Blepharitis is an extremely common condition characterized by inflammation of the eyelid margins with associated tear film instability. The term blepharitis is used in a variety of presentations that may include periocular irritation, itching, burning sensation, ocular dryness, and fluctuation of vision. In many cases, the lid inflammation causes dysfunction of the Meibomian gland system that’s embedded in the eyelid margin. This causes a deficiency of the sebaceous component of the tear film.

It’s important to explain to patients that blepharitis is a chronic condition, and treatment is aimed at minimizing symptoms and exacerbations (as with other sebaceous gland inflammatory conditions such as acne vulgaris and rosacea). Blepharitis can affect people of any age but treatment approaches are the same regardless.

It’s recommended that all patients with blepharitis moisten the eyelid margin skin with a warm water-soaked cloth (at least once daily) to soften and remove the accumulated sebaceous debris. An even more effective technique is to add a small amount of over-the-counter baby shampoo to the cleansing cloth, and then gently rub the eyelid margins a few times with the eyes closed. This will serve to dissolve the oily film that builds up on the lid margin skin and at the bases of the lashes.

Something fishy

There’s substantial evidence to suggest that dietary supplementation with omega-3 oils (i.e. flax seed oil, fish oils) improves sebaceous gland function throughout the body, and may minimize the irritating effect of oily accumulations on the lid margin.

If symptoms of eye dryness or fluctuating vision are most prominent, over-the-counter artificial tear drops often help in maintaining a moistened and comfortable eye surface.

If all else fails…

In recalcitrant cases, short courses of antibiotic and/or steroid anti-inflammatory agent (i.e. dexamethasone) can be used effectively and safely. But chronic use of steroid eye medications can, in rare cases, raise pressure inside the eye, predisposing to glaucoma. It must be stressed that patients on steroid medications should use them only as instructed and attend scheduled follow-up to monitor for eye pressure elevation.

The tetracycline class of antibiotics (i.e. tetracycline, doxycycline, minocycline) have long been used to treat skin conditions characterized by oil gland inflammation (i.e. acne, rosacea, etc.). This anti-inflammatory effect is independent of their antibiotic properties. Short 4-6 week courses of these agents have shown to be highly effective in treating the symptoms of chronic blepharitis.