Blepharitis means lid inflammation, or more specifically, an inflammation of the lid margin.
In each eyelid, we have 25 - 30 glands called Meibomian glands. And in blepharitis, the
inflammation starts within these glands. Their role is to produce an oily layer that covers
the tear film and prevents the tears from evaporating too quickly. In blepharitis, the
Meibomian glands become inflamed and the secretions they produce become too thick. So, they fail
to flow out of the glands and fail to reach the surface of the eyeball. As a result, the
tear film evaporates too quickly and the eyes become gritty and uncomfortable and dry. Often
this is associated with redness of the eye as the surface of the eyeball itself becomes
inflamed as well.
Several factors contribute to the development
of blepharitis. Environmental factors, hormones, the immune system, nutrition. We know that
people who work in offices in an air-conditioned environment or work on computers for prolonged
periods of time or have to do a lot of studying and reading are more prone to developing blepharitis.
We also know it is more common in women from the age of 40 to 50 years upwards. Lastly,
we know that nutrition may well play a part, because the addition of essential fatty acids
such as omega 3 & 9 to the diet can alleviate some of the symptoms. We also all have bacteria
on the skin called staphylococci. And people with blepharitis have more staphylococci on
the lid margins than people who don't have blepharitis. This probably causes the severe
inflammation of the eye surface that we see in children with blepharitis. Because staphylococci
produce a toxin which is very irritant to the surface of the eye, causing inflammation
of the conjunctiva: the white part of the eye, and even the cornea: the clear window
at the front of the eye.
The mainstay, the most important part of treating
blepharitis is lid hygiene both in adults and in children. The minimum you should do
if you have blepharitis are warm compresses, and lid margin scrubbing every day for at
least two minutes. Warm compresses can be applied very simply. All you need to do is
take a flannel, soak it in boiled water that has cooled down a bit, and then apply these
compressors to the closed eyelids for at least two minutes at least once a day. This will
dilate the Meibomian glands and it will soften the secretions that have become stuck; allowing
them to flow out and onto the ocular surface more easily. In children, this can be difficult,
but can be combined with their bath time routine and can be turned into a peekaboo game, applying
the warm compress to one eye at a time. The two minutes of warm compresses then should
be followed by a thorough scrubbing of the lid margin. It needs to be quite a mechanical
scrubbing effect to be effective, because bacteria on the lid margin secrete a bio matrix:
something like a sticky film that they are embedded in and that adheres to the lip margin.
To carry out effective lid margin scrubbing, parents have told me that often it is easiest
to use the warm flannel again. Wrap it around the index finger, soak it in warm water again,
and then use it like a little brush to scrub along the line where the eyelashes are coming
through the skin on the lower lid and on the upper lid if possible. Although, in young
children this might not be possible. Another way for lid scrubbing is to soak a cotton
bud, a Q-Tip in warm water and then use this to massage and scrub the lid margin.
My advice for people who suffer from blepharitis, or for parents whose child suffers from blepharitis
is to try simple measures first. So, the warm compresses everyday, the lid scrubbing everyday,
and possibly enriching the diet in essential fatty acids. Omega-3 and omega-9 essential
fatty acids can be found in many vegetables and fish and legumes such as salmon, mackerel,
avocados, flaxseed, linseed. All these contain a high degree of omega-3 essential fatty acids.
In addition, many supplements are available particularly for children which contain these
substances. If these measures fail, I would recommend seeing a specialist, because in
particular, if there is inflammation of the surface of the eye, a red eye and possibly
inflammation of the clear window at the front of the eye: the cornea, eyedrops are needed
to calm down this inflammation. In children, an oral medication can also be very effective
and it has to be prescribed by a specialist and has to be taken for a prolonged period
of time as blepharitis is a chronic condition that needs to be addressed patiently over time.