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Blepharitis

What is blepharitis?  

Blepharitis is the term used to define eyelids which either are inflamed or cease to provide adequate oil nutrition to the surface of the eye.  

Blepharitis is extremely common and most adults have this to a greater or lesser extent, but fortunately not all people with this condition suffer symptoms.

Symptoms felt or observed include:

An irritable eye, sometimes an itchy eye;
Tearing;
Mildly red eye;
An eye that is very sensitive to wind, light & dusty environment and intolerant of reading for long periods of time.

The symptoms are usually moderate in the morning, a little better through the midday, and become progressively worse as the day gets on.  For some, only the evening symptoms occur, with in the morning the eye being relatively comfortable.  The classic symptoms are those of an eye that is hard to wake up in the morning, with mild redness, settling a little after a few hours, and then becoming progressively irritable as the day progresses.

Other symptoms will be awareness of reduced amount of lashes, or lashes that become pale.  Occasionally the lashes may turn in, known as trichiasis, which causes marked discomfort until the lash is removed.

Further complications can include a lump forming on the eyelid margin known as a stye, or a larger lump forming within the lid body itself known as a chalazion.

Blepharitis is observed more frequently in people with a variety of dermatological conditions, most notably rosacea and atopic eczema.

Treatments for blepharitis:

Warm Compress

Even though the condition of blepharitis progresses over many months if not years, the symptoms can be brought under control usually within a few weeks.  The mainstay of treatment for blepharitis is the application of warm compress to the gently closed eyelids.  The simplest is the application of a very warm, not scalding, face washer (flannel) folded and removed of excess fluid and applied to the eyelids with reasonable pressure.  The flannel is rewarmed a few times, as this technique is often met by rapid cooling of the flannel.  After the lids warm through, the soft underside of a finger is used to massage the lower lid upwards toward the lashes in a sort of rolling fashion, and the upper lid downward.  The upper lid is usually more difficult and a more uncomfortable experience.

There are a variety of ways to providing constant heat to the lids, such as using a small wheat bag, a warmed spoon, or a warmed potato, but whichever method is used one must be careful not to apply this directly to the skin, but through a cloth.  The warm compress and massage of the lid should be performed at least once/day when symptoms are minimal, up to three times/day when bothersome.   

Bathing

Bathing is also soothing to the eye, but has less influence on the disease itself.  Traditionally bathing is performed with either salt or bicarb soda.  Dr Chehade recommends trying the bicarb first, and salt if not providing improved symptoms.  

The preparation is as follows:

Have a clean glass container of 1-2 cup volume available and boiling water.  Pour the boiling water from the kettle into the volume of 1 cup into the glass container and let cool (usually overnight).  When ready to use, dissolve thoroughly 1 teaspoon by measure of bicarb soda (McKenzie type, preferably recently opened and not one that has sat in the cupboard for more than a few months), or 1 teaspoon of table salt.  When thoroughly dissolved, pour small quantities into an eye bath or similar small, clean container.  Protecting the other clothes with a towel, hold the small eyebath between thumb and first finger and, using the thumb and while bringing the container close to the eye, use the thumb to gently pull down the lower eyelid and then simply tip the container up to bathe the eye thoroughly with the liquid.  Refill the eyebath, swapping to the other hand, right hand for right eye and left hand for left eye, and repeat.  Usually one bathing is enough, although it can be done twice if preferred.  

The dilution of 1 teaspoon (5mL) into one measured cup (250mL) usually provides a very comfortable solution, although some people prefer to use 2/3rds (3.3mL) of a teaspoon into one cup.  At the end of the day, all the utensils are cleaned thoroughly, usually by rinsing in hot water with minimal detergent, and prepared for the next day.  It is not recommend that fluid be carried over, even if kept in the fridge.

Lid Cleaning

Even though frequently recommended, this can be an extremely difficult task to perform, as most people who have problematic blepharitis have reduced ability to see without glasses at close range and it is not possible to perform this with glasses on.  Therefore, it is either given to a partner or other family member to perform, or ideally the use of a good quality illuminated makeup or magnifying mirror available from chemists and department stores (e.g. Shaver Shop).  The simplest is to apply 2 or 3 drops of Johnson's Baby Shampoo into a tablespoon of cooled boiled water.  Using a cotton bud, stir this until dissolved.  Using a cotton bud tip, gently under direct visualisation wipe the margin of the eyelid just behind where the lashes emerge from the lid margin, being careful to avoid any contact with the eye.  The approach must be very gentle, not to scrub, but rather simply wipe.  There are commercial products available.  The ones recommended are i~Soothe, which are pre-moistened pads, very comforting and very effective, and also excellent eyelid makeup removers.

Perhaps the most effective, however, at controlling the germ growth on the eyelid which is responsible for much of the problem of blepharitis is a product called SteriLid.  This is a foam cleaner and comes with excellent instructions for its use.  Dr Chehade would normally recommend this be used once or twice/day.

Other Treatment Measures

The scientific evidence would also indicate that people who do not have a diet rich in omega-3 fatty acids would benefit from the addition to their diet of flaxseed oil at the dose recommended by the manufacturer.  This is available from chemists and health food shops and usually located in the fridge section.  For people with blepharitis which is moderate to severely symptomatic, this is recommended and would seem to have benefits above and beyond those of fish oil.  In theory, after long-term use, fish oil becomes unnecessary if a person uses flaxseed regularly.  

The use of oral and topical antibiotics is reserved for the most problematic cases and these antibiotics are provided and monitored by your general practitioner or eye specialist.

In summary, blepharitis is not a condition that can be cured, but it need not be to provide the sufferer with excellent eye comfort.  Pivotal to long-term health of the eye and comfort is the diligent use of the above measures.  There is little a general practitioner or specialist will be able to do above and beyond the measures outlined above.  The sufferer of this condition must be patient and must be consistent in the application of these measures, with knowledge that an occasional flare-up of symptoms will occur.  If symptoms do not come under control in a reasonable time, or if there should be evidence of reduced vision, you must draw this to the attention of your general practitioner or eye health care professional as soon as possible.

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