Blepharitis is a very common inflammation of the eyelid margins the exact origin of which is unclear.

There is a close relationship between the eyelids and the front surface of the eye so chronic blepharitis may also cause secondary changes in the conjunctiva and the cornea and many patients have unstable tear films . The symptoms apart from being annoying may also interfere with contact lens wear and aggravate people with dry eyes.

The two main types of chronic blepharitis are: Anterior, and Posterior.

The symptoms of the various types are similar and many are caused by secondary tear instability. The most common symptoms are burning, foreign body sensation, mild photophobia and lid crusting, which are frequently worse in the mornings and characterised by remissions and exacerbations.

Anterior Blepharitis is further divided into staphycoccal and seborrhoeic anterior blepharitis.

Staphylococcal anterior blepharitis is caused by chronic infection of the bases of the eyelashes which results in the formation of tiny interfollicular abcesses. It is frequently seen in patients with atopic eczema and is more common in females. It tends to affect younger patients the seborrhoeic blepharitis and may start in childhood. Loss of the lashes or white lashes can be a complication in long standing cases.
Treatment:- lid hygiene is the main treatment. It is aimed at removing the crusts and toxic products by scrubbing the lids margins twice daily with either a commercially available lid scrub or a cotton bud dipped in baby shampoo or a solution of bicarbonate of soda.
Further treatments can involve antibiotic ointments, possibly weak topical steroids and artificial tears. .

Seborrhoeic blepharitis is a disorder of the glands of Zeis and Moll and frequently associated with seborrhoeic dermatitis. The lid margins look waxy with a dandruff like appearance of the skin giving rise to yellow greasy scales on the lid margins. The lashes are greasy and stuck together.
Treatment:- is mainly with lid hygiene using bicarbonate of soda as a degreasing agent with artificial tears if necessary.

Lid care preparations and artificial tears are available for sale in the practice along with a leaflet with further advice.

Posterior Blepharitis is caused by dysfunction of the meibomian glands on the eyelids and often occurs with seborrhoeic blepharitis. There are variations from reduced secretion to gland stagnation.

The glands openings show caps of oil and the expressed gland secretions look cloudy.
Treatment:- very similar to those for anterior blepharitis with warm compresses to open and express the meibomian glands. More complicated cases could require further topical medications.

Don’t forget a routine eye examination with detect early changes in the eyes so that prompt treatment can begin.

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