There are 3 forms of blepharitis (staphylococcal, seborrheic and MGD). All three forms of blepharitis are chronic in nature. Patients with staphylococcal blepharitis are relatively young (mean age 42 years) with a short history of ocular symptoms (mean 1.8 years). Patients with seborrheic blepharitis and MGD blepharitis are generally older and have a longer history of ocular symptoms. Staphlycoccal blepharitis is a type of external eye inflammation. As with dandruff, it is usually asymptomatic until the disease progresses. As it progresses, the sufferer begins to notice a foreign body sensation, matting of the lashes, and burning. Usually, the primary care physician will prescribe topical antibiotics for staphylococcal blepharitis. Unfortunately this is not an effective treatment.
Seborrheic blepharitis, the most common type of blepharitis, is usually one part of the spectrum of seborrheic dermatitis seborrhea which involves the scalp, lashes, eyebrows, nasolabial folds and ears. Treatment is best accomplished by a dermatologist.
In Meibomian gland dysfunction (MGD) there are prominent blood vessels crossing the eyelid margin. In addition there is pouting or plugging of meibomian gland openings, and poor expressibility and/or turbidity of the oily meibomian secretions. Patients with MGD frequently are noted to have coexisting rosacea and seborrheic dermatitis (Rosacea's Red Face). Use of isotretinoin (Accutane), an oral medication for severe cystic acne, has also been implicated as a cause of blepharitis.
Treatment:
Blepharitis is a chronic disease for which there is no cure, and requires long-term treatment to keep it under control. Treatment consists of 2 phases (Acute phase and Maintenance phase). Acute phase treatment involves intensive therapy to rapidly bring the disease under control. In the maintenance phase the goal is to indefinitely continue the minimum amount of therapy that is necessary to keep the disease quiet. Herein we will not focus on the treatment of specific steroid responsive complications of blepharitis like marginal ulcers and phlyctenules, as they are less common and require specific diagnosis. We will focus on the treatments that help control the blepharitis process itself. Needless to say, controlling blepharitis itself, will reduce all the other blepharitis related complications.
Warm Compresses followed by Lid Scrubs is the most critical element of effective blepharitis control. This therapy removes the eyelid debris (which can be colonized by bacteria), reduces the bacterial load (mechanically as well as by lysis of bacteria due to detergent action of the soap in lid scrubbing) and stabilizes the tear film by releasing oily secretions from the meibomian glands, thus reducing tear evaporation (so the dry eye symptoms are also reduced).
Antibiotic treatment
The use of an ointment on the eyelid margin immediately after lid scrubbing may help to increase patient comfort. The choice here is usually Erythromycin eye ointment or Tobradex eye ointment (steroid-antibiotic combination). In addition, the antibiotics help to further reduce the bacterial load on the eyelids.
Oral tetracyclines (doxycycline or minocycline) for about 3 months can be used in recalcitrant Meibomian Gland Dysfunction (MGD) cases. Tetracycline antibiotics affect the meibomian gland secretions, inhibit bacterial lipases as well as reduce the eyelid bacterial load.
Anti-Inflammatory treatment
Castor oil has been used traditionally in folk medicine as an anti-inflammatory remedy for treatment of blepharitis. The main ingredient in Castor oil is ricinoleic acid. Castor oil could either increase or decrease eyelid inflammation depending upon whether it is used only once or is used several times for many days. Eyelid inflammation may increase initially after starting treatment but with repeated use over a week, the blepharitis inflammation will be reduced.
Antioxidant treatment
Eating more grapes may help blepharitis patients. The formation of oxidants like nitric oxide in the involved eyelid margin have been speculated to play a role in blepharitis. The substance, known as resveratrol is an anti-oxidant that is very effective against these nitrite type of oxidants. Grapes are particularly good sources of resveratrol. Resveratrol is found in the skin (not flesh) of grapes. Fresh grape skin contains about 50 to 100 micrograms of resveratrol per gram and red wine (also rich in resveratrol) contains about 1.5 to 3 milligrams per liter.
Seborrheic blepharitis, the most common type of blepharitis, is usually one part of the spectrum of seborrheic dermatitis seborrhea which involves the scalp, lashes, eyebrows, nasolabial folds and ears. Treatment is best accomplished by a dermatologist.
In Meibomian gland dysfunction (MGD) there are prominent blood vessels crossing the eyelid margin. In addition there is pouting or plugging of meibomian gland openings, and poor expressibility and/or turbidity of the oily meibomian secretions. Patients with MGD frequently are noted to have coexisting rosacea and seborrheic dermatitis (Rosacea's Red Face). Use of isotretinoin (Accutane), an oral medication for severe cystic acne, has also been implicated as a cause of blepharitis.
Treatment:
Blepharitis is a chronic disease for which there is no cure, and requires long-term treatment to keep it under control. Treatment consists of 2 phases (Acute phase and Maintenance phase). Acute phase treatment involves intensive therapy to rapidly bring the disease under control. In the maintenance phase the goal is to indefinitely continue the minimum amount of therapy that is necessary to keep the disease quiet. Herein we will not focus on the treatment of specific steroid responsive complications of blepharitis like marginal ulcers and phlyctenules, as they are less common and require specific diagnosis. We will focus on the treatments that help control the blepharitis process itself. Needless to say, controlling blepharitis itself, will reduce all the other blepharitis related complications.
Warm Compresses followed by Lid Scrubs is the most critical element of effective blepharitis control. This therapy removes the eyelid debris (which can be colonized by bacteria), reduces the bacterial load (mechanically as well as by lysis of bacteria due to detergent action of the soap in lid scrubbing) and stabilizes the tear film by releasing oily secretions from the meibomian glands, thus reducing tear evaporation (so the dry eye symptoms are also reduced).
Antibiotic treatment
The use of an ointment on the eyelid margin immediately after lid scrubbing may help to increase patient comfort. The choice here is usually Erythromycin eye ointment or Tobradex eye ointment (steroid-antibiotic combination). In addition, the antibiotics help to further reduce the bacterial load on the eyelids.
Oral tetracyclines (doxycycline or minocycline) for about 3 months can be used in recalcitrant Meibomian Gland Dysfunction (MGD) cases. Tetracycline antibiotics affect the meibomian gland secretions, inhibit bacterial lipases as well as reduce the eyelid bacterial load.
Anti-Inflammatory treatment
Castor oil has been used traditionally in folk medicine as an anti-inflammatory remedy for treatment of blepharitis. The main ingredient in Castor oil is ricinoleic acid. Castor oil could either increase or decrease eyelid inflammation depending upon whether it is used only once or is used several times for many days. Eyelid inflammation may increase initially after starting treatment but with repeated use over a week, the blepharitis inflammation will be reduced.
Antioxidant treatment
Eating more grapes may help blepharitis patients. The formation of oxidants like nitric oxide in the involved eyelid margin have been speculated to play a role in blepharitis. The substance, known as resveratrol is an anti-oxidant that is very effective against these nitrite type of oxidants. Grapes are particularly good sources of resveratrol. Resveratrol is found in the skin (not flesh) of grapes. Fresh grape skin contains about 50 to 100 micrograms of resveratrol per gram and red wine (also rich in resveratrol) contains about 1.5 to 3 milligrams per liter.
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