Lid hygiene and medications can help manage the irritating signs and symptoms of blepharitis.
A patient presents with and complains of red, irritated, and itchy eyes. You also notice dandruff-like scales on the eyelashes.Most likely, the patient has blepharitis, which is inflammation and swelling at the edge of the eyelids and eyelashes. Blepharitis commonly occurs when the tiny oil glands of the inner eyelid become inflamed. Symptoms are usually worse in the morning, when patients complain of “crusting” on awakening.
Blepharitis can affect people of all ages. It is not contagious and does not cause any permanent damage to eyesight.
Everyone has some bacteria on their skin. Some people, however, have more bacteria at the base of their eyelashes that looks like dandruff flakes, or they have problems with oil glands in their eyelids that can also lead to blepharitis.
There are several types of blepharitis. The two most common are anterior and posterior blepharitis.
Individuals who have anterior blepharitis may complain of burning, excessive tearing, red eyelids, puffy eyelids, red eyes, lash loss and foreign-body sensation. They may complain of light sensitivity and crusting of the lids, and they may have a history of chalazion or hordeolum.
Posterior blepharitis, which affects the inner edge of the eyelid, can be caused by irregular oil production by the glands of the eyelids. This creates a good environment for bacterial growth that may also result in other skin conditions, such as acne rosacea and dandruff.
Blepharitis is diagnosed when the patient presents for a comprehensive eye examination. During the history, the patient may report a gritty, burning sensation in the eyes, excessive tearing, red and swollen eyelids, dry eyes or crusting eyelids.
Some patients might only experience minor irritation or itching, while others may experience more severe signs and symptoms, such as blurry vision or missing or misdirected eyelashes. Blepharitis may cause inflammation to other eye tissue, particularly to the cornea.
The optometrist will do an external examination of the eye, including lid structure, skin texture and eyelash appearance. The doctor also will evaluate the lid margins and the quantity and quality of tears, checking for any abnormalities.
Although some cases of blepharitis may require a more complex treatment plan, the key to treating most types of blepharitis is keeping the lids clean and free of crusts. Treatment options include:
• Warm compresses. Instruct the patient to wet a clean washcloth with warm water, wring it out and place it over closed eyes for five minutes to loosen the crusts. This should be followed by gentle scrubbing of the eyes with a mixture of water and baby shampoo.
• Eyelid scrubs. A number of commercial products are available to help with lid hygiene. (To learn about more eyelid scrubs, see “Put It on a Lid,” June 2017.)
• Antibiotic ointments. The doctor may prescribe erythromycin or bacitracin ointment. Instruct the patient remove crusting and debris with a warm washcloth or lid scrub and then use a cotton swab or a clean fingertip to apply the ointment.
• Antibiotic-steroid combinations. Combination agents, such as sulfacetamide and prednisolone, may help decrease inflammation and quickly diminish symptoms of blepharitis for the short-term. Long-term use is not recommended.
Blepharitis seldom disappears completely, as there is no cure. Even with successful treatment a relapse may occur.
Patient self-care plays a major role in the management of blepharitis. Individuals with blepharitis must understand the importance of keeping their eyelids, skin and hair clean. Making this a routine procedure will keep the blepharitis under control. It is always a good practice for the technician to reiterate the instructions the doctor gave the patient.
Roberta Beers, CPOT, is an optometric assistant in Erie, PA.