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Blepharitis

Key points about blepharitis

Blepharitis is a common condition that causes inflammation of your eyelids.
It's caused by blocked glands in your eyelids and symptoms include swollen red eyelids and dry itchy eyes.
You can treat blepharitis at home by applying a warm compress, followed by eyelid massage and light cleaning.
Make-up and contact lens wear can make blepharitis worse and irritate your eyes further.
See your eye care provider if the condition gets worse or your vision gets blurry.

Blurred-out man removes his glasses to rub his eyes

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Blepharitis is caused when the small glands in your eyelids, which produce oils, become blocked. This causes dry, sore, irritated eyes and eyelids. Blepharitis tends to be a long-term, ongoing condition. It can occur in people of any age and gender.

Blepharitis can be associated with conditions such as rosacea and hypersensitivity to toxins released by bacteria that live on your eyelid (Staphylococcus). However, it sometimes may be related to an infestation by phthiriasis (crab louse) or Demodex (mites). Treatment, therefore, involves treating any infection or infestation and inflammation.

Blepharitis can cause:

red, sore, swollen eyelids
itching, irritation, discomfort around your eyes
dry, burning, gritty eyes
light sensitivity and blurred vision
foreign body sensation
tiny flakes (like dandruff) at the bottom of your eyelashes
crusting of the eyelids.

Managing blepharitis involves a stepwise approach. This includes identifying any underlying condition leading to blepharitis, treating any infection and inflammation, and any other eye complications. The aim of treatment is to keep your eyelids clean, treat any infection and avoid irritants.

Video: Lid hygiene

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(Moorfields Eye Hospital NHS Foundation Trust, UK, 2018)

Cleaning your eyes (lid hygiene)

Because blepharitis does not go away completely, you need to clean your eyelids regularly. This involves applying a warm compress to your eyelid to loosen the crusts, followed by eyelid massage and light cleaning of your eyelid for 3–5 minutes at least 2 times daily. Warm compression is important as it softens the secretions, allowing them to flow more freely during lid massage. The scrubbing removes accumulated gland secretions and follicle debris.

Warm compress

Hold a warm flannel against your closed eyelids for 5 minutes.

Eyelid massage

Use the tip of your finger to firmly stroke the skin of your eyelids towards the opening of the eyelids. This helps unblock the oil glands and squeeze out the oils.

Eyelid cleaning

Make up a solution of baby shampoo (1 part baby shampoo and 10 parts water). Dip a clean cotton bud in the solution and clean away any crusts on your eyelashes and rub along the eyelids. Use a clean cotton bud for each eyelid. Repeat this process twice a day.

Alternatively, commercially available lid scrubs are available from the pharmacy, such as Sterilids and Lidcare.

Antibiotics

Blepharitis caused by infection may be treated with a topical antibiotic ointment followed by lid cleaning. This is usually chloramphenicol or fucithalmic ointment. The length of treatment depends on how severe the inflation is. You may also be prescribed a combination of antibiotic and steroid ointment.

In some cases, your eye care provider may suggest a course of oral antibiotics. This is effective in treating blepharitis that is in conjunction with acne rosacea. Doxycycline and Azithromycin are usually prescribed and are known for their anti-inflammatory and lipid regulation properties.

A diet with increased omega-3 fatty acids may also be recommended.