What is Blepharitis?
Blepharitis (blef ah RYE tis) is a very common, chronic infection of the eyelids. It is a disorder that often recurs and needs repeated treatment. In some cases, the symptoms can disappear for months or years before returning. The severity of the condition, however, may change over time. Blepharitis is a condition due to inflammation of the eyelid margin. This may be due to several causes including infection and excess oil production. The disorder is usually a form of eczema. In some cases bacteria infect the area and make the condition worse.

How does Blepharitis develop?
Among the most common causes of blepharitis are:
* poor eyelid hygiene
* excess oil produced by the glands in the eyelid
* a bacterial infection (often staphylococcal)
* an allergic reaction

There are two main types of blepharitis: staphylococcus and seborrhea. Staphylococcus blepharitis is caused by a germ called Staphylococci, commonly known as "staph." It often begins in childhood and continues throughout adulthood. This form of the condition results in collar scales on lashes, crusting, and chronic redness at the lid margin. Dilated blood vessels, loss of lashes, sties, and chalazia also occur.

Seborrhea blepharitis is the most common and least severe form of this condition. It is not an infection but is caused by improper function of the oil glands, which causes greasy, waxy scales to accumulate along the eyelid margins. Seborrhea may be a part of an overall skin disorder that affects other areas. Hormones, nutrition, general physical condition and stress are factors in seborrhea.

Ulcerative blepharitis is a less common but more severe condition that may be characterized by matted, hard crusts around the eyelashes, which, when removed, leave small sores that may bleed or ooze. There may also be a loss of eyelashes, distortion of the front edges of the eyelids and chronic tearing.
In severe cases, the cornea, the transparent covering of the front of the eyeball, may also become inflamed.

What are the symptoms?
Some patients with acute or chronic blepharitis may have a bacterial infection of the eyelid margins caused by staph. Typical changes of staph blepharitis are scaly skin flakes along the eyelid margins. These crusts cause the eyelid margins to stick together and can alter the growth of the eyelashes or cause lashes to fall out. When these flakes get into the tear film, a gritty sensation occurs that can lead to red, irritated eyes and light sensitivity.

Common symptoms of Seborrhea blepharitis include blurred vision and redness. Excess oil gland production can lead to roughened eyelids and mucous debris that accumulates during sleep. Sometimes, Seborrhea blepharitis may result in a roughness of the normally smooth tissue that lines the inside of the eyelids, or chalazia, which are nodules on the eyelids (often painless and firm in texture). Acute infection of the eyelids can result in styes. Some patients with this form of blepharitis have dandruff, acne or other skin conditions such as seborrhea or acne rosacea.

How can Blepharitis be prevented?
Good hygiene is very important for both preventing blepharitis and minimizing the irritation caused by the condition. Any eye irritation, from cosmetics to air pollution, can prolong and intensify the symptoms of blepharitis.

What treatments are available?
Treatment is very important. In addition to eliminating the redness and soreness, treatment can prevent potential infection and scarring of the cornea and conjunctiva. A complete eye examination is necessary in order to determine the most effective treatment.

Cleaning
Usually, blepharitis can be controlled by careful, daily cleaning of the eyelashes. This can be accomplished by moistening a clean washcloth with tap water as warm as you can stand without burning. Hold the washcloth against the eyelids until it cools, then rewarm and repeat for five to ten minutes. We recommend using a clock to follow the time. After soaking, each eyelid should be gently scrubbed for one minute. A clean washcloth wrapped around the index finger and moistened with warm tap water may be all that is necessary. Some patients have found that cotton-tipped applicators, like Q-tips, are also useful to remove accumulated material from the eyelashes.

In order to remove excessive amounts of material from the eyelids, a few drops of a non-irritating shampoo, such as baby shampoo, can be mixed in lukewarm water. Being careful to avoid getting shampoo in the eye, scrub back and forth along the eyelashes of all eyelids, then rinse with plain tap water. Once the redness and soreness are under control, this cleaning may be decreased from daily to twice weekly. However, if the symptoms return, daily cleansing must be resumed immediately.

Medication
In some cases, eye drops or ointment will be prescribed to be used along with the daily cleansing regimen. For ointments, use a clean fingertip to rub a small amount into the eyelashes. Be careful to follow recommended dosages; excess medication will cause temporary blurring of vision. And with any medication, there is a small possibility of allergy or other reaction. If you think this is happening, stop the medication and contact your doctor immediately.

For certain types of blepharitis, medications taken by mouth are helpful. Most of these medications are antibiotics, however, they also improve or alter the oil composition of the eyelid oil glands. When taken properly, they are safe drugs. However, side effects may occur in some individuals, including skin rash, slight nausea and increased sensitivity to sun.

Although medications may help control the symptoms of blepharitis, they alone are not sufficient; keeping the eyelids clean is essential. If you think you may have blepharitis, your eye doctor can determine the cause and recommend the right combination of treatment specifically for you.