid or artificial tears should only be used if it is prescribed or advised by healthcare providers.  If blepharitis is caused by other health problems such as mentioned previously in those at high risk, treating that underlying issues may improve blepharitis itself. It is worth noting that blepharitis may never completely go away and patients need to follow a routine of making sure the eyelids are clean for their lifetime to keep it under control.

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