What is Blepharitis?
Blepharitis (blef-uh-RYE-tis) is an ocular surface disorder that consists of an inflammation of the eyelid margin. This results most often when the meibomian glands, the oil glands located near the base of the lids, close to the eyelashes (see illustration), get clogged. The condition is typically chronic and characterized by recurring acute flare-ups. Symptoms include swelling or thickening of the eyelids, scaling, crusting or redness on the lid margin, gritty eyes, missing or misdirected eyelashes, and most often, greasy or flaky scales at the base of the lashes. If not treated, the inflammation can lead to substantial notching and scarring of the lid margin.
Patients that are at risk for Blepharitis include individuals with systemic diseases such as dermatitis, and patients with ocular surface disorders like dry eye, meibomian gland dysfunction (MGD), conjunctivitis or keratitis. The incidence of blepharitis, dry eye and meibomian gland dysfunction also increases with age and with the use of certain medications. NYC patients who suffer from blepharitis can treat their condition by visiting Dr. Sandra Belmont and discussing the right treatment plan.
Treatments for Blepharitis
Blepharitis treatments differ depending on the severity of the case.
In mild cases, an at home, warm compress routine, along with lid hygiene and lid scrubbing (see our page for lid scrub instructions*) will suffice. Adhering to the routine can prove to be a bit much for some patients as it is rather labor intensive. Doing the compress while at the sink or in the shower may help in integrating it into a more viable daily routine. Over-the-counter lid cleaning pads may also be used for the lid scrub. It is important to remember here that the more diligent the patient is, the better the results will be.
In moderate cases, topical antibiotics to decrease the bacterial load and corticosteroids for severe inflammation may be prescribed in addition to the routine of compresses and lid hygiene.
For more severe cases there are also in-office treatments available, some of which may be covered by insurance. These procedures focus on the lids and meibomian glands themselves to provide faster results than the gradual ones derived from a persistent regimen of compresses and lid hygiene.
Lipiflow is a relatively new procedure available for moderate to more severe cases which is at present not covered by insurance. The 12 minute, in-office procedure works directly on the meibomian glands through a thermal pulsation system that applies a gentle, controlled heat to the inner eyelid along with an adaptive pressure. These serve to unblock the meibomian glands on the eyelids and to encourage the body to restart the natural secretion and production of lipids (oils) produced by the meibomian glands that are necessary for a healthy tear film. Lipiflow is also used for the treatment of dry eye and meibomian gland dysfunction (MGD) which can, when left untreated, lead to chronic blepharitis.
BlephEx is a painless, in-office treatment that Dr. Belmont performs for the management and prevention of blepharitis, a pathological condition where the eyelids and lid margins become inflamed due to an overgrowth of the normal bacteria that live on the lids and base of the eyelashes.
Blepharitis is considered to be the most undertreated eye disease. As it progresses, the ailment leads to redness, itching, constant eye irritation, inflammation, and swelling. Left untreated, the biofilm build up becomes a host to bacterial exotoxins that will adversely affect other structures in the lids including the tear ducts, lacrimal and meibomian glands and lead to evaporative dry eye disease, contact lens intolerance, meibomian gland dysfunction and corneal ulceration.
BlephEx thoroughly cleans the lid margins and removes the sugary biofilm that lets bad bacteria flourish. In the process, the overall health of the eyelids is greatly improved. With a healthier biofilm, the meibomian glands and tear ducts can begin to function more effectively once again. As this happens, the outer lipid layer of the tear film is stabilized and stops evaporating too rapidly and causing dry spots. Patients can start to produce more of their own tears to finally find relief from the chronic symptoms of blepharitis and dry eye disease.
The BlephEx instrument spins a patented, sterile micro-sponge on the edge of the eyelids, lid margin and lashes. A fresh, sterile, disposable micro-sponge is used for each individual lid. With great accuracy and safety, scurf and debris are removed. The eyelids are also exfoliated to promote a more hygienic lid margin and a restored, healthier biofilm. Numbing drops are used on the eyes prior to the procedure to insure patient comfort. Most patients report nothing more than a tickling sensation in the course of treatment. The whole process takes less than 10 minutes after which the eyes are thoroughly rinsed.
After the procedure, patients are instructed on how to maintain their clean eyelids with regular nightly lid hygiene. BlephEx can be repeated annually or in 4-6 month intervals if necessary to keep blepharitis in check where home treatments prove to be less than optimal.
For patients with moderate blepharitis who are about to undergo cataract surgery or laser vision correction, BlephEx is an ideal pre-operative treatment to decrease biofilm and bacterial exotoxins on the lid margins that may slow down recovery following surgery.
Research conducted at Harvard Medical School confirmed several years ago, that an imbalance of too much estrogen and not enough testosterone is linked to the presence of dry eyes, meibomian gland dysfunction and blepharitis. Women using birth control pills, for instance, will often experience problems with dry eyes. Testosterone plays a crucial role in producing the oil, the lipid constituent that lubricates, covers and protects the tear film on the eyes. Developing a testosterone eye drop to address dry eye, MGD, and blepharitis, which concern the lids rather than the eye itself, has not been very effective for any number of reasons. Most notably, only 1 to 3 percent of an eye drop actually penetrates the eye to reach the intended target tissue, the remainder will drain away. The eye’s rapid turnover of tears also creates a problem for any eye drop. It’s no surprise that topical creams have proven to be far superior to drops for the treatment of dry eye, MGD, and blepharitis, as they provide longer residence time at the site of application and also insure much better penetration.
Doctor Belmont states that “correcting the imbalance locally, with a topical testosterone cream applied directly to the skin on the eyelid has been very successful for our chronic sufferers.”
If you are a blepharitis patient living in the Manhattan/ New York City area, you can find the right eye treatments at Belmont Eye Center. All appointments can be scheduled online or by calling our office at (212) 486-2020. Board certified ophthalmologist, Sandra Belmont, is always accepting new patients.