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.
Treatment for blepharitis differs from mild to moderate to severe and chronic cases.
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.
Testosterone Cream. 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.”